Does Intra-Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double-Blinded Randomized Clinical Trial

Abstract

To evaluate the effectiveness of chlorhexidine (CHX) gel and platelet-rich fibrin (PRF) compared with PRF alone in preventing the development of alveolar osteitis (AO). In a double-blinded trial, patients undergoing surgical management of bilateral impacted mandibular third molars were randomly divided into 2 groups; 1 group received PRF in 1 extraction socket with the other socket as its control and the other group received 0.2% CHX gel plus PRF in 1socket with the other socket serving as its control. The study and control sides were unknown to the surgeon and the patient. The predictor variables were PRF application (PRF vs non-PRF) and PRF plus CHX application (PRF-CHX vs non-PRF-CHX). The outcome variable was the development of AO during the first week after surgery. Age, gender, surgical difficulty score, surgeon's experience, number of anesthesia cartridges injected, and irrigation volume were other variables. Data were analyzed in SPSS 11.5 using the t test and χ2 test, with the confidence interval set at 95%. In total, 482 surgeries were performed on 241 patients (mean age, 24yr). The overall frequencies of AO in all surgeries, the PRF group, and the PRF-CHX group were 15.14, 17.37, and 13%, respectively. The frequency of AO in the PRF and PRF-CHX sockets was significantly lower than in the non-PRF (relative risk=0.46) and non-PRF-CHX (relative risk=0.18) sockets, respectively (P<.05). Moreover, the risk of developing AO in the PRF-CHX sockets was significantly lower than in the PRF sockets (relative risk=0.37; P<.05). According to the present findings, the application of CHX gel with PRF increases the efficiency of PRF in lowering the risk of developing AO after surgical removal of impacted mandibular third molars.