Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Abstract

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. Objectives: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study Design: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d’Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). Results: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. Conclusions: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance. Key words:Alveolar osteitis, dry socket, chlorhexidine bioadhesive gel, mandibular third molar surgery.

The efficacy of chlorhexidine gel in the prevention of alveolar osteitis after mandibular third molar extraction: a systematic review and meta-analysis

“…However, a study done by Rubio-Palau showed there was a significant reduction of AO incidence in the intervention group (22.22% times compared with the control group) [19]. …”

The efficacy of intra‐alveolar 0.2% chlorhexidine gel on alveolar osteitis: a meta‐analysis

“…The remaining 21 articles were browsed according to the inclusion criteria. Finally, 11 articles (Torres‐Lagares et al , ,b; Hita‐Iglesias et al , ; Babar et al , ; Haraji et al , ; Haraji and Rakhshan, , ; Rubio‐Palau et al , ; Freudenthal et al , ; Jovanovic et al , ; Requena‐Calla and Funes‐Rumiche, ) were adopted for final analysis (Figure ).…”

“…Detailed characteristics of the 11 primary studies (Torres‐Lagares et al , ,b; Hita‐Iglesias et al , ; Jovanovic et al , ; Babar et al , ; Haraji et al , ; Haraji and Rakhshan, , ; Freudenthal et al , ; Rubio‐Palau et al , ; Requena‐Calla and Funes‐Rumiche, ) are listed in Table . The publication year varied from 2006 to 2016.…”

“…Of the 11 studies comparing the 0.2% CHX gel and control, 1116 mandibular third molars were extracted altogether, with 16.8% developing AO (11.4% in the control group and 5.4% in the 0.2% CHX gel group). Seven studies randomly divided patients into experimental and placebo groups (Torres‐Lagares et al , ,b; Hita‐Iglesias et al , ; Jovanovic et al , ; Babar et al , ; Rubio‐Palau et al , ; Requena‐Calla and Funes‐Rumiche, ), and another three studies randomly selected one‐third molar as the experimental site, with third molar another side serving as the control site (Haraji et al , ; Haraji and Rakhshan, , ). The included teeth in the remaining study (Freudenthal et al , ) were randomly divided into two study treatment groups (patients extracted either one‐third molar or two‐third molars).…”

“…The included teeth in the remaining study (Freudenthal et al , ) were randomly divided into two study treatment groups (patients extracted either one‐third molar or two‐third molars). In five studies (Torres‐Lagares et al , ; Hita‐Iglesias et al , ; Haraji et al , ; Haraji and Rakhshan, ; Rubio‐Palau et al , ), smokers were not excluded, and in one study (Rubio‐Palau et al , ), patients taking oral contraceptives were also not excluded. The follow‐up for all studies occurred within 7 days according to the DS diagnostic criteria of 2002.…”