The use of hyaluronic and aminocaproic acid in the treatment of alveolar osteitis

Dejan N Dubovina; Branko Mihailović; Zoran Bukumirić; Zoran Vlahović; Milan Miladinović; Nikola Miković; Zoran Lazić

doi:10.2298/VSP150304125D

Dejan N Dubovina Department of Oral Surgery, Faculty of Medicine, University of Priština Kosovska Mitrovica, Kosovska Mitrovica, Serbia
Branko Mihailović Department of Oral Surgery, Faculty of Medicine, University of Priština Kosovska Mitrovica, Kosovska Mitrovica, Serbia
Zoran Bukumirić Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Zoran Vlahović Department of Oral Surgery, Faculty of Medicine, University of Priština Kosovska Mitrovica, Kosovska Mitrovica, Serbia
Milan Miladinović Department of Oral Surgery, Medical Faculty, University in Pristina, Kosovska Mitrovica, Serbia
Nikola Miković Clinic of Maxillofacial Surgery, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
Zoran Lazić Clinic of Dental Medicine, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP150304125D

Keywords: tooth extraction, postoperative complications, dry socket, hyaluronic acid, aminocaproic acids, curettage,

Abstract

Background/Aim. Alveolar osteitis (AO), also known as “dry socket”, is relatively common post-extraction complication. It probably occurs due to excessive fibrinolytic activity in the coagulum and is characterized by intense pain sensations. The aim of this clinical study was to examine the role of hyaluronic acid and aminocaproic acid in the treatment of AO. Methods. The study included 60 patients with the clinical diagnosis of AO. All the patients were divided into two groups of 30 patients each according to the applied non-pharmacological measure: irrigation – irrigation of dry socket with sterile saline; curettage – careful curettage. Both of these groups were further divided into three subgroups regarding the applied treatment (hyaluronic acid; hyaluronic acid + aminocaproic acid; Alvogyl^®, an anesthetic and antiseptic paste), each with 10 patients, according to the following protocol: 0.2 mL of hyaluronic acid in the form of a 0.8% gel; 2 mL of aminocaproic acid and hyaluronic acid; Alvogyl^®. During each visit, scheduled for every two days until complete absence of painful sensations, the patients had the therapeutic method repeated as at the first examination. At each control visit the number of present symptoms and signs of AO was recorded, as well as the level of pain (measured with a visual analogue scale). Results. With the use of hyaluronic acid, with or without aminocaproic one, a statistically significantly faster reduction in pain sensations was achieved, along with the reduction in the number of symptoms and signs of AO compared to the use of Alvogyl^®. Conclusion. Hyaluronic acid, applied alone or in combination with aminocaproic acid significantly reduces pain sensation, thus it can be successfully used in the treatment of AO.

References

Blum IR. Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. Int J Oral Maxillofac Surg 2002; 31(3): 309−17.

Noroozi A, Philbert RF. Modern concepts in understanding and management of the "dry socket" syndrome: Comprehensive review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107(1): 30−5.

Tjernberg A. Influence of oral hygiene measures on the devel-opment of alveolitis sicca dolorosa after surgical removal of mandibular third molars. Int J Oral Surg 1979; 8(6): 430−4.

Rubio-Palau J, Garcia-Linares J, Hueto-Madrid JA, González-Lagunas J, Raspall-Martin G,et al. 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. Med Oral Pa-tol Oral Cir Bucal 2015; 20(1): 117−22.

Birn H. Etiology and pathogenesis in fibrinolytic alveolitis (dry socket). Int J Oral Surg 1973; 2: 211−63.

Fridrich KL, Olson RA. Alveolar osteitis following removal of mandibular third molars. Anaesth Prog 1990; 37(1): 32−41.

Nitzan DW. On the genesis of "dry socket". J Oral Maxillofac Surg 1983; 41(11): 706−10. 41(11): 706-10.

Fazakerley M, Field EA. Dry socket: A painful post-extraction complication (a review). Dent Update 1991; 18(1): 31−4.

Trieger N, Schlagel GD. Preventing dry socket: A simple proce-dure that works. J Am Dent Assoc 1991; 122(2): 67−8.

Demarosi F, Sardella A, Lodi G, Carassi A. Acido ialuronico: ef-fetti biologici e applicazioni cliniche. Dent Clin 2007; I(2): 7−13.

Rodgers KE, Johns DB, Girgis W, Campeau JD, diZerega GS. Re-duction of adhesion formation with hyaluronic acid after peri-toneal surgery in rabbits. Fertil Steril 1997; 67(3): 553−8.

Beck DE. The role of Seprafilm registreted bioresorbable membrane in adhesion prevention. Eur J Surg Suppl. 1997; (577): 49−55.

Burns JW, Colt MJ, Burgess LS, Skinner KC. Preclinical evaluation of Seprafilm registreted bioresorbable membrane. Eur J Surg 1997; 163(Suppl 577): 40−8.

Liguori V, Guillemin C, Pesce GF, Mirimanoff RO, Bernier J. Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol 1997; 42(2): 155−61.

Mendes RM, Silva GA, Lima MF, Calliari MV, Almeida AP, Alves JB, et al. Sodium hyaluronate accelerates the healing process in tooth sockets of rats. Arch Oral Biol 2008; 53(12): 1155−62.

Ozier Y, Bellamy L. Pharmacological agents: Antifibrinolytics and desmopressin. Best Pract Res Clin Anaesthesiol 2010; 24(1): 107−19.

Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985; 29(3): 236−61.

Betts NJ, Makowski G, Shen YH, Hersh EV. Evaluation of topi-cal viscous 2% lidocaine jelly as an adjunct during the man-agement of alveolar osteitis. J Oral Maxillofac Surg 1995; 53(10): 1140−4.

King SR, Hickerson WL, Proctor KG. Beneficial actions of ex-ogenous hyaluronic acid on wound healing. Surgery 1991; 109(1): 76−84.

MacGregor AJ. Aetiology of dry socket: A clinical investigation. Br J Oral Surg 1968; 6(1): 49−58.

Sweet JB, Butler DP. Predisposing and operative factors: Effect on the incidence of localized osteitis in mandibular third molar surgery. Oral Surg Oral Med Oral Pathol 1978; 46(2): 206−15.

Kaya GŞ, Yapici G, Savaş Z, Güngörmüş M. Comparison of al-vogyl, SaliCept patch, and low-level laser therapy in the man-agement of alveolar osteitis. J Oral Maxillofac Surg 2011; 69(6): 1571−7.

Ritzau M. The prophylactic use of tranexamic acid (Cykloka-pron®) on alveolitis sicca dolorosa. Int J Oral Surg 1973; 2(5): 196−9.

Gersel-Pedersen N. Tranexamic acid in alveolar sockets in the prevention of alveolitis sicca dolorosa. Int J Oral Surg 1979; 8(6): 421−9.

Weigel PH, Fuller GM, Leboeuf R. A model for the role of hyalu-ronic acid and fibrin in the early events during the inflammatory response and wound healing. J Theor Biol 1986; 119(2): 219−34.

Bartold MP. The effect of interleukin-1 beta on hyaluronic acid synthesized by adult human gingival fibroblasts in vitro. J Pe-riodont Res 1988; 23(2): 139−47.

Oksala O, Salo T, Tammi R, Häkkinen L, Jalkanen M, Inki P, et al. Expression of proteoglycans and hyaluronan during wound healing. J Histochem Cytochem 1995; 43(2): 125−35.

Bartold PM. Platelet-derived growth factor stimulates hyaluro-nate but not proteoglycan synthesis by human fibroblasts in vitro. J Dental Res 1993;72:1473−80.

Irwin CR, Schor SL, Ferguson MW. Effects of cytokines on gin-gival fibroblasts in vitro are modulated by the extracellular ma-trix. J Periodont Res 1994; 29(5): 309−17.

Rabasseda X. The role of hyaluronic acid in the management of periodontal disease. Drugs Today (Barc) 2000; 36(Suppl C): 1−20.