Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial.

OBJECTIVES: The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. MATERIAL AND METHODS: A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher's exact test. RESULTS: A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. CONCLUSION: Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. CLINICAL RELEVANCE: Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.

Reconstruction of the mandible with an autogenous irradiated cortical scaffold, autogenous corticocancellous bone-graft and autogenous platelet-rich-plasma: an animal experiment.

This paper reports on an experimental animal study evaluating a method of mandibular reconstruction using irradiated cortical scaffolds. Twelve goats underwent a continuity resection at the mandibular angle. Primary reconstruction was carried out using specially designed osteosynthesis plates and screws. The defect was bridged by the original, irradiated cortical scaffold, which was filled with an autogenous particulate bone graft from the anterior iliac crest. To accelerate bone healing, platelet rich plasma (PRP) was mixed with the particulate bone graft. The hypothesis of this study was that bone healing in segmental reconstruction of the goat mandible by means of an irradiated cortical scaffold, filled with a particulate cancellous bone graft mixed with PRP, would be as successful as when using a non-irradiated scaffold. All goats had an uneventful healing. The osteosynthesis plates and screws withstood immediate loading for periods varying from three to six weeks. The radiologic and histologic results were less favourable with regard to bone remodelling than the results obtained in similar experiments with non-irradiated cortical bone scaffolds.

Reconstruction of the mandible using preshaped 2.3 mm titanium plates, autogenous particulate cortico-cancellous bone grafts and platelet rich plasma: a report on eight patients.

The results are presented of eight patients who had partial mandibulectomies for malignant tumours and were secondarily reconstructed with pre-shaped 2.3 mm titanium plates, autogenous particulate cortico-cancellous bone grafts and platelet rich plasma. Healing was uneventful in all cases and when prosthodontically needed, implants were inserted after approximately 6 months, whilst biopsies were taken. The histology showed bone remodelling in six cases, whilst in one case after 6 months the bone was largely replaced by abundant fibrous tissue. In this case the implants were lost after 9 months. In one case a new carcinoma developed after 6 months with subsequent death of the patient. Thus, in six patients adequate results were achieved with adequate functional and aesthetic outcome, given the poor conditions of the surrounding tissues. This method provides three-dimensional reconstruction with sufficient bone height and volume to facilitate prosthodontic treatment.

Mandibular reconstruction: a histological and histomorphometric study on the use of autogenous scaffolds, particulate cortico-cancellous bone grafts and platelet rich plasma in goats.

Twenty-eight goats underwent a continuity resection of the mandibular angle. In all goats primary reconstruction was carried out using specially designed pre-shaped osteosynthesis plates and monocortical screws. The original cortical scaffold was used to bridge the defect, filled with an autogenous particulate bone graft in 14 goats, whereas platelet-rich-plasma (PRP) was added in another 14 goats. Both groups were divided in three subgroups that were sacrificed after 3, 6 and 12 weeks. Histological and histomorphometric evaluation revealed that the use of PRP enhanced the bone healing considerably. This effect was statistically significant and particularly visible in the 6 and 12 weeks' groups

Mandibular reconstruction: a clinical and radiographic animal study on the use of autogenous scaffolds and platelet-rich plasma.

This paper reports on an experimental animal study evaluating a method of mandibular reconstruction. After a successful pilot study, 28 goats underwent a continuity resection of the mandibular angle. Primary reconstruction was carried out using specially designed osteosynthesis plates and screws. The defect was bridged by the original cortical scaffold, filled with an autogenous bone graft from the iliac crest. To accelerate bone healing, platelet-rich plasma (PRP) was mixed with the particulate bone graft in 14 goats. All goats had uneventful healing. The osteosynthesis plates and screws withstood immediate loading for periods varying from 3 weeks to 3 months. The use of PRP appeared to enhance bone healing considerably.