A Comparative Clinical Study between Concentrated Growth Factor and Low-Level Laser Therapy in the Management of Dry Socket

Abstract

Objective A dry socket is a well-recognized complication of wound healing following tooth extraction. Its etiology is poorly understood and commonly occur among healthy patients. As such, management strategies for dry socket has always been empirical rather than scientific with varying outcome. The aim of this study is to investigate the efficacy of concentrated growth factor (CGF) and low-level laser therapy (LLLT) and compared them to the conventional treatment in the management of dry socket.

Materials and Methods Sixty patients with one dry socket each, at University Dental Hospital Sharjah, were divided into three treatment groups based on their choice. In group I (n = 30), conventional treatment comprising of gentle socket curettage and saline irrigation was done. Group II (n = 15) dry sockets were treated with CGF and group III (n = 15) sockets were lased with LLLT. All dry socket patients were seen at day 0 for treatment and subsequently followed-up at 4, 7, 14, and 21 days. Pain score, perisocket inflammation, perisocket tenderness, and amount of granulation tissue formation were noted.

Statistical Analysis Data were analyzed as mean values for each treatment group. Comparisons were made for statistical analysis within the group and among the three groups to rank the efficacy of treatment using one-way analysis of variance (ANOVA). Statistically significant difference is kept at p < 0.05.

Results  Conventional treatment group I took more than 7 days to match the healing phase of group II CGF treated socket and group III LLLT irradiated socket (p = 0.001). When healing rate between CGF and LLLT are compared, LLLT group III showed a delay of 4 days compared with CGF in granulation tissue formation and pain control.

Conclusion  CGF treated socket was superior to LLLT in its ability to generate 75% granulation tissue and eliminate pain symptom by day 7 (p = 0.001).

Keywords

dry socket - granulation tissue - low-level laser therapy - concentrated growth factor

Publication History

Article published online:
10 August 2020

• References

• 1 Almutairi BM. Dry sockets-a systemic review. Advancements in Life Sciences 2019; 7: 48-57
• 2 Mamoun J. Dry socket etiology, diagnosis, and clinical treatment techniques. J Korean Assoc Oral Maxillofac Surg 2018; 44 (02) 52-58
• 3 Halberstein RA, Abrahmsohn GM. Clinical management and control of alveolalgia (“dry socket”) with vitamin C. Am J Dent 2003; 16 (03) 152-154
• 4 Dubovina D, Mihailović B, Bukumirić Z. et al. The use of hyaluronic and aminocaproic acid in the treatment of alveolar osteitis. Vojnosanit Pregl 2016; 73 (11) 1010-1015
• 5 Ansari A, Joshi S, Garad A, Mhatre B, Bagade S, Jain R. A study to evaluate the efficacy of honey in the management of dry socket. Contemp Clin Dent 2019; 10 (01) 52-55
• 6 Lone PA, Ahmed SW, Prasad V, Ahmed B. Role of turmeric in management of alveolar osteitis (dry socket): a randomised clinical study. J Oral Biol Craniofac Res 2018; 8 (01) 44-47
• 7 Supe NB, Choudhary SH, Yamyar SM, Patil KS, Choudhary AK, Kadam VD. Efficacy of alvogyl (combination of iodoform + butylparaminobenzoate) and zinc oxide eugenol for dry socket. Ann Maxillofac Surg 2018; 8 (02) 193-199
• 8 Çebi AT. Evaluation of the effects of intra-alveolar irrigation with clindamycin, rifampicin and sterile saline in alveolar osteitis treatment. J Stomatol Oral Maxillofac Surg 2020; 2468-7855
• 9 Prataap N, Sunil PM, Sudeep CB, Ninan VS, Tom A, Arjun MR. Platelet-rich plasma and incidence of alveolar osteitis in high-risk patients undergoing extractions of mandibular molars: a case-control study. J Pharm Bioallied Sci 2017; 9 (suppl 1) S173-S179
• 10 Xu Y, Qiu J, Sun Q. et al. One-year results evaluating the effects of concentrated growth factors on the healing of intrabony defects treated with or without bone substitute in chronic periodontitis. Med Sci Monit 2019; 25: 4384-4389
• 11 Masuki H, Okudera T, Watanebe T. et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent 2016; 2 (01) 19
• 12 Tanaka E, Kuroda S, Horiuchi S, Tabata A, El-Bialy T. Low-intensity pulsed ultrasound in dentofacial tissue engineering. Ann Biomed Eng 2015; 43 (04) 871-886
• 13 Parihar AS, Pathak R. Effect of low level laser therapy (LLLT) on post extraction wound healing. Journal of Advanced Medical and Dental Sciences Research 2018; 6: 6-14
• 14 Corigliano M, Sacco L, Cipollina A, Crescentini F, Baldoni E. Concentrated Growth Factors (CGFs) in the restorative tissue techniques. J Dent Res 2010; 89: 4691
• 15 Malli Sureshbabu N, Selvarasu K, V. JK, Nandakumar M, Selvam D. Concentrated growth factors as an ingenious biomaterial in regeneration of bony defects after periapical surgery: a report of two cases. Case Rep Dent 2019; 2019: 7046203
• 16 Jin R, Song G, Chai J, Gou X, Yuan G, Chen Z. Effects of concentrated growth factor on proliferation, migration, and differentiation of human dental pulp stem cells in vitro. J Tissue Eng 2018; 9: 2041731418817505
• 17 Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 2012; 40 (02) 516-533
• 18 Hamad SA, Naif JS, Abdullah MA. Effect of diode laser on healing of tooth extraction socket: an experimental study in rabbits. J Maxillofac Oral Surg 2016; 15 (03) 308-314
• 19 Eshghpour M, Ahrari F, Najjarkar NT, Khajavi MA. Comparison of the effect of low level laser therapy with alvogyl on the management of alveolar osteitis. Med Oral Patol Oral Cir Bucal 2015; 20 (03) e386-e392
• 20 Kesler G, Shvero DK, Tov YS, Romanos G. Platelet derived growth factor secretion and bone healing after Er:YAG laser bone irradiation. J Oral Implantol 2011; 37 (Spec No) 195-204
• 21 Haraji A, Lassemi E, Motamedi MH, Alavi M, Adibnejad S. Effect of plasma rich in growth factors on alveolar osteitis. Natl J Maxillofac Surg 2012; 3 (01) 38-41
• 22 Rutkowski JL, Johnson DA, Radio NM, Fennell JW. Platelet rich plasma to facilitate wound healing following tooth extraction. J Oral Implantol 2010; 36 (01) 11-23
• 23 Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents 2012; 26 (2, suppl 1) 3S-22S
• 24 Khan BT, Kiani MN, Saeed MHB. et al. Risk factors assessment for dry sockets: A logistic regression analysis study. J Oral Maxillofac Surg Med Pathol 2015; 27: 753-756
• 25 Rakhshan V. Common risk factors of dry socket (alveolitis osteitis) following dental extraction: a brief narrative review. J Stomatol Oral Maxillofac Surg 2018; 119 (05) 407-411
• 26 Fortunato L, Bennardo F, Buffone C, Giudice A. Is the application of platelet concentrates effective in the prevention and treatment of medication-related osteonecrosis of the jaw? A systematic review. J Craniomaxillofac Surg 2020; 48 (03) 268-285
• 27 Kreisler M, Christoffers AB, Al-Haj H, Willershausen B, d’Hoedt B. Low level 809-nm diode laser-induced in vitro stimulation of the proliferation of human gingival fibroblasts. Lasers Surg Med 2002; 30 (05) 365-369
• 28 Basso FG, Pansani TN, Turrioni AP, Bagnato VS, Hebling J, de Souza Costa CA. In vitro wound healing improvement by low-level laser therapy application in cultured gingival fibroblasts. Int J Dent 2012; 2012: 719452
• 29 Saygun I, Karacay S, Serdar M, Ural AU, Sencimen M, Kurtis B. Effects of laser irradiation on the release of basic fibroblast growth factor (bFGF), insulin like growth factor-1 (IGF-1), and receptor of IGF-1 (IGFBP3) from gingival fibroblasts. Lasers Med Sci 2008; 23 (02) 211-215
• 30 Posten W, Wrone DA, Dover JS, Arndt KA, Silapunt S, Alam M. Low-level laser therapy for wound healing: mechanism and efficacy. Dermatol Surg 2005; 31 (03) 334-340
• 31 Peplow PV, Chung T-Y, Baxter GD. Laser photobiomodulation of proliferation of cells in culture: a review of human and animal studies. Photomed Laser Surg 2010; 28 (Suppl. 01) S3-S40
• 32 van CR Roeyen, Ostendorf T, Floege J. The platelet-derived growth factor system in renal disease: an emerging role of endogenous inhibitors. Eur J Cell Biol 2012; 91 (6-7) 542-551
• 33 Chanprapaph K, Vachiramon V, Rattanakaemakorn P. Epidermal growth factor receptor inhibitors: a review of cutaneous adverse events and management. Dermatol Res Pract 2014; 2014: 734249