Optimising mandibular fracture repair: the combination of T-PRF and LLLT

The management of mandibular body fractures, frequently following road traffic accidents, traditionally relies on open reduction and internal fixation (ORIF). While mechanical stability is achieved through osteosynthesis using titanium plates and screws, the clinical challenge is now shifting towards optimising bone healing kinetics and reducing postoperative morbidity.

This pilot study explores the synergistic potential of two adjunctive technologies: titanium-prepared platelet-rich fibrin (T-PRF) and low-level laser therapy (LLLT). While T-PRF ensures a prolonged release of growth factors, LLLT is recognised for stimulating osteogenesis and angiogenesis. The specific objective is to evaluate whether the addition of postoperative LLLT sessions to the intraoperative application of T-PRF significantly improves bone mineral density and clinical recovery dynamics.

The authors test the hypothesis that a combined protocol promotes superior bone regeneration, measurable by computed tomography (bone density) at 12 weeks, while accelerating the resolution of pain, oedema and the recovery of maximum mouth opening (MMO), compared to the isolated use of T-PRF during a standard ORIF procedure.

Study design and population

This pilot clinical trial involved 12 patients presenting with 14 fracture lines in the posterior mandibular body. All subjects underwent open reduction and internal fixation (ORIF) using titanium plates and screws, supplemented by a regenerative medicine approach.

Experimental groups and protocol

The patients were divided into two distinct groups to evaluate the synergistic effect of the therapies:

• Control group: Exclusive intraoperative application of titanium-prepared platelet-rich fibrin (T-PRF) directly to the fracture site.
• Study group: Intraoperative application of T-PRF combined with postoperative low-level laser therapy (LLLT) sessions to stimulate osteogenesis and angiogenesis.

Evaluation and analyses

The follow-up was based on a dual quantitative and qualitative approach:

• Imaging: Measurement of bone mineral density by computed tomography (CT scan) at 12 weeks postoperatively.
• Clinical follow-up: Pain assessment (VAS scale), healing kinetics, oedema resolution and maximum mouth opening (MMO).

The statistical analysis was configured to identify significant intergroup differences with a threshold of p < 0.05.

Analysis of the results: Bone density and recovery kinetics

The study included 12 patients presenting a total of 14 mandibular fracture lines, equally divided between the control group (T-PRF alone) and the experimental group (T-PRF + LLLT). All subjects achieved satisfactory anatomical reduction and stable occlusion following the procedure (ORIF).

Bone regeneration: the contribution of photobiomodulation

Computed tomography (CT) assessment at 12 weeks postoperatively constitutes the primary endpoint. The data show a clear superiority of the combined approach for bone callus mineralisation.

Evolution of pain (VAS)

Pain control represents the second major benefit of this pilot study. The group that received the low-level laser therapy (LLLT) sessions reported a significantly greater reduction in pain than the control group during the critical phases of healing:

• Week 1: Significantly greater reduction in the study group (p < 0.05).
• Week 2: Maintenance of a statistically significant difference in favour of the combined protocol (p < 0.05).

Clinical parameters and tissue healing

Regarding functional recovery and soft tissue inflammation, both protocols showed comparable results. No statistically significant difference was observed between the two groups for the following variables:

• Maximum mouth opening (MMO): Similar recovery dynamics.
• Resolution of oedema: Equivalent swelling reduction kinetics.
• Mucosal healing: Assessed via early healing scores, with no superiority of one group over the other.

In summary, while the addition of LLLT to T-PRF does not visibly accelerate soft tissue healing or the recovery of mandibular function compared to T-PRF alone, it significantly improves the quality of bone consolidation at 3 months and patient comfort during the first two postoperative weeks.

Clinical analysis: the synergistic effect of LLLT and T-PRF

The results of this pilot study demonstrate that the addition of photobiomodulation (LLLT) to T-PRF transforms the healing dynamics of mandibular fractures. Clinically, the significant gain in bone density at 12 weeks (p < 0.05) suggests accelerated mineralisation. This synergy is explained by the capacity of LLLT to stimulate angiogenesis and osteogenesis, thereby optimising the prolonged release of growth factors intrinsic to T-PRF.

In terms of comfort, the advantage is immediate: pain reduction during the first two postoperative weeks is significantly more pronounced in the combined group. Notably, the study shows no significant difference regarding oedema, mucosal healing or maximum mouth opening (MMO), which indicates that while the laser boosts bone density and analgesia, it does not further accelerate soft tissue resolution compared to T-PRF alone.

Limitations and practical implications

The main limitation of this study lies in its small sample size (12 patients, 14 fracture lines), inherent to its status as a pilot study. Although the results are statistically significant for bone density (HU) and pain (VAS), larger cohorts are required to confirm these trends.

For the practitioner, these data suggest that the integration of post-ORIF laser therapy is not merely a comfort adjunct. It is a tangible lever to secure early bone consolidation. In practice, the combined use of intraoperative T-PRF and postoperative LLLT sessions offers a promising pathway to improve the clinical outcomes of complex mandibular trauma.

Summary of results

This pilot study conducted on 12 patients (14 mandibular fractures) demonstrates that the combination of T-PRF and low-level laser therapy (LLLT) significantly increases bone density at 12 weeks compared to T-PRF alone. The combined group also benefited from a markedly greater pain reduction during the first two postoperative weeks (p < 0.05), although mouth opening and oedema resolution remained similar between the two groups.

In practical terms for the practitioner:

• Bone density optimisation: Consider adding LLLT sessions after osteosynthesis with T-PRF to accelerate bone callus mineralisation at 3 months.
• Non-pharmacological pain management: Use the laser as a complementary analgesic tool during the critical phase of the first 14 days to improve immediate postoperative comfort.
• Targeted clinical expectations: Inform your patients that while bone regeneration and pain are improved, swelling resolution kinetics and mouth opening recovery will not be accelerated by this specific protocol.

Technical glossary of the study

T-PRF (Titanium-Prepared Platelet-Rich Fibrin): Platelet concentrate obtained by centrifugation in titanium tubes. This biological matrix enables a sustained release of growth factors at the fracture site to promote bone regeneration.

LLLT (Low-Level Laser Therapy): Low-intensity laser therapy used in the postoperative phase. It stimulates osteogenesis and angiogenesis processes to accelerate tissue repair and reduce pain symptomatology.

ORIF (Open Reduction and Internal Fixation): Open surgical reduction procedure of the fracture lines, followed by stabilisation using osteosynthesis material (titanium plates and screws) to restore anatomy and occlusion.

Bone Mineral Density (BMD): Quantitative value measured by computed tomography (CT) three months after the procedure. It expresses the degree of mineralisation of the bone callus at the mandibular fracture site.

MMO (Maximum Mouth Opening): Measurement of maximum mouth opening used as a clinical indicator of functional recovery and post-surgical healing dynamics.

Hounsfield Units (HU): Measurement scale used in computed tomography to quantify tissue radiodensity, allowing here for the precise evaluation of regenerated bone density.

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