Can Plasma Rich in Growth Factors Expedite Healing of Postextraction Tooth Sockets in Patients Undergoing Urgent Liver Transplantation?

Infections foster morbidity and mortality after liver transplantation (LT). Pre-LT eradication of oral infectious foci is not always possible for patients needing an urgent LT because postextraction sockets must be healed before the patient is operated, and this requires at least 3 weeks. To accelerate healing, we tested the effect of plasma-rich growth factor (PRGF), a highly concentrated form of autogenous platelets on healing. Prospective case-control split-mouth study for more than 100 candidates for LT needing routine extractions of 2 homologous teeth: a socket was to be treated with PRGF, whereas its match (control [CTRL]) was to undergo natural healing. The outcome of interest was the socket size derived from the measurements on the transversal diameters and deepest level of penetration on the PRGF and CTRL sides after extraction and on day 7, 14, and 21 postextraction. The primary predictor was treatment status (PRGF vs CTRL); secondary predictors, the tooth extracted and patient's features. The statistical analysis used nonparametric tests and best subset regression. All measurements evidenced a significantly (P < .0001) more advanced closure on the PRGF side than the CTRL side. One week after extraction, PRGF sockets were reduced to 12% (molars) and 6% (nonmolars) of the original wound versus 32 and 20% for CTRL, respectively. The percentage of PRGF sockets with size less than or equal to 5% was 7% for molars and 44% for nonmolars versus 0 and 12% for CTRL (P < .0001), respectively. The percentages with size less than or equal to 10% were 37% for molars and 81% for nonmolars on the PRGF side versus 2 and 26% on the CTRL side, respectively. These percentages showed a significant decrease for smoking patients. The outcome of our trial showed that PRGF significantly accelerates closure of postextraction sockets. Its use, at least in patients who occupy top positions in the LT waiting list, is recommended.

Published by Elsevier Inc.