Platelet-rich fibrin and photobiomodulation in postoperative recovery after third molar extraction: a narrative review
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Introduction: Third molar extraction is one of the most frequent procedures in oral surgery and may be associated with postoperative complications such as pain, edema, trismus, and secondary infections. To improve postoperative recovery, adjuvant therapies such as platelet-rich fibrin (PRF) and photobiomodulation (PBM) have been proposed. Objective: To describe and analyze the available scientific evidence on the effects of PRF and PBM on postoperative recovery following third molar extraction. Materials and methods: A narrative review was conducted through searches in PubMed, ScienceDirect, SciELO, LILACS, and Google Scholar. Original articles published in Spanish and English between January 2021 and April 2026 that evaluated PRF and/or PBM in patients undergoing third molar extraction were included. The information was selected, organized, and analyzed through a narrative synthesis according to the intervention and the main clinical outcomes. Results: A total of 32 articles were included, most of them randomized clinical trials. Studies evaluating PRF frequently reported favorable outcomes, particularly in pain reduction and healing, although findings related to edema and trismus were variable. Studies evaluating PBM showed benefits mainly in pain control and some healing parameters, with heterogeneous results for edema and trismus. Evidence on the combined application of PRF and PBM was limited, with only one study identified. Conclusion: PRF and PBM may contribute favorably to postoperative recovery following third molar extraction, particularly in pain control and healing. However, the heterogeneity of the protocols and methodological differences limit the possibility of establishing consistent effects. Studies with standardized protocols are required to determine more precisely their clinical benefit and the potential effect of their combined application.
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1. Gururaj SB, Shankar SM, Parveen F, Chidambar CK, Bhushan K, Prabhudev CM. Assessment of Healing and Pain Response at Mandibular Third Molar Extraction Sites with and Without Pre- and PostOperative Photobiomodulation at Red and Near-Infrared Wavelengths: A Clinical Study. Journal of Pharmacy and Bioallied Sciences. 2022; 14(Suppl 1):S470. doi: 10.4103/jpbs.jpbs_675_21. https://journals.lww.com/jpbs/fulltext/2022/14001/Assessment_of_Healing_and_Pain_Response_at.114.aspx
2. Largo AAR, Guillén MKG, Matamoros CLR, Ruiz EDM, Rodríguez SJP. Complicaciones Relacionadas a la Exodoncia. Revisión Bibliográfica. Ciencia Latina Revista Científica Multidisciplinar. 2023; 7(6):8758–72.doi:10.37811/cl_rcm.v7i6.9539. https://ciencialatina.org/index.php/cienciala/article/view/9539
3. Ye L, He Y, Ma W, Zhou F, Liu J. Effect of platelet-rich fibrin on the recovery after third molar surgery: A systematic review and meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2024; 52(10):1095–108. doi:10.1016/j.jcms.2024.06.022. https://www.sciencedirect.com/science/article/pii/S1010518224002051
4. Mena Alencastro SA, Rockenbach Binz Ordóñez MC, Mena Alencastro SA, Rockenbach Binz Ordóñez MC. Complicaciones en la extracción de terceros molares mandibulares incluídos, retenidos e impactados. Revisión de la literatura. Odontología Vital. 2023;(38):17–25. http://www.scielo.sa.cr/scielo.php?script=sci_abstract&pid=S1659-07752023000100017&lng=en&nrm=iso&tlng=es
5. Erismen Agan B, Uyanık LO, Donmezer CM. Comparison of the postoperative effect of low laser therapy and platelet rich fibrin on mandibular third molar surgery: a randomized study. BMC Oral Health. 2025; 25(1):427. doi:10.1186/s12903-025-05828-3 https://pubmed.ncbi.nlm.nih.gov/40134000/
6. Jamjoom AG. From Healing to Regeneration: A Comprehensive Review of the Efficacy of Platelet-Rich Fibrin in Periodontal Plastic Surgery Procedures. Cureus. 2024 Sep 12;16(9):e69287. doi: 10.7759/cureus.69287. https://pmc.ncbi.nlm.nih.gov/articles/PMC11392565/
7. Hernández-López A, Lorena-Olvera M, Maldonado-Guereca MDJ, Gómez Palacio-Gastélum M, Vargas-Chávez N. Fotobiomodulación como coadyuvante en la reducción del dolor postoperatorio en la cirugía de terceros molares. Revisión sistemática. Rev Odont Mex. 2024;26(4). doi:10.22201/fo.1870199xp.2022.26.4.83318 https://revistas.unam.mx/index.php/rom/article/view/83318
8. Starzyńska A, Kaczoruk-Wieremczuk M, Lopez MA, Passarelli PC, Adamska P. The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy. International Journal of Environmental Research and Public Health. 2021;18(24):13343. doi:10.3390/ijerph182413343 https://www.mdpi.com/1660-4601/18/24/13343
9. Torres da Silva M, de Almeida Barros Mourão CF, Mello-Machado RC, Montemezzi P, de Lima Barbosa R, Sartoretto SC, et al. Effects of Leukocyte-Platelet-Rich Fibrin (L–PRF) on Pain, Soft Tissue Healing, Growth Factors, and Cytokines after Third Molar Extraction: A Randomized, Split-Mouth, Double-Blinded Clinical Trial. Applied Sciences. 2021;11(4):1666. doi:10.3390/app11041666 https://www.mdpi.com/2076-3417/11/4/1666
10. Öhrnell Malekzadeh B, Öhrnell LO, Widmark G, Beigi RM, Ivanoff CJ. Effects of platelet-rich fibrin on outcomes following mandibular third molar removal: a randomized controlled clinical trial. International Journal of Oral and Maxillofacial Surgery. 2025;54(11):1131–7. doi:10.1016/j.ijom.2025.06.007 https://www.sciencedirect.com/science/article/pii/S090150272501327X
11. Moraes RP, Costa FWG, Silva PG de B, Carvalho FSR, Paz JERM, Matos GC, et al. Impact of L-PRF on pain and healing outcomes in lower third molar surgery: a randomized split-mouth trial. Braz Oral Res. 2024;38:e089. doi:10.1590/1807-3107bor-2024.vol38.0089 https://pubmed.ncbi.nlm.nih.gov/39292127/
12. Bahadur R, A A, Salam S, Kulkarni V, D NK, Karande V, et al. Effect of platelet-rich fibrin in enhancing healing after impacted mandibular third molar extractions: A randomized controlled trial. Bioinformation. 2025;21(11):4167–72. doi:10.6026/973206300214167 https://pmc.ncbi.nlm.nih.gov/articles/PMC12880118/
13. Iftikhar I, Singh S, Bhardwaj A, Kaur M, Shrivastava PK, Monga N, et al. Role of platelet-rich fibrin in soft and hard tissue healing after impacted third molar surgery: A triple-blind split-mouth randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2024;18(4):284–90. doi:10.34172/joddd.41122 https://pmc.ncbi.nlm.nih.gov/articles/PMC11786011/
14. Aliberti A, Mariniello M, Bergaminelli M, Dolce P, Gargiulo D, Sammartino G, et al. Using injectable Platelet-Rich fibrin to improve recovery after impacted lower third molar extraction: a randomized controlled clinical trial. Clin Oral Investig. 2025;29(10):467. doi:10.1007/s00784-025-06563-3 https://pubmed.ncbi.nlm.nih.gov/40971054/
15. Zwittnig K, Kirnbauer B, Truschnegg A, Jakse N, Wolf A, Sokolowski A, et al. Effectiveness of platelet-rich fibrin in third molar extractions: a randomized controlled split-mouth study. Clin Oral Investig. 2024;28(11):615. doi:10.1007/s00784-024-06002-9 https://pubmed.ncbi.nlm.nih.gov/39467892/
16. Mathialagan Kalai Selvam L, M A, Lakshmanan S, Kumar SP. Effectiveness of Advanced Platelet-Rich Fibrin on Postoperative Sequelae for Impacted Mandibular Third Molar Surgery: A Prospective Study. Cureus. 2024. doi:10.7759/cureus.52297 https://www.cureus.com/articles/204159-effectiveness-of-advanced-platelet-rich-fibrin-on-postoperative-sequelae-for-impacted-mandibular-third-molar-surgery-a-prospective-study
17. Starch-Jensen T, Giordano R, Alsadi DM, Bruun NH, Arendt-Nielsen L. Patient perceptions of recovery following surgical removal of an impacted mandibular third molar and application of advanced platelet-rich fibrin: a prospective randomized controlled clinical trial. International Journal of Oral and Maxillofacial Surgery. 2026;55(3):373–84. doi:10.1016/j.ijom.2025.10.002 https://www.sciencedirect.com/science/article/pii/S0901502725014699
18. Momeni E, Barati H, Arbabi MR, Jalali B, Moosavi MS. Low-level laser therapy using laser diode 940 nm in the mandibular impacted third molar surgery: double-blind randomized clinical trial. BMC Oral Health. 2021;21(1):77. doi:10.1186/s12903-021-01434-1 https://pubmed.ncbi.nlm.nih.gov/33602198/
19. Camolesi GCV, El Kattan AS, Lopez-Lopez J, Blanco-Carrión A, García-García A, Gándara-Vila P, et al. Pain, Oedema and Trismus Responses Following Photobiomodulation Therapy Immediately After Lower Third Molar Extraction: Results of a Randomized, Doble-Blind and Split Mouth Clinical Trial. J Evid Based Dent Pract. 2025;25(1):102080. doi:10.1016/j.jebdp.2024.102080 https://pubmed.ncbi.nlm.nih.gov/39947773/
20. Rujano-Salinas J, Pérez A, Ramirez A, Moreno-Garces, Bernotti A, Machado D, et al. Photobiomodulation as an adjuvant for pain relief and healing pre-orthodontic mandibular third molar surgery: double-blinded randomized clinical trial. Saudi Dent J. 2026;38(2):6. doi:10.1007/s44445-025-00098-9 https://doi.org/10.1007/s44445-025-00098-9
21. Isolan CP, Kinalski M de A, Leão OA de A, Post LK, Isolan TMP, dos Santos MBF. Photobiomodulation therapy reduces postoperative pain after third molar extractions: A randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2021;26(3):e341–8. doi:10.4317/medoral.24228 https://pmc.ncbi.nlm.nih.gov/articles/PMC8141316/
22. Pereira DA, Bonatto MS, Santos S de S, Mendes PGJ, Sales E Pessoa R, de Oliveira GJPL. Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial. Photodiagnosis Photodyn Ther. 2024;46:104054. doi:10.1016/j.pdpdt.2024.104054 https://pubmed.ncbi.nlm.nih.gov/38503387/
23. Uzeda MJ, Silva AM, Costa LN, Brito FS, Fernandes GV, Resende RF. Evaluating the effectiveness of low-level laser therapy in patients undergoing lower third molar extraction: A double-blinded randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2025;30(1):e129–34. doi:10.4317/medoral.26894 https://www.medicinaoral.com/medoralfree01/aop/26894.pdf
24. Yüksek MN, Eroğlu CN. Clinical evaluation of single and repeated sessions of photobiomodulation with two different therapeutic wavelengths for reducing postoperative sequelae after impacted mandibular third molar surgery: a randomized, double-blind clinical study. J Appl Oral Sci. 2021;29:e20210383. doi:10.1590/1678-7757-2021-0383 https://pubmed.ncbi.nlm.nih.gov/34787280/
25. Şen E, Balel Y. Does Laser-LED Photobiomodulation Therapy Alleviate Swlling, Pain, and Trismus Following Impacted Third Molar Extraction? Cumhuriyet Dental Journal. 2025;28(1):115–21. doi:10.7126/cumudj.1615267 http://dergipark.org.tr/en/doi/10.7126/cumudj.1615267
26. Sekerci E, Schiefersteiner M, Wiedemeier D, Valdec S. Is Low-Level Laser Treatment Effective in Reducing Pain, Swelling, and Trismus After Removing Impacted Maxillary and Mandibular Third Molars? J Oral Maxillofac Surg. 2025;874–84. https://dx.doi.org/10.1016/j.joms.2025.03.017
27. Giovannacci I, Romeo U, Spadari F, Biasotto M, Pentenero M, Pedrazzi G, et al. An italian multicenter triple-blind randomized controlled trial on photobiomodulation after third molar extraction (BIOSTOTT). A study of Italian society for laser in dentistry (SILO). Med Oral Patol Oral Cir Bucal. 2026;31(2):e363–72. doi:10.4317/medoral.27834 https://pmc.ncbi.nlm.nih.gov/articles/PMC12983389/
28. Vargas A, Perales A, Villafañe A, Manresa C, Villarroel-Dorrego M. Photobiomodulation as an adjuvant in the management of edema and postoperative pain in patients undergoing superior and inferior third molar extraction. Randomized controlled clinical trial. Rev Esp Cirug Oral y Maxilofac. 2024; 46(1): 28-35. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-05582024000100005&lng=es
29. Shruthi TM, Shetty AD, Akash KS, Ahmed F, Shetty N, Singarapu R. Evaluation of effects of platelet-rich fibrin on treatment outcomes after impacted mandibular third molar surgery: A randomized controlled clinical study. National Journal of Maxillofacial Surgery. 2022;13(Suppl 1):S46. doi:10.4103/njms.NJMS_16_20 https://journals.lww.com/njms/fulltext/2022/13001/evaluation_of_effects_of_platelet_rich_fibrin_on.7.aspx
30. Konuk B, Senturk MF. Three-Dimensional evaluation of the effect of platelet-rich fibrin on edema in lower impacted third molar surgery performed with piezosurgery. Niger J Clin Pract. 2022;25(7):1107–14. doi:10.4103/njcp.njcp_1700_21 https://pubmed.ncbi.nlm.nih.gov/35859473/
31. Barone S, Bennardo F, Salviati M, Antonelli A, Giudice A. Evaluation of the usefulness of platelet-rich fibrin (PRF) in mandibular third molar surgery with 3D facial swelling analysis: a split-mouth randomized clinical trial. Head Face Med. 2025;21(1):8. doi:10.1186/s13005-025-00482-0 https://link.springer.com/content/pdf/10.1186/s13005-025-00482-0.pdf
32. Momeni E, Kazemi F, Sanaei-Rad P. Extraoral low-level laser therapy can decrease pain but not edema and trismus after surgical extraction of impacted mandibular third molars: a randomized, placebo-controlled clinical trial. BMC Oral Health. 2022;417–417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490913
33. Trybek G, Rydlińska J, Aniko-Włodarczyk M, Jaroń A. Effect of Platelet-Rich Fibrin Application on Non-Infectious Complications after Surgical Extraction of Impacted Mandibular Third Molars. Int J Environ Res Public Health. 2021;18(16):8249. doi:10.3390/ijerph18168249 https://pubmed.ncbi.nlm.nih.gov/34443998/
34. Yuan Z, Xu Z, Wan X, Zhang T. Er:YAG and Nd:YAG-based low-level laser therapy (LLLT) with medical collagen improve third-molar extraction wound healing: a randomized controlled trial. Lasers Med Sci. 2025;40(1):512. doi:10.1007/s10103-025-04763-7 https://link.springer.com/content/pdf/10.1007/s10103-025-04763-7.pdf
35. Karsici S, Balaban E. The effect of preoperative low-level laser therapy on pain, swelling, and trismus associated with mandibular third molar extraction. BMC Oral Health. 2025;306–306. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866568
36. Asif M, Ullah A, Mujtaba H, Umer MF, Khurshid Z. Comparative Study of Frequency of Alveolar Osteitis, with and without using Platelet-Rich Fibrin in Mandibular Third Molar Surgery. International Journal of Dentistry. 2023;2023(1):2256113. doi:10.1155/2023/2256113 https://onlinelibrary.wiley.com/doi/abs/10.1155/2023/2256113
37. Starch-Jensen T, Giordano R, Alsadi DM, Bruun NH, Arendt-Nielsen L. Long-term Assessment of Oral Health-Related Quality of Life Following Surgical Removal of Mandibular Third Molar with Advanced Platelet-rich Fibrin: a Single-blinded Randomized Controlled Trial. J Oral Maxillofac Res. 2026;17(1):e1. doi:10.5037/jomr.2026.17101 https://www.ejomr.org/JOMR/archives/2026/1/e1/v17n1e1ht.htm
38. Ruiz EMM, Alvarado EAM, Guzmán EER, Martínez TML. Efectividad del plasma rico en fibrina en extracciones de terceros molares. Revisión sistemática. Revista Ciencias de la Salud y Educación Médica. 2022;4(5):16–21. https://revistas.unan.edu.ni/index.php/Salud/es/article/view/4295/6671
39. Xiang X, Shi P, Zhang P, Shen J, Kang J. Impact of platelet-rich fibrin on mandibular third molar surgery recovery: a systematic review and meta-analysis. BMC Oral Health. 2019 Jul 25;19(1):163. doi: 10.1186/s12903-019-0824-3. https://pubmed.ncbi.nlm.nih.gov/31345203/
40. Zhu J, Zhang S, Yuan X, He T, Liu H, Wang J, Xu B. Effect of platelet-rich fibrin on the control of alveolar osteitis, pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2021 Mar;50(3):398-406. doi: 10.1016/j.ijom.2020.08.014. https://pubmed.ncbi.nlm.nih.gov/32950350/
41. Hernández-López Angélica, Lorena-Olvera Mayra, Maldonado-Guereca Manuel de Jesús, Gómez Palacio-Gastélum Marcelo, Vargas-Chávez Nohé. Fotobiomodulación como coadyuvante en la reducción del dolor postoperatorio en la cirugía de terceros molares. Revisión sistemática. Rev. Odont. Mex; 26(4): 32-39. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-199X2022000400032&lng=es.
42. Duarte de Oliveira FJ, Brasil GMLC, Araújo Soares GP, Fernandes Paiva DF, de Assis de Souza Júnior F. Use of low-level laser therapy to reduce postoperative pain, edema, and trismus following third molar surgery: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2021 Nov;49(11):1088-1096. doi: 10.1016/j.jcms.2021.06.006. https://pubmed.ncbi.nlm.nih.gov/34217567/
43. Camolesi GCV, Silva FFVE, Aulestia-Viera PV, Marichalar-Mendía X, Gándara-Vila P, Pérez-Sayáns M. Is the photobiomodulation therapy effective in controlling post-surgical side effects after the extraction of mandibular third molars? A systematic review and meta-analysis. J Evid Based Dent Pract. 2024 Jun;24(2):101983. doi: 10.1016/j.jebdp.2024.101983. https://pubmed.ncbi.nlm.nih.gov/38821660/