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Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review. Int J Dent 2024; 2024:7712829. [PMID: 38756385 PMCID: PMC11098612 DOI: 10.1155/2024/7712829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. Objectives This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Results Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. Conclusion This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.
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Affiliation(s)
- Peter Dignam
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Mariam Elshafey
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Aparna Jeganathan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Magdalen Foo
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Australia
- International Research Collaborative—Oral Health and Equity, School of Allied Health, The University of Western Australia, Crawley, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Victoria, Ballarat, Australia
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Romero-Olid MDN, Bucataru E, Ramos-García P, González-Moles MÁ. Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1552. [PMID: 37887254 PMCID: PMC10604691 DOI: 10.3390/antibiotics12101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.
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Affiliation(s)
- María de Nuria Romero-Olid
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Bucataru
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Wang D, Sun Y, Zhang D, Kong X, Wang S, Lu J, Liu F, Lu S, Qi H, Zhou Q. Root-shaped antibacterial alginate sponges with enhanced hemostasis and osteogenesis for the prevention of dry socket. Carbohydr Polym 2023; 299:120184. [PMID: 36876799 DOI: 10.1016/j.carbpol.2022.120184] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Danyang Wang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266003, China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China
| | - Yinyin Sun
- Oral Medicine, The People's Hospital of Jimo, Qingdao, Qingdao 266200, China
| | - Dongjie Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Xiaowen Kong
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Sainan Wang
- School of Stomatology, Qingdao University, Qingdao 266003, China; Oral Department of Qingdao Municipal Hospital, Qingdao 266011, China
| | - Jinglin Lu
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Fengyuan Liu
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Shulai Lu
- Oral Department of Qingdao Municipal Hospital, Qingdao 266011, China
| | - Hongzhao Qi
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China.
| | - Qihui Zhou
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao 266071, China.
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Hoffman JJ, Arunga S, Mohamed Ahmed AHA, Hu VH, Burton MJ. Management of Filamentous Fungal Keratitis: A Pragmatic Approach. J Fungi (Basel) 2022; 8:1067. [PMID: 36294633 PMCID: PMC9605596 DOI: 10.3390/jof8101067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/02/2023] Open
Abstract
Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current topical antifungals are not always effective and are often unavailable. Alternatives topical therapies to natamycin include voriconazole, chlorhexidine, amphotericin B and econazole. Surgical therapy, typically in the form of therapeutic penetrating keratoplasty, may be required for severe cases or following corneal perforation. Alternative treatment strategies such as intrastromal or intracameral injections of antifungals may be used. However, there is often no clear treatment strategy and the evidence to guide therapy is often lacking. This review describes the different treatment options and their evidence and provides a pragmatic approach to the management of fungal keratitis, particularly for clinicians working in tropical, low-resource settings where fungal keratitis is most prevalent.
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Affiliation(s)
- Jeremy J. Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Sagarmatha Choudhary Eye Hospital, Lahan 56500, Nepal
| | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Abeer H. A. Mohamed Ahmed
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Victor H. Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
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5
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Yan M, Pan Y, Lu S, Li X, Wang D, Shao T, Wu Z, Zhou Q. Chitosan-CaP microflowers and metronidazole loaded calcium alginate sponges with enhanced antibacterial, hemostatic and osteogenic properties for the prevention of dry socket after tooth removal. Int J Biol Macromol 2022; 212:134-145. [PMID: 35588978 DOI: 10.1016/j.ijbiomac.2022.05.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
Abstract
Tooth removal, particularly for patients with severe periodontitis, can frequently cause massive bleeding, postoperative infection, and bone resorption, resulting in a dry socket. Thus, developing bio-multifunctional materials with excellent antibacterial, hemostatic, and osteogenic characteristics for the prevention of dry sockets after tooth removal is highly desirable in clinical applications. Herein, chitosan-CaP microflowers (CM) and metronidazole (MD) loaded calcium alginate (CA) sponges (CA@CM/MD) with enhanced antibacterial, hemostatic, and osteogenic properties were developed via Ca2+ crosslinking, lyophilization, and electrostatic interaction for the prevention of dry socket after tooth removal. The fabricated CM particles display 3-dimensional, relatively homogeneous, and flower-shaped architectures. The CA@CM/MD composite sponges were facilely shaped into the tooth root as well as exhibit interconnected porous and lamellar structures with remarkable porosity, suitable maximum swelling ratio, as well as excellent compressive and hemostatic performance. Besides, the in vitro cellular assessment demonstrates that the prepared CA@CM/MD composite sponges possess satisfactory cytocompatibility. Importantly, the designed sponges significantly suppress the growth of S. aureus and E. coli, as well as promote cellular osteogenic differentiation by upregulating the formation of alkaline phosphatase. Our findings indicate that the tooth root-shaped composite sponges hold great promise for wound management after tooth removal.
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Affiliation(s)
- Mingzhe Yan
- Department of Human Anatomy, Histology and Embryology, School of basic medicine, Qingdao University, Qingdao 266073, China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China
| | - Yingxiao Pan
- School of Stomatology, Qingdao University, Qingdao 266003, China; Oral department of Qingdao Municipal Hospital, Qingdao 266011, China
| | - Shulai Lu
- Oral department of Qingdao Municipal Hospital, Qingdao 266011, China
| | - Xin Li
- Department of Stomatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Danyang Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China; School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Tianyi Shao
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China
| | - Zhihang Wu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China; Department of Biomedical Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Qihui Zhou
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266021, China; School of Stomatology, Qingdao University, Qingdao 266003, China.
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Amaliya A, Ramadhanti R, Hadikrishna I, Maulina T. The Effectiveness of 0.2% Chlorhexidine Gel on Early Wound Healing after Tooth Extraction: A Randomized Controlled Trial. Eur J Dent 2022; 16:688-694. [PMID: 35016228 PMCID: PMC9507567 DOI: 10.1055/s-0041-1739544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective
This study aimed to evaluate the effect of 0.2% chlorhexidine (CHX) gel on wound healing after tooth extraction.
Materials and Methods
A single blind, randomized controlled trial was performed recruiting 32 participants who underwent dental extractions. Patients were randomly allocated for CHX group or placebo group. The primary outcomes were wound closure measured with calipers and healings were assessed by Landry et al index after 7 days of topical application of allocated gels on extraction sites.
Results
The wound closures were greater in CHX group compared with placebo group and healing scores were correlated with the use of CHX gel (
p
-value < 0.05).
Conclusion
In a population of healthy nonsmoker adults, application of 0.2% CHX gel twice a day for 7 days after tooth extraction has a beneficial effect on wound healing.
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Affiliation(s)
- Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Rika Ramadhanti
- Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Indra Hadikrishna
- Department of Oral Surgery, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Tantry Maulina
- Department of Oral Surgery, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
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Brunello G, Becker K, Scotti L, Drescher D, Becker J, John G. The Effects of Three Chlorhexidine-Based Mouthwashes on Human Osteoblast-Like SaOS-2 Cells. An In Vitro Study. Int J Mol Sci 2021; 22:ijms22189986. [PMID: 34576150 PMCID: PMC8470316 DOI: 10.3390/ijms22189986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
Several decontamination methods for removing biofilm from implant surfaces during surgical peri-implantitis treatment have been reported, including the intraoperative usage of chlorhexidine (CHX)-based antiseptics. There is a lack of information on possible adverse effects on bone healing. The study aimed to examine the impact of three CHX-based mouthwashes on osteoblast-like cells (SaOS-2) in vitro. Cells were cultured for three days in 96-well binding plates. Each well was randomly treated for either 30, 60 or 120 s with 0.05% CHX combined with 0.05% cetylpyridinium chloride (CPC), 0.1% CHX, 0.2% CHX or sterile saline (NaCl) as control. Cell viability, cytotoxicity and apoptosis were assessed at day 0, 3 and 6. Cell viability resulted in being higher in the control group at all time points. At day 0, the CHX 0.2 group showed significantly higher cytotoxicity values compared to CHX 0.1 (30 s), CHX + CPC (30 s, 60 s and 120 s) and control (60 s and 120 s), while no significant differences were identified between CHX + CPC and both CHX 0.1 and NaCl groups. All test mouthwashes were found to induce apoptosis to a lower extent compared to control. Results indicate that 0.2% CHX presented the highest cytotoxic effect. Therefore, its intraoperative use should be carefully considered.
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Affiliation(s)
- Giulia Brunello
- Department of Oral Surgery, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany; (G.B.); (L.S.); (J.B.); (G.J.)
- Department of Neurosciences, University of Padua, 35128 Padua, Italy
| | - Kathrin Becker
- Department of Orthodontics, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany;
- Correspondence: ; Tel.: +49-211-8118145
| | - Luisa Scotti
- Department of Oral Surgery, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany; (G.B.); (L.S.); (J.B.); (G.J.)
- Dental Practice, 46147 Oberhausen, Germany
| | - Dieter Drescher
- Department of Orthodontics, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany;
| | - Jürgen Becker
- Department of Oral Surgery, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany; (G.B.); (L.S.); (J.B.); (G.J.)
| | - Gordon John
- Department of Oral Surgery, University Clinic of Düsseldorf, 40225 Düsseldorf, Germany; (G.B.); (L.S.); (J.B.); (G.J.)
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Adekunle AA, Egbunah UP, Erinoso OA, Adeyemo WL. Effectiveness of warm saline mouth bath in preventing alveolar osteitis: A systematic review and meta-analysis. J Craniomaxillofac Surg 2021; 49:980-988. [PMID: 34509363 DOI: 10.1016/j.jcms.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
This systematic review and meta-analysis aimed to assess the effectiveness of a warm saline mouth bath (WSMB) in preventing dry socket after tooth extractions. A systematic search for randomized controlled trials published until August 30, 2020, in seven databases was conducted: Cochrane, PubMed, Ovid Medline, Google Scholar, and OpenGrey databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry. The inclusion criteria were studies investigating the use of a warm saline mouth bath postoperatively in a population of participants who had a tooth extraction, compared to no mouth rinse at all/any other mouth rinse. The primary outcome assessed in the studies was the incidence of alveolar osteitis. Only eight randomized studies met all inclusion criteria and were selected for qualitative analysis. Six of the studies compared WSMB with antimicrobial rinses, and two studies compared WSMB with no-rinse. This review found no significant difference (P > 0.05) in the incidence of alveolar osteitis between WSMB and other antimicrobial rinses. Based on the results of this review, WSMB has potential in reducing post-operative complications such as alveolar osteitis following a routine or surgical extraction of teeth. However, more studies are needed to validate these findings, as most of the studies reviewed had a high level of bias.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Post-Fellowship Senior Registrar, Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
| | - Uchenna Patrick Egbunah
- Registrar, Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
| | - Olufemi Akinwunmi Erinoso
- Senior Registrar, Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - Wasiu Lanre Adeyemo
- Professor/ Consultant, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
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Arunga S, Mbarak T, Ebong A, Mwesigye J, Kuguminkiriza D, Mohamed-Ahmed AHA, Hoffman JJ, Leck A, Hu V, Burton M. Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmol 2021; 6:e000698. [PMID: 34368461 PMCID: PMC8258663 DOI: 10.1136/bmjophth-2020-000698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Fungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis. METHODS This study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up. RESULTS Thirteen patients were followed in this substudy. The patients were aged 27-73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9-8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up. CONCLUSION Chlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation.
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Affiliation(s)
- Simon Arunga
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tumu Mbarak
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Abel Ebong
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - James Mwesigye
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jeremy John Hoffman
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Astrid Leck
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Hu
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- St Paul's Eye Unit, Liverpool, UK
| | - Matthew Burton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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González-Serrano J, López-Pintor RM, Cecilia-Murga R, Torres J, Hernández G, López-Quiles J. Application of propolis extract, nanovitamin C and nanovitamin E to prevent alveolar osteitis after impacted lower third molar surgery. A randomized, double-blind, split-mouth, pilot study. Med Oral Patol Oral Cir Bucal 2021; 26:e118-e125. [PMID: 33609021 PMCID: PMC7980291 DOI: 10.4317/medoral.23915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Propolis has anti-inflammatory, analgesic and healing properties. The purpose of this study was to determine whether a gel containing 2% of propolis extract, 0.2% of ascorbic acid and 0.2% of tocopherol acetate is effective in preventing surgical complications related to impacted lower third molar extractions. MATERIAL AND METHODS A randomized, double-blind, split-mouth study was performed. Fifteen patients were recruited who needed bilateral impacted lower third molar extractions with a similar surgical difficulty. A test or placebo gel was administered randomly inside post-extraction sockets. Each patient was instructed to apply the gel 3 times/day in the surgical wound for a week. After a month, the contralateral third molar was extracted, and the opposite gel applied. The following parameters were diagnosed/evaluated and then recorded: alveolar osteitis following Blum's criteria, swelling and trismus at day one, two, three and seven post-intervention, wound healing at day 7 post-intervention, and postoperative pain using a visual analog scale, as well as, the number of analgesic pill intake. RESULTS A total of twenty-six surgical procedures were performed in 13 patients (mean age 20.67±2 years). Alveolar osteitis was reported in 3 patients from the placebo group (23.1%) and none in the test group (0%) (p=0.25). No statistically significant differences were reported in swelling, trismus, wound healing or analgesic pill consumption between two groups. But statistically lower postoperative pain during the 7 days after surgical extractions was found according to visual analog scale in test group compared to the placebo group (p=0.007). No side effects were reported. CONCLUSIONS The application of this gel may be effective in preventing alveolitis and thus reducing postoperative pain after impacted third molar extractions. More randomized clinical trials with larger sample are needed to confirm these results.
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Affiliation(s)
- J González-Serrano
- Departamento de Especialidades Clínicas Odontológicas Facultad de Odontología. Universidad Complutense de Madrid Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
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Hoffman JJ, Yadav R, Das Sanyam S, Chaudhary P, Roshan A, Singh SK, Arunga S, Matayan E, Macleod D, Weiss HA, Leck A, Hu V, Burton MJ. Topical chlorhexidine 0.2% versus topical natamycin 5% for fungal keratitis in Nepal: rationale and design of a randomised controlled non-inferiority trial. BMJ Open 2020; 10:e038066. [PMID: 32998924 PMCID: PMC7528427 DOI: 10.1136/bmjopen-2020-038066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Fungal infections of the cornea, fungal keratitis (FK), are challenging to treat. Current topical antifungals are not always effective and are often unavailable, particularly in low-income and middle-income countries where most cases occur. Topical natamycin 5% is usually first-line treatment, however, even when treated intensively, infections may progress to perforation of the eye in around a quarter of cases. Alternative antifungal medications are needed to treat this blinding disease.Chlorhexidine is an antiseptic agent with antibacterial and antifungal properties. Previous pilot studies suggest that topical chlorhexidine 0.2% compares favourably with topical natamycin. Full-scale randomised controlled trials (RCTs) of topical chlorhexidine 0.2% are warranted to answer this question definitively. METHODS AND ANALYSIS We will test the hypothesis that topical chlorhexidine 0.2% is non-inferior to topical natamycin 5% in a two-arm, single-masked RCT. Participants are adults with FK presenting to a tertiary ophthalmic hospital in Nepal. Baseline assessment includes history, examination, photography, in vivo confocal microscopy and cornea scrapes for microbiology. Participants will be randomised to alternative topical antifungal treatments (topical chlorhexidine 0.2% and topical natamycin 5%; 1:1 ratio, 2-6 random block size). Patients are reviewed at day 2, day 7 (with reculture), day 14, day 21, month 2 and month 3. The primary outcome is the best spectacle corrected visual acuity (BSCVA) at 3 months. Primary analysis (intention to treat) will be by linear regression, with treatment arm and baseline BSCVA prespecified covariates. Secondary outcomes include epithelial healing time, scar/infiltrate size, ulcer depth, hypopyon size, perforation and/or therapeutic penetrating keratoplasty (corneal transplant), positive reculture rate (day 7) and quality of life (EuroQol-5 dimensions, WHO/PBD-VF20, WHOQOL-BREF). ETHICS AND DISSEMINATION The Nepal Health Research Council, the Nepal Department of Drug Administration and the London School of Hygiene and Tropical Medicine ethics committee have approved the trial. The results will be presented at local and international meetings and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER ISRCTN14332621; pre-results.
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Affiliation(s)
- Jeremy John Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Cornea Department, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | - Reena Yadav
- Cornea Department, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | | | - Pankaj Chaudhary
- Cornea Department, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | - Abhishek Roshan
- Cornea Department, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Einoti Matayan
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - David Macleod
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of External Eye Disease, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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WANG CH, YANG SH, JEN HJ, TSAI JC, LIN HK, LOH EW. Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials. J Nurs Res 2020; 29:e137. [PMID: 32956135 PMCID: PMC7808365 DOI: 10.1097/jnr.0000000000000401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature. PURPOSE A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO. METHODS PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model. RESULTS The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.
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Affiliation(s)
- Chia-Hui WANG
- PhD, RN, Supervisor, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
- contributed equally
| | - Shu-Hui YANG
- BSN, RN, Department of Nursing, Taipei Medical University Shuang Ho Hospital, Taiwan, ROC
- contributed equally
| | - Hsiu-Ju JEN
- BSN, RN, Head Nurse, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
| | - Jui-Chen TSAI
- MSN, RN, Consultant, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
| | - Hsi-Kuei LIN
- DDS, Department of Dentistry, Taipei Medical University Shuang Ho Hospital, and Lecturer, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taiwan, ROC
| | - El-Wui LOH
- PhD, Joint Appointment Medical Researcher, Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Department of Medical Research, and Department of Dentistry, Taipei Medical University Shuang Ho Hospital; Researcher, Cochrane Taiwan, Taipei Medical University; and Assistant Professor, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan, ROC
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Sáez-Alcaide LM, Molinero-Mourelle P, González-Serrano J, Rubio-Alonso L, Bornstein MM, López-Quiles J. Efficacy of a topical gel containing chitosan, chlorhexidine, allantoin and dexpanthenol for pain and inflammation control after third molar surgery: A randomized and placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal 2020; 25:e644-e651. [PMID: 32683390 PMCID: PMC7473436 DOI: 10.4317/medoral.23661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery. MATERIAL AND METHODS A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n=72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product. RESULTS Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p=0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered 'good' in 22.2% for the CG and 97.2% for the EG (p<0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56±1,19) compared to the placebo group (3.25±1.6) (p=0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26±0.51) in comparison to the CG (0.56±0.67) (p=0.003). CONCLUSIONS The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal.
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Bailey E, Kashbour W, Shah N, Worthington HV, Renton TF, Coulthard P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev 2020; 7:CD004345. [PMID: 32712962 PMCID: PMC7389870 DOI: 10.1002/14651858.cd004345.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity. OBJECTIVES To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication. SELECTION CRITERIA Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth. DATA COLLECTION AND ANALYSIS Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies. MAIN RESULTS We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported. AUTHORS' CONCLUSIONS In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.
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Affiliation(s)
- Edmund Bailey
- Department of Oral Surgery, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wafa Kashbour
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Neha Shah
- Department of Oral Surgery, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tara F Renton
- Department of Oral Surgery, Dental Institute, King's College London, London, UK
| | - Paul Coulthard
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Eshghpour M, Danaeifar N, Kermani H, Nejat AH. Does Intra-Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double-Blinded Randomized Clinical Trial. J Oral Maxillofac Surg 2018; 76:939.e1-939.e7. [DOI: 10.1016/j.joms.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
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