Efficacy of Aloe Vera Gel in Dry Socket After Removal of Mandibuler Third Molar

Objective: To evaluate the effectiveness of Aloe Vera gel in management of dry socket after surgical removal of 3rd molar. Study Design & Setting: From December 2020 to November 2021, a descriptive research was conducted in the Section of Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad, Sindh. Methodology: Total 70 patients were included and divided equally in two groups i.e. Group-A (Alveora dressing) and Group-B (Controls). Dry socket, pre-operative assessment was carried out on the basis of pain Visual analog scale (VAS) and healing index. Socket was irrigated with sterile saline 0.9% in experimental group. In control group, patient were given tablet Panadol 1gm SOS. Patients were evaluated post operatively at 1st, 2nd, and 3rd day on the basis of pain (VAS) and healing index. Results: In group-A mean postoperative VAS at day-1, day-2 and day-3 was 6.69±2.59, 3.17±2.39 and 1.14±1.03 respectively. In group-B it was 7.77±2.03, 6.97±2.14 and 4.57±2.57. In group-A, mean postoperative healing scale at day-1, day-2 and day-3 was 2.83±0.56, 3.49±0.61 and 4.37±0.73 respectively and in group-B it was 2.31±0.58, 2.63±0.69 and 3.26±0.65 respectively. Significant association of pain intensity at day-2 and day-3 and healing index (at day-1, day-2 and day-3) was observed. Conclusion: Aloe Vera gel significantly reduced postoperative pain and improve healing index. Keywords: Effectiveness, Aloe Vera Gel, Dry Socket, Surgical Removal, Third Molar

A Comparative Study to Evaluate the Effect of Honey and Zinc Oxide Eugenol Dressing for the Treatment of Dry Socket: A Double-Blind Randomized Controlled Trial

Dry socket is a common postoperative complication secondary to any tooth extraction but is more commonly associated with mandibular third molars. Dry socket has been treated with various treatment modalities with different success rates. This study aimed to evaluate the effect of using honey and zinc oxide eugenol as an intra-socket medicament for the treatment of dry sockets. Ninety patients were divided into three groups as follows: Group 1 “honey”: 30 patients; Group 2 “zinc oxide eugenol”: 30 patients; and Group 3 “control”: 30 patients. Pre-medication and post-medication pain scores at different time intervals were measured on a verbal rating scale. The mean ages of the patients in each of the groups were as follows: Group 1: 44.26 ± 14.14; Group 2: 45.30 ± 18.08; and Group 3: 51.93 ± 9.75. As regards verbal rating scale pain scores, a significant difference was noted in patients that belonged to Groups 1 and 2, with an immediate reduction in post-medication pain scores. However, patients belonging to Group 3 reported pain and discomfort for over a week. The use of honey and zinc oxide eugenol resulted in significant immediate post-medication pain scores in patients as compared to the control group. Therefore, both honey and zinc oxide eugenol can be used as treatment options for dry socket patients.

Comparison of Iodoform and Paraminobenzoate for The Managment of Dry Socket

Objective: The aim of present study is to compare effectiveness of two different modalities Iodoform and Para-Aminobenzoate for the management of Dry socket. Material And Methods: Patients reported with dry socket at the OPD of Oral and Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical and Health Sciences, after mandibular molar tooth extraction were included After thorough irrigation with sterile saline and followed up for three alternative days by replacing dressing and then findings were recorded in the designated proforma of the patients. Pain was measured by Visual Analogue Scale (VAS). Results: The mean age of group A was 26.18+4.41 years and mean age in group B was observed 26.0+3.92 years. Males were predominantly reported in both groups. In this study 3rd molar extraction was commonest as 81.1% in group A. Similarly 3rd molar extraction was 85.5% in group B. Most of the cases of both groups underwent surgical extraction. In our study mostly onset symptoms were seen at 72 hours in both study groups. On day 3 and 4 pain was markedly decrease in patients of group B as compared to group A, p-values were quite insignificant (p=0.001). Conclusion: Para-Aminobenzoate showed better effectiveness in decreasing the pain from day 2nd. Keywords: Dry socket, Iodoform, Para-Aminobenzoate, Pain

Comparison of Alveolar Osteitis (AO) occurrence after impacted mandibular third molar removal with and without post-extraction socket irrigation

Objective: We wanted to see whether impacted third mandibular molar extractions resulted in Alveolar Osteitis if post-extraction socket irrigation was used or not. Methodology: A randomized control experiment on 70 patients study was conducted from July 2019 to January 2020 at Islamabad Dental Hospital's OMFS department. Patients presenting with the mandibular third molars fulfilling the inclusion criteria had their teeth extracted with and without socket irrigation using the computer lottery method. In cases of dry socket, clinical diagnosis was made between the 3rd, 5th, and 7th postoperative days. Results: 70 patients/sockets were evaluated with 35 having been irrigated and 35 non-irrigated. The age range was 16-50years with a mean of 29.49 and most patients were between the 16-35 age group. There were 48.6% males and 51.4% females. Dry Socket was evaluated on the 3rd, 5th, and 7th day between groups (A=irrigation, B=Non-irrigation). On the 3rd postop day, 14 (40%) patients in group A and 15(42.9%) patients were diagnosed as dry Sockets. A similar number of patients in both groups (20%) exhibited symptoms of dry socket on the fifth and seventh postoperative days, as did 5 (14.3 %) in group A, 3 (8.6 %) in group B, and 1(2.9 %t) in group A, all on the fifth postoperative day. Conclusion: On the third, fifth, and seventh postoperative days, there was no significant difference in the result of Alveolar Osteitis between the groups.

Advanced Platelet-Rich Fibrin as a Therapeutic Option in the Treatment of Dry Socket: Literature Review and Case Series

Alveolar osteitis (AO) is one of the complications that occur after tooth extraction. The aim of this study has been to evaluate the efficacy of Advanced Platelet-rich Fibrin (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of AO. Consecutive patients who were diagnosed with AO, recruited from patients referred to the Oral Surgery Department of the University of Naples Federico II, were enrolled. After local anesthesia, the dry socket was curetted and irrigated with saline. The Platelet-rich Fibrin (PRF) clot was placed in the socket and then covered with an A-PRF membrane. Clinical parameters, such as the degree of pain and rate of granulation tissue (GT) formation, were measured before treatment and after 1, 3, 7, 14, and 21 days. The Friedman test for dependent samples was used to detect the treatment and time effect. Four patients with established AO were included. On all the examination days, the post-operative recovery was uneventful. The pain scores progressively reduced, from an average of 8.5 before treatment to 0.25 on the third day, and the GT formation improved over time. The use of A-PRF in the treatment of AO significantly reduced the pain level and enhanced the wound-healing process.

Application of Bio-Resorbable Membranes in Preventing Complications of Lower Jaw Surgery

Summary Background/Aim: Prevention of inflammation and alveolar bone atrophy is very important in oral surgery. The aim of this study was to compare the use of two osteoplastic bio-resorbable membranes in order to prevent inflammatory complications and atrophy of the alveolar part of the mandible after surgical interventions. Material and Methods: We examined 86 patients 45-70 years old who were classified into four groups. In group 1, there were 21 patients who had a “bio-resorbable membrane type 1 implanted. The group 2 consisted of 23 persons treated with bio-resorbable membrane type 2. Only the occurrence of inflammatory complications after the placement of these membranes was monitored. Group 3 included 20 persons treated with membrane type 1 and group 4 included 22 patients treated with membrane type 2 to prevent both inflammatory complications and atrophy of the alveolar part of the mandible. The level of atrophy of the alveolar bone after one year was determined by cone-beam computed tomography. The obtained data were statistically evaluated. Results: Six inflammatory complications (“dry socket”) have been identified in operated patients treated with a membrane type 1 (the first and the third groups). Only two “dry socket” occurred in patients treated with membrane type 2 (the second and fourth groups). Group 4 had significant advantages in the alveolar crest height 14.6 (11.2-22.3) and in its width 7.7 (5.1-10.2) both in relation to the indices of group 3 (11.1 (9.7-20.4) and 6.2 (4.2-9.0). Conclusions: The bio-resorbable membrane type 2 prevented inflammatory complications in the short postoperative period after surgical interventions, as well as, the atrophy of the mandible.

Factors Affecting Gelation of Lidocaine Hydrochloride-Loaded Polyelectrolyte Complex Thermosensitivity Gel for Dry Socket Treatment

Dry socket disease, a pocket wound caused by the tooth extraction that resulted in severe acute pain which requires a topical analgesic with rapidly pain reduction and suppress the pain until the wound healed. This study aimed to investigate factors affecting gelation temperature and gelation time of lidocaine hydrochloride (LH)-loaded polyelectrolyte complex (PEC) thermosensitivity gel for treating dry socket wound. The first factor was investigated the effects of the ratio of three different types of polymers as chitosan (CS), hyaluronic acid (HA) and poloxamer407 (P407) on the phase transition caused by temperature. The second factor was examined the effects of gel preparation methods. The results showed that increasing concentration of the cationic polymer as CS induced the separation of the solution to gel (sol-to-gel) system due to the charge of CS and the charge of PEC. The ratio of HA:P407 affected the gel forming which high concentration of P407 reduced the gelation temperature while low concentration of HA disturbed the sol-to-gel state causing coagulation. The viscosity, spreadability, and swelling were significantly increased due to the concomitant increased in each polymer, HA and P407. The particle of the formulation observed under microscope was found to be less than 1 µm. Phase inversion from sol-to-gel was found after a min at 23°C. Since gelation temperature of the purposed formula is supposed to form gel below 37°C within a short period of injection. The results of the study indicate the suitable sol-to-gel forming in the appropriate temperature and time which should be used for further investigation in the efficacy and safety.

Incidence of complications after the surgical removal of impacted mandibular third molars: A single center retrospective study

Objectives: The aim of the study was to study the incidence of complications associated with the surgical removal of impacted mandibular third molars in a single center. Material and Methods: A single center retrospective study was conducted in the Department of Oral and Maxillofacial Surgery at NSVK Sri Venkateshwara Dental College and Hospital located in Bannerughatta, Bengaluru. The study included patients between the ages of 15–60 years who had undergone surgical extraction of one or more mandibular third molar and had a difficulty score between 3 and 6 (Pederson’s difficulty index). During the course of study variables such as age, gender, impacted side, difficulty index, medical, and habit history along with complications and medications were recorded and accessed from the patient’s case history reports. In due course of the study, these variables were analyzed and correlated using descriptive analysis, Chi-square test, Contingency test, and regression analysis to understand whether or not these variables play an important role in aggravating post-extraction complications for mandibular third molars. Results: The study sample was composed of 250 patients with 52% female and 48% male with a mean age of 34 years. The complication rate observed was 7.6%, there was a statistically significant co-relation seen between gender (P = 0.016), age groups (p<0.05), spatial relationship (P = 0.019), and medical history (P = 0.016) when compared to the complications observed. The most common complications observed were trismus/muscle spasm followed by dry socket. However, the cases of neurosensory complications were extremely rare. Conclusion: There was a significant association to be found between the complication-rate and gender. Conditions such as muscle spasms/trismus and dry socket had a significant predilection toward the males while complications associated with neurosensory changes were commonly seen in females. There was also a significant association between habit history and rate of complication especially in conditions such as dry-socket where all the observed cases had positive history of tobacco/pan chewing habit. Interestingly all the males who complained of dry socket also had reported medical history of type (2) diabetes. Patients with complications such as neurosensory changes were few and could have been prevented with good surgical skills and precision; moreover, even if they were found they were temporary and treated with regular follow-ups.