Treatment Of Alveolar Osteitis Research Articles

Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials

ObjectivesTo assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.Materials and methodsThree databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.ResultsFive preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.ConclusionsHyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.Clinical relevanceHyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.

Comparison between Olive Oil and Nano-Bio Fusion Gel and their Role in the Treatment of Alveolar Osteitis: A Double-Blind Randomized Trial

Abstract: Background: Alveolar osteitis is a painful condition that occurs after tooth extraction. This condition has been treated with various chemical and herbal formulations that are found to be efficacious with different success rates. Objectives: The present study is aimed to evaluate and compare the efficacy of organic olive oil and Nano-Bio Fusion (NBF) gel in the management of alveolar osteitis. Materials and Methods: 90 patients who were diagnosed with alveolar osteitis following non-surgical dental extractions were selected and randomly divided into two groups. The extraction socket was irrigated with warm normal saline followed by insertion of sterile gauze soaked in organic olive oil in Group I patients (n=45) and with NBF gel in Group II patients (n=45). The patients were recalled for the change in dressings on day 3, day 5 and day 7. The subjects were evaluated for the following parameters on 7th day; pain, gingival erythema, granulation tissue and the extraction socket margin. Data were analyzed using Friedman test and Mann-Whitney U test. P≤0.05 was considered statistically significant. Results: The mean VAS score on day 1 for group I was 8.9 and group II was 8.6. The mean VAS score for both the groups was zero on day 7 though the participants of group II reported better pain relief from day 3 to day 7 when compared with group I patients. Subjects treated with olive oil showed a mildly inflamed gingival to a normal pink variant on day 7. However, all the subjects treated with NBF gel presented with healthy pink gingival on day 7. There was significant improvement in the healing of the margin in both cases. Conclusion: Compared to the olive oil, NBF gel helps in enhanced healing in cases of alveolar osteitis. Keywords Alveolar osteitis, Pain, Extraction, Mandibular third molars, Olive oil, Nano-Bio Fusion.

Platelet-rich plasma and platelet-rich fibrin in oral surgery: A narrative review.

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are biological products derived from the plasma fraction of autologous blood that have a platelet concentration above that of the original blood. Cytokines and growth factors are present in platelet-based preparations, and their application has gained great attention in dentistry. The aim of this review was to comprehensively examine the latest scientific evidence on the use of PRF and PRP in oral surgery, and to describe current operational protocols. Platelet-rich fibrin is used after third molar extractions, in the treatment of alveolar osteitis and trismus, and in implant surgery. Platelet-rich plasma is utilized in sinus lift procedures, after tooth extractions, and in patients undergoing the treatment of bisphosphonate-related osteonecrosis of the jaw. Based on this review, plenty of data indicates that the PRF-PRP usage in oral surgery shows promising results. However, no consistent protocols have been presented in the analyzed articles. Further research is needed to provide clinicians with evidence-based clinical recommendations and to develop protocols on the use of these preparations in dental surgery.

Comparison of effectiveness of metronidazole, chlorhexidine, and lignocaine combination gel with that of zinc oxide eugenol dressing for the treatment of alveolar osteitis

Alveolar osteitis (AO) is the most common complication of dental extractions, especially, the mandibular third molar. Zinc oxide eugenol (ZOE) is commonly used as a surgical dressing for the treatment of AO. However, the search for better dressing materials is still underway. Therefore, the present study aims to evaluate the impact of the intra-alveolar application of Metronidazole (MN), Chlorhexidine (CHX), and Lignocaine (LC) on the treatment of alveolar osteitis and compare it with that of ZOE. A total sample of n=32 patients was randomly assigned into the experimental group treated with MN+CHX+LC combination, while the control group was treated with ZOE paste dressing. Pain, discomfort, and healing were assessed on 3-day and 2-week follow-ups. A statistically significant difference was noted in the number of individuals with pain (p=0.006) and halitosis (p=0.002) on the third day follow-up with higher number of individuals in the control group still experiencing the symptoms. By the end of two weeks, all the patients in the experimental group (n=16) had relief from pain and discomfort while they persisted in n=4 patients and halitosis was noted in n=9 patients treated with ZOE dressing. The experimental combination has a clear advantage as a medicament dressing because of its superior antibacterial and anesthetic properties over ZOE dressings. The combination reduces the time period required for healing the socket in AO, while greatly adding to the patient’s comfort and overall well-being.

Methods of prevention and treatment of alveolar osteitis

Alveolar osteitis is an infectious complication after tooth extraction. They appear in two forms: serous, characterized by pain syndrome and decayed clot, purulent, which is identified by provoked pain and filling of alveoli, and chronic hypertrophic, in which body temperature decreases and general well-being improves.Aim. To explore different methods of preventing and treating alveolar osteitis.Alveolar osteitis usually occurs more frequently in young adults between the ages of 30 and 50 and is slightly more common in women than in men. Treatment methods for dry socket are quite limited, but there are a large number of drugs for treatment: eugenol-based drugs, chlorhexidine, antibiotics, analgesics and local anesthetics, enzymes, hemostatic agents, hormonal agents soaked in collagen sponges, pastes, gels, turundas, preparations based on biopolymers such as chitosan, and platelet-rich plasma.

Local interventions for the management of alveolar osteitis (dry socket).

Local interventions for the management of alveolar osteitis (dry socket).

Alveolar osteitis: the current state of knowledge

Introduction and purpose:
 Alveolar osteitis, also known as dry socket is a common complication after tooth extraction, especially third molar extraction. Taking into consideration only third molar extractions, the prevalence of dry socket reaches even 45%. The aim of this literature review was to describe current knowledge about etiology, risk factors, treatment, and prevention of dry socket.
 State of knowledge:
 The symptoms of alveolar osteitis most frequently are reported between the first and third post-extraction days and they include discomfort, lancing, and intense pain which radiates to the neck and ear. The etiopathogenesis of dry socket remains unclear. However, the currently accepted hypothesis describes a loss of formed after an extraction blood clot from the alveolar socket as the main cause of this pathology. Several factors may increase the risk of dry socket and include smoking, oral hygiene, female gender, oral contraceptive drugs, and anesthesia. In the treatment of alveolar osteitis, irrigation of the socket with chlorhexidine gluconate, iodopovidone, or physiological saline followed by filling the socket with intra-alveolar dressing constitute a current fundamental procedure. Plenty of substances are currently used as an intra-alveolar dressing. Part of them exhibits only pain-decreasing features, whereas some drugs can also stimulate the regeneration of treated tissue. In the prevention, the use of alveolar osteitis warm saline, antibiotics, chlorhexidine, ozone gas, or autologous platelet therapy may be useful maneuvers.
 Conclusion:
 This literature review summarizes the current state of knowledge about causes, risk factors, and therapeutic and preventive methods with regard to alveolar osteitis.

Management of Dry Socket: New regenerative techniques emerge while old treatment prevails

Although dry socket has been recognized for more than a century, its etiology is still poorly understood, and treatment approach is diverse with varying outcome. The aim of this review is to investigate, classify, summarize, and discuss the treatment of dry socket. Four databases (PubMed, Science Direct, Scopus and Medline) were searched from April 2000 till April 2020 for articles featuring the key words: ‘dry socket’, OR ‘alveolar osteitis’, OR ‘post-extraction complication’, OR ‘treatment of dry socket’, OR ‘treatment of alveolar osteitis’, OR ‘treatment of pain following tooth extraction’. The Standard Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were adopted for data gathering. A total of 3,857 results were found and 17 articles were finally selected and reviewed thoroughly. Treatment initiatives were categorized into empirical approach, conventional approach and regenerative strategies. 19 treatment products were identified. Earlier therapeutic approaches focus on pain control, infection prevention and resolving inflammation while current strategies modulate angiogenesis and granulation tissue formation. These latter armamentariums use blood-based products such as Platelet-Rich Plasma; employing laser and ultrasound technology that initiate and propagate tissue regeneration. While evidence support a regenerative approach for dry socket healing, the old treatment modality controlling infection, inflammation and pain prevails.

Title- Comparison between Olive Oil and Nano-Bio Fusion Gel in the Treatment of Alveolar Osteitis: A Double-Blind Randomized Trial

Title- Comparison between Olive Oil and Nano-Bio Fusion Gel in the Treatment of Alveolar Osteitis: A Double-Blind Randomized Trial

Alveogyl: Foreign Body Reaction

Alveolar osteitis (AO) is a painful complication experienced by approximately 3–4% of patients who have undergone a dental extraction. A frequently used intra-alveolar dressing material, such as Alveogyl is commonly used to treat sockets where a diagnosis of AO is made. However, unexpected problems may be encountered by the dentist when using such materials and this article explores a case where a diagnosis of a foreign body reaction to Alveogyl was identified in a symptomatic patient with no overt clinical or radiographical signs. CPD/Clinical Relevance: Dental professionals should be aware of the possible complications with the use of Alveogyl in the treatment of alveolar osteitis, in particular foreign body reactions.

Clinical management of alveolar osteitis. A systematic review.

Background Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several therapeutic interventions have been described for the treatment of AO, however, there are no treatment standardized protocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the different treatments for AO. The feasibility of the application of these interventions is also discussed.Material and Methods A structured electronic and hand search strategy was applied to PubMed, Scopus, Cochrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies according to PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients’ percentages. Those treatments that reach VAS ≤ 4 on day 2 or before; or ≥ 85% of patients with absence of pain symptoms at day 7 or before were considered accepTable for their recommendation.Results The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AO treatments. 53,8% of the treatments fulfill the proposed parameters for pain control.Conclusions Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management of AO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCept Patch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected according to their availability and advantages or disadvantages. Key words:Dry socket, alveolar osteitis, treatment, management, pain control, pain relief.

Incidence of alveolar osteitis after mandibular third molar surgery. Can inflammatory cytokines be identified locally?

Objectives The aims of the present study were to evaluate the relative incidence of alveolar osteitis (AO) after mandibular third molar surgery, post-operative findings and local expression of bone markers and cytokines. Study design In 445 patients, unilateral surgical third molars extractions were undertaken (584 teeth). Bone markers and cytokines were explored at the AO side and on the un-operated contralateral side and compared with the levels in samples from a control group of 18 persons without AO. Results The relative incidence of AO was 4.6%. Patients (n = 27) with AO were invited to participate in the study and 21 (77.8%) did so. Patients with AO had 1–4 extra visits for treatment of AO, the mean follow-up time was 2.6 days for all patients. There were significantly higher levels of bone markers and cytokines in the AO site compared with the un-operated contralateral site, except for Epidermal growth factor (EGF). No significant difference in expression of bone markers and cytokines between the AO and control groups was found. Lower maximum inter-incisor opening (MIO) was correlated with increased Macrophage inflammatory protein 1 alpha. A negative correlation between patients’ complaint of trismus and MIO was seen. Conclusions The relative incidence of AO was low in our patient group treated with surgical removal of third molars. AO was more frequently seen in female patients. Treatment of AO required up to four extra visits. The study provides some information on the role of cytokines in AO; but further studies are required.

Evaluation of the effects of intra-alveolar irrigation with clindamycin, rifampicin and sterile saline in alveolar osteitis treatment

BackgroundTo evaluate the efficacy of intra-alveolar irrigation made with clindamycin, rifampicin and sterile saline on pain and alveolar mucosa healing in the treatment of alveolar osteitis (dry socket). MethodsFifty-four patients diagnosed with alveolar osteitis were divided into three groups for the treatment protocol. Sterile saline was used in Group A, rifampicin was used in Group B and clindamycin was used in Group C for intra-alveolar irrigation. In the groups, the patients were evaluated for their pain levels and alveolar mucosa healing. ResultsThe incidence of alveolar osteitis was significantly higher in females and mandibles at a statistically significant. In the group that used clindamycin for intra-alveolar irrigation, the pain level was found lower than the two other groups. Clindamycin and rifampicin groups were superior to the sterile saline group in clinical alveolar mucosa healing. ConclusionIrrigation with clindamycin appears to reduce the pain associated with alveolar osteitis when compared to rifampicin and sterile saline. In the treatment of alveolar osteitis, irrigation with antibiotics following curettage was found effective for pain relief and alveolar mucosa healing.

The effect of photobiomodulation therapy in the management of alveolar osteitis after tooth extraction: a scoping review

This scoping review evaluated the effects of photobiomodulation therapy (PBMT) in treatment of alveolar osteitis (AO) (dry socket) after the tooth extraction. This search was carried out using the MEDLINE/PubMed database, up to June 2017. The articles were selected focusing the effects of the PBMT in the management of AO after tooth extraction. Three prospective randomized clinical studies were selected. All articles were conducted on systemically healthy adult humans. The PBMT was performed on 105 patients, while the mean age ranged 32.85 years, including males and females. The laser used in these studies ranged from 660 to 2780 nm wavelengths, while the diode laser was the most used (808 nm and 810 nm) with the laser power ranging from 0.1 to 1 W. All laser-treated groups showed positive effects compared with other groups, and there were no adverse or negatives effects reported. Within the limitation of this scoping review, PBMT showed to be significant and faster in the decrease of pain and swelling. The authors also observed an increase in the healing process when PBMT was used in AO treatment. The dry socket irrigation for the debris remotion plays an important role in any chosen treatment for AO. Further clinical studies should be made not only to elaborate a PBMT protocol for treatment of this clinical situation but also to prevent it. The protocols should contain different types of laser to take all therapeutic benefits from each one.

Angiogenesis and the prevention of alveolar osteitis: a review study.

Angiogenesis is one of the essential processes that occur during wound healing. It is responsible for providing immunity as well as the regenerative cells, nutrition, and oxygen needed for the healing of the alveolar socket following tooth extraction. The inappropriate removal of formed blood clots causes the undesirable phenomenon of alveolar osteitis (AO) or dry socket. In this review, we aimed to investigate whether enhanced angiogenesis contributes to a more effective prevention of AO. The potential pro- or anti-angiogenic activity of different materials used for the treatment of AO were evaluated. An electronic search was performed in the PubMed, MEDLINE, and EMBASE databases via OVID from January 2000 to September 2016 using the keywords mentioned in the PubMed and MeSH (Medical Subject Headings) terms regarding the role of angiogenesis in the prevention of AO. Our initial search identified 408 articles using the keywords indicated above, with 38 of them meeting the inclusion criteria set for this review. Due to the undeniable role of angiogenesis in the socket healing process, it is beneficial if strategies for preventing AO are directed toward more proangiogenic materials and modalities.

Effects of honey in the management of alveolar osteitis: A study.

Introduction:Alveolar osteitis (AO) is a complication of tooth extraction which indicates inflammation of alveolar bone of either maxilla or mandible. This study uses Apitherapy where honey catalyses biological reactions to improve immune system, makes local environment unbearable for microorganisms in the affected socket and enhances healing.Materials and Methods:50 patients of AO were included in the study. After cleansing of the affected socket, honey dressing was applied. Dressings were changed daily for first 2 days and then altenatively. In biochemical investigations, CRP levels in the body were measured using Nephelometry method. Microbiological examination was done for the identification of microorganism and semi quantitative count of colony forming units.Result:Results were assessed from clinical, microbiological, biochemical and radiological findings at 1st, 2nd, 3rd, 5th, 7th day based on VAS score, erythema, pus discharge, swelling, lymphadenitis, fever, bleeding on probing, exposed bone and necrotic debris. Pre-Treatment CRP was 2.08 ± 1.62 which significantly (P = 0.0001) decreased to 0.82 ± 0.48. Mean change and average percentage change were 1.25 ± 1.51 and 44.1% respectively.Conclusion:Majority of the patients with exposed bone got healed socket with evidance of granulation tissue and healing gingiva in about one week. CRP levels at the completion of treatment of AO with honey dressing showed a significant decrease from the pre-treatment values indicating fast recovery. Microbiological examination showed presence of normal commensal flora at AO sites like Streptococcus, Staphyloccocus and Enterococcus. So, the role of bacteria in the genesis of AO, if any, appears unclear.

In vitro evaluation of polymeric formulations designed for use in alveolar osteitis

ABSTRACTIn this article, we present a potential use of biodegradable polymers as a drug‐delivery system designed for alveolar osteitis (AO) management. The release characteristics of lidocaine hydrochloride from alginate or hyaluronate xerogels, which covered the microcrystalline chitosan scaffold, were examined as drug carriers, wound dressings, and potential devices in bone regeneration. The materials were characterized by Fourier transform infrared spectroscopy to confirm that there was no additional covalent bonding between the polymeric membranes and the anesthetic agent. Surface‐eroding matrices (ca. 120 μm) encapsulated the main substance, and the morphologies of all of the structures were measured by scanning electron microscopy. Positive results were obtained, and the data suggested an important impact of materials selection on the physicochemical properties and drug release. Additionally, the mechanical properties, such as the hardness, adhesiveness, springiness, and cohesiveness, of the tested materials were evaluated. A study of the swelling confirmed one of the assumptions that the materials could be used as a potential wound dressing and emphasized the resistance of the materials in the condition imitating the movement of the masticatory system. A cytotoxicity test of the formulations was performed to prove the materials’ nontoxicity. The aim of this study was to design and propose an in vitro evaluation of a new drug formulation as a potential application for the treatment of AO. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2016, 133, 42991.

Local interventions for the management of alveolar osteitis (dry socket)

Local interventions for the management of alveolar osteitis (dry socket)

Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis

Alveolar osteitis (AO) is the extraction wound healing disorder with a presence of severe pain. Low level laser therapy stimulates cell metabolism and microcirculation, have has pronounced analgesic, antiedematous and anti-inflammatory effect and speeds up wound healing process. The aim of this study was to present results of clinical research that examined the effectiveness of low level laser in pain relief and healing of extraction wounds with alveolar osteitis in the lower jaw which was formed on the second day after tooth extraction. The study was conducted on 60 subjects divided into the study and the control group. In both groups extraction wounds were processed in similar way, except that in the study group was applied daily treatment of low level laser with a total of eight sessions of radiation, while in the control group extraction wounds were dressed with zinc oxide eugenol paste, which was changed every 48 hours up to the pain cessation. Measurement of pain intensity was done with a visual analogue scale (VAS) 10 min prior to processing of extraction wounds and daily for the next eight days. Assessment of the effectiveness of low level laser on healing of extraction wounds was performed on the day eight of the treatment. On the day five after beginning of the treatment of extraction wounds with alveolar osteitis in the patients of the study group a lower average value of pain as compared to the control group was registered. This difference was increased within the following days. Extraction wounds healing in the study group was more successful and faster than in the control group. This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.

Evaluation of topical viscous 2% lidocaine jelly as an adjunct during the management of alveolar osteitis

Purpose : This study evaluated the efficacy of topical viscous 2% lidocaine jelly for the alleviation of pain experienced during the instrumentation of mandibular third molar extraction sites diagnosed with alveolar osteitis and for pain relief during the postinstrumentation period. Patients and Methods : Thirty adult patients with a diagnosis of alveolar osteitis in a mandibular third molar extraction site were included in this prospective, double-blind study. Each patient had their sutures removed, the socket irrigated, and 2% lidocaine jelly placed on the tip and side of the tongue to blind the patient against the test substances. The subjects were then randomly distributed into two groups. Group 1 had a nonactive jelly base placed into the socket 2 minutes prior to the placement of a standard obtundant dressing. Group 2 had viscous 2% lidocaine jelly placed into the socket in the same manner. Patients subjectively quantified their pain intensity pretreatment, during instrumentation, immediately postmanipulation, at 5-minute intervals to 30 minutes, and at 45 and 60 minutes. They also subjectively quantified their pain relief at each of the time intervals following instrumentation. Results : There was no statistical difference between the pretreatment pain experienced by both groups. The use of 2% lidocaine jelly had a measurable ( P = .056), but not statistically significant, effect on pain due to instrumentation. At every time interval thereafter, the use of 2% lidocaine jelly elicited a statistically significant ( P < .05) decrease in pain perception, and a statistically significant increase in pain relief when compared with the inactive jelly. Conclusion : Topical viscous 2% lidocaine jelly is a useful adjunct during the treatment of alveolar osteitis, especially in the early (≤60 minutes) postinstrumentation period.