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Intra-alveolar chlorhexidine gel for the prevention of dry socket in mandibular third molar surgery. A pilot study.

PURPOSE: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. MATERIALS AND METHOD: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar post-extraction dry socket alveolitis and its post-operative effects on patients. RESULTS: A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. CONCLUSIONS: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary.

Adult↗

Comparison of two chlorhexidine rinse protocols on the incidence of alveolar osteitis following the surgical removal of impacted third molars.

PRINCIPLES: Alveolar osteitis (dry socket) is the most common complication following the extraction of permanent teeth. This study was undertaken to compare the effect of two chlorhexidine rinse protocols on the incidence of alveolar osteitis in patients undergoing surgical removal of impacted mandibular third molar teeth. METHODS: A prospective randomized clinical trial was conducted among 99 subjects. Patients were randomly assigned into two groups. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine rinse 30 seconds for one week before and one week after surgery (group I) or one week after surgery (group II). Postoperatively, all patients were instructed to return in one week or sooner if bothersome pain increased or persisted. Data were collected regarding abnormal healing, presence of necrotic tissue, exposed bone, and absence of clot. RESULTS: The results indicated group I and group II were not statistically significant different in the reduction of alveolar osteitis. CONCLUSIONS: To reduce alveolar osteitis after impacted third molar surgery, it was observed use of postoperative chlorhexidine rinse was adequate. The postoperative use of chlorhexidine is more feasible than both preoperative and postoperative use.

Adolescent↗

Bone maintenance: implant versus transplant.

Bone maintenance based on various attachment mechanisms is the key to tooth-root replacement safety and efficacy. The dental implant has broad applicability based on design, but demonstrates progressive peri-implant bone loss. The allogeneic tooth transplant, significantly less applicable because of size, is antigenic and rejected by bone-replacement root resorption. Since the predictability and survival times of these implant and transplant modalities are similar and there is less residual bone loss with the transplant, it is suggested that for clinical situations such as the fresh extraction socket, where there is room, the allotransplant, rather than implant, is the root-replacement of choice.

Alveolar Process↗

Effects of prostaglandin inhibition on the bone activities associated with the spontaneous drift of molar teeth in the rat.

Little is known about local bone regulation that enables spontaneous molar tooth drift. In this study the role of prostaglandins (PGs) were investigated in the rat by inhibiting PG-synthesis with indomethacin (7 mg/kg/d). Untreated animals were killed at the start of the experiment, while treated ones were killed after 3, 7, or 14 days of treatment. Mandibles were processed for histomorphometry without demineralization. Changes in osteoclasts and extent of the different steps of the bone remodeling sequence (resorption, reversal, and formation) were assessed along the remodeling side of the socket of the buccal root of the first molar. The total number of osteoclasts decreased after 7 days of PG inhibition (P < 0.01 vs controls) and then partially recovered. This change was due to a sharp decrease in active cells on day 7 (P < 0.01), while inactive cells remained unchanged throughout the experimental period. The extent of resorption fell on day 7 (P < 0.01) and then recovered almost to the control level on day 14. Reversal at first increased insignificantly and thereafter decreased (P < 0.02) for the remaining 7 days. Formation was modified only on day 14; at that time it had doubled compared with controls. These results show that PGs are involved in the local regulation of bone remodeling accompanying tooth drift. Resorption inhibition was partial, indicating that other factors participate with PGs in this regulation; in addition, the trend to recovery observed at the end of the experimental period suggests that these factors can take over from PGs to achieve the necessary remodeling of the socket.

Alveolar Process↗

Influence of polylactic acid mesh on the incidence of localized osteitis.

A biodegradable polylactic acid surgical implant, designed to facilitate dental extraction wound heading, is described. Animal studies have proved the safety and tissue compatibility of the implanted polylactic acid material. A clinical study using this material in mandibular third molar extraction sites in human subjects is reviewed. Results of that study reveal the implant to be effective in reducing the incidence of localized osteitis following mandibular third molar extractions.

Adolescent↗

Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: a randomised controlled trial.

We randomised 119 patients who had been referred for removal of partially impacted mandibular third molars to be given either metronidazole 1600 mg or placebo as a single dose 45 min before operation. Ten of the fifty-nine patients who were given metronidazole and 13 of the 60 given placebo developed dry sockets. Two variables were significantly associated with the development of a dry socket: pericoronitis and oral contraceptives.

Administration, Oral↗

Alveolitis after operative removal of third molars in the mandible.

The aim of the investigation was to assess the importance of various factors in the aetiology of alveolitis sicca dolorosa. Two hundren partially erupted or totally impacted mandibular third molars were surgically removed. The patients were divided into four groups. The patients in group 1 were premedicated with a single dose of penicillin-V (phenoxymethylpenicillin), those in group 2 with an antisialogogue (methylscopolamine nitrate), and those in group 3 with an antifibrinolytic agent (tranexamic acid). Group 4 were non-premedicated controls. The frequency of alveolitis in the groups 1 and 2 was significantly less than in the groups 3 and 4. This indicates the importance of salivary contamination of the surgical field and of infection as aetiologic factors in alveolitis.

Adolescent↗

Effect of chlorhexidine rinse on the incidence of dry socket in impacted mandibular third molar extraction sites.

This nonrandomized prospective study was conducted in a private practice setting to determine the effect of a 0.12% chlorhexidine gluconate rinse (Peridex, Proctor and Gamble, Cincinnati, Ohio) on the incidence of dry socket after removal of impacted mandibular third molars. Over a 3-year period, 371 patients (total of 654 impacted mandibular third molars) received either no treatment (group 1), 2 weeks of twice daily Peridex rinse postsurgery (group 2), or one rinse presurgery (group 3). The group that used Peridex twice daily for 2 weeks after surgery (group 2) showed a significant reduction (56%) in the incidence of dry socket when compared with either the group that did not rinse (group 1) or the group that rinsed only once just before surgery (group 3). The incidence of dry socket was higher in smokers and in females who used oral contraceptives. Twice daily use of Peridex for 2 weeks also yielded significant reductions in dry socket in smokers, nonsmokers, and in females who did not use oral contraceptives. Results from this study demonstrate that the use of Peridex for 2 weeks after surgery is effective in prevention of dry socket after surgical extraction of impacted molars.

Adult↗

Considerations in the management of patients taking oral contraceptives.

Among the undesirable effects associated with the use of oral contraceptives are an increased incidence of thromboembolic events, an increased risk of myocardial infarction, and, in certain users, a significant elevation in blood pressure. An altered fibrinolytic activity may have a direct effect on the occurrence of localized osteitis, "dry sockets." It is also possible that gingival inflammation and loss of attachment may occur even under conditions of adequate plaque control. Salivary changes and alterations in the bony trabecular pattern of the mandible have been observed, but the clinical significance is as yet undetermined (Illustration).

Contraceptives, Oral↗