###### Abstract  
Alveolar osteeitis (AO) is one of the complications that occur after tooth extraction. The aim of this study has been to evaluate the efficacy of Advanced Platelet-rich Fibr (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of AO. Consecutive patients who were diagnosed with AO, recruited from patients referred to the Oral Surgery Department of the University of Naples Federico II, were enrolled. After local anesthesia, the dry socket was cureted and irrigated with saline. The Platelet-rich Fibr (PRF) clot was placed in the socket and then covered with an A-PRF membrane. Clinical parameters, such as the degree of pain and rate of granulation tissue (GT) formation, were measured before treatment and after 1, 3, 7, 14, and 21 days. The Friedman test for dependent samples was used to detect the treatment and time effect. Four patients with established AO were included. On all the examination days, the post-operative recovery was uneventful. The pain scores progressively reduced, from an average of 8.5 before treatment to 0.25 on the third day, and the GT formation improved over time. The use of A-PRF in the treatment of AO significantly reduced the pain level and enhanced the wound-healing process.  
case series; alveolar osteeitis; dry socket; platelet-rich fibrin; vasoconstrictor; A-PRF membrane; PRF +
Footnote †: journal: Medical  
embedded [14; 15]. Clinical studies and systematic reviews have reported an advantage in the topical use of APCs in order to support hemostasis and promote bone graft healing [16]. Alpha granules are the main platelet components that contribute to wound healing by means of growth factors (i.e., \"Platelet-Derived Growth Factors\" (PDGF), \"Transforming Growth Factors \(\beta\)1 and \(\beta\)2\" (TGF\(\beta\)1-TGF\(\beta\)2), \"Vascular Endothelial Growth Factor\" (VEGF), \"Insulin-like Growth Factor-1\" (IGF-1), and \"Epidermal Growth Factor (EGF)) [17]. Platelet-rich Fibrin (PRF) represents the second generation of APCs [18]. During the PRF preparation, the polymerization of fibrinogen into fibrin occurs slowly, naturally, and progressively in the presence of physiological thrombin, resulting in a strong natural fibrin meshwork, composed of a tetra molecular structure. This meshwork is able to entrap the activated platelets, leukocytes, and circulating/intrinsic cytokines, favoring their slow release (over seven days) [19; 20].  
In the recent past, different methods have been proposed for the prevention and management of dry socket. Mediated dressings, phototherapy, topical anesthetic gel, Alvogyl, etc., [20] were used mainly for pain relief, but at present, no current evidence-based consensus exists on which modality should be used as the gold standard in the treatment of AO to obtain socket healing. The literature evaluating the effect of PRF on alveolar osteitis is mainly focused on the prevention of this complication, especially after the extraction of the lower third molar [21], where the incidence of AO is higher. Moreover, different platelet concentrates have been used for the management of AO, such as the concentrated growth factor and platelet-rich in growth factors, without giving definitive recommendations [22; 23; 24]. PRF can act as a stable blood clot for neovascularization and tissue healing. The aim of this study has been to evaluate the efficacy of Advanced Platelet-Rich Fibrin (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of dry socket.