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 1^st, 3^rd, 7^th, and 14^th 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 3^rd and 7^th post-PRF placement day in the extraction socket along with mark decrease in the degree of inflammation at the 3^rd post-PRF placement day, and there was better wound healing by the end of the 2^nd 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.

Key words:

Alveolar osteitis - dry socket - pain - platelet-rich fibrin - tooth extraction

• REFERENCES

• 1 Crawford JY. Dry socket. Dent Cosmos 1896; 38: 929-929
• 2 Bloomer CR. Alveolar osteitis prevention by immediate placement of medicated packing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 282-4
• 3 Blum IR. Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. Int J Oral Maxillofac Surg 2002; 31: 309-17
• 4 Oginni FO. Dry socket: A prospective study of prevalent risk factors in a Nigerian population. J Oral Maxillofac Surg 2008; 66: 2290-5
• 5 Quinley JF, Royer RQ, Gores RJ. “Dry socket” after mandibular odontectomy and use of soluble tetracycline hydrochloride. Oral Surg Oral Med Oral Pathol 1960; 13: 38-42
• 6 Birn H. Aetiology and pathogenesis of fibrinolytic alveolitis (Dry socket). Int J Oral Surg 1973; 2: 251-63
• 7 Tarakji B, Saleh LA, Umair A, Azzeghaiby SN, Hanouneh S. Systemic review of dry socket: Aetiology, treatment and prevention. J Clin Diagn Res 2015; 9: ZE10-3
• 8 Fernandes GJ, Hatton MN. Prevention of alveolar osteitis. A case report and review of literature. N Y State Dent J 2016; 82: 21-5
• 9 Wates E, Ria B. The prevention and management of dry socket: Do antibiotics have a role to play?. Prim Dent J 2015; 4: 42-3
• 10 Hedström L, Sjögren P. Effect estimates and methodological quality of randomized controlled trials about prevention of alveolar osteitis following tooth extraction: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 8-15
• 11 Nitzan DW. On the genesis of “dry socket”. J Oral Maxillofac Surg 1983; 41: 706-10
• 12 Freudenthal N, Sternudd M, Jansson L, Wannfors K. A double-blind randomized study evaluating the effect of intra-alveolar chlorhexidine gel on alveolar osteitis after removal of mandibular third molars. J Oral Maxillofac Surg 2015; 73: 600-5
• 13 Rakhshan V. Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg 2015; 41: 59-65
• 14 Xu JL, Sun L, Liu C, Sun ZH, Min X, Xia R. et al. Effect of oral contraceptive use on the incidence of dry socket in females following impacted mandibular third molar extraction: A meta-analysis. Int J Oral Maxillofac Surg 2015; 44: 1160-5
• 15 Jesudasan JS, Wahab PU, Sekhar MR. 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. Br J Oral Maxillofac Surg 2015; 53: 826-30
• 16 Khiyavi R, Barghi V, Yazdani J, Ghavimi MA, Saadat M, Khiyavi G. et al. Effect of Biotene mouth wash on prevention of alveolar osteitis after extraction of permanent mandibular first molar teeth. Elixir Human Physiol 2012; 47: 8672-4
• 17 Anand KP, Patro S, Mohapatra A, Mishra S. The efficacy of Tranexamic acid in the reduction of incidence of dry socket: An Institutional double blind study. J Clin Diagn Res 2015; 9: ZC25-8
• 18 Hooley JR, Golden DP. The effect of polylactic acid granules on the incidence of alveolar osteitis after mandibular third molar surgery. A prospective randomized study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80: 279-83
• 19 Jovanović G, Urić N, Krunić N, Tijanić M, Stojanović S. Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis. Vojnosanit Pregl 2011; 68: 506-10
• 20 Goldsmith SM, De Silva RK, Tong DC, Love RM. Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal. Int J Oral Maxillofac Surg 2012; 41: 371-5
• 21 Ross R, Glomset J, Kariya B, Harker L. A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. Proc Natl Acad Sci U S A 1974; 71: 1207-10
• 22 Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL. 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. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 299-303
• 23 Haraji A, Lassemi E, Motamedi MH, Alavi M, Adibnejad S. Effect of plasma rich in growth factors on alveolar osteitis. Natl J Maxillofac Surg 2012; 3: 38-41
• 24 Pal US, Singh BP, Verma V. 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. Contemp Clin Dent 2013; 4: 37-41
• 25 Corso MD, Toffler M, David M, Ehrenfest D. Use of autologous leukocyte and platelet rich fibrin (L-PRF) membrane in post avulsion sites: An overview of Choukroun's PRF. J Implant Adv Clin Dent 2010; 1: 27-35
• 26 Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J. et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet concentrates?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: e51-5
• 27 Bortoluzzi MC, Manfro R, De Déa BE, Dutra TC. Incidence of dry socket, alveolar infection, and postoperative pain following the extraction of erupted teeth. J Contemp Dent Pract 2010; 11: E033-40
• 28 Kumar YR, Mohanty S, Verma M, Kaur RR, Bhatia P, Kumar VR. et al. Platelet-rich fibrin: The benefits. Br J Oral Maxillofac Surg 2016; 54: 57-61
• 29 Eshghpour M, Rezaei NM, Nejat A. Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: A single-blind randomized clinical trial. J Oral Maxillofac Surg 2013; 71: 1484-9
• 30 Eshghpour M, Dastmalchi P, Nekooei AH, Nejat A. Effect of platelet-rich fibrin on frequency of alveolar osteitis following mandibular third molar surgery: A double-blinded randomized clinical trial. J Oral Maxillofac Surg 2014; 72: 1463-7
• 31 Das S, Jhingran R, Bains VK, Madan R, Srivastava R, Rizvi I. et al. Socket preservation by beta-tri-calcium phosphate with collagen compared to platelet-rich fibrin: A clinico-radiographic study. Eur J Dent 2016; 10: 264-76
• 32 Mathur A, Bains VK, Gupta V, Jhingran R, Singh GP. Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis. Eur J Dent 2015; 9: 100-8