Role of Vitamin E in Reducing Dry Socket
Condition: Dry Socket
MeSH terms: Dry Socket
Study type: Interventional
Phase: Phase 4

Summary: 
      90 female patients seeking extraction of a single tooth in the lower posterior region were
      divided randomly into 45 patients received vitamin E inside the socket after extraction
      (study group) and 45 patients didn't receive vitamin E after extraction (control group).
    

Detailed description: 
      I. Patient Selection and Grouping:

      This study was conducted on a total number of 90 female patients seeking extraction of a
      single tooth in the lower posterior region, selected from those attending the outpatient
      clinic of the oral and maxillofacial surgery department in the faculty of dentistry, Ain
      Shams University and Misr University for Science & Technology, Egypt as divided randomly into
      45 patients received vitamin E inside the socket after extraction (study group) and 45
      patients didn't receive vitamin E after extraction (control group).

      II. Sample Size Calculation:

      In the prior assessment of the article by Haraji et al. (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) and setting alpha at 0.05 and
      Beta at 0.8 the data showed that the minimum number of patients to be included in each group
      was 18.

      III. Blinding\Masking:

      Blinding of biostatistician was achieved while blinding of participants and operator wasn't
      possible as the operator is the outcome assessor.

      IV. Research Ethics Approval:

      The research was reviewed by the Research Ethics Committee (REC) of the Faculty of Dentistry,
      Ain Shams University.

      V. Preoperative Assessment:

        1. Patient Evaluation:

           Each female has been evaluated for the following:

           A. Medical History:

           Full medical history was taken to exclude any patient according to the exclusion
           criteria.

           B. Dental History:

           Full dental history was taken including the history of previous incidences of dry
           socket.

           C. Chief Complaint All patients were asked about the current dental chief complaint to
           exclude any patient who needed dental treatment other than extraction.

        2. Clinical Examination:

           A. Extra-Oral Examination:

           All patients were examined by the operator including facial appearance and facial bone.

           B. Intra-Oral Examination:

           This examination included:

             -  General examination of oral health, checking the teeth adjacent to the extracted
                tooth and oral hard and soft tissues.

             -  Examination of extracted tooth including tenderness and mobility tests.

        3. Radiographic Assessment Radiographic assessment was done using a periapical radiograph
           to examine the surrounding bone, exclude any pathological lesion, and detect the
           location of the inferior alveolar canal, especially during extraction of lower third
           molars.

        4. Photography:

           Intra-oral Photographs were taken before establishing the surgical procedure. Figure (1)

        5. Surgical Preparation:

      A. Anesthetic Protocol:

      The extraction procedures were done under local anesthesia using 4% articaine solution with
      adrenaline 1:100,000, as 1.2 ml for Inferior Alveolar Nerve block (IANB), 0.3 ml for lingual
      nerve block and 0.3 ml for long buccal nerve block on the side of the extraction.

      B. Preparation of Gel Foam and Vitamin E:

      A piece of gel foam was cut into 1 X1 cm2.

      C. Extraction Procedure:

        -  All extractions were performed by the same surgeon using standard English-Style Vertical
           Hinge forceps in a standardized buccolingual technique for socket expansion.

        -  The extraction procedures were done simply using forceps or elevators without raising
           mucoperiosteal flaps or anything that make the procedure surgical. Figure (2)

      D. Packing of the Gel Foam:

      The prepared gel foam was packed inside the socket to be covering the walls of the socket and
      not be oversized.

      E. Suture with Figure 8:

      A horizontal Figure 8 suture was applied for stabilization. Figure (3)

      F. Post-Operative Instructions:

        -  Keep biting on the gauze for 1 hour.

        -  Avoid eating or drinking hot stuff on the first post-extraction day.

        -  Soft and cold food can be consumed after 2 hours on the other side.

        -  Avoid rinsing for the next 24 hours after extraction.

        -  Rinsing the mouth with warm saline 3 times daily on the 2nd day and continued for 5
           days.

        -  Avoid smoking.

        -  Rest and avoid strenuous activities for the remainder of the day.

        -  Patients were given a prescription for Diclofenac Potassium to be used twice daily for
           three days.
    

Intervention name(s): Vitamin E application
Intervention type(s): Drug
Intervention description(s): patients received vitamin E inside the socket after extraction
Other intervention name(s): tocopherol
Intervention MeSH terms: Vitamin E; Tocopherols
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized clinical trial two groups
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: dry socket