TERJEMAHAN JURNAL

JUDUL

To irrigate or not to irrigate: Immediate

postextraction socket irrigation and
alveolar osteitis
Motamedi, Mahmood Reza Kalantar. Dental Research Journal 12.3  (May 2015): 289-
290.

PENERJEMAH :
REZKI AN NAJMI FATHAN
NIM : J2A016023

PROGRAM SARJANA KEDOKTERAN GIGI

UNIVERSITAS MUHAMMADIYAH SEMARANG
 2016

Alveolar osteitis (AO), biasa disebut socket kering, diidentifikasi

sebagai sakit parah di atau di sekitar lokasi gigi diekstraksi, mengintensifkan
setiap waktu antara hari-hari pertama pasca operasi dan ketiga, disertai dengan
hilangnya bekuan darah parsial atau total di alveolar socket. [1] AO adalah
komplikasi umum dari ekstraksi dampak molar mandibula ketiga (20-30%) atau
gigi lainnya (1-70%). [6/2]

osteitis alveolar adalah berat dan membatasi diri sakit, membutuhkan beberapa
kunjungan pasca operasi untuk disembuhkan, menyebabkan peningkatan
morbiditas pasien dan biaya. Oleh karena itu, dasar dan pengobatan terbaik adalah
pencegahan.

Beberapa faktor risiko yang mempengaruhi kejadian AO setelah pencabutan gigi

telah diidentifikasi. [1] Faktor risiko yang diidentifikasi paling penting adalah
merokok, [7,8] minum, [9] kebersihan mulut yang buruk, [10,11] usia, [8,11] jenis
kelamin perempuan, [7,8,12] dan pencabutan gigi traumatis. [ 8,9] Namun, peran
irigasi postextraction dan hisap dari soket segar belum diselidiki secara
menyeluruh

Secara tradisional, setelah ekstraksi gigi, soket irigasi dan disedot dengan jumlah
berlebihan saline normal (NS). Teknik ini end-of-operasi memungkinkan
penghapusan puing-puing dari soket. Beberapa dokter gigi percaya bahwa dengan
pengecualian dari puing-puing, penyembuhan bisa berjalan dengan normal. Di sisi
lain, tujuan dari operator adalah untuk mempertahankan bekuan darah dalam soket
segar untuk mengurangi kejadian AO. Perlu dicatat bahwa irigasi dengan jumlah
besar NS diikuti oleh pengisapan dari soket dapat membasuh bekuan darah segar,
dan pendarahan mungkin tidak terisi kembali lagi dalam soket. [13] Oleh karena
itu, pertanyaan apakah socket harus diairi setelah ekstraksi masih dalam
perdebatan.
 Tujuan dari laporan ini adalah untuk secara sistematis meninjau uji coba
sebelumnya acak kontrol (RCT) mengenai pengaruh end-of-operasi irigasi
terhadap kejadian AO.
database elektronik digeledah dengan "osteitis alveolar" atau "dry socket," dan
"irigasi" atau "lavage" sebagai kata kunci untuk judul dan abstrak. Selain itu,
referensi dari artikel ditinjau.
Ulasan ini termasuk uji coba kontrol diterbitkan sampai dengan 24 Februari 2014,
dalam database bahasa Inggris termasuk PubMed, Scopus, EBSCO, Ovid
Medline, dan Cochrane register pusat untuk percobaan kontrol, yang kembali 25,
23, 38, 80, dan 10 hasil, masing-masing . Hasil semua database tersebut serupa
dengan yang dari PubMed
kriteria inklusi terbatas pada artikel jurnal pada calon, split-mulut, dan
RCT. Kriteria eksklusi meliputi terpenuhinya salah satu atau semua kriteria
inklusi, tidak menggunakan plasebo, dan hasil dari bunga menjadi selain kejadian
AO

Dari 25 artikel diidentifikasi di PubMed, tiga studi yang relevan dengan subjek
penelitian ini. Teks-teks penuh artikel yang tersisa tiga diperoleh dan dievaluasi
untuk memenuhi kriteria inklusi / eksklusi. Akhirnya, hanya satu split-mulut RCT
memenuhi kriteria inklusi. [13] Dua penelitian lain [14,15] dikeluarkan karena
mereka dievaluasi hanya kejadian AO untuk besar (175 ml NS solusi) dan jumlah
kecil (<25 ml) irigasi dan tidak termasuk kelompok plasebo (non irigasi socket).
Dalam studi yang dipilih tunggal, irigasi tradisional akhir-of-operasi dari soket
secara signifikan meningkatkan risiko kejadian AO. [13] Penelitian ini
melaporkan bahwa pasien yang lebih muda lebih mungkin untuk mengalami
pendarahan dinding soket dan repopulation darah bahkan setelah lavage luas
sebagai lawan pasien yang lebih tua. Soket dari pasien yang lebih tua mungkin
lebih sensitif terhadap end-of-operasi irigasi. Namun, aturan prinsip ekstraksi gigi
harus diperhitungkan, yaitu, irigasi harus digunakan ketika puing-puing terlihat
dalam soket atau di bawah flap periosteal untuk mencegah abses subperiosteal.
Meskipun NS irigasi keren diperlukan selama pengeboran tulang untuk mencegah
kenaikan suhu tulang, itu harus digunakan secara selektif setelah ekstraksi selesai.
Irigasi dengan NS steril disampaikan oleh jarum suntik tangan monoject
cenderung untuk mencuci darah dan penurunan socket perdarahan pergi segar.
pendarahan mungkin atau mungkin tidak terisi kembali dalam soket sering
meninggalkan soket kosong atau penuh NS bukan darah
berbagai kesulitan bedah (tingkat impaksi) di kedua sisi mulut dapat dianggap
sebagai variabel pengganggu, yang tidak diperhitungkan dalam studi yang dipilih.
Keterbatasan lainnya termasuk seorang ahli bedah tangan kanan beroperasi hanya
pada sisi kanan dan soket eksperimental yang tepat. Memiliki untuk beroperasi di
sisi kontralateral dapat menambah kesulitan operasi dan akibatnya dapat
meningkatkan trauma. Selanjutnya, pencabutan gigi traumatis dapat meningkatkan
risiko kejadian AO. [1] Keterbatasan lain adalah ukuran sampel yang kecil yang
digunakan dalam studi yang dipilih. Dari tiga artikel teks lengkap diperoleh, [13-
15] dua dikeluarkan. [14,15] Mereka adalah studi tua, yang diterbitkan pada tahun
1976 dan 1977. Selain itu, karena penelitian ini percaya pada teknik postextraction
tradisional yang melibatkan menggunakan irigasi berlebihan untuk soket, mereka
hanya dibandingkan jumlah yang berbeda dari irigasi tanpa kelompok plasebo
(non irigasi socket). Namun, Tolstunov [13] menyoroti faktor risiko baru untuk
kejadian AO yang harus dievaluasi lebih teliti dalam studi masa depan.

Seperti dapat dilihat, ada sedikit penelitian yang dirancang dengan baik pada
akhir-of-operasi irigasi dan kejadian AO. Oleh karena itu, penelitian lebih lanjut
diperlukan pada double-blind, RCT split-mulut dengan kontrol yang lebih pada
faktor-faktor risiko AO disertakan.
Kesimpulannya, irigasi tradisional akhir-of-operasi prosedur socket dapat
meningkatkan risiko kejadian AO, terutama pada pasien yang lebih tua. socket
alami pendarahan di situs ekstraksi menciptakan lingkungan yang baik untuk
pembentukan gumpalan darah yang diperlukan untuk penyembuhan tulang yang
baik dari soket. Kesimpulan dari penelitian ini harus dipertimbangkan dengan
hati-hati karena penulis percaya bahwa lebih prospektif RCT diperlukan untuk
memvalidasi mereka.

Bagaimana mengutip artikel ini: Motamedi MK. Untuk mengairi atau tidak untuk
mengairi: irigasi postextraction socket Segera dan osteitis alveolar. Dent Res J
2015; 12: 289-90. Sumber Dukungan: Nil. Benturan Kepentingan: Para penulis
naskah ini menyatakan bahwa mereka tidak memiliki konflik kepentingan, nyata
atau dirasakan, keuangan atau non-keuangan dalam artikel ini.

Referensi

1. 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;31:309-17.

2. Berwick JE, Lessin ME. Effects of a chlorhexidine gluconate oral rinse on the
incidence of alveolar osteitis in mandibular third molar surgery. J Oral Maxillofac
Surg 1990;48:444-8.

3. Larsen PE. Alveolar osteitis after surgical removal of impacted mandibular

third molars. Identification of the patient at risk. Oral Surg Oral Med Oral Pathol
1992;73:393-7.

4. Larsen PE. The effect of a chlorhexidine rinse on the incidence

of alveolar osteitis following the surgical removal of impacted mandibular third
molars. J Oral Maxillofac Surg 1991;49:932-7.

5. Ragno JR Jr, Szkutnik AJ. Evaluation of 0.12% chlorhexidine rinse on the

prevention of alveolar osteitis. Oral Surg Oral Med Oral Pathol 1991;72:524-6.

6. Ritzau M, Hillerup S, Branebjerg PE, Ersbøl BK. Does metronidazole prevent

alveolitis sicca dolorosa? A double-blind, placebo-controlled clinical study. Int J
Oral Maxillofac Surg 1992;21:299-302.
7. Abu Younis MH, Abu Hantash RO. Dry socket: Frequency, clinical picture,
and risk factors in a Palestinian dental teaching center. Open Dent J 2011;5:7-12.

8. Kolokythas A, Olech E, Miloro M. Alveolar osteitis: A comprehensive review

of concepts and controversies. Int J Dent 2010;2010:249073.

9. Halabí D, Escobar J, Muñoz C, Uribe S. Logistic regression analysis of risk

factors for the development of alveolar osteitis. J Oral Maxillofac Surg
2012;70:1040-4.

10. Cardoso CL, Rodrigues MT, Ferreira Júnior O, Garlet GP, de Carvalho PS.
Clinical concepts of dry socket. J Oral Maxillofac Surg 2010;68:1922-32.

11. Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD.
Frequency estimates and risk factors for postoperative morbidity after third molar
removal: A prospective cohort study. J Oral Maxillofac Surg 2008;66:2276-83.

12. Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar
removal: Risk indicators for extended operation time, postoperative pain, and
complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:438-
46.

13. Tolstunov L. Influence of immediate post-extraction socket irrigation on

development of alveolar osteitis after mandibular third molar removal: A
prospective split-mouth study, preliminary report. Br Dent J 2012;213:597-601.

14. Butler DP, Sweet JB. Effect of lavage on the incidence of localized osteitis in
mandibular third molar extraction sites. Oral Surg Oral Med Oral Pathol
1977;44:14-20.

15. Sweet JB, Butler DP, Drager JL. Effects of lavage techniques with third molar
surgery. Oral Surg Oral Med Oral Pathol 1976;41:152-68.

AuthorAffiliation
Mahmood Reza Kalantar Motamedi1

1Dental Students Research Center, School of Dentistry, Isfahan University of

Medical Sciences, Isfahan, Iran

Address for correspondence:

Dr. Mahmood Reza Kalantar Motamedi, Hezar-Jarib Avenue, School of

Dentistry, Isfahan University of Medical Sciences, Isfahan 81746 - 73461, Iran.

E-mail: kalantardnt@hotmail.com

Word count: 1398
Copyright Isfahan University of Medical Sciences May 2015
 NASKAH ASLI

Alveolar osteitis (AO), commonly referred to as dry socket, is identified as a

severe pain in or around the site of an extracted tooth, intensifying any time
between the first and third postoperative days, accompanied by partial or total
blood clot loss in the alveolarsocket.[1] AO is a common complication of
extraction of impacted mandibular third molar (20-30%) or any other teeth (1-
70%).[2-6]

Alveolar osteitis is a severe and self-limiting pain, requiring several postoperative

visits to be healed, leading to increase in patient morbidity and costs. Therefore,
the basic and the best treatment is prevention.

Several risk factors that affect the incidence of AO after tooth extraction have
been identified.[1] The most important identified risk factors are smoking,[7,8]
drinking,[9] poor oral hygiene,[10,11] age,[8,11] female gender,[7,8,12] and
traumatic exodontia.[8,9] However, the role of postextraction irrigation and
suction of the fresh socket has not yet been thoroughly investigated.

Traditionally, after extraction of a tooth, the socket is irrigated and suctioned with
copious amounts of normal saline (NS). This end-of-surgery technique enables the
removal of debris from the socket. Some dentists believe that by exclusion of
debris, the healing can progress normally.

On the other hand, the goal of an operator is to maintain the blood clot within the
fresh socket to reduce AO incidence. It should be noted that irrigation by large
amounts of NS followed by suctioning of the socket may wash away the fresh
blood clot, and bleeding may not repopulate again in the socket.[13] Therefore,
the question of whether a socket must be irrigated after extraction is still under
debate.
The aim of this report was to systematically review previous randomized control
trials (RCTs) regarding the influence of end-of-surgery irrigation on the incidence
of AO.

Electronic databases were searched with "alveolar osteitis" or "dry socket," and

"irrigation" or "lavage" as keywords for titles and abstracts. In addition, the
references of the articles were reviewed.

This review included control trials published up to February 24, 2014, in English
language databases including PubMed, Scopus, EBSCO, Ovid Medline, and
Cochrane central registers for control trial, which returned 25, 23, 38, 80, and 10
results, respectively. The results of all the aforementioned databases were similar
to those of PubMed.

Inclusion criterion was limited to journal articles on prospective, split-mouth, and

RCTs. The exclusion criteria included nonfulfillment of one or all of the inclusion
criteria, not using placebo, and the outcome of interest being other than AO
incidence.

Of the 25 articles identified in PubMed, three studies were relevant to the subject
of this study. The full texts of the three remaining articles were obtained and
evaluated for compliance with inclusion/exclusion criteria. Finally, only one split-
mouth RCT satisfied the inclusion criteria.[13] The other two studies[14,15] were
excluded because they evaluated only the incidence of AO for large (175 ml NS
solution) and small amounts (<25 ml) of irrigation and did not include any
placebo group (nonirrigated socket). In the single selected study, the traditional
end-of-surgery irrigation of socket significantly increased risk of AO incidence.
[13] This study reported that younger patients were more likely to experience
socket wall bleeding and blood repopulation even after extensive lavage as
opposed to older patients. Sockets of older patients might be more sensitive to
end-of-surgery irrigation. However, principle rules of tooth extraction must be
taken into account, namely, irrigation must be employed when debris is seen
within the socket or under the periosteal flap to prevent subperiosteal abscess.

Although a cool NS irrigation is necessary during bone drilling to prevent an

increase of bone temperature, it must be employed selectively after the extraction
is complete. Irrigation with sterile NS delivered by a hand monoject syringe tends
to wash away fresh blood and decrease socket bleeding. The bleeding may or may
not repopulate in the socket often leaving the socket empty or full of NS instead
of blood.

The varying surgical difficulty (level of impaction) on both sides of a mouth can
be considered as a confounding variable, which was not taken into account in the
selected study. Other limitations include a right-handed surgeon operating only on
the right-hand side and right experimental socket. Having to operate on the
contralateral side may add to the difficulty of the surgery and may consequently
increase trauma. Further, traumatic tooth extraction may increase the risk of AO
incidence.[1] Another limitation was the small sample size employed in the
selected study.

Of the three full-text articles obtained,[13-15] two were excluded.[14,15] They

were old studies, published in 1976 and 1977. Moreover, because these studies
believed in the traditional postextraction technique that involves using copious
irrigation for the socket, they only compared different amounts of irrigation with
no placebo group (nonirrigated socket). However, Tolstunov[13] highlighted a
new risk factor for AO incidence that must be evaluated more thoroughly in future
studies.

As can be seen, there are very few properly designed studies on end-of-surgery
irrigation and incidence of AO. Therefore, further studies are needed on double-
blind, split-mouth RCTs with more control on included AO risk factors.

In conclusion, the traditional end-of-surgery irrigation of socket procedure may

increase the risk of AO incidence, especially in older patients. Natural socket
bleeding at an extraction site creates a favorable environment for the formation of
a blood clot necessary for good osseous healing of the socket. The conclusions of
this study must be considered with caution because the authors believe that more
prospective RCTs are needed to validate them.

Sidebar
How to cite this article: Motamedi MK. To irrigate or not to irrigate: Immediate
postextraction socket irrigation and alveolar osteitis. Dent Res J 2015;12:289-90.

Source of Support: Nil. Conflict of Interest: The authors of this manuscript

declare that they have no conflicts of interest, real or perceived, financial or non-
financial in this article.

References
REFERENCES

1. 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;31:309-17.

2. Berwick JE, Lessin ME. Effects of a chlorhexidine gluconate oral rinse on the
incidence of alveolar osteitis in mandibular third molar surgery. J Oral Maxillofac
Surg 1990;48:444-8.

3. Larsen PE. Alveolar osteitis after surgical removal of impacted mandibular

third molars. Identification of the patient at risk. Oral Surg Oral Med Oral Pathol
1992;73:393-7.

4. Larsen PE. The effect of a chlorhexidine rinse on the incidence

of alveolar osteitis following the surgical removal of impacted mandibular third
molars. J Oral Maxillofac Surg 1991;49:932-7.

5. Ragno JR Jr, Szkutnik AJ. Evaluation of 0.12% chlorhexidine rinse on the

prevention of alveolar osteitis. Oral Surg Oral Med Oral Pathol 1991;72:524-6.
6. Ritzau M, Hillerup S, Branebjerg PE, Ersbøl BK. Does metronidazole prevent
alveolitis sicca dolorosa? A double-blind, placebo-controlled clinical study. Int J
Oral Maxillofac Surg 1992;21:299-302.

7. Abu Younis MH, Abu Hantash RO. Dry socket: Frequency, clinical picture,
and risk factors in a Palestinian dental teaching center. Open Dent J 2011;5:7-12.

8. Kolokythas A, Olech E, Miloro M. Alveolar osteitis: A comprehensive review

of concepts and controversies. Int J Dent 2010;2010:249073.

9. Halabí D, Escobar J, Muñoz C, Uribe S. Logistic regression analysis of risk

factors for the development of alveolar osteitis. J Oral Maxillofac Surg
2012;70:1040-4.

10. Cardoso CL, Rodrigues MT, Ferreira Júnior O, Garlet GP, de Carvalho PS.
Clinical concepts of dry socket. J Oral Maxillofac Surg 2010;68:1922-32.

11. Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD.
Frequency estimates and risk factors for postoperative morbidity after third molar
removal: A prospective cohort study. J Oral Maxillofac Surg 2008;66:2276-83.

12. Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar
removal: Risk indicators for extended operation time, postoperative pain, and
complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:438-
46.

13. Tolstunov L. Influence of immediate post-extraction socket irrigation on

development of alveolar osteitis after mandibular third molar removal: A
prospective split-mouth study, preliminary report. Br Dent J 2012;213:597-601.

14. Butler DP, Sweet JB. Effect of lavage on the incidence of localized osteitis in
mandibular third molar extraction sites. Oral Surg Oral Med Oral Pathol
1977;44:14-20.
15. Sweet JB, Butler DP, Drager JL. Effects of lavage techniques with third molar
surgery. Oral Surg Oral Med Oral Pathol 1976;41:152-68.

AuthorAffiliation
Mahmood Reza Kalantar Motamedi1

1Dental Students Research Center, School of Dentistry, Isfahan University of

Medical Sciences, Isfahan, Iran

Address for correspondence:

Dr. Mahmood Reza Kalantar Motamedi, Hezar-Jarib Avenue, School of

Dentistry, Isfahan University of Medical Sciences, Isfahan 81746 - 73461, Iran.

E-mail: kalantardnt@hotmail.com

Word count: 1398
Copyright Isfahan University of Medical Sciences May 2015