Oral manifestations in women using hormonal contraceptive methods: a systematic review.

OBJECTIVES: To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. MATERIALS AND METHODS: This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined. RESULTS: Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias. CONCLUSIONS: Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome. CLINICAL RELEVANCE: The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.

Possible roles of short-chain fatty acids produced by oral bacteria in the development of alveolar osteitis.

PURPOSE: Alveolar osteitis (dry sockets) is a painful condition characterized by a limited immune response. It is typically caused by the removal of blood clots from extracted tooth sockets, which leads to the fermentation of trapped food remnants by oral bacteria in the cavities, producing high concentrations of short-chain fatty acids (SCFAs). This study examined the effects of SCFAs on immunity and bone metabolism. METHODS: Mouse macrophage Raw264.7 cells were treated with oral bacteria supernatants or SCFA mixtures, and inducible nitric oxide synthase (iNOS) levels were determined by western blot. The same cells were treated with SCFA mixtures in the presence of receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoclast-like cells were counted. MC3T3-E1 cells were treated with SCFA mixtures and stained with alizarin red S. RESULTS: Raw264.7 cells treated with oral bacterial culture supernatants of Porphyromonas gingivalis and Fusobacterium nucleatum inhibited lipopolysaccharide (LPS)-induced iNOS production, likely due to SCFA content. SCFA mixtures mimicking these supernatants inhibited the number of RANKL-induced tartrate-resistant acid phosphatase (TRAP)-positive cells and MC3T3-E1 cell mineralization. CONCLUSION: These data suggest that SCFAs produced by P. gingivalis and F. nucleatum may reduce the inflammatory response and mildly induce mineralization of the alveolar walls. These results may contribute to the understanding of alveolar osteitis.

Er:YAG Laser Therapy on Alveolar Osteitis After Mandibular Third Molar Surgery: A Randomized Controlled Clinical Study.

Background: Alveolar osteitis (AO) or "dry socket" affects the quality of life of patients, and there is a high clinical demand for its effective treatment. Objective: To evaluate the effect of Er:YAG laser therapy (ErLT) on AO after mandibular third molar surgery. Methods: Eighty-three patients were randomly divided into Er (n = 43) and control groups (n = 40). In the Er group, the Er:YAG laser (2940 nm; AT Fidelis Fotona, Ljubljana, Slovenia) was used to irradiate the AO site directly in micro short-pulsed mode (pulse duration 0.1 ms, pulse energy 100 mJ, frequency 40 Hz, water 4, and air 2) until all debris and necrotic material had been removed, exposing fresh bone and soft tissue surfaces with blood exudation. The control group received mechanical therapy until the treated lesions resembled those in the Er group. Pain assessment was performed at baseline and on days 1-7 post-intervention using the visual analog scale (VAS). Wound healing was assessed using the wound healing index (WHI). The operating times of the two therapies were also recorded. Results: Group Er had lower VAS scores than the control group on days 1-3 (p = 0.00). There was no significant difference between the two groups on days 4-7 (p = 0.15). The WHI scores were better in the Er group than those in the control group (t = 2.65, p = 0.01), especially in terms of redness (t = 2.70, p = 0.01). There was no significant difference in the operating time between the two groups (t = 0.76, p = 0.45). Conclusions: Compared with mechanical therapy, ErLT for AO provides rapid pain relief and improved wound healing.

Complicações odontológicas em indivíduos com insuficiência renal crônica: estudo retrospectivo / Dental complications in chronic renal failure individuals: a retrospective study

A doença renal crônica em estágio terminal pode levar a alterações sistêmicas que tornam o manejo clínico odontológico desses indivíduos desafiador, especialmente se os procedimentos forem invasivos. As preocupações incluem alteração do metabolismo de drogas, da resposta imunológica e do metabolismo ósseo, além do risco aumentado de sangramento e discussão sobre risco aumentado para endocardite infecciosa. O objetivo deste estudo retrospectivo foi conhecer a frequência e o tipo de complicações durante e após execução de procedimentos odontológicos em indivíduos com insuficiência renal crônica em diálise (IRC-D), atendidos no Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da USP (FOUSP). Adicionalmente, comparamos a quantidade e o tipo de complicações entre os indivíduos que usaram antibiótico profilático e aqueles que não usaram, antes dos procedimentos odontológicos. Para tanto desenvolvemos um formulário específico para este estudo, no qual compilamos as informações relativas aos períodos trans e pós-operatórios de procedimentos odontológicos realizados nos pacientes com IRC em diálise. Nossa hipótese era a de que a prevalência de complicações durante e após os procedimentos odontológicos de indivíduos com IRC em diálise fosse baixa, e que ouso do antibiótico prescrito profilaticamente não interferiria na qualidade dareparação ou na incidência de complicações relacionadas aos procedimentos odontológicos. Analisamos retrospectivamente 225 prontuários de pacientes com IRC em diálise atendidos no CAPE-FOUSP desde 1990 até os dias atuais. Desse total, 130 eram pacientes do sexo masculino e do 95 do feminino. A idade média destes indivíduos foi de 48,4 anos. As principais doenças de base que levaram a ocorrência da IRC-HD foram a hipertensão arterial sistêmica (48 pacientes) e o diabetes mellitus (23 pacientes). Nos 225 pacientes, 1.390 procedimentos odontológicos foram realizados, dos quais 856 foram não invasivos, 443 invasivos e 91 tratamentos endodônticos. Dentre os procedimentos invasivos, houve 259 exodontias. Antes de 80 das 259 intervenções cirúrgicas (31%) houve a prescrição de antibiótico profilático em diferentes posologias; em 29 exodontias (11%) foram utilizados hemostáticos locais no momento da realização da sutura. Foram descritos nos prontuários 16 casos de sangramento transoperatório (6%), 5 casos de sangramento pós-operatório (2%) e 2 casos de complicação pós-operatória (0,8%), definidos como uma alveolite e uma infecção alveolar. Nossos resultados permitiram nos concluir que a incidência de complicações após exodontias é baixa e que o uso de antibiótico profilático (AP) não interferiu nessa incidência.

Antibiotic prophylaxis in the prevention of dry socket and surgical site infection after lower third molar extraction: a network meta-analysis.

Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.

Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials.

OBJECTIVES: To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment. MATERIALS AND METHODS: Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies. RESULTS: Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected. CONCLUSIONS: HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth. CLINICAL RELEVANCE: HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.

Prophylactic therapy for prevention of surgical site infection after extraction of third molar: An overview of reviews

Background: To compare the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars with different degree of impaction. Material and Methods: Systematic reviews and meta-analyses evaluating the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars were included. An electronic search was performed in PubMed, EMBASE, and the Cochrane Database of Systematic reviews. AMSTAR 2 tool was used to evaluate the confidence in results from the included reviews. Descriptive analyses were performed. Results: Six reviews were included. A significant benefit of different antibiotics to the prevention of site infection after extraction of third molars was reported. Amoxicillin/amoxicillin clavulanic acid could significantly reduce the rate of surgical site infection versus placebo. Chlorhexidine gel could significantly reduce the frequency of alveolar osteitis versus placebo. Conclusions: Based on the limited evidence, there is a significant benefit of prophylactic therapy while the comparative effect of different types of prophylactic regimes are controversial. (AU)

Further evidence confirms the association between smoking and dry socket: a motivational opportunity for tobacco cessation.

DESIGN: A systematic review and meta-analysis of observational studies. DATA SOURCES: Electronic search included PubMed, Scopus, and Web of Science databases up to March 2022 using appropriate keywords. SELECTION CRITERIA: The review included all observational studies (case-control, cohort and cross-sectional studies) published in English after 2000, comparing the prevalence of dry socket between smokers and non-smokers after simple or surgical tooth extraction. Exclusion criteria included patients with other post-extraction complications, prevalence of different risk factors, and unrelated study designs (literature reviews, case reports, expert opinion, and conference reports). DATA EXTRACTION AND SYNTHESIS: Two independent investigators screened the records (by title, abstract, and full text), and selected the eligible studies according to the predefined criteria. Collected data from each study included author name and country, year of publication, gender and age of patients, smoking status, inclusion and exclusion criteria, medical history and oral hygiene, prevalence of dry socket, type of tooth and extraction technique, symptoms and treatment. Risk of bias was assessed according to the (NHLBI, NIH) Quality Assessment Tool For Observational Cohort and Cross-Sectional Studies, while the level of evidence was assessed using the classification of the Oxford Centre for Evidence-Based Medicine levels for diagnosis. Two independent reviewers conducted the assessments, and any disagreements were addressed through discussion. RESULTS: Eleven studies from ten different countries representing a total of 10,195 patients (3007 smokers and 7188 non-smokers) were included in the final analysis. Nine studies were classified as having "good" quality and two as "intermediate," while all of the studies have the third or fourth level of evidence (through 5-graded scale). The prevalence of dry socket in smokers was about 13.2% (95% CI: 5.8-23.1%) and in non-smokers about 3.8% (95% CI: 2.1-6.0%). Meta-analysis showed that regular tobacco smoking was associated a more than 3-fold increase in the odds of dry socket after tooth extraction. CONCLUSION: Despite heterogeneity among the included studies (different age groups and types of teeth extracted), there was a consistent association between cigarette smoking and an elevated risk of developing dry socket post tooth extraction.

Incidencia de osteítis alveolar por exodoncia de terceros molares mandibulares impactados: una revisión sistemática / Incidence of alveolar osteitis due to extraction of impacted mandibular third molars: a systematic review

La extracción de terceros molares mandibulares impactados trae consigo, en muchas oportunidades, complicaciones posoperatorias como la osteítis alveolar o comúnmente llamada alveolitis seca que dificulta la cicatrización del alveolo. En este sentido, el objetivo de la revisión fue determinar la incidencia de la osteítis alveolar por exodoncia de terceros molares mandibulares impactados. Se realizó la búsqueda bibliográfica sin restricción de año ni de idioma en PubMed, Scopus, Science Direct, Lilacs y Scielo, empleando tèrminos estandarizados en Medical Subject Headings (MeSH NLM). La confección de la investigación se realizó siguiendo los lineamientos PRISMA-2020 y para la evaluación de la calidad y sesgo de los artículos se empleó las herramientas de la National Heart Lung and Blood Institute (NHLBI). Se obtuvieron (n=4907) estudios, los cuales se subieron al aplicativo web Rayyan para seleccionarlos siguiendo los criterios de inclusión y exclusión planteados previamente. Tras el análisis crítico se eligieron 2 estudios para su revisión, cuyos datos se extrajeron según los indicadores establecidos por los autores. Se concluye que existe una incidencia baja de osteítis alveolar despuès de la extracción de terceros molares mandibulares impactados, descartándose la relación entre el gènero y el padecimiento de esta complicación. Además se resalta la irrigación con clorhexidina y suero fisiológico como tratamiento para esta afección. (AU)

The extraction of impacted mandibular third molars often brings with it postoperative complications such as alveolar osteitis or commonly called dry socket that makes it difficult for the alveolus to heal. In this sense, the objective of the review was to determine the incidence of alveolar osteitis due to extraction of impacted mandibular third molars. The bibliographic search was carried out without restriction of year or language in PubMed, Scopus, Science Direct, Lilacs and Scielo, using standardized terms in Medical Subject Headings (MeSH NLM). The preparation of the research was carried out following the PRISMA-2020 guidelines and the tools of the National Heart Lung and Blood Institute (NHLBI) were used to evaluate the quality and bias of the articles. Studies (n=4907) were obtained, which were uploaded to the Rayyan web application to select them following the inclusion and exclusion criteria previously stated. After critical analysis, 2 studies were chosen for review, whose data were extracted according to the indicators established by the authors. It is concluded that there is a low incidence of alveolar osteitis after the extraction of impacted mandibular third molars, ruling out the relationship between gender and suffering from this complication. In addition, irrigation with chlorhexidine and physiological serum is highlighted as a treatment for this condition. (AU)

Prevalencia de Complicaciones de Post Exodoncia de Terceros Molares / Prevalence of Post-Extraction Complications of Third Molars

El Centro de Salud Familiar (CESFAM) de San Pedro de Atacama, es el único establecimiento de Atención de salud en la comuna y alrededores, se hace imperativo para los Cirujanos Dentistas ser resolutivos y entregar una solución efectiva a la demanda local. El objetivo de este trabajo consistió en determinar prevalencia de complicaciones postexodoncia de terceros molares de pacientes atendidos en CESFAM San Pedro de Atacama entre enero y octubre de 2020. Estudio descriptivo de corte transversal entre enero y octubre 2020, se realizó revisión retrospectiva de fichas clínicas manuales y base de datos electrónica de atenciones odontológicas realizadas en CESFAM. Se incluyeron en el estudio pacientes mayores 18 años, sistémicamente sanos o ASA II compensados, que se hayan realizado exodoncia de tercer molar superior o inferior y que hayan asistido a control clínico a los 7 días. Se excluyeron fichas clínicas ilegibles o sin evolución, pacientes que tuvieran antecedentes de pericoronaritis hasta 7 días previos y pacientes inmunocomprometidos. La frecuencia de complicaciones postoperatorias se relacionó según dificultad de la intervención (leve/moderada/alta) y si el diente era maxilar o mandibular. Se realizó un análisis descriptivo y estadístico de los datos obtenidos mediante prueba exacta de Fisher para evaluar asociación entre las variables utilizando programa estadístico STATA v. 15. Entre enero y octubre de 2020 se realizaron 146 exodoncias de terceros molares; 61 fueron de dificultad leve (41,7 %), 58 dificultad moderada (39,8 %) y 21 dificultad alta (18,5 %). El total de complicaciones postexodoncia alcanza 5,4 % (n=8) donde la complicación más frecuente es alveolitis. Las complicaciones postexodoncia se relacionan significativamente con el nivel de dificultad leve (p0,05).

The Communnity Health Center (CESFAM) of San Pedro de Atacama, is the only establishment of health assistance in the community and surroundings, it is imperative for Dental Surgeons to be decisive and deliver an effective solution to local demand. Determinate the prevalence of post-extraction complications of third molars in patients treated at CESFAM San Pedro de Atacama between January and October 2020. Descriptive cross- sectional study between January and October 2020. It has been done a retrospective review of manual clinical records and electronic database of dental care performed at CESFAM. Patients over 18 years old, systemically healthy or compensated ASA II, who had extracted an upper or lower third molar and who had attended a 7-day clinical check-up were included in the study. Were excluded Illegible or no follow up clinical records, patients with a history of pericoronitis up to 7 days previously, and immunocompromised patients. The frequency of postoperative complications was related to the difficulty of the intervention (mild / moderate / high) and whether the tooth was maxillary or mandibular. A descriptive and statistical analysis of the data obtained by Fisher's exact test was carried out to evaluate the association between the variables using the statistical program STATA v. 15. Between January and October 2020, 146 third molar extractions were performed; 61 were of mild difficulty (41.7 %), 58 of moderate difficulty (39.8 %) and 21 of high difficulty (18.5 %). The result of post-extraction complications reached 5.4 % (n = 8), where the most frequent complication was alveolitis. Post-extraction complications are significantly related to the level of mild difficulty (p 0,05).

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life

Background: The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction. Material and methods: This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction. Results: The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05). Conclusions: Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice. (AU)

Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis.

BACKGROUND: Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars. TYPES OF STUDIES REVIEWED: The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty). PRACTICAL IMPLICATIONS: Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.

Prophylactic therapy for prevention of surgical site infection after extraction of third molar: An overview of reviews.

BACKGROUND: To compare the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars with different degree of impaction. MATERIAL AND METHODS: Systematic reviews and meta-analyses evaluating the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars were included. An electronic search was performed in PubMed, EMBASE, and the Cochrane Database of Systematic reviews. AMSTAR 2 tool was used to evaluate the confidence in results from the included reviews. Descriptive analyses were performed. RESULTS: Six reviews were included. A significant benefit of different antibiotics to the prevention of site infection after extraction of third molars was reported. Amoxicillin/amoxicillin clavulanic acid could significantly reduce the rate of surgical site infection versus placebo. Chlorhexidine gel could significantly reduce the frequency of alveolar osteitis versus placebo. CONCLUSIONS: Based on the limited evidence, there is a significant benefit of prophylactic therapy while the comparative effect of different types of prophylactic regimes are controversial.

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life.

BACKGROUND: The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction. MATERIAL AND METHODS: This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction. RESULTS: The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05). CONCLUSIONS: Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.

La alveolitis y sus factores de riesgo en la población adulta joven / Dry socket and its risk factors in a young adult population

Introducción: La alveolitis es la complicación más frecuente de la extracción dental, y constituye la causa más común de las consultas de Urgencias, pues los pacientes presentan dolor en el período postoperatorio. Aunque la etiología de esta afección no es muy conocida, se considera que es un trastorno multifactorial. Objetivos: Determinar el tipo de alveolitis más frecuente en la muestra objeto de estudio, así como establecer la relación entre los factores de riesgo y el tipo de alveolitis. Métodos: Se realizó un estudio descriptivo y trasversal en el Servicio de Urgencias de la Clínica Estomatológica «Celia Sánchez Manduley», de Santa Clara, Villa Clara, desde febrero de 2020 a junio de 2021. El estudio se realizó en un total de 51 pacientes diagnosticados con alveolitis dental. Se estudiaron las siguientes variables: tipo de alveolitis y factores de riesgo (edad, sexo, antecedentes de enfermedades, el uso de tabletas anticonceptivas, hábitos tóxicos, condiciones del medio bucal, características de la maniobra quirúrgica y cuidados postoperatorios); los datos fueron recogidos en un formulario. Resultados: Predominó la alveolitis seca en las pacientes del sexo femenino. El hábito de fumar y la práctica de una maniobra quirúrgica compleja fueron los factores de riesgo preponderantes. Conclusiones: Existe una relación significativa entre la presencia de alveolitis seca y las pacientes del sexo femenino asociadas a los hábitos tóxicos, el uso de tabletas anticonceptivas, y haber sido sometidas a una maniobra quirúrgica compleja.

Introduction: dry socket is the most frequent complication after a dental extraction and constitutes the most common cause of emergency consultations, since patients have pain in the postoperative period. It is considered to be a multifactorial disorder although the etiology of this condition is not well known. Objectives: to determine the most common type of dry socket in the sample under study, as well as to establish the relationship between risk factors and the type of dry socket. Methods: a descriptive and cross-sectional study was carried out in the emergency department at "Celia Sánchez Manduley" Dental Clinic, in Santa Clara, Villa Clara, from February 2020 to June 2021. The study was carried out in a total of 51 patients who were diagnosed with dry socket. Type of dry socket and risk factors such as age, gender, history of diseases, use of contraceptive tablets, toxic habits, conditions of the oral environment, characteristics of the surgical procedure and postoperative care were the variables studied; the data was collected in a form. Results: dry socket predominated in female patients. Smoking and performing a complex surgical maneuver were the predominant risk factors. Conclusions: there is a significant relationship among the presence of dry socket and female patients associated with toxic habits, the use of contraceptive tablets, and having undergone a complex surgical maneuver.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review.

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Assessment of Dry Socket after Mandibular Third Molar Surgery Using Platelet-Rich Fibrin - A Prospective Clinical Study.

OBJECTIVE:  To determine the efficacy of Platelet-Rich Fibrin (PRF) in preventing Dry Socket (DS) after mandibular third molar surgery in comparison with the control group. STUDY DESIGN: Experimental study. Place and Duration of the Study: Oral and Maxillofacial Surgery Department, Dental Section, Faisalabad Medical University, Faisalabad, Pakistan, from July 2019 to June 2021. METHODOLOGY: Patients aged 18-35 years with good oral hygiene, and requiring surgical extraction of their mandibular third molar were included in the study. Those with periodontal disease, pregnant or nursing women, smokers, or allergic to the agents that were recommended for use before and after surgery, were excluded. Patients presenting for surgical removal of the mandibular third molar and meeting the inclusion criteria were enrolled and randomly divided into 2 groups. Standard protocol for tooth removal was followed in both groups. Group1 (study group) received PRF and group 2 (control group) did not receive PRF. RESULTS: A total of 170 consecutive patients (85/group) were randomly selected and allocated to the study group and control group. The mean age in the study group was 24.28±3.7 years while the mean age in the control group was 24.14±3.64 years. Out of them, 51.2% (n=87) were males and 48.8% (n=83) were females with a M: F of 1:1.05. On the 3rd postoperative day, DS frequency in the study group was 2.4% (n=2) and 18.8% (n=16) in the control group (p=0.0001), which reduced to 01 and 05 respectively on 7th day (p=0.096). CONCLUSION: PRF administration was effective in preventing DS on the third postoperative day in mandibular third molar surgery, with statistically significant results. However, on postoperative day 7, the results were not statistically significant. KEY WORDS: Third molar, Tooth extraction, Dry socket, PRF.

Investigation of the clinical efficacy of CGF and ozone in the management of alveolar osteitis: a randomized controlled trial.

OBJECTIVES: To investigate the efficacy of concentrated growth factors (CGF) and ozone in the treatment of alveolar osteitis (AO). MATERIALS AND METHODS: Patients admitted for the treatment of AO and eligible for the study were included and divided into control, ozone, and CGF + ozone groups. For the treatment of AO alveogyl, ozone, and CGF + ozone were applied to control, ozone, and CGF + ozone groups, respectively, and repeated on 3rd day. Demographic data and oral hygiene were recorded at the initial visit. Pain with visual analog scale (VAS) and analgesic consumption were evaluated at the 6th and 24th h, and on 2nd-7th days. Granulation tissue health and inflammation severity were evaluated on the 1st, 3rd, and 7th days. Quality of life was evaluated with the postoperative symptom severity scale (Posse) on the 7th day. RESULTS: A total of 60 patients (43 females/17 males; mean age 42.7 ± 13.76 years), 20 patients per group were included. Among the groups, pain scores on the 7th day (p = 0.042), granulation tissue health on the 3rd (p = 0.003) and 7th (p = 0.015) days showed a significant difference while analgesic consumption, Posse scores, and inflammation severity showed no significant differences (p > 0.05). Between genders analgesic consumption at 6 h (p = 0.027), 24 h (p = 0.033), and on the 2nd day (p = 0.034) and inflammation severity on the 7th day (p = 0.012) showed significant differences while Posse scores and granulation tissue health showed no significant differences (p > 0.05). CONCLUSIONS: This study demonstrates that regenerative treatment which modulates angiogenesis, and tissue regeneration by stimulating stem cells, growth factors, and cytokines with CGF + ozone are more effective than conventional treatment regarding AO. CLINICAL RELEVANCE: Usage of CGF and ozone together provides faster and more satisfactory management of AO.

Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review.

OBJECTIVES: The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis. MATERIALS AND METHODS: Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described. RESULTS: The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis. CONCLUSIONS: Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions. CLINICAL RELEVANCE: Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.

Root-shaped antibacterial alginate sponges with enhanced hemostasis and osteogenesis for the prevention of dry socket.

Tooth extraction commonly causes uncontrolled bleeding, loss of blood clots, and bacterial infection, leading to the dry socket and bone resorption. Thus, it is highly attractive to design a bio-multifunctional scaffold with outstanding antimicrobial, hemostatic, and osteogenic performances for avoiding dry sockets in clinical applications. Herein, alginate (AG)/quaternized chitosan (Qch)/diatomite (Di) sponges were fabricated via electrostatic interaction, Ca2+ cross-linking, as well as lyophilization methods. The composite sponges are facilely made into the shape of the tooth root, which could be well integrated into the alveolar fossa. The sponge shows a highly interconnected and hierarchical porous structure at the macro/micro/nano levels. The prepared sponges also possess enhanced hemostatic and antibacterial abilities. Moreover, in vitro cellular assessment indicates that the developed sponges have favorable cytocompatibility and significantly facilitate osteogenesis by upregulating the formation of alkaline phosphatase and calcium nodules. The designed bio-multifunctional sponges display great potential for trauma treatment after tooth extraction.