Antimicrobial and bone repair effects of boric acid in a rat model of dry socket (alveolar osteitis) following dental extraction.

BACKGROUND: Alveolitis occurs after dental extraction without blood clot formation, leading to an inflammatory process and bacterial contamination. Boric acid (BA) demonstrates anti-inflammatory, antimicrobial, and osteogenic properties. This study aims to evaluate the possible antimicrobial effects and bone repair of BA in a rat model of alveolitis (dry socket). METHODS: 33 male Wistar rats were submitted to the extraction of the upper right incisor and dry socket induction. They were first divided into two groups: dry socket (n = 17) and dry socket + 0.75 % BA (n = 16). Samples for the microbiological analysis were collected immediately after dental extraction, at the detection of clinical alveolitis, 7, and 14 days after BA application. For microCT and histological analysis, samples from euthanized rats were used in 14 and 28 days after alveolitis detection. RESULTS: Higher bacterial counts were found in 4-5 days after alveolitis induction, compared to the baseline in both experimental groups, decreasing significantly after 7 and 14 days of treatment with BA (P < 0.05). The microCT evaluation displayed increased bone volume, bone volume fraction, trabecular thickness, and bone mineral density in a time-dependent manner, regardless of BA treatment. On the other hand, the number of trabeculae and total bone porosity decreased over the 28 days of the experiment in the dry-socket group and both groups, respectively (P < 0.05). Histological analysis did not differ on bone repair in both experimental groups. CONCLUSION: This was the first report investigating the effects of BA in a rat model of alveolitis regarding microbiological and bone repair aspects. The BA local application decreased the total aerobic and facultative bacteria counts and does not seem to benefit the bone repair after alveolitis development. This study paves the way for more studies involving alveolitis and different BA applications.

Guaiacol/ß-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair-an animal study.

PURPOSE: Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties. METHODS: An inclusion complex of guaiacol and ß-cyclodextrin (Gu/ßcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/ßcd was evaluated histologically after the treatment of DS in rats. RESULTS: ßcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/ßcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™). CONCLUSION: The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/ßcd complex as a future alternative for the treatment of DS.

Comparative Study to Determine the efficacy of Zinc Oxide Eugenol and Alveogyl in Treatment of Dry Socket.

Background Dry socket is one of the most common complications following permanent tooth extraction, especially mandibular third molar. Management remains controversial and different authors have shown different results with the use of zinc oxide eugenol and AlveogylTM, some preferring AlveogylTM over zinc oxide eugenol. Objective To determine the incidence, possible risk factors and compare the effectiveness of two most commonly used agents (Zinc oxide eugenol and AlveogylTM) for management of dry socket. Method Dry socket patients were randomly divided into two groups. Various risk factors were recorded through proper history. After thorough irrigation with normal saline, zinc oxide eugenol paste mixed with cotton pellet was placed in one group whereas AlveogylTM was placed in another group. Intensity of pain was recorded on visual analogue scale of Zero to ten. Pain score was recorded at the time of diagnosis, thirty and sixty minutes after placement of medication and on second, fifth, seventh and tenth day. The medication was changed every day until the pain subsided. The data were collected and analyzed using SPPS software (version 20). Result Incidence of dry socket was 4.70%, more common in males (59.09%). It was more common after extraction mandibular third molar. Initial and final pain relief on visual analogue scale was better with use of zinc oxide eugenol. Conclusion Zinc oxide Eugenol paste is more effective in management of dry socket for early as well as final pain relief compared to AlveogylTM.

Alveolitis: factores que predisponen a su aparición / Alveolitis: factors that predispose its appearance

La exodoncia es el acto quirúrgico mediante el que se extraen los dientes brotados de sus alveolos con el menor trauma posible.La alveolitis es una de las complicaciones más dolorosas que puede presentarse como consecuencia de una perturbación en la cicatrización de la herida alveolar que resulta de una extracción dentaria. Se considera que la alveolitis es una afección multifactorial, que los agentes incriminados son numerosos y que pueden tener una incidencia variable en la patogenia del proceso. A criterio de los autores resulta muy importante que el Especialista en Estomatología sea capaz de precisar los factores que se vinculan con el origen de la alveolitis en su población para de esta forma planificar y ejecutar acciones encaminadas a la eliminación de estos agentes causales y, por tanto, disminuir la incidencia de esta alteración tan dolorosa(AU)

Caracterização morfométrica e molecar do papel da iNOS no processo de reparo ósseo alveolar em condições homeostáticas e infecciosas / Morphometric and molecular characterization of the role of iNOS in alveolar bone repair process in homeostatic and infectious conditions

A óxido nítrico sintase induzível (iNOS) é uma enzima responsável pela síntese do óxido nítrico, envolvido na regulação de vários processos fisiológicos, com destaque para relevantes efeitos sobre o tecido ósseo. Entretanto, o papel da iNOS no reparo ósseo alveolar permanece pouco conhecido. Assim, o objetivo deste estudo foi caracterizar o papel da iNOS no processo de reparo ósseo alveolar pósexodontia em condições homeostáticas (controle) e infecciosas em camundongos. Para isso, foram utilizados animais das linhagens WT (C57Bl/6) e iNOSKO, divididos em 2 grupos, condição homeostática (exodontia do incisivo superior direito) e alveolite experimental (induzida pela inoculação de uma suspensão de cultura bacteriana), e analisados de acordo com os diferentes períodos experimentais (0, 7, 14 e 21 dias pós-exodontia), através da análise histomorfométrica e molecular. Na análise histomorfométrica, avaliou-se a densidade de volume das estruturas referentes ao coágulo sanguíneo, tecido conjuntivo e tecido ósseo. Na análise molecular, quantificou-se a expressão de mRNA codificando genes de marcadores do metabolismo ósseo; marcadores de osteoclastos; citocinas e quimiocinas, através de reações de RealTimePCR. A expressão de iNOS esteve presente durante todo o processo de reparo ósseo alveolar nos camundongos C57Bl/6, porém de maneira mais expressiva no período de 7 dias pós-exodontia, e se mostrou aumentada pela indução de alveolite. A análise histomorfométrica demonstrou discretas alterações no processo de reparo ósseo alveolar, na ausência de iNOS, tanto em condições homeostáticas quanto infecciosas. Em condições homeostáticas, a ausência de iNOS não impactou de forma significativa o processo de reparo ósseo alveolar pósexodontia, mas se mostrou associada à modulação de vasos sanguíneos. Já em condições infecciosas, a ausência de iNOS se mostrou associada à modulação de células inflamatórias, osteoblastos e osteoclastos. De forma geral, conclui-se que embora...

The inducible nitric oxide synthase (iNOS) is an enzyme responsible for the synthesis of nitric oxide, a reactive molecule involved in the regulation of several physiological processes, highlighting relevant effects on bone tissue. However, the role of iNOS in alveolar bone repair remains unknown. The aim of this study was to characterize the role of iNOS in alveolar bone healing process after dental extraction in homeostatic and infectious conditions in mice. With this aim, WT (C57Bl/6) and iNOSKO mice strains were divided into 2 groups, homeostatic condition (extraction of the upper right incisor) and experimental alveolitis (induced by inoculation of a suspension of bacterial culture), and analyzed according to the different experimental periods (0, 7, 14 and 21 days post-extraction), through molecular and histomorphometric analysis. In histomorphometric analysis, the volume density of structures related to blood clot, tissue and bone were evaluated. The molecular analysis quantified the expression of mRNA encoding genes of defined as bone metabolism markers; osteoclast markers, as well cytokines and chemokines through RealTimePCR reactions. The expression of iNOS was detected during the all process of the alveolar bone repair in C57Bl/6 mice, with an expression peak at 7 days post-extraction time point, and was significantly enhanced by alveolitis induction. Histomorphometric analysis showed small changes in alveolar bone repair process in the absence of iNOS, in both homeostatic as infectious conditions. Under homeostatic conditions, the absence of iNOS did not impact significantly the process of alveolar bone healing after dental extraction, but it was associated with modulation of blood vessels formation. In the infectious conditions scenario, the absence of iNOS was associated with modulation of inflammatory cells, osteoblasts and osteoclasts counts. In general, it is concluded that even the enzyme iNOS module some aspects of alveolar bone...

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities / Alveolite experimental: análise microscópica e molecular de duas modalidades de tratamento

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2 percent sodium iodide and 3 percent hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

OBJETIVO: Avaliar duas modalidades de tratamento da alveolite em ratos e discutir os primeiros achados de uma análise molecular neste modelo experimental. MÉTODOS: 84 ratos foram submetidos a uma extração dentária e foram divididos em quatro grupos: I- alvéolo não infectado (controle), II- alvéolo infectado sem tratamento, III- alvéolo infectado tratado com irrigação de iodeto de sódio a 2 por cento e solução de peróxido de hidrogênio a 3 por cento, IV- alvéolo infectado submetido à curetagem, irrigação com solução salina fisiológica e preenchimento com pasta a base de metronidazol. Os grupos foram subdivididos em períodos de sacrifício pós-operatório: 6/15/28 dias. Uma análise quantitativa e qualitativa microscópica foi realizada. Além disso, uma análise quantitativa foi realizada utilizando RealTimePCR para avaliar a expressão de genes no reparo alveolar: o colágeno tipo I / COL-I, o fator de crescimento endotelial vascular / VEGF, osteocalcina / OCN, fosfatase alcalina / ALP, fator de transcrição runt relacionados 2 / RUNX2 e fator de necrose tumoral alfa / TNF-α. RESULTADOS: O grupo I mostrou maior formação óssea, seguido pelos grupos IV, III, II, respectivamente. O grupo II apresentou maior infiltrado inflamatório e a cicatrização foi atrasada em comparação com outros grupos. Foi obtida uma correlação positiva entre a neoformação óssea e a expressão de OCN e RUNX2, infiltrado inflamatório com TNF-α e uma correlação negativa entre a neoformação óssea e TNF-α. CONCLUSÃO: Nenhuma diferença significativa foi encontrada entre os tratamentos.

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities.

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2% sodium iodide and 3% hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

Experimental alveolitis in rats: microbiological, acute phase response and histometric characterization of delayed alveolar healing.

UNLABELLED: The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

Experimental alveolitis in rats: microbiological, acute phase response and histometric characterization of delayed alveolar healing

The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

Clinical concepts of dry socket.

Dry socket is one of the most studied complications in dentistry, and a great number of studies have searched for an effective and safe method for its prevention and treatment. One of the great clinical challenges since the first case was reported has been the inconsistency and differences in the various definitions of dry socket and the criteria used for diagnosis. The pathophysiology, etiology, prevention, and treatment of dry socket are very important in the practice of oral surgery. The aim of the present report was to review and discuss each aspect.

Oronasal fistula in a 53-year-old hippopotamus (Hippopotamus amphibius).

An oronasal fistula is described in a 53-year-old captive hippopotamus, the animal having shown a nasal discharge, consisting mainly of food particles, during and after feeding for at least 15 years. Necropsy of the emaciated animal revealed an oronasal fistula, measuring 4.5 x 3.5 cm, adjacent to the third left molar tooth, the first and second molars being missing. The fistula was thought to have been caused by an earlier necrotizing alveolitis and osteitis. There was no evidence of rhinitis or aspiration pneumonia. Unrelated findings consisted of a follicular thyroid adenoma and generalized muscle atrophy.

Quantifying the healing of dry socket using a clinical volumetric method.

OBJECTIVES: To quantify the healing of dry sockets using a simple clinical volumetric method that measures the reduction in the volume of dry sockets and to study the effects of sex and smoking on socket healing. STUDY DESIGN: Volumes of 28 mandibular dry sockets were measured under standard conditions by injecting sterile normal saline solution into them and aspirating the solution back into a calibrated syringe. Measurements were done at diagnosis (T0), at 4 days after diagnosis (T4), at 7 days after diagnosis (T7), and at 14 days after diagnosis (T14). Differences in socket volumes at different intervals were analyzed using paired samples t test and differences between males and females or between smokers and nonsmokers were analyzed using independent samples t test. RESULTS: Average socket volume in all patients decreased by an average of 5.16% daily from 1.44 (+/- 0.36) mL at T0 to 1.08 (+/- 0.43) mL at T4, 0.74 (+/- 0.35) mL at T7, and 0.40 (+/- 0.28) mL at T14. These differences were statistically significant (P = 0.00). No statistically significant difference in the rate of socket healing was found between males and females or between smokers and nonsmokers. CONCLUSION: Dry socket healing can be quantified using the volumetric method described in this study. Sex and smoking do not appear to affect the rate of dry socket healing.

Incidência de alveolites em exodontias realizadas por alunos da Faculdade de Odontologia da Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS / Incidence of alveolar osteitis after extraction tooh performed by graduation students a the Pontifícia Universidade Católica do Rio Grande do Sul

Neste estudo, foram analisados os resultados do pós-operatório de 511 exodontias, realizadas no ambulátorio de cirurgia da Faculdade de Odontologia da Pontifícia Universidade Católica do Rio Grande do Sul, no decorrer das disciplinas de Cirurgia I e II. Tais extraçöes foram efetuadas pelo alunos de 5§ e 6§ semestres do curso de Odontologia. Avaliou-se a incidência de alveolite de cada dentre, isoladamente, de cada grupo de dentes, por hemiarcadas, e no total. Os resultados sugerem que a menor experiência do profissional pode ser um dos fatores etiológicos da alveolite

Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania.

AIM: To investigate the types and magnitude of post extraction complications. SETTING: A referral hospital in Dar es Salaam, Tanzania. SUBJECTS: All dental patients who had their teeth extracted at the Muhimbili Medical Centre dental outpatient clinic during the study period (May September 1999). A total of 3,818 extractions were performed under local anaesthetic in 3,732 patients. METHOD: Oral examination of all patients who reported back with post-extraction problems. RESULTS: The frequency of post extraction complications was low (1.1 per cent), and was mainly due to; infected sockets (48.7 per cent), followed by bleeding sockets (41.0 per cent) and retained roots (10.3 per cent). There were eight 'other' complications suffered by 11 patients: necrotising fasciitis (n=l), herpes zoster (n=l), Ludwig's angina (n=l), infections of the submandibular (n=l), parapharyngeal (n=2), masticator (n=2) and submasseteric spaces (n =2), and reaction to local anaesthesia (2ml of 2 per cent lignocaine hydrochloride) (n=1). CONCLUSION: The results of this study indicate that post-extraction complications are few, mostly minor, self-limiting and easily treatable. The study does not support routine antibiotic prophylaxis or special pre-extraction procedures, even in this patient population with poor oral hygiene and high HIV seroprevalence.

Postsurgical complications.

The most common complications of oral surgery include bleeding, pain, swelling, infection, dry socket, and fracture. Bleeding can be controlled by applying gauze pressure to the area or through the use of hemostatic agents. A dry socket should have a dressing with eugenol applied, whereas a prescription for antibiotics or analgesics can take care of some of the other problems. Patients with fractures should be referred to a dentist or oral surgeon for treatment.

Alveolitis: una complicación postoperatoria frecuente: prevención y tratamiento / Dry socket: a frequent postoperative complication: prevention and treatment

Como hemos descripto, la alveolitis está en relación directa a los factores etiopatogénicos. Realizar un correcto diagnóstico y tratamiento aliviará al paciente de una complicación extremedamente dolorosa. Las medidas terapéuticas aconsejadas van dirigidas principalmente a acciones locales sobre las sistémicas

Alveolitis: una complicación postoperatoria frecuente: prevención y tratamiento / Dry socket: a frequent postoperative complication: prevention and treatment

Como hemos descripto, la alveolitis está en relación directa a los factores etiopatogénicos. Realizar un correcto diagnóstico y tratamiento aliviará al paciente de una complicación extremedamente dolorosa. Las medidas terapéuticas aconsejadas van dirigidas principalmente a acciones locales sobre las sistémicas (AU)

Treatment of fibrinolytic alveolitis with rifamycin B diethylamide associated with gelfoam: a histological study.

The most common complication in the healing of extraction wounds is fibrinolytic alveolitis, which may also be termed "dry socket". Reduction in the incidence of this condition after the application of topical antibiotics and the use of systemic antibiotics has been reported. A histological study of disturbed alveolar socket healing in rats was carried out to analyze the influence of application of rifamycin B diethylamide (Rifocin M) associated or not with Gelfoam. Sixty-four male rats (Rattus norvegicus albinus, Wistar), weighing 120-150 g, were divided into 4 groups of 16 animals each. In the second group of rats which received implants of Gelfoam, there was an intense resorption of bone walls in the initial stage. The rats that received implants of Gelfoam saturated with Rifocin M (fourth group) showed better results than the second group. The third group (only irrigation with rifamycin) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. Thus, these results showed that rifamycin irrigation is useful in the control of alveolar infections.

Trabecular bone formation in the healing of the rodent molar tooth extraction socket.

The aim of this study was to investigate the nature of the template structure on which trabecular bone formation occurs during healing of the rodent tooth extraction socket, a well studied bone healing system. The presence of collagen type II mRNA has previously been described in the healing socket, although the formation of the protein or cartilage has not been observed. However, recent evidence from developmental and other bone healing studies indicates that collagen type III may be important in forming the preliminary scaffold on which bone trabeculae are formed. The maxillary right molar teeth were removed from rats under general anaesthesia and the animals killed at various times afterward. The tissues were examined using histological, in situ hybridization, and immunohistochemical staining techniques. It was concluded that collagen type IIA mRNA was produced by osteoblast cells of the socket, but that collagen type II, if present, would account for less than 0.01% of the total proteins extracted. During bone formation, Sharpey's fibers were seen radiating from the peripheral bone toward the center of the socket. These optically active collagen fibers were inserted into the forming bone trabeculae and were recognized by antibodies raised against collagen type III. The arrangement and composition of these fibers therefore suggest that they form a preliminary framework on which deposition of woven bone trabeculae occurs.