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Purpose: To investigate the effect of platelet-rich plasma (PRP) on the healing of hard and soft tissues of extraction sockets with a pilot study., Material and Methods: Patients undergoing tooth extraction under intravenous sedation were asked to participate in the trial. Autologous platelet concentrates were prepared from the patients' blood and autologous thrombin was produced. Outcome measures were: pain level, analgesic consumption, oral function (ability to eat food, swallowing, mouth opening and speech), general activity, swelling, bruising, bleeding, bad taste or halitosis, food stagnation, patient satisfaction, healing complications, soft tissue healing, trabecular pattern of newly formed bone in extraction sockets, trabecular bone volume, trabecular separation, trabecular length, trabecular width, and trabecular number. Patients were followed up to 3 months post-extraction., Results: Twelve patients (15 sockets) were randomly allocated to the PRP group and 11 patients (14 sockets) to the control group. Two patients from the control group did not attend any of the scheduled appointments following tooth extraction, and were considered dropouts. Additionally, one more patient from the control group and four patients from the PRP group did not attend their 3-month radiographic assessment appointments. Statistically significantly more pain was recorded in the control group for the first (P=0.02), second (P=0.02) and third (P=0.04) post-operative days for Visual Analogue Scale scores, whereas no differences were observed for the fourth (P=0.17), fifth (P=0.38), sixth (P=0.75) and seventh (P=0.75) post-operative days. There was a statistically significantly higher analgesic consumption for the first (P=0.03) and second (P=0.02) post-operative days in the control group and no differences thereafter. Differences in patients' responses in the health-related quality of life questionnaire were statistically significant in favour of PRP treatment only for the presence of bad taste or bad smell in the mouth (P=0.03), and food stagnation in the operation area (P=0.03). The difference between groups was not statistically significant for patient satisfaction with the treatment (P=0.31). Regarding complications, two dry sockets and one acutely inflamed alveolus occurred in patients of the control group, which determined a borderline statistically significant difference in favour of the PRP group (P=0.06). Soft tissue healing was significantly better in patients treated with PRP (P=0.03). Radiographic evaluation carried out by the two blinded examiners revealed a statistically significant difference (P=0.01) for sockets with dense homogeneous trabecular pattern, a borderline statistically significant difference in the trabecular pattern for bone volume (P=0.06) favouring PRP use, and no significant differences for trabecular separation (P=0.66), trabecular length (P=0.16), trabecular width (P=0.16) and trabecular number (P=0.38)., Conclusions: PRP may have some benefits in reducing complications such as alveolar osteitis and improving healing of soft tissue of extraction sockets. There were insufficient data to support the use of PRP to promote bone healing or to enhance the quality of life of patients following tooth extraction, although the sample size was too small to detect statistically significant differences.

The aim of the study is to compare the prevalence of post-operative inferior dental nerve (IDN) deficit after coronectomy with total removal of wisdom teeth showing specific radiographic signs of close proximity to IDN. A randomized clinical trial comparing total removal and coronectomy of wisdom tooth was conducted. Analyses of the correlations of IDN deficit and various radiographic signs of wisdom tooth roots showing close proximity to IDN were performed. Two radiographic signs were found to be positive predictors ofintra-operative IDN exposure. Specific radiographic signs or the presence of two or more radiographic signs are positive predictors of post-operative IDN deficit. The study concluded that darkening of the wisdom tooth root and presence of two or more specific signs in radiographs significantly increased the risk of IDN deficit in lower wisdom tooth surgery. Coronectomy can significantly reduce the prevalence of an IDN deficit in patients with lower wisdom teeth showing radiographic signs of close proximity to IDN. It also carries less surgical morbidities when compared with total removal of lower wisdom tooth.

The use of prophylactic antibiotics to reduce postoperative complications in third molar surgery remains controversial. The study was a prospective, randomized, double blind, placebo-controlled clinical trial. 100 patients were randomly assigned to two groups. Each patient acted as their own control using the split-mouth technique. Two unilateral impacted third molars were removed under antibiotic cover and the other two were removed without antibiotic cover. The first group received antibiotics on the first surgical visit. On the second surgical visit (after 3 weeks), placebo capsules were given or vice versa. The second group received antibiotics with continued therapy for 2 days on the first surgical visit and on the second surgical visit (after 3 weeks) placebo capsules were given or vice versa. Pain, swelling, infection, trismus and temperature were recorded on days 3, 7 and 14 after surgery. Of 380 impactions, 6 sockets (2%) became infected. There was no statistically significant difference in the infection rate, pain, swelling, trismus, and temperature between the two groups (p>0.05). Results of the study showed that prophylactic antibiotics did not have a statistically significant effect on postoperative infections in third molar surgery and should not be routinely administered when third molars are removed in non-immunocompromised patients., (Copyright 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: One of the most common postoperative complications following the extraction of permanent teeth is a condition known as dry socket. Although the aetiology of dry socket is debated, it is probably multifactoral, and its pathogenesis remains unknown., Objectives: The aim of the study was to evaluate incidence of dry socket following extraction of permanent teeth at dental out-patient department (OPD) of Dhulikhel hospital, Kathmandu university teaching hospital (KUTH), Kavre, Nepal., Materials and Methods: Retrospective reviews of records of total 1860 no of patients were studied who underwent extraction of permanent teeth for various reasons since January 2007 to December 2008 period. There were 873(47%) male patients and 987 (53%) female patients. Information regarding indications for extraction, extracted tooth status, onset of symptoms, relevant findings of the examining clinician, interval between presentation, management given, and its outcome were retrieved and analysed., Results: A total 1860 no of patients were studied who underwent extraction of total 2640 number of permanent teeth for various reasons. A total of 103 (3.9%) extractions were complicated by dry socket in patients aged 11 to 80 years with female predominance (54.4%)., Conclusion: The etiology of dry socket is multifactorial and ultimately it is the host's healing potential which determines the severity and duration of the condition. The incidence of dry socket was found as 3.9% in this study. The incidence was higher in female patients (54.4%) and in mandibular teeth extraction cases (68.93%).

Aim: The aim of this study was to determine the incidence of dry socket, alveolar infection, and postoperative pain following the routine extraction of erupted teeth., Methods and Materials: Using a questionnaire, this prospective cross-sectional study evaluated 357 consecutive surgeries in which 473 erupted teeth were extracted by dental students under rigorous control of microbiologic contaminants during a 22-month period. The subject sample consisted of 210 (58.8%) male patients ranging in age from 11 to 79 years (mean 41 +/- 16.3). The most prevalent self-reported ethnicity was Caucasian (78.2%). The questionnaire consisted of 60 questions directed to the patient and to the dental student who performed the surgical procedure. The questionnaires were completed before and within seven days after the surgery to obtain outcomes data. Forty-five questionnaires were excluded due to lack of information, inconsistencies, or lack of contact with the patient; however, none had indications of alveolar infection or dry socket. The data were analyzed using descriptive statistics, chi-square tests (x(2)), and an odds ratio (OR) as appropriate at the critical level of significance, set at p<0.05 (x(2)) or p<0.01 (x(2), with the Monte Carlo simulation)., Results: The observed incidence was 0.6% (two cases each) for both alveolar infection and dry socket. Higher pain levels and pain persisting longer than two days were observed with more traumatic surgeries, or associated with postoperative complications. Smoking was found to be statistically associated with the development of postoperative complications., Conclusion: The incidence of alveolar infection, dry socket, and severe pain were very low for the routine extraction of erupted teeth. Severe pain that persists for more than two days can represent a sign of a postoperative complication such as dry socket., Clinical Significance: Dental extraction is part of the dentists' daily work and intercurrences like dry socket, infection, and pain can occur. This manuscript reports the incidence of these occurrences and search for its predisposing factors.

Purpose: This prospective randomized clinical study assessed the efficacy of pain control for postextraction alveolar osteitis comparing the use of eugenol on a gauze strip versus a thermosetting gel containing 2.5% prilocaine and 2.5% lidocaine., Patients and Methods: Thirty-five patients who presented with postextraction alveolar osteitis were randomly assigned to either a control group or test group. After irrigation of the extraction site with normal saline solution, the control patients were treated with eugenol on a gauze strip placed in the socket and the test patients were treated with the thermosetting gel placed directly into the socket. All patients were given a series of visual analog scales to record their pretreatment pain and post-treatment pain at 5, 10, and 15 minutes and then at 1-hour increments during waking hours for the next 48 hours. They were also given a prescription for an analgesic to use for breakthrough pain during the 48-hour period, if necessary, and instructed to record the dose and timing of any pain medication taken. All patients were seen for follow-up at 48 hours after treatment., Results: The mean pretreatment pain score was 6.72 on a scale ranging from 1 to 10 for the eugenol group and 6.37 for the prilocaine-lidocaine group (SE, 0.46), and the 2 groups were not different (P = .62). In the immediate post-treatment period (0-15 minutes) the pain levels were significantly reduced in both groups (Ps < .001). However, the thermosetting gel produced a significantly greater reduction in pain (mean, 3.23; SE, 0.62) than the eugenol (mean, 4.83; SE, 0.43) (P = .022). Over the next 48 hours, the pain level was nominally less with the thermosetting gel, but this difference was not statistically significant (Ps = .2)., Conclusion: Although the efficacy of the 2 treatments was not significantly different, the nominal superiority and ease of using the thermosetting gel warrant further investigation.

Objectives: Obesity is a disease that affects millions of Americans. Sixty-nine million Americans are considered to be overweight including at least 1 in 5 children. Overweight and obesity as risk factors for complications associated with dentoalveolar surgery have not been extensively studied. The purpose of this study was to prospectively investigate the frequency and the nature of postoperative complications in obese patients receiving ambulatory dentoalveolar surgery., Study Design: Patients undergoing dentoalveolar outpatient ambulatory surgery at the University of Cincinnati Oral and Maxillofacial Surgery Clinic from January 10, 2005 to December 7, 2005 were enrolled in a prospective study. At the preoperative visit, height, weight, and age were recorded. The body mass index (BMI) was calculated and patients were divided into weight categories based on CDC and WHO classifications. Unfavorable outcomes studied included number of postoperative visits, infections, alveolar osteitis, soft and hard tissue problems, and postoperative bleeding. Complication categories were created for all complications identified during postoperative exams and t tests were performed to see if increased BMI correlated to higher postoperative complication rates, if multiple complications correlated to increased BMI, and to see if individual postoperative complication groups and BMI correlated. Because it was thought that complications would increase the number of postoperative exams for a particular patient, simple linear regression was used to see if BMI correlated to increased number of postoperative visits., Results: No significant differences were noted in number of postoperative complications when comparing patients' BMIs (t = -0.62, P = .5350). Simple linear regression analysis showed that increased BMI did not predict increased number of postoperative visits. Increased age was the only predictor of increased postoperative complication risk (t = -3.17, P = .0016) and of increased number of postoperative visits (t = -16.35, P < .0001, and P < .0001 by nonparametric Wilcoxon rank sum test)., Conclusions: The BMI is not statistically correlated to higher postoperative complication rates or increased number of postoperative visits. Obesity remains an important risk factor for dentoalveolar ambulatory outpatient anesthesia; however, it is not associated with poorer postoperative complication rates.

The most frequent complications after surgical removal of an impacted mandibular third molar are the following: alveolar osteitis, infections, neurological damage involving the inferior alveolar and lingual nerves. All of these postoperative complications are more frequent in older patients. Their increase starts at about 25 years of age. Alveolar osteitis is the most frequent postoperative complication, but it is easily handled; its pathogenesis remains unknown, even if cigarette smoking enhances its incidence; other putative risk factors have not been confirmed. An effective etiologic therapy is not yet available, but the symptoms can be managed by means of local medication. Postoperative infections can still cause very severe problems, especially in elderly patients, if the treatment is not correct and timely. Antibiotic prophylaxis is indicated in selected cases. The possibility of neurological complications is often associated with anxiety both in the patient and doctor: fortunately, their incidence has been lowered by improved surgical techniques; moreover, risk indicators have been identified on the panoramic radiographs; three-dimensional imaging is useful in planning the surgical intervention in risky cases.

Unlabelled: Paget's disease of bone, although common in the long bones and pelvis, is less common in the head and neck. A 20-year follow-up is reported of a patient who was diagnosed with Paget's disease following the investigation of her initial oral complaint. Following surgical extraction of two teeth in her maxilla, the sockets have failed to heal, despite numerous attempted interventions. This case highlights both the cranio-maxillofacial and oral manifestations of Paget's disease of bone, its effects on surgical exodontia and the possible effects of bisphosphonate therapy., Clinical Relevance: Paget's disease of bone does not manifest in the head and neck commonly but, when it does, there are significant implications for the dentist. Prevention and conservation of the patient's remaining teeth are paramount as the complications of extraction are significant.

Objectives: This paper provides a comprehensive review of the etiology, pathophysiology and current treatment of dry socket., Study Design: The Medline database (Ovid version) from 1966 to 2007 was searched for the term "dry socket" published in the English language, and 317 results were obtained. The articles were screened by abstract for relevance to etiology, pathophysiology, or treatment of dry socket. Treatment papers were ranked on the quality of evidence presented as assessed using the evidence-based systematic review worksheet of the University of Alberta. A total of 62 publications were included in the final review., Results: Prevention methods remain the key to avoiding this complication. Prophylactic placement of topical antibiotics can be considered, whereas systemic antibiotics should be reserved for patients who are immunocompromised., Conclusion: This paper provided a comprehensive review of the etiology, pathophysiology, and current treatment of dry socket in dental practice.

Introduction: The dental surgeon is often confronted by complications particularly after extraction ofunerupted lower third molars. The most common complication is alveolar periostitis. The healing process after extraction is accompanied by physiologic atrophy of the alveolus involving on the average 30% of bone tissue. Beta-tricalcium phosphate (TCP) is a synthetic material used in medicine to fill up bone defects caused by pathologic processes. The properties of TCP are appropriate for the material to be used as a carrier for drugs, in particular antibiotics. This study was undertaken to determine whether lincomycin applied to the alveolus on TCP carrier can be used to accelerate wound healing and reduce inflammation after surgical extraction of a third molar., Materials and Methods: We enrolled 80 patients (males and females between the age of 18 and 50 years) who underwent extraction of a third molar at the Department of Dental Surgery, Pomeranian Medical University in Szczecin. Surgical difficulty in the patients according to the Pederson scale corresponded to grade 2 or 3 (medium or high difficulty). The study group consisted of 40 patients who received lincomycin on TCP. Beta-tricalcium phosphate (300-700 microm pores) obtained from the Department of Technology of Ceramics and Refractories, AGH University of Science and Technology in Cracow, was soaked with 500 mg of lincomycin in solution and applied to the dental alveolus after tooth extraction. The alveolus was tightly sutured. The control group comprised 40 patients not treated with lincomycin. The patients reappeared for examination on the first, third, and seventh day after surgery. Attention during follow-up was directed to alveolar periostitis, pain, and trismus. Pain intensity was assessed with the 10-degree Visual Analog Scale (VAS)., Results: We analyzed the subjective pain intensity reported during follow-up by the patients. In the study group, 20 patients reported no pain 24 hours after extraction. On the third day after surgery, alveolar periostitis was present in 15% of patients in the study group and 75% of patients in the control group. On the last day of follow-up, periostitis was present in only 2.5% of patients in the study group as opposed to 45% of patients in the control group. The differences were statistically significant (chi-square 36.05, p < 0.0001)., Conclusions: (1) Lincomycin on TCP can be used to prevent alveolar periostitis. (2) Lincomycin on TCP reduces complications in the form of pain and trismus. (3) Beta-tricalcium phosphate prevents atrophy of the alveolar process.

Purpose: To identify major risk factors for developing dry socket in some Nigerians, and to formulate a nonpharmacologic protocol for its effective prevention., Patients and Methods: Patients presenting with dry socket at the Oral Surgery Clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria, over an 18-month period were studied. Biographic data, preoperative diagnoses, teeth extracted, oral hygiene status, and history relevant to the extractions and presentations of dry socket were documented. Procedures were classified as traumatic or atraumatic. Data were analyzed using SPSS version 11.0 (SPSS Inc, Chicago, IL) with simple descriptive statistics and the chi(2) test, as appropriate. P

Purpose: The aim of this study was to estimate the frequency of postoperative complications after mandibular third molar (M3) surgery and identify the risk indicators., Patients and Methods: This was a prospective cohort study of a sample of subjects having at least 1 mandibular M3 surgically extracted at a teaching hospital in Jordan. The predictor variables were categorized as patient, anatomic, and operative specific. The outcome variables were postoperative complications recorded as present or absent. Bivariate analyses were computed, then a multivariate logistic regression model was used to identify independent predictors for the common postoperative complications., Results: The study sample was comprised of 149 patients who had 245 extractions. The mean age was 21.6 +/- 3.32 years; 64.9% were females. In the multivariate logistic regression model, age (P = .033, odds ratio [OR] = 1.178), M3 side in relation to the handedness of the operator (P = .048, OR = 4.078), and lingual retraction (P = .001, OR = 11.293) were the variables found as independent predictors for alveolar osteitis. The level of impaction had a significant association with trismus, and operation time acted as an independent predictor for pain (P < .001, OR = 1.085)., Conclusion: Postoperative morbidity increases with older age, deeper impaction, M3 side differing from the handedness of the operator, and longer procedures.

Purpose: To estimate the frequency of inflammatory complications (surgical site infection and alveolar osteitis) following third molar (M3) extraction and identify risk factors for such complications., Materials and Methods: This study was designed as a prospective cohort study and enrolled a sample composed of subjects having >or=1 M3 extracted as part of the American Association of Oral and Maxillofacial Surgeons' Age-Related Third Molar Study. Predictor variables were categorized as demographic, health status, anatomic, and pathologic factors. The outcome variable was the presence of a postoperative inflammatory complication (ie, surgical site infection or alveolar osteitis). Descriptive and bivariate statistics were computed. Variables with P values less than .15 in bivariate analyses were included in a multiple logistic regression model, used to identify factors associated with inflammatory complications., Results: The study sample consisted of 4,004 subjects with a mean age of 39.8 +/- 13.6 years having 8,748 M3s extracted. In bivariate analyses, impaction level, periodontal disease in or around M3, pre-existing infection around M3, and M3 pathology were associated with postoperative inflammatory complications. In the multiple regression model, level of impaction (soft tissue: odds ratio [OR] = 2.5; 95% confidence interval [CI], 1.7, 3.7), partial bony OR = 4.7 (95% CI, 3.6, 6.1), full bony, 6.0 (95% CI, 4.7, 7.7); P < .0001), and pre-existing infection (OR = 1.3 [95% CI, 1.0, 1.6; P = .05) or pathology (OR = 3.1; 95% CI, 2.2, 4.3; P < .0001) were associated with an increased risk of inflammatory complications following M3 surgery., Conclusions: Level of impaction, pre-existing infection, and pathology were associated with increased risk for postoperative inflammatory complications following M3 surgery.

Dry sockets, or alveolar osteitis, is one of the most common postoperative complications following the extraction of teeth. For the patient this is often a very painful and distressing condition. Most dental practitioners will experience this complication at some or other stage of their career. The aetiology of dry socket is multifactorial with several predisposing factors having been identified. The aims of this study were to assess the incidence of dry sockets at the Medunsa Oral Health Centre, to assess the demographic details of these patients and to explore the predisposing factors for the development of dry socket. It is hoped that this will help to minimize or prevent this condition from occurring. This was a prospective study conducted over an eight-month period in the Department of Maxillofacial and Oral Surgery, University of Limpopo, Medunsa Campus. The data was collected by means of a structured questionnaire. Of the 4077 patients that presented for dental extractions, 2% (79) developed a dry socket. The ages of the patients ranged from 12-79 years with a mean age of 35 years. There was a slight female preponderance (1.5:1). The mandibular second molar was the most common site to be affected (22%). Pain was the most common presenting symptom. Underlying systemic conditions were found in 19% of the patients, while 25% smoked, consumed alcohol or both. Identifying risk factors, attention to procedural details and patient education were found to be important in the prevention of dry socket.

Purpose: This study evaluated the efficacy of the HemCon Dental Dressing (HDD; HemCon Medical Technologies, Inc, Beaverton, OR) hemostatic oral wound dressing derived from the US military HemCon Bandage combat wound dressing and whether early hemostasis affects postoperative care and surgical healing outcomes following oral surgical procedures., Patients and Methods: All patients aged 18 to 90, except those allergic to seafood, who consented to participate were eligible for enrollment into this study regardless of other medical history findings. All patients were required to have 2 or more surgical sites so they would have internal surgical control sites. All patients taking oral anticoagulation therapy (OAT) were included for treatment in this study without altering their anticoagulant medication regimens. All data were evaluated by biomedical statisticians and Institutional Review Board approval was obtained., Results: All HDD surgically treated sites, including all from patients taking OAT, achieved hemostasis in less than 1 minute and control wounds in 9.53 minutes (P < .001). All HDD sites achieved hemostasis sooner than control sites (P <.001). Approximately 32% of HDD treated sites had significantly better healing compared with control sites (P <.020) and no control sites healed better than HDD treated sites; 32% of HDD treated oral surgery wounds achieved statistically significant improved healing (P <.001). All patients taking OAT achieved hemostasis within 1 minute and were treated without altering their anticoagulant regimens. Although the pain scores and incidence of alveolar osteitis were lower for the HDD-treated sites, these scores were not significantly different than control-treated sites. There was no negative healing sequela associated with early hemostasis of oral surgical wounds., Conclusion: The HDD has been proven to be a clinically effective hemostatic device that significantly shortens bleeding time following oral surgery procedures for all patients, including those patients taking OAT. Patients receiving the HDD had improved surgical wound healing compared with those receiving controls.

The estimation of possible intra- and postoperative complications for surgical removal of third molars in the mandible poses a frequent dilemma in oral surgery. In the present study, the influence of the patient's age and gender, a reduced mouth opening, and the anatomical position of the tooth in the mandible on intra- and postoperative complications were evaluated. In a total of 120 surgically removed third molars, 9.2% intraoperative complications occurred, mainly bleeding. Factors influencing the risk for intraoperative complications were a male patient, a reduced mouth opening, and distally angulated teeth. Postoperative complications were encountered in 6.7%, mainly dry sockets. For this group, a female gender, a higher age, and distally angulated teeth were identified as risk parameters. As most of the patient- and anatomy-related factors are set parameters when evaluating possible risk factors for third molar surgery, only the timepoint of surgery can be influenced by the surgeon. Regarding the increase in intra- and postoperative complications for third molar removal in higher age groups, the prophylactic third molar surgery between the age of 18 and 25 seems justified.

Objectives: The purpose of this study is to assess the contribution of smoking to postoperative complications, including alveolar osteitis (dry socket), after dental extractions. In addition, it attempts to determine the effect of the ban imposed on tobacco use in the prison on postoperative complications., Study Design: All inmates having dental extractions at the Federal Correctional Institution in Danbury, CT, during the period January 2004 to April 2005, were included in this study (N = 219; mean age = 37.7 years). Data on postextraction complications were analyzed for association with smoking by using the chi-square test. Significance was set at P < .05., Results: The incidences of overall complications and alveolar osteitis were 19.6% and 5.0%, respectively. It was found that (1) there was a significant difference in overall complications between smokers and nonsmokers (P = .02), (2) there was a significant difference in the incidence of alveolar osteitis between mandibular third molar and other extractions, regardless of smoking status (P = .02), (3) surgical trauma contributed significantly to both an increase in total complications (P = .05) and alveolar osteitis (P = .01), and (4) smoking appeared to be a contributing factor to increased complications among multiple extractions (P = .03)., Conclusion: In this study, smoking, mandibular third molars, and surgical trauma were significantly associated with the increased incidence of overall complications including alveolar osteitis.

Objectives: To determine the incidence and pattern of presentation of dry socket as a complication of intra-alveolar dental extraction at the Lagos University Teaching Hospital., Methods: Patients who were referred for intra-alveolar dental extractions under local anaesthesia at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital between July and December 2002 were included in the study. The following data were recorded for each patient: biodata, reason for extraction, number and type of teeth extracted, time taken for the extraction to be done, smoking habit, and use of oral contraceptives. Onset of symptoms and type of teeth involved for those with diagnosis of dry socket were also recorded., Results: Thirty-one teeth (5.6%) of a total of 554 teeth extracted during the period of the study developed dry socket. The mean age (SD) of the 27 patients who developed dry socket was 32.2 +/- 13.0 years, (m; f ratio of 1: 4.4). Most (44.5%) of the patients who presented with dry socket were in the 3rd decade of life, with more than half (59%) of them presenting on the 3rd day following extraction. Mandibular and maxillary teeth were equally affected. Molars and premolars were exclusively affected. Difficulty of extraction was significantly associated with the development of dry socket (p<.05)., Conclusion: The incidence of dry socket in our centre is similar to previous reports. Female patients were significantly affected. Difficulty of extraction was significantly associated with the development of dry socket. Non-dressing treatment provided satisfactory relief of the symptoms and subsequent granulation of the socket.

Purpose: We conducted a synthetic quantitative review of the published clinical trials on the effectiveness of antibiotic prophylaxis in third molar surgery., Materials and Methods: Electronic databases were searched for randomized controlled trials. The primary outcome variables included alveolar osteitis (AO) and surgical wound infection. The extracted data were analyzed using a meta-analytical program with a random-effect model. Number needed to treat (NnT) was calculated., Results: A total of 2,932 patients randomized in 16 clinical trials reported AO as an outcome. AO occurred in 84 of 1,350 patients in the treatment group, a frequency of 6.2%; and in 228 of 1,582 patients in the control group, a frequency of 14.4%. Systemic antibiotic therapy was effective in reducing the risk of AO (odds ratio [OR], 2.175) with an NnT of 13. A total of 2,396 patients randomized in 12 clinical trials reported wound infection as an outcome. Wound infection occurred in 44 of 1,110 patients in the treatment group, a frequency of 4%; and in 78 of 1,286 patients in the control group, a frequency of 6.1%. Systemic antibiotic therapy was effective in reducing the risk of wound infection (OR, 1.794) with an NnT of 25. Antibiotics reduced the risk of AO and wound infection only when first dose was given before surgery., Conclusions: Systemic antibiotics given before the surgery were effective in reducing the frequencies of AO and wound infection after third molar surgery.

Objective: The purpose of this prospective study was to evaluate the incidence of various complications, including alveolitis, infection and paresthesia of the inferior alveolar nerve, in association with removal of impacted mandibular third molars. The relation between these 3 complications and several clinical variables (age, sex, degree of impaction, surgical difficulty and use of oral contraceptives) was also examined., Materials and Methods: Data were collected prospectively for all patients who underwent extraction of an impacted third molar in a single private dental practice over a 12-month period. A variety of data were collected for each patient, including age, sex, medical status at the time of the procedure and type of procedure performed. Patients were contacted at 2 days and 4 weeks after surgery to establish the occurrence of complications, and those with complications were treated; those with paresthesia were followed for at least 24 months., Results: A total of 550 impacted mandibular third molars were extracted from 327 patients (136 males and 191 females). The complication rate was 6.9%, consisting of 20 cases of alveolitis, 12 cases of infection and 6 cases of paresthesia of the inferior alveolar nerve. Of the 6 neurosensory deficits, 3 resolved and 3 were permanent. The risk factors associated with permanent neurosensory deficit were female sex, Pell and Gregory IC or IIC classification of impaction, and age greater than 24 years. The risk of postoperative alveolitis and infection was also greater among women. There was no significant relation between the use of oral contraceptives and alveolitis., Conclusions: Surgical removal of impacted mandibular third molars should be carried out well before the age of 24 years, especially for female patients. Older patients are at greater risk of postoperative complications and permanent sequelae. A surgeon's lack of experience could also be a major factor in the development of postoperative complications.

Objective: To evaluate the efficacy and tolerance of azithromycin in the prevention of post-extraction alveolar osteitis (dry socket) in women according to their use of tobacco and oral contraceptives., Method and Materials: A clinical trial was conducted in 400 women who underwent tooth extraction, stratified into 4 risk groups according to their use of tobacco (yes/no) and oral contraceptives (yes/no). Each stratum (n = 100) was randomly divided into 2 groups: a study group that received azithromycin 500 mg once daily for 3 days after extraction and a control group that received physiologic saline 3 times daily from 24 hours after extraction for 7 days., Results: Azithromycin was significantly superior to conventional postextraction treatment with physiologic saline. There were no significant interactions with the use of either tobacco or oral contraceptives, and these variables had no confounding effects., Conclusion: Azithromycin is a safe and efficacious treatment for the prevention of dry socket in women.

Aims: The aims of this study were to determine the prevalence, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST)., Methods and Materials: Two specially designed questionnaires were completed over a four-month period. One questionnaire was completed for every patient who had one or more permanent teeth extracted in the Oral Surgery Clinic. The other questionnaire was completed for every patient who returned for a post-operative visit and was diagnosed with dry socket during the study period., Results: There were 838 dental extractions carried out in 469 patients. The overall prevalence of dry socket was 4.8%. There was no statistically significant association between the development of dry socket and age, sex, medical history, medications taken by the patient, indications for the extraction, extraction site, operator experience, or the amount of local anesthesia and administration technique used. The prevalence of dry socket following non-surgical extractions was 3.2%, while the prevalence following surgical extractions was 20.1% (P< 0.002). The prevalence of dry socket following surgical and non-surgical extractions was significantly higher in smokers (9.1%) than in non-smokers (3%) (P = 0.001), and a direct linear trend was observed between the amount of smoking and the prevalence of dry socket (P = 0.034). The prevalence of dry socket was significantly higher in the single extraction cases (7.3%) than in the multiple extraction cases (3.4%) (P = 0.018). The clinical picture and management of dry socket at DTC/JUST were similar to previous reports in the literature. The prevalence of dry socket, its clinical picture, and management at DTC/JUST are similar to those reported in the literature., Conclusion: Smoking and surgical trauma are associated with an increased incidence of dry socket. Moreover, patients who had single extractions were more likely to develop dry socket than those who had multiple extractions in the same visit.

Purpose: To estimate and compare the frequencies of inflammatory complications after third molar (M3) surgery in subjects receiving intravenous prophylactic antibiotics or saline placebo., Materials and Methods: Using a placebo-controlled, double-blind, randomized clinical trial, the investigators enrolled a sample composed of subjects who required extraction of at least 1 impacted M3 and requested intravenous sedation or general anesthesia. The predictor variable was treatment group classified as active treatment (penicillin or clindamycin for penicillin-allergic subjects) or placebo (0.9% saline). Study medications were randomly assigned. Both surgeon and subject were blinded to treatment assignment. The medication was administered intravenously prior to any incision. The outcome variable was postoperative inflammatory complication classified as present or absent and included alveolar osteitis (AO) or surgical site infection (SSI). Other variables were demographic, anatomic, or operative. Descriptive and bivariate statistics were computed. Statistical significance was set at P < or = .05, single-tailed test of hypothesis., Results: The sample was composed of 118 subjects (n = 59 per study group). In the active treatment group, there were no postoperative inflammatory complications. In the placebo group, 5 subjects (8.5%) were diagnosed with SSI, (P = .03). No subject met the case definition for AO. All SSIs were associated with the removal of partial bony or full bony impacted mandibular M3s., Conclusion: In the setting of third molar removal, these results suggest that the use of intravenous antibiotics administered prophylactically decrease the frequency of SSIs. The authors cannot comment on the efficacy of intravenous antibiotics in comparison to other antibacterial treatment regimens, eg chlorhexidine mouthrinse or intrasocket antibiotics.

Aim: Surgical extraction of impacted Mandibular third molar is one of the commonest dentoalveolar surgeries. This study aims to investigate the pattern of presentation of impacted Mandibular third molars, the indications for extraction and the post operative complications after this procedure at the Lagos University Teaching Hospital., Patients and Methods: A prospective study of patients who required surgical extraction of impacted Mandibular third molars between October 2003 and May 2006 at the Lagos University Teaching Hospital (LUTH) was carried out. Data collected included Patients' age, sex, indication for extraction, tooth/teeth extracted. Also collected were the types of impactions and surgical morbidity (postoperative complications). The data collected were evaluated using the SPSS for windows (version 11.0: SPSS Inc, Chicago, IL) descriptive analysis was used as appropriate., Results: Three hundred and thirty one (331) Mandibular third molars were extracted from 329 patients. The ages ranged from 17 to 55 years with a mean of 26.63 (+/- 7.39). There were 153 males and 176 females; with male to female ratio was 1:1.15. Recurrent Pericoronitis was the most common indication for extraction (209 extractions; 63.1%), while the mesioangular impaction was the most common angulation (117 impactions; 53.4%). 47 (14.2%) of the extractions had postoperative complications and dry socket which occurred in 25 (53.2%) cases was most common., Conclusion: The pattern of presentation of impacted Mandibular third molars is similar to earlier reports. The morbidity is however higher than the average value in the literature, it however does not seem to increase with increasing age.

Aim: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation., Methods and Materials: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients., Results: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01)., Conclusions: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.

Aim: The aim of this prospective study was to evaluate the clinical pattern of post-extraction wound healing with a view to identify the types, incidence, and pattern of healing complications following non-surgical tooth extraction., Study Design: A total of 311 patients, who were referred for non-surgical (intra-alveolar) extractions, were included in the study. The relevant pre-operative information recorded for each patient included age and gender of the patient, indications for extraction, and tooth/teeth removed. Extractions were performed under local anesthesia with dental forceps, elevators, or both. Patients were evaluated on the third and seventh postoperative days for alveolus healing assessment. Data recorded were: biodata, day of presentation for alveolus healing assessment, day of onset of any symptoms, body temperature (degrees C) in cases of alveolus infection, and presence or absence of pain., Results: Two hundred eighty-two patients (282) with 318 extraction sites were evaluated for alveolus healing. Healing was uneventful in 283 alveoli (89%), while 35 alveoli (11%) developed healing complications. These complications were: localized osteitis 26 (8.2%); acutely infected alveolus 5 (1.6%); and an acutely inflamed alveolus 4 (1.2%). Females developed more complications than males (p=0.003). Most complications were found in molars (60%) and premolars (37.1%). Localized osteitis caused severe pain in all cases, while infected and inflamed alveolus caused mild or no pain. Thirty patients (12%) among those without healing complications experienced mild pain., Conclusions: Most of the post-extraction alveoli healed uneventfully. Apart from alveolar osteitis (AO), post-extraction alveolus healing was also complicated by acutely infected alveoli and acutely inflamed alveoli. This study also demonstrated a painful alveolus is not necessarily a disturbance of post-extraction site wound healing; a thorough clinical examination must, therefore, be made to exclude any of the complications.

At a hospital in Damman, Saudi Arabia, it was noticed that many patients had developed dry socket after surgical removal of wisdom teeth. To enhance haemostasis, Surgicel (oxidized cellulose) gauze was sometimes used in the tooth socket in patients who were operated under general anaesthesia. An analysis was made of the records of 104 lower wisdom teeth removed surgically from 86 patients. The incidence of dry socket in the 20 Surgicel-treated teeth was 25.0%, compared with 6.0% among the 84 non-Surgicel-treated teeth. The use of Surgicel in wisdom tooth extraction seems to be associated with an increased incidence of dry socket.

Pain, swelling and dry socket formation commonly follow third molar surgery. The objective was to investigate the effect of intrasocket Covomycin D, an antibiotic/anti-inflammatory medication, on pain, swelling and dry socket following lower third molar removal. Nineteen subjects had bilateral lower third molars removed. The patients were blinded to the side of medication; the opposite side acted as the control; post-operatively a pain visual analogue scale was completed, the side of the worst swelling and the incidence of dry socket noted. The data was analysed using the Wilcoxons matched pairs signed ranks test. Results showed that the pain score was lower for the medicated side in 11 patients on day one and in 16 patients over the six day post-operative period (p < 0.6). The swelling was less on the medicated side in fourteen patients. Three dry sockets developed in non-medicated sockets. In conclusion this study shows that the use of intra-socket Covomycin D favourably influences post-operative sequelae following lower third molar removal.

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

Purpose: The purpose of this study is to identify surgical outcomes in third molar surgery when no sutures are used for primary closure., Patients and Methods: A total of 1,280 third molars were removed from 366 patients in an outpatient setting using intravenous sedation and local anesthesia. A small V-shaped flap was raised in all cases and no sutures were placed over a 2-year period (2001 to 2003). All people were contacted by a registered nurse within 24 hr. All records were reviewed by a medical investigator and IRB approval was obtained., Results: The mean age was 22.14 years, males 39%, females 61%, white 75%, African American 22%, and Asian 3%. Ninety-three people of 366 experienced at least 1 complaint. Alveolar osteitis was 2.81% for the total teeth extracted and 10.7% for the mandibular Class IV impactions. A total of 652 mandibular third molars were removed (Class III, n= 113; Class IV, n= 522). Forty-eight of 366 patients (13.1%) had postoperative diagnosis of alveolar osteitis., Conclusions: Small flap third molar surgery without sutures is less invasive and saves time. Delayed healing in oral surgery is not new. The outcome of 1,280 extractions demonstrates good results.

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

Objectives: To determine whether smoking influences the postoperative course (pain and trismus) of lower third molar surgery, with a clinical evaluation of surgical wound condition and analysis of the possible differences between smokers and nonsmokers., Design: The study subjects were randomly distributed into two groups (smokers and nonsmokers) and subjected to lower third molar extraction in the Unit of Oral and Maxillofacial Surgery (Madrid Complutense University, Spain). The study variables were trismus after 7 days, the intensity of pain and the need for rescue medication during a period of one week. The surgical wound was also assessed (color, presence of plaque, etc)., Results: Two cases of postoperative infection were documented among the smokers, and postoperative trismus was found to be greater among the latter (p=0.05)., Conclusions: There were no statistically significant differences between the two groups in terms of pain, though trismus was greater among the smokers. Smoking did not influence wound condition (color, marginal inflammation, appositioning of the margins, ulceration, etc).

Purpose: The aim of the study was to compare the incidence of healing complications of extraction socket with the use of sterile or clean nonsterile gloves during nonsurgical dental extractions., Material and Methods: This was a randomized prospective study conducted at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (Nigeria), between October 2002 and January 2003. Patients who were referred for nonsurgical extractions of permanent teeth and who satisfied the inclusion criteria into the study were randomly allocated into 2 groups. One group had their extractions performed with the surgeon wearing a pair of sterile gloves and the second group had their extractions performed with the surgeon wearing a pair of clean nonsterile gloves. Two hundred sixty-nine patients who had 301 teeth extracted and satisfied the inclusion criteria for socket healing assessment were assessed for postoperative socket healing., Results: Three different types of socket healing complications were identified (dry socket, acutely inflamed socket, and acutely infected socket). A total of 32 patients (11.9%) developed socket healing complications. Nineteen of 122 patients in the sterile glove group and 13 of 147 patients in the clean nonsterile glove group developed socket healing complications (P = .09)., Conclusion: The study confirmed that the use of sterile surgical gloves offers no advantage over clean nonsterile gloves in minimizing extraction socket healing complications following dental extraction. Therefore, nonsurgical dental extraction can be safely performed with the surgeon wearing clean nonsterile gloves.

We randomised 128 patients who required operations on mandibular third molars and who had radiological evidence of proximity of the third molar to the canal of the inferior alveolar nerve to one of two operations: extraction [n=102], and coronectomy [n=94]. Some roots were dislodged during intended coronectomy and were therefore removed, resulting in two subgroups (successful coronectomy n=58, and failed coronectomy n=36). The mean (S.D.) follow up was 25 (13) months. Nineteen nerves were damaged (19%) after extraction, none after successful coronectomy, and three (8%) after failed coronectomy (p=0.01). The incidence of dry socket infection was similar in the three groups (10/102, 10%, 7/58, 12%, and 4/36, 11%, respectively). No root required removal or reoperation. To our knowledge this is the first clinical trial of the efficacy of coronectomy in preserving the inferior alveolar nerve. The length of follow up was about 2 years, which for the assessment of delayed eruption of the root fragments is not sufficient as this process may continue for up to 10 years. However, it seems that coronectomy reduces the incidence of injury to the inferior alveolar nerve without increasing the risk of dry socket or infection.

Dry socket is a postoperative complication that occurs after a dental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1% until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, ten times more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the risk factors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and criticize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket.

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

Aim: Alveolar ostitis occurs with an incidence of 3-25% after tooth extraction. Antimicrobial photodynamic therapy (aPDT) with HELBO Blue and TheraLite laser enables local decontamination of the extraction socket. The aim of the study was to evaluate the possibility of aPDT with HELBO Blue and diode soft laser to reduce the prevalence of alveolar ostitis., Material and Methods: In an intraindividual study with 100 patients in 130 jaws, one or multiple contralateral teeth were removed at 1-week intervals. Randomly each side was treated with or without aPDT with a standardized protocol. At recall the evaluation of the extraction socket was performed by the investigator and the postoperative pain sensation was judged by the patient on an analog pain scale (0-100)., Results: In the group with aPDT alveolar ostitis occurred at one extraction site and in the control group without aPDT in 13 cases. The subjective pain assessment on the day after tooth removal was scored with 11.2+/-9.8 in the aPDT-group and with 19.0+/-12.2 in the control group. One week after extraction the pain sensation in the aPDT group was scored with 2.4+/-9.2 and in the control group with 13.1+/-25.2. The difference was significantly lower with p=0.000 for the 1st and 8th post-surgical days in the aPDTgroup., Conclusions: The significantly lower incidence of alveolar ostitis after antimicrobial photodynamic therapy seems to be a new and promising possibility for the prevention of alveolar ostitis.

Objectives: The aim of this study was to identify risk indicators for extended operation time and postoperative complications after removal of mandibular third molars., Study Design: There were 388 molars included in the study. The teeth were removed using the buccal approach under local anesthesia. Four hours postoperatively the patient recorded his or her pain perception on a visual analogue scale (VAS). After surgery a surgeon recorded parameters regarding the tooth and if the mandibular nerve had been visible during the operation. One week postoperatively the postoperative pain and complications were recorded. Logistic regression models were made to identify risk indicators for extended operation time, postoperative pain, and complications., Results: Females were at higher risk for postoperative pain and dry socket than males. Older patients were at higher risk for extended operation time than younger patients. Radiographically fully impacted molars increased the risk of postoperative general infection. If the nerve was visible during surgery there was a higher risk of a high VAS score, postoperative pain, and general infection than if the nerve had not been visible., Conclusion: Several indicators were found to increase the risk of postoperative complications, but a visible alveolar inferior nerve during the operation was repeatedly found to be the highest single risk indicator.

Purpose: This study was undertaken to determine whether "shisha" (water pipe) smokers (SS) were at a different risk of developing dry socket (DS) than were cigarette smokers (CS) or nonsmokers (NS) and to assess the effect of preoperative and postoperative smoking habits on the incidence of DS., Materials and Methods: One hundred NS, 100 CS, and 100 SS were enrolled. Surgery for removal of mandibular third molars was performed under local anesthesia with no incision or bone removal. At 1, 4, and 7 days after surgery, postoperative evaluation and postoperative smoking were recorded by the same examiner. The chi(2) test was used for statistical analysis of results. Statistical significance was defined as a value of P <.05., Results: Smokers had 2 to 3 times the risk of NS for developing DS. Although SS had a greater incidence of DS than did CS, the difference was not significant (P =.083). The incidence of DS was not age dependent. Smokers who smoked the day of surgery had a significantly higher incidence of DS than did smokers who smoked the second day after surgery. Compared with NS, CS who smoked the day of surgery and SS who smoked the day of surgery or the first day after surgery had a significantly increased incidence of DS (CS/NS, day 0, P =.001; SS/NS, day 0, P =.001; day 1, P =.005)., Conclusion: SS had 3 times the risk of NS for developing DS, but there was no statistically significant difference between SS and CS. Increased frequency of smoking and smoking during the day of surgery significantly increased the incidence of DS.

Dental extractions and other oral surgical procedures, including local analgesic injections, potentially can cause problems in haemophiliac and HIV infected persons. There are few data on treatment results in HIV-infected haemophiliacs compared with non-HIV-infected haemophiliacs. The oral surgery treatment results in 48 patients with special needs, including HIV-infected haemophiliacs, non-HIV-infected haemophiliacs, HIV-infected non-haemophiliacs, and a group with other medical problems were therefore studied. Around 20% of the haemophiliacs developed post-oral surgical complications, which was not significantly different whether or not they were HIV-infected. However, complications were less frequent (8%) in HIV-infected non-haemophiliacs or other patients with special needs. Although the patient groups are not large, it would appear that haemophiliacs had more postoperative complications but that the presence of HIV infection had no notable influence on treatment outcome.