Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these risk factors, the treatment led to recovery within two or three days. The patient pretreated with Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively. According to these initial observations, it seems smoking and previous treatment with Alveogyl prolong the treatment of AO using the HA + OCT device that, in turn, shows a rapid effect if these risk factors are not present.

Department of Dentistry Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Sokolská 581 50005 Hradec Králové Czech Republic

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Chow O., Wang R., Ku D., Huang W. Alveolar Osteitis: A Review of Current Concepts. J. Oral Maxillofac. Surg. 2020;78:1288–1296. doi: 10.1016/j.joms.2020.03.026. PubMed DOI

Chytilova K. The Causes of Origin and Present Possibility for Treatment of Alveolitis (A Review) Čes. Stomatol. Zub. Lékařství. 2007;107:22–26.

Fernandes G.J., Hatton M.N. Prevention of Alveolar Osteitis: A Case Report and Review of Literature. N. Y. State Dent. J. 2016;82:21–25. PubMed

Šafářová M. Complications and Disorders in Healing of Extraction Wound. Čes. Stomatol. Zub. Lékařství. 2005;105:154–158.

Daly B., Sharif M.O., Newton T., Jones K., Worthington H.V. Local Interventions for the Management of Alveolar Osteitis (Dry Socket) Cochrane Database Syst. Rev. 2012 doi: 10.1002/14651858.CD006968.pub2. PubMed DOI

Kolokythas A., Olech E., Miloro M. Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies. Int. J. Dent. 2010;2010:249073. doi: 10.1155/2010/249073. PubMed DOI PMC

Almutairi B.M. Dry Sockets—A Systemic Review. Adv. Life Sci. 2019;7:10.

Sweet J.B., Butler D.P. The Relationship of Smoking to Localized Osteitis. J. Oral Surg. 1979;37:732–735. PubMed

Veale B. Alveolar Osteitis: A Critical Review of the Aetiology and Management: Alveolar Osteitis: A Critical Review. Oral Surg. 2015;8:68–77. doi: 10.1111/ors.12130. DOI

Nusair Y.M., Younis M.H.A. Prevalence, Clinical Picture, and Risk Factors of Dry Socket in a Jordanian Dental Teaching Center. J. Contemp. Dent. Pract. 2007;8:53–63. doi: 10.5005/jcdp-8-3-53. PubMed DOI

Taberner-Vallverdu M., Nazir M., Sanchez-Garces M.Á., Gay-Escoda C. Efficacy of Different Methods Used for Dry Socket Management: A Systematic Review. Med. Oral Patol. Oral Cir. Bucal. 2015;20:e633–e639. doi: 10.4317/medoral.20589. PubMed DOI PMC

Kaya G.Ş., Yapici G., Savaş Z., Güngörmüş M. Comparison of Alvogyl, SaliCept Patch, and Low-Level Laser Therapy in the Management of Alveolar Osteitis. J. Oral Maxillofac. Surg. 2011;69:1571–1577. doi: 10.1016/j.joms.2010.11.005. PubMed DOI

Mazánek J., Hubálková H., Staňková H., Šmucler R., Linetskiy I., Seidler V. Dry Socket and the Lenght of Healing Depending on the Type of the Treatment—Part One: Classical Treatment. Čes. Stomatol. Zub. Lékařství. 2011;111:55–60. doi: 10.51479/cspzl.2011.009. DOI

Kalsi H.K., Major R., Jawad H. Alvogyl or Alveogyl? Br. Dent. J. 2020;229:211. doi: 10.1038/s41415-020-2073-x. PubMed DOI

Suchánek J., Ivančaková R., Mottl R., Browne K., Pilneyová K., Pilbauerová N., Schmidt J., Suchánková Kleplová T. Hyaluronic Acid-Based Medical Device for Treatment of Alveolar Osteitis—Clinical Study. Int. J. Environ. Res. Public Health. 2019;16:3698. doi: 10.3390/ijerph16193698. PubMed DOI PMC

Matou-Nasri S., Gaffney J., Kumar S., Slevin M. Oligosaccharides of Hyaluronan Induce Angiogenesis through Distinct CD44 and RHAMM-Mediated Signalling Pathways Involving Cdc2 and Gamma-Adducin. Int. J. Oncol. 2009;35:761–773. doi: 10.3892/ijo_00000389. PubMed DOI

Longaker M.T., Chiu E.S., Adzick N.S., Stern M., Harrison M.R., Stern R. Studies in Fetal Wound Healing. V. A Prolonged Presence of Hyaluronic Acid Characterizes Fetal Wound Fluid. Ann. Surg. 1991;213:292–296. doi: 10.1097/00000658-199104000-00003. PubMed DOI PMC

Chen W.Y., Abatangelo G. Functions of Hyaluronan in Wound Repair. Wound Repair Regen. 1999;7:79–89. doi: 10.1046/j.1524-475X.1999.00079.x. PubMed DOI

Singampalli K.L., Balaji S., Wang X., Parikh U.M., Kaul A., Gilley J., Birla R.K., Bollyky P.L., Keswani S.G. The Role of an IL-10/Hyaluronan Axis in Dermal Wound Healing. Front. Cell Dev. Biol. 2020;8:636. doi: 10.3389/fcell.2020.00636. PubMed DOI PMC

Koburger T., Hübner N.-O., Braun M., Siebert J., Kramer A. Standardized Comparison of Antiseptic Efficacy of Triclosan, PVP-Iodine, Octenidine Dihydrochloride, Polyhexanide and Chlorhexidine Digluconate. J. Antimicrob. Chemother. 2010;65:1712–1719. doi: 10.1093/jac/dkq212. PubMed DOI

Hübner N.-O., Siebert J., Kramer A. Octenidine Dihydrochloride, a Modern Antiseptic for Skin, Mucous Membranes and Wounds. Skin Pharmacol. Physiol. 2010;23:244–258. doi: 10.1159/000314699. PubMed DOI

Dogan A.A., Cetin E.S., Hüssein E., Adiloglu A.K. Microbiological Evaluation of Octenidine Dihydrochloride Mouth Rinse after 5 Days’ Use in Orthodontic Patients. Angle Orthod. 2009;79:766–772. doi: 10.2319/062008-322.1. PubMed DOI

Briese V., Neumann G., Waldschläger J., May T.W., Siebert J., Gerber B. Efficacy and Tolerability of a Local Acting Antiseptic Agent in the Treatment of Vaginal Dysbiosis during Pregnancy. Arch. Gynecol. Obstet. 2011;283:585–590. doi: 10.1007/s00404-010-1414-4. PubMed DOI

Mottl R., Kunderová M., Suchánek J., Duška J., Slezák R. Treatment of alveolar osteitis with hyaluronic acid-based medical formulation. A prospective clinical study. LKS. 2021 accepted for publication.

Alexander R.E. Dental Extraction Wound Management: A Case against Medicating Postextraction Sockets. J. Oral Maxillofac. Surg. 2000;58:538–551. doi: 10.1016/S0278-2391(00)90017-X. PubMed DOI

Cohen M.E., Simecek J.W. Effects of Gender-Related Factors on the Incidence of Localized Alveolar Osteitis. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 1995;79:416–422. doi: 10.1016/S1079-2104(05)80120-9. PubMed DOI

Blum I.R. Contemporary Views on Dry Socket (Alveolar Osteitis): A Clinical Appraisal of Standardization, Aetiopathogenesis and Management: A Critical Review. Int. J. Oral Maxillofac. Surg. 2002;31:309–317. doi: 10.1054/ijom.2002.0263. PubMed DOI

Eshghpour M., Rezaei N.M., Nejat A. Effect of Menstrual Cycle on Frequency of Alveolar Osteitis in Women Undergoing Surgical Removal of Mandibular Third Molar: A Single-Blind Randomized Clinical Trial. J. Oral Maxillofac. Surg. Off. J. Am. Assoc. Oral Maxillofac. Surg. 2013;71:1484–1489. doi: 10.1016/j.joms.2013.05.004. PubMed DOI

Syrjänen S.M., Syrjänen K.J. Influence of Alvogyl on the Healing of Extraction Wound in Man. Int. J. Oral Surg. 1979;8:22–30. doi: 10.1016/S0300-9785(79)80035-6. PubMed DOI

Slezák R., Ryška A. Kouření a Dutina Ústní. 1st ed. Havlíček Brain Team; Prague, Czech Republic: 2006.

Editorial of Special Issue "Hyaluronic Acid in Human Medicine"