Abstract：
OBJECTIVE: To investigate, through a network meta-analysis, the effectiveness of blood concentrates in reducing pain perception, trismus, and edema after mandibular third molar extraction.
METHODS: An electronic search was performed in nine databases to locate randomized clinical trials comparing blood concentrate use after mandibular third molar extraction. Two authors selected and extracted the data independently. The individual risk of bias in the studies was assessed with the RoB v2.0 tool. A network meta-analysis compared postoperative pain and trismus scores after applying different blood concentrates, using the mean difference (MD) as an effect estimate. The GRADE approach assessed the certainty of evidence.
RESULTS: Thirty-one randomized clinical trials were included in the review and 18 in the meta-analysis. Leukocyte- and platelet-rich fibrin (L-PRF) was the most used blood concentrate, followed by platelet-rich plasma (PRP). The network meta-analysis, depending on the analyzed period, evaluated up to 1240 surgeries. Among the analyzed blood concentrates, advanced platelet-rich fibrin (A-PRF) performed better among the analyzed blood concentrates, decreasing postoperative pain in 1, 2, 3, and 7 days and reducing trismus up to the inflammatory peak compared to blood clots. Only two studies had a low risk of bias.
CONCLUSIONS: Based on very low certainty of evidence, using concentrates seemed efficient compared to blood clots in reducing pain and trismus after mandibular third molar surgeries. A-PRF decreased postoperative pain throughout the evaluated time and trismus during the acute inflammatory peak.
CONCLUSIONS: A-PRF after mandibular third molar extractions performed better among the analyzed blood concentrates and seemed efficient in improving postoperative quality by decreasing inflammatory signs and symptoms.
METHODS: An electronic search was performed in nine databases to locate randomized clinical trials comparing blood concentrate use after mandibular third molar extraction. Two authors selected and extracted the data independently. The individual risk of bias in the studies was assessed with the RoB v2.0 tool. A network meta-analysis compared postoperative pain and trismus scores after applying different blood concentrates, using the mean difference (MD) as an effect estimate. The GRADE approach assessed the certainty of evidence.
RESULTS: Thirty-one randomized clinical trials were included in the review and 18 in the meta-analysis. Leukocyte- and platelet-rich fibrin (L-PRF) was the most used blood concentrate, followed by platelet-rich plasma (PRP). The network meta-analysis, depending on the analyzed period, evaluated up to 1240 surgeries. Among the analyzed blood concentrates, advanced platelet-rich fibrin (A-PRF) performed better among the analyzed blood concentrates, decreasing postoperative pain in 1, 2, 3, and 7 days and reducing trismus up to the inflammatory peak compared to blood clots. Only two studies had a low risk of bias.
CONCLUSIONS: Based on very low certainty of evidence, using concentrates seemed efficient compared to blood clots in reducing pain and trismus after mandibular third molar surgeries. A-PRF decreased postoperative pain throughout the evaluated time and trismus during the acute inflammatory peak.
CONCLUSIONS: A-PRF after mandibular third molar extractions performed better among the analyzed blood concentrates and seemed efficient in improving postoperative quality by decreasing inflammatory signs and symptoms.
摘要：
目的：调查，通过网络荟萃分析，血液浓缩物在减少疼痛感知方面的有效性，刺耳,下颌第三磨牙拔除后水肿。
方法：在9个数据库中进行了电子搜索，以查找比较下颌第三磨牙拔除后使用血液浓缩物的随机临床试验。两位作者独立选择和提取数据。使用RoBv2.0工具评估研究中的个体偏倚风险。一项网络荟萃分析比较了应用不同血浓缩物后的术后疼痛和三联肌评分，使用平均差(MD)作为效果估计。等级方法评估了证据的确定性。
结果：31项随机临床试验纳入综述，18项纳入荟萃分析。富含白细胞和血小板的纤维蛋白（L-PRF）是最常用的血液浓缩物，其次是富含血小板的血浆（PRP）。网络荟萃分析，根据分析的时间段，评估了多达1240例手术。在分析的血液浓缩物中，高级富血小板纤维蛋白（A-PRF）在分析的血液浓缩物中表现更好，与血凝块相比，可在1、2、3和7天内减轻术后疼痛，并将三端肌减少至炎症峰值。只有两项研究的偏倚风险较低。
结论：基于证据的确定性非常低，在下颌第三磨牙手术后，与血凝块相比，使用浓缩物似乎更有效。A-PRF在整个评估时间和急性炎症高峰期间减少了术后疼痛。
结论：A-PRF在下颌第三磨牙拔除后的血液浓缩物中表现更好，通过减少炎症体征和症状，似乎可以有效改善术后质量。
方法：在9个数据库中进行了电子搜索，以查找比较下颌第三磨牙拔除后使用血液浓缩物的随机临床试验。两位作者独立选择和提取数据。使用RoBv2.0工具评估研究中的个体偏倚风险。一项网络荟萃分析比较了应用不同血浓缩物后的术后疼痛和三联肌评分，使用平均差(MD)作为效果估计。等级方法评估了证据的确定性。
结果：31项随机临床试验纳入综述，18项纳入荟萃分析。富含白细胞和血小板的纤维蛋白（L-PRF）是最常用的血液浓缩物，其次是富含血小板的血浆（PRP）。网络荟萃分析，根据分析的时间段，评估了多达1240例手术。在分析的血液浓缩物中，高级富血小板纤维蛋白（A-PRF）在分析的血液浓缩物中表现更好，与血凝块相比，可在1、2、3和7天内减轻术后疼痛，并将三端肌减少至炎症峰值。只有两项研究的偏倚风险较低。
结论：基于证据的确定性非常低，在下颌第三磨牙手术后，与血凝块相比，使用浓缩物似乎更有效。A-PRF在整个评估时间和急性炎症高峰期间减少了术后疼痛。
结论：A-PRF在下颌第三磨牙拔除后的血液浓缩物中表现更好，通过减少炎症体征和症状，似乎可以有效改善术后质量。
