Concentrated Growth Factor Constructs Improve Wound Healing After Third Molar Surgery: A Split-Mouth Randomized Controlled Trial.

Abstract

Background: Concentrated growth factor (CGF), an autologous platelet concentrate consists of a fibrin scaffold and its internal loading of biomolecules. Little is known about the effect of CGF on wound healing after third molar surgery.

Purpose: This study compared the healing and in vitro and ex vivo levels of biomolecules after third molar surgery between CGF-treated and untreated extraction sites.

Study design, setting and sample: This double-blinded split-mouth randomized controlled trial was conducted at the Department of Stomatology of Shanghai Fourth People's Hospital between December 2023 and November 2024 with patients who underwent bilaterally mandibular impacted third molar extraction. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease.

Predictor variable: The predictor variable was socket management. Within each subject, one extraction socket was randomly selected as the treatment side (CGF), and the contralateral side was allowed to heal without CGF.

Main outcome variable(s): The primary outcome variable was socket healing, which measured using the wound healing index measured on postoperative days 1, 3, and 7. The secondary outcome variables were the in vitro concentrations of growth factors and cytokines from the CGF membranes and the ex vivo concentrations of growth factors and cytokines in the wound fluid taken from each side measured on postoperative days 1, 3, and 7.

Covariates: Age, sex, surgery duration, and extraction difficulty were covariates.

Analyses: The data were analyzed by paired t test, Wilcoxon matched-pairs signed-rank test, analysis of variance, and generalized estimating equation, with statistical significance set at P < .05.

Results: The study included 25 subjects, 12 (48%) women and 13 (52%) men, with a mean age of 23.72 ± 4.23 years. The wound healing index was significantly better on the test sides on days 3 (CGF vs control: 5.16 ± 0.69 vs 5.72 ± 0.79; P < .001) and 7 (CGF vs control: 4.12 ± 0.33 vs 4.56 ± 0.77; P < .05). Among all the proteins released from CGF in vitro, the total concentration of transforming growth factor-β1 was the greatest (P < .001). The concentrations of transforming growth factor-β1, platelet-derived growth factor, vascular endothelial growth factor, epidermal growth factor, fibroblast growth factor-2, and interleukins (IL)-1β, IL-6, and IL-10 were greater in the wound fluid from the CGF sockets than in that from the control sockets at all time points (P < .05).

Conclusions and relevance: CGF constructs increase the biomolecule concentrations in wound fluid and are associated with improved early wound healing after impacted third molar extraction. CGF appears to be a viable biomaterial for this procedure.