Efficacy of a topical gel containing chitosan, chlorhexidine, allantoin and dexpanthenol for pain and inflammation control after third molar surgerya randomized and placebo-controlled clinical trial

  1. Luis Miguel Sáez Alcaide 1
  2. Pedro Molinero Mourelle 2
  3. José González Serrano 1
  4. Luis Jesús Rubio Alonso 1
  5. Michael M. Bornstein 3
  6. Juan López Quiles 1
  1. 1 Department of Dental Clinical Specialties. Faculty of Dentistry, Complutense University, Madrid, Spain
  2. 2 Department of Conservative Dentistry and Orofacial Prosthetics. Faculty of Dentistry, Complutense University, Madrid, Spain
  3. 3 Applied Oral Sciences and Community Dental Care. Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Revista:
Medicina oral, patología oral y cirugía bucal. Ed. inglesa

ISSN: 1698-6946

Año de publicación: 2020

Volumen: 25

Número: 5

Páginas: 10

Tipo: Artículo

DOI: 10.4317/MEDORAL.23661 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Medicina oral, patología oral y cirugía bucal. Ed. inglesa

Resumen

The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery. A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n=72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product. Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p=0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered ‘good’ in 22.2% for the CG and 97.2% for the EG (p<0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56±1,19) compared to the placebo group (3.25±1.6) (p=0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26±0.51) in comparison to the CG (0.56±0.67) (p=0.003). The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal.

Referencias bibliográficas

  • Friedman, JW. (2007). The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 97. 1554
  • Lee, CT,Zhang, S,Leung, YY,Li, SK,Tsang, CC,Chu, CH. (2015). Patients' satisfaction and prevalence of complications on surgical extraction of third molar. Patient Prefer Adherence. 9. 257
  • Cobo-Vázquez, C,Fernández-Tresguerres, I,Ortega-Aranegui, R,López- Quiles, J. (2014). Effects of local melatonin application on post-extraction sockets after third molar surgery. A pilot study. Med Oral Patol Oral Cir Bucal. 19. 628
  • Bouloux, GF,Steed, MB,Perciaccante, VJ. (2007). Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 19. 117
  • Caso, A,Hung, LK,Beirne, OR. (2005). Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 99. 155
  • Zhou, J,Hu, B,Liu, Y,Yang, Z,Song, J. (2017). The efficacy of intra-alveolar 0.2% chlorhexidine gel on alveolar osteitis: a meta-analysis. Oral Dis. 23. 598-608
  • Torres-Lagares, D,Infante-Cossio, P,Gutierrez-Perez, JL,Romero-Ruiz, MM,Garcia-Calderon, M,Serrera-Figallo, MA. (2006). Intra-alveolar chlorhexidine gel for the prevention of dry socket in mandibular third molar surgery. A pilot study. Med Oral Patol Oral Cir Bucal. 11. 179
  • Rubio-Palau, J,Garcia-Linares, J,Hueto-Madrid, JA,Gonzalez-Lagunas, J,Raspall-Martin, G,Mareque-Bueno, J. (2015). 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 Patol Oral Cir Bucal. 20. 117
  • Eshghpour, M,Danaeifar, N,Kermani, H,Nejat, AH. (2018). Does Intra-Alveolar Application of chlorhexidine gel in combination with platelet-rich fibrin have an advantage over application of platelet-Rich fibrin in decreasing alveolar osteitis after mandibular third molar surgery? A double-blinded randomized clinical trial. J Oral Maxillofac Surg. 76. 939
  • Cho, H,Lynham, AJ,Hsu, E. (2017). Postoperative interventions to reduce inflammatory complications after third molar surgery: review of the current evidence. Aust Dent J. 62. 412
  • Cicciù, M,Fiorillo, L,Cervino, G. (2019). Chitosan Use in Dentistry: A Systematic Review of Recent Clinical Studies. Mar Drugs. 17. 417
  • Lopez-Lopez, J,Jan-Palli, E,Gonzalez-Navarro, B,Jane-Salas, E,Estrugo-Devesa, A,Milani, M. (2015). Efficacy of chlorhexidine, dexpanthenol, allantoin and chitosan gel in comparison with bicarbonate oral rinse in controlling post-interventional inflammation, pain and cicatrization in subjects undergoing dental surgery. Curr Med Res Opin. 31. 2179
  • Madrazo-Jiménez, M,Rodríguez-Caballero, Á,Serrera-Figallo, MÁ,Garrido-Serrano, R,Gutiérrez-Corrales, A,Gutiérrez-Pérez, JL. (2016). The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction. Med Oral Patol Oral Cir Bucal. 21. 696-702
  • Malmquist, JP,Clemens, SC,Oien, HJ,Wilson, SL. (2008). Hemostasis of oral surgery wound with the HemCon Dental Dressing. J Oral Maxillofac Surg. 66. 1177
  • Schulz, KF,Altman, DG,Moher, D,Group, C. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMC Med. 8. 18
  • Small, LT,Lampkin, M,Vural, E,Moreno, MA. (2019). American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps. Otolaryngol Head Neck Surg. 161. 91
  • Sainz de Baranda, B,Silvestre, FJ,Silvestre-Rangil, J. (2019). Relationship between surgical difficulty of third molar extraction under local anesthesia and the postoperative evolution of clinical and blood parameters. J Oral Maxillofac Surg. 77. 1337
  • Haraji, A,Rakhshan, V,Khamverdi, N,Alishahi, HK. (2013). Effects of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on dry socket incidence and postsurgical pain: a double-blind split-mouth randomized controlled clinical trial. J Orofac Pain. 27. 256
  • Amin, MM,Laskin, DM. (1983). Prophylactic use of indometacin for prevention of postsurgical complications after removal of impacted third molars. Oral Surg. 55. 448
  • Blum, IR. (2002). Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. Int J Oral Maxillofac Surg. 31. 309
  • Bello, SA,Adeyemo, WL,Bamgbose, BO,Obi, EV,Adeyinka, AA. (2011). Effect of age, impaction types and operative time on inflammatory tissue reactions following lower third molar surgery. Head Face Med. 7. 8-16
  • Rodríguez Sánchez, F,Rodríguez Andrés, C,Arteagoitia Calvo, I. (2017). Does chlorhexidine prevent alveolar osteitis after third molar extractions? Systematic review and meta-analysis. J Oral Maxillofac Surg. 75. 901
  • Thesome, A. (2017). The efficacy of chlorhexidine gel in the prevention of alveolar osteitis after mandibular third molar extraction: a systematic review and meta-analysis. BMC Oral Health. 17. 82
  • Shariatinia, Z,Jalali, A. (2018). Chitosan-based hydrogels: Preparation, properties and applications. Int J Biol Macro. 115. 194-220
  • Ebner, F,Heller, A,Rippke, F,Tausch, I. (2002). Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol. 3. 427
  • Flötra, L,Gjermo, P,Rölla, G,Waerhaug, J. (1971). Side effects of hlorhexidine mouth washes. Scand J Dent Res. 79. 119
  • Koray, M,Ofluoglu, D,Onal, EA,Ozgul, M,Ersev, H,Yaltirik, M. (2014). Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars. Int J Oral Maxillofac Surg. 43. 1399
  • Hasheminia, D,Moaddabi, A,Moradi, S,Soltani, P,Moannaei, M,Issazadeh, M. (2018). The efficacy of 1% Betadine mouthwash on the incidence of dry socket after mandibular third molar surgery. J Clin Exp Dent. 10. 445
  • Giammarinaro, E,Cosola, S,Oldoini, G,Gulia, F,Peñarrocha-Oltra, D,Marconcini, S. (2019). Local formula with mucoadhesive propery: A randomized clinical trial of a therapeutic agent for the treatment of oral apthous ulcers. J Contemp Dent Pract. 20. 1249
  • Cosola, S,Giammarinaro, E,Marconcini, S,Lelli, M,Lorenzi, C,Genovesi, AM. (2019). Prevention of bacterial colonization on suture threads after oral surgery: comparison between propolis- and chlorhexidine-based formulae. J Biol Regul Homeost Agent. 33. 1275
Fuente de los datos: Dialnet