Evaluation of pain, soft tissue healing and newly formed bone tissue density in surgical extraction sockets after photobiomodulation applications with LOW level laser and platelet rich fibrin

Objective: Impacted wisdom teeth extraction is a frequent oral surgical procedure. In the postoperative period after wisdom tooth extraction, symptoms that cause a decrease in the quality of life of the patients may occur. Recently, the effect of using blood-derived products and applying laser treatments to extraction sockets on healing has been a matter of interest. The aim of this study is to compare the effects of photobiomodulation applications with low-dose laser and platelet-rich fibrin in extraction sockets on pain and healing of soft tissue and bone tissue. Method: The study was carried out on a total of 34 patients, 26 female and 8 male, aged 18-29, without systemic disease, who applied to Akdeniz University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Polyclinic. Patients with bilateral, mesioangular, similarly positioned impacted wisdom teeth with bone retention and those with an indication for extraction were included in the case group. All patients were informed about the risks of the operation, complications, duration of the study, the purpose for which it was performed, the conditions that the patient should pay attention to, and the patients who accepted the study signed the Informed Consent Form and the necessary appointments were made. In the extraction sockets in which PRF wasn't placed, on the 2nd, 4th, 7th, 11th, 14th, 18th and 21st days after the operation, photobiomodulation was performed intraorally from the occlusal and buccal regions, 10 J and 0.5 W per cm², for 60 seconds in continuous mode by adjusting the diameter of 2 cm with a 940 nm wavelength InGaAsP laser. Statistical analysis was done using Shapiro Wilk's and Mann Whitney U tests for comparisons between the two groups. Results: Postoperative pain assessment was done with VAS being scored between 0-10 on the 2nd,4th and on the 7th days. There was no statistically significant difference between the two groups as the P values ​​were greater than 0.05. Although it was not statistically significant, it was observed that the pain level of the PRF group was lower on the 2nd postoperative day and after the 2nd day with laser application the pain was lower in the laser group compared to the PRF group. In the evaluation of soft tissue healing, scoring with the Landry Index was made at the postoperative 1st week, 2nd week and 1st month, and the probing depth of the distal of tooth number 7 was measured. The differences were not found to be statistically significant. Bone density and trabeculation (Fractal Dimension- FD) in the apical 1/3 and middle 1/3 parts of the extraction sockets were examined with the help of Image J program on the OPGs taken from the patients in the 1st and 3rd months and their averages were calculated. There was no statistically significant difference between the two groups in the measurement of density and FD. Pain, soft tissue and bone healing were evaluated between 26 female and 8 male patient groups. Although there was no statistically significant difference in the level of pain, there was a statistically significant difference in the 1st month Landy Healing Index in favor of females and in the 1st month trabecular density in favor of males. Conclusion: There was no statistically significant difference between the PRF and laser groups in terms of pain reduction, soft tissue healing and hard tissue healing. Differences were found between the genders, but the number of patients and the number of male and female applicants varied during the study period due to the Covid 19 pandemic.