Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing associated with established alveolar osteitis (dry socket)

ABSTRACT Objective: To assess the efficacy of platelet-rich fibrin (PRF) on the pain and healing of the extraction socket related with established alveolar osteitis (dry socket, AO) after the removal of maxillary and mandibular molars. Materials and Methods: One hundred consecutive adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in this single-arm clinical trial. PRF was placed in the maxillary and mandibular molar extraction sockets after adequate irrigation of the socket. All the patients evaluated for the various study variables which include pain, degree of inflammation, and healthy granulation tissue formation (wound healing) at the 1st, 3rd, 7th, and 14th post-PRF placement day in the alveolar socket. Data were analyzed using Shapiro-Wilk's test, Chi-square test and/or Student's t-test, Friedman's test, Wilcoxon signed-rank test, and Bonferroni test, with the significance level set at P < 0.05. Results: There was significant reduction in pain associated with AO at the 3rd and 7th post-PRF placement day in the extraction socket along with mark decrease in the degree of inflammation at the 3rd post-PRF placement day, and there was better wound healing by the end of the 2nd week. Conclusion: The use of PRF in this clinical trial illustrates the promising results in terms of reduced pain and better healing in the patients with sustained AO.

[1]  Ruchi Srivastava,et al.  Socket preservation by beta-tri-calcium phosphate with collagen compared to platelet-rich fibrin: A clinico-radiographic study , 2016, European Journal of Dentistry.

[2]  P. A. Wahab,et al.  Effectiveness of 0.2% chlorhexidine gel and a eugenol-based paste on postoperative alveolar osteitis in patients having third molars extracted: a randomised controlled clinical trial. , 2015, The British journal of oral & maxillofacial surgery.

[3]  R. Xia,et al.  Effect of oral contraceptive use on the incidence of dry socket in females following impacted mandibular third molar extraction: a meta-analysis. , 2015, International journal of oral and maxillofacial surgery.

[4]  Sumita Mishra,et al.  The Efficacy of Tranexamic Acid in the Reduction of Incidence of Dry Socket: An Institutional Double Blind Study. , 2015, Journal of clinical and diagnostic research : JCDR.

[5]  B. Ria,et al.  The Prevention and Management of Dry Socket: Do Antibiotics Have a Role to Play? , 2015, Primary dental journal.

[6]  S. Azzeghaiby,et al.  Systemic review of dry socket: aetiology, treatment, and prevention. , 2015, Journal of clinical and diagnostic research : JCDR.

[7]  V. Rakhshan Common risk factors for postoperative pain following the extraction of wisdom teeth , 2015, Journal of the Korean Association of Oral and Maxillofacial Surgeons.

[8]  L. Jansson,et al.  A double-blind randomized study evaluating the effect of intra-alveolar chlorhexidine gel on alveolar osteitis after removal of mandibular third molars. , 2015, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[9]  V. Bains,et al.  Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis , 2015, European journal of dentistry.

[10]  M. Eshghpour,et al.  Effect of platelet-rich fibrin on frequency of alveolar osteitis following mandibular third molar surgery: a double-blinded randomized clinical trial. , 2014, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[11]  M. Eshghpour,et al.  Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: a single-blind randomized clinical trial. , 2013, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  D. Tong,et al.  Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal. , 2012, International journal of oral and maxillofacial surgery.

[13]  G. Jovanović,et al.  [Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis]. , 2011, Vojnosanitetski pregled.

[14]  F. Oginni Dry socket: a prospective study of prevalent risk factors in a Nigerian population. , 2008, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[15]  A. Dohan,et al.  Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[16]  A. Dohan,et al.  Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates? , 2006, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[17]  I. Blum Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. , 2002, International journal of oral and maxillofacial surgery.

[18]  C. Bloomer Alveolar osteitis prevention by immediate placement of medicated packing. , 2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[19]  D. P. Golden,et al.  The effect of polylactic acid granules on the incidence of alveolar osteitis after mandibular third molar surgery. A prospective randomized study. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[20]  D. Nitzan On the genesis of "dry socket". , 1983, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[21]  R. Ross,et al.  A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. , 1974, Proceedings of the National Academy of Sciences of the United States of America.

[22]  G. Fernandes,et al.  Prevention of Alveolar Osteitis. A Case Report and Review of Literature. , 2016, The New York state dental journal.

[23]  S. Mohanty,et al.  Platelet-rich fibrin: the benefits. , 2016, The British journal of oral & maxillofacial surgery.

[24]  B. Singh,et al.  Comparative evaluation of zinc oxide eugenol versus gelatin sponge soaked in plasma rich in growth factor in the treatment of dry socket: An initial study , 2013, Contemporary clinical dentistry.

[25]  M. H. Motamedi,et al.  Effect of plasma rich in growth factors on alveolar osteitis , 2012, National journal of maxillofacial surgery.

[26]  R. Manfro,et al.  Incidence of dry socket, alveolar infection, and postoperative pain following the extraction of erupted teeth. , 2010, The journal of contemporary dental practice.

[27]  L. Hedström,et al.  Effect estimates and methodological quality of randomized controlled trials about prevention of alveolar osteitis following tooth extraction: a systematic review. , 2007, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[28]  H. Birn Etiology and pathogenesis of fibrinolytic alveolitis (“dry socket”) , 1973 .

[29]  R. Royer,et al.  "Dry socket" after mandibular odontectomy and use of soluble tetracycline hydrochloride. , 1960, Oral surgery, oral medicine, and oral pathology.