Evaluating the effectiveness of advanced platelet-rich fibrin, photobiomodulation, pentoxifylline, and Alveogyl in the treatment of alveolar osteitis: a randomized controlled clinical trial.

Abstract

Background: Alveolar osteitis is a type of small-scale osteomyelitis of the alveolar bone that occurs after tooth extraction, the etiology of which remains unknown, and alternative methods are being investigated for its treatment. The aim of this study was to compare the effectiveness of advanced platelet-rich fibrin (A-PRF), photobiomodulation (PBM), and Alveogyl (butamben, idoform, eugenol), which have shown success in the treatment of alveolar osteitis, with that of pentoxifylline (PTX) to determine whether PTX could be an alternative treatment for alveolar osteitis.

Methods: This study included 80 healthy volunteers diagnosed with alveolar osteitis in the extraction sockets of their mandibular first, second, and third molars. The patients were divided into four groups, with 20 patients in each group: A-PRF, PBM, PTX, and Alveogyl. After physiological saline irrigation, the patients were treated according to their respective group. The patients were followed up on the 2nd, 4th, 7th, and 14th days. Primary outcomes included pain assessment and the evaluation of soft tissue healing. Pain was assessed via the visual analog scale (VAS), soft tissue healing was evaluated via the Landry Healing Index (LHI), and granulation tissue was measured. Age and sex were used as study variables. The data were analyzed via ANOVA and post hoc tests to compare the treatment groups.

Results: There was no statistically significant difference in the mean VAS score between the groups (p > 0.05). However, the degree of reduction in the VAS score increased in the following order: A-PRF, PBM, PTX, and Alveogyl. In the LHI data, there was a statistically significant difference in the mean scores between the groups, with Alveogyl being favored preoperatively and PBM being favored at the 2nd week (p < 0.05). Statistically significant differences were observed in granulation tissue measurements on the preoperative day, as well as on Days 4 and 7, in favor of Alveogyl on Day 4 and PBM on Day 7 (p < 0.05). The greatest increase in granulation tissue scores was observed in the A-PRF group, whereas the greatest change in LHI scores was observed in the PBM group. PTX did not produce a statistically significant difference in soft tissue healing, although there were periods when it showed results similar to those of Alveogyl and PBM. There were significant differences between the VAS score, granulation tissue score and LHI score in terms of age and sex within the time periods followed.

Conclusion: The findings of this study indicate that although PTX has similar efficacy in terms of wound healing and analgesic properties to the methods used, it does not offer significant advantages. Compared with other methods, A-PRF and PBM have provided better results in the treatment of alveolar osteitis, particularly regarding pain and soft tissue healing.

Trial registration: The study was retrospectively registered in the clinical trial registry with the number TCTR20231014003 on 14.10.2023.