A prospective randomised clinical study on evaluation of platelet-rich fibrin versus zinc oxide eugenol in the management of alveolar osteitis

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.

Comparison of platelet-rich fibrin with zinc oxide eugenol in the relief of pain in alveolar osteitis

BACKGROUND AND AIMS

Alveolar osteitis (AO) is the most common painful post-operative complication after tooth extraction. The common modalities used in the management of AO are lavage, placement of medicated dressings, analgesics, and antibiotics. The present study was undertaken to compare platelet-rich fibrin (PRF) and zinc oxide eugenol (ZOE) for pain relief in AO.

METHODS

All cases meeting the eligibility criteria received two different treatment modalities over a span of 18 months. At the analysis stage, the final sample size comprised 70 patients, with 35 patients appropriated in each group. Group A patients received ZOE and Group B received PRF. Pain scores were measured on "1st, 3rd, 5th, and 7th" days based on a visual analogue scale (VAS) and compared in both groups of patients. The collected data were analyzed using the chi-square test, t test, and Mann-Whitney U test.

RESULTS

In patients treated with ZOE dressing, the average VAS scores observed were 7.4 ± 1.5, 5.1 ± 1.1, 3.4 ± 0.9, and 2.1 ± 0.7, respectively, on the "1st, 3rd, 5th, and 7th" follow-up days. In patients treated with PRF, the average VAS score observed were 4.1 ± 1.2, 2.6 ± 0.9, 1.7 ± 0.9, and 0.8 ± 0.8 respectively.

CONCLUSION

Both ZOE and PRF were effective in pain control during the follow-up period. However, the pain intensity measured as a pain score using VAS was, lower in the PRF group than in the ZOE group on all follow-up days.

Hyaluronic Acid-Based Medical Device for Treatment of Alveolar Osteitis-Clinical Study

Alveolar Osteitis (AO) is a complication following the extraction of a tooth. AO manifests through localized pain in, and around, the extraction site, where the post-operative blood clot has been disintegrated. The aim of this single cohort study was to evaluate the outcome of a treatment of AO, using a pharmacological device composed of hyaluronic acid and octenidine dihydrochloride. The tested device is a sponge-like material, composed solely of a fully dissoluble medicaments (hyaluronic acid, calcium chloride, and octenidine dihydrochloride). It was designed to serve as a non-toxic, slow-dissolving antiseptic, that adheres to mucosa and obturates the wound. This study includes 58 subjects who were diagnosed with AO. The tested device was administered once daily until local pain subsided to < 20 mm of the Visual Analog Scale (VAS). The treatment was considered effective when the pain subsided to < 20 mm VAS in < 8 days of treatment; as per comparative studies. Our findings provide a statistically significant success rate of 96.0% (95.0% confidence interval of 75.75% to 97.8%) after pharmacological device administrations. No adverse medical effects were detected. Acquired data confirmed that lyophilized hyaluronic acid, combined with octenidine, is effective for the treatment of AO. The results are clinically important as AO is a common complication after third molar extractions.

Platelet-rich fibrin in oral surgical procedures: a systematic review and meta-analysis

The effect of platelet-rich fibrin (PRF) in enhancing the healing after oral surgical interventions is still a matter of debate. The purpose of this study was to identify instances where PRF has been shown to be effective in oral surgical procedures. A comprehensive literature search was performed up to 2017 on PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus and LILACS databases and grey literature. The full-text of potentially relevant studies were reviewed and only randomized clinical trials (RCTs) were included. A total of 559 studies were found, of which 30 were included for qualitative analysis and 13 for quantitative analysis. Three review authors assessed the risk of bias independently. The available literature suggests that PRF has a positive effect in improving alveolar preservation on extraction sockets and around dental implants. The qualitative analysis showed a significantly better effect of PRF in promoting bone regeneration for alveolar cleft reconstruction. The meta-analysis for third molar surgery showed a decrease in prevalence of alveolar osteitis. PRF increased implant stability 1 week and 1 month after surgery (P=0.0005 and 0.0003). Due to the lack of studies with low risk of bias and a limited number of patients available, further RCTs are needed to confirm these results.