COMPREHENSIVE EVALUATION OF PLATELET-RICH FIBRIN AND ZINC OXIDE EUGENOL IN MANAGEMENT OF ALVEOLAR OSTEITIS AT TWO CENTRES : A CLINICAL TRIAL

Alveolar osteitis (AO), or "dry socket," is a painful condition of jaws that typically begins one to three days following the extraction of teeth. Once other causes of pain in the region are eliminated, Blum defined dry socket as "postoperative pain in and around the extraction site, which increases in severity at any time between 1 and 3 days after the extraction, accompanied by a partially or completely disintegrated blood clot within the alveolar socket, with or without halitosis". Crawford used the term "dry socket" in 1896 to describe the condition. This condition has also been called othernames, such as fibrinolytic alveolitis, alveolitis sicca dolorosa, postoperative alveolitis, alveolalgia, septic socket, necrotic socket, localized osteomyelitis, and delayed extraction wound healing. Clinical manifestations and symptoms of AO are severe, often radiating, throbbing pain within and around the extraction socket, a clot-less extraction socket that can even appear totally empty or partially filled with a grayish-yellow membrane of necrotic tissue, foul mouth odor, offensive taste, gingival edema, and localized lymphadenitis. Oral anaerobic bacteria, anatomical site,traumatic removals, overuse of irrigation solution at the surgical area, curettage of the extraction socket, mechanical removal of the blood clot, fibrinolysis of the blood clot, smoking, oral contraceptives, immunosuppression, female sex, and vasoconstrictors are some of the possible etiologies of dry socket. Alveolar lavage, medicated dressings, analgesics, antibiotics, topical anesthetics, and obtundent, and their combinations, are the usual methods applied in the management of AO. Dry sockets can be treated with many medicines such as iodoform, zinc oxide eugenol (ZOE), acemannan, guaiacol, chlorobutanol, neocone, alvogyl, butylparaminobenzoate, and chlorhexidine. For the purpose of treating dry sockets, the sedative, antimicrobial, and obtundent properties of ZOE have been utilized in the form of intra-alveolar dressings. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that was introduced by Choukroun et al in 2001. PRF is a tetra meric polymer gel that has the ability to accelerate the formation of new bone and physiologic healing of wounds by injecting circulating stem cells, platelets, leukocytes, cytokines, and growth factors in its matrix. It has been postulated that application of PRF may accelerate the healing process of the extraction socket, which will reduce postoperative pain wherein PRF serves as a scaffold for enhanced healing. In 2021, Reeshma S et al. compared efficacy of platelet-rich fibrin with zinc oxide eugenol in the relief of pain in alveolar osteitis published in Health Science Reports and resulted in PRF gives greater pain relief than ZOE but study lacks evaluation of wound healing. Therefore the current study intended to assess efficacy of PRF and ZOE in treatment of Alveolar osteitis by measuring pain reduction and healing of wound as clinical outcomes.