Dental extraction wound management: A case against medicating postextraction sockets

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In an era of evidence-based care, few areas of clinical controversy pose as substantial a dilemma to clinicians, as the topic of what medicaments and materials, if any, should be placed in an alveolar socket after tooth removal. More specifically, this applies to mandibular third molar teeth in attempts to prevent the minor complication termed ‘‘dry socket.’’ Unfortunately, the literature is replete with conflicting data (including intermingled data from ‘‘cases,’’ ‘‘teeth,’’ and ‘‘surgical sites’’), anecdotal reports, inadequate sample sizes, varying experience of surgeons, varying diagnostic criteria, poorly designed studies, statistical biases or lack of analysis, and opinions disguised as scientific evidence. It is little wonder that the rational clinician has so much difficulty deciding which viewpoints have the most validity for practice application. Additionally, numerous authors have proposed inserting various materials into postextraction sockets to augment or maintain the dentoalveolar ridge height after tooth removal, or to fill large residual defects. This article does not explore the available information regarding these protocols. Before the reader can attempt to reconcile the discrepancies and acquire a sense of what, if anything, should be used in postextraction defects, it is essential to carefully interpret the literature (nearly 140 articles over at least the last 3 decades) and ascertain what data have emerged from the various studies and reviews. The available information about normal extraction site healing will first be summarized, then prevailing theories on the pathophysiology of localized alveolitis (AO, or ‘‘dry socket’’) as well as the alleged factors that are targets for the various preventive regimens, are reviewed. Such a review is necessary before deciding whether the various proposed regimens are reasonable, logical, and scientifically supportable. Finally, the rationales for or against various medicaments and complications inherent in their usage are summarized. Because of space limitations, the table references are identified only by author and year of publication. A complete bibliography of the referenced articles is available from the author on request. Normal Extraction Site Healing