Autologous plasma rich in growth factors in the socket preservation after tooth extractions in diabetic patients: A split mouth study

Background: Patients affected by type 2 Diabetes mellitus (DM) have a higher risk of developing of oral diseases than the general population. Plasma-rich growth factor (PRGF) is a technique that transforms a biological and autologous product in a platelet membrane, which can be positioned in the healing site, so that delivers platelet-derived growth factor, and stimulates soft tissue and bone regeneration. The purpose of this study is to evaluate the efficacy of PRGF in post extractive sockets in patients affected by Type 2 DM, evaluating socket reduction, VAS scores, the Healing Index (HI), and patient satisfaction based on answers to a form. Material and methods: This is a split-mouth study in which each patient also served as the control: the study socket was treated with PRGF, whereas the control socket underwent natural healing. The outcome variables were the Healing Index, residual socket volume, VAS score, postsurgical complications, and outcome of a patient questionnaire. The investigation considered the impact of hyperglycemia, glycated hemoglobin, End Organ Disease Score and smoking habits. 4 weeks of follow-up (we had all healings at 4 weeks so we didn’t continue the study beyond 4 weeks) was considered. Pairs of correlated continuous variables were analyzed with the Wilcoxon test, independent continuous variables with the Mann-Whitney test, and categorical variables with the c2 test or Fisher test. Results: From January 2017 to December 2017, 58 patients affected by insulin-dependent diabetes mellitus (type 2 Diabetes mellitus (DM)) underwent contemporary bilateral extractions of homologous teeth. The treatment-versus- control postoperative comparison showed that PRGF resulted in significantly smaller residual socket volumes and better Healing Indices from days 3 to 21 (PRGF brings an healing improvement as an increase in wound closure speed statistically significant in all 4 follow ups (p < 0.0001 at 3 days, p < 0.0001 at 7 days, p = 0.0002 at 14 days, p = 0.005 at 21 days)). The patients’ questionnaire outcomes were unanimously in favor of PRGF treatment. Discussion: PRGF application after extraction improved the healing process in diabetic patients by accelerating socket closure (epithelialization) and tissue maturation, proving the association between PRGF use and improved wound healing in diabetic patients.