management of dry socket is of great concern for all the dental clinicians due to severe pain along with frequent visits of patient to the hospital . it is generally well - localized to the socket but may radiate to the ear or other parts of the face and neck . the incidence is 3 - 5% in non - surgical extraction and up to 15% in impacted third molar extraction socket . dry socket generally presents with either totally empty or partly covered with grayish - yellow membrane of necrotic tissue . predisposing factors are pre - existing systemic diseases , female , oral contraceptives , bacterial infections , smoking . its etiology is still not very clear so it is also known as alveolar osteitis , localized osteitis alveolgia , alveolar sicca dolorosa , localized osteomyelitis , septic socket , necrotizing socket and fibrinolytic alveolitis . he stated that trauma and inflammation causes release of stable tissue activator from the adjacent bony socket and soft - tissues . dry socket is unlikely to be present within first 2 days of extraction due to presence of antiplasmin , which gets consumed later . most of the studies suggest the treatment with intra - alveolar dressing with different medicaments and in some cases antibiotics and analgesics if required . despite all the research and development it is still posing a challenge in terms of delayed healing and frequent visits along with mental agony of the patients . plasma rich in growth factor ( prgf ) obtained from autologous blood is used to deliver growth factors in high concentrations to the site of bone defect . so , we have used prgf along with gelatin sponge to promote healing and compared it with the traditional treatment of zinc oxide eugenol dressing . guided bone regeneration has emerged as accepted surgical procedure used to increase the quantity and quality of host bone in localized alveolar defects . an autologous bone graft requires a second surgical site , postoperative discomfort and time and cost expenditure . in 1990 , gibble and ness introduced the fibrin gel to act as to improve availability of hemostatic agents . our research is aimed to promote the socket healing and reduce the visits of the patients . this study comprised of 45 patients of dry socket in the span of 1 year . exclusion criteria were smokers , steroid therapy , diabetes , pregnant , and lactating women . the patients reporting with complain suggestive of dry socket were diagnosed for the presence of disease . after confirmation they were subjected to exclusion criteria as mentioned . after the inclusion of patient into study they were attributed into any one group out of three , one by one , i.e. , 1 patient goes into group a then 2 patient goes into group b and 3 patient goes to group c and repeating the same until each group contains 15 patients each . group a patients were operated under local anesthesia and prgf along with gelatin sponge was placed . ten milliliter of blood was obtained from cephalic or basilic veins ( due to their accessibility and sufficient diameter ) using 19-gauge needle to avoid platelet rupture or activation in the lumen . sampled blood was immediately transferred to a syringe containing anticoagulant ( 1 ml of 3.8% sodium citrate for 10 ml blood ) and centrifuged in prgf system set for 460 g in 8 min , to sediment platelets . three layers were isolated after centrifugation : red blood cells ( rbcs ) at the bottom , white blood cells in the middle , and plasma on the surface . the surface plasma itself contained three distinct layers : platelet poor in growth factors ( ppgf ) on the top ( 500 l ) . plasma growth factors ( pgf ) in the middle and prgf at the bottom that contains the highest concentrations of platelets and growth factors accumulated right above the rbcs [ figure 1 ] . test tube containing plasma rich in growth factors ppgf and pgf were separately retrieved using two 500 l pipettes . cacl2 was then added to prgf ( 0.05 ml / ml ) and coagulation was obtained within 5 - 8 min . to decrease coagulation time , prgf was placed on a thermal block prior to activation to reach body temperature ( 37c ) . finally the formed gel was placed in the socket with help of gelatin sponge [ figures 2 and 3 ] . pre - operative status on day 0 the day 0 status of the dry socket being prepared for the placement of gelatin sponge with prgf patients in group a were treated with this gel placed in the socket . observation was noted on 1 , 2 , 3 , 7 , and 15 days postoperatively for pain and healing [ figure 4 ] . the 7 day status of socket treated with gelatin sponge soaked in prgf zinc oxide eugenol dressing was done in group b cases after proper cleaning and irrigation of the socket without local anesthesia . observation was noted on 1 , 2 , 3 , 7 and 15 days postoperatively for pain and healing . in group c , i.e. , control group , patients were treated only by irrigation with saline without any other manipulation of the socket or any medicament . the pain was measured on a visual analog scale as follows : 1  slight pain on socket manipulation 2  moderate pain on socket manipulation 3  severe pain on socket manipulation 4  slight continuous pain even in relaxed state 5  moderate continuous pain even in relaxed state 6  severe continuous pain even in relaxed state 7  pt . irritated with pain , not able to relax 8  unbearable pain , patient eagerly seeks for relief . the healing was measured on a scale as follows : 0  no healing , no clot formation 0.5  clot formed / seen 1.5  1/2 of socket epithelialized and covered 2  2/3 of socket epithelialized and covered 2.5  epithelialization almost complete , wound closed 3  socket appears closed with normal mucosa coverage . the data were processed with statistical package for social sciences ( spss ) version 15.0 for windows statistical software ( spss inc . , chicago , il , usa ) . probability level of p < 0.05 was considered statistically significant . ten milliliter of blood was obtained from cephalic or basilic veins ( due to their accessibility and sufficient diameter ) using 19-gauge needle to avoid platelet rupture or activation in the lumen . sampled blood was immediately transferred to a syringe containing anticoagulant ( 1 ml of 3.8% sodium citrate for 10 ml blood ) and centrifuged in prgf system set for 460 g in 8 min , to sediment platelets . three layers were isolated after centrifugation : red blood cells ( rbcs ) at the bottom , white blood cells in the middle , and plasma on the surface . the surface plasma itself contained three distinct layers : platelet poor in growth factors ( ppgf ) on the top ( 500 l ) . plasma growth factors ( pgf ) in the middle and prgf at the bottom that contains the highest concentrations of platelets and growth factors accumulated right above the rbcs [ figure 1 ] . test tube containing plasma rich in growth factors ppgf and pgf were separately retrieved using two 500 l pipettes . cacl2 was then added to prgf ( 0.05 ml / ml ) and coagulation was obtained within 5 - 8 min . to decrease coagulation time , prgf was placed on a thermal block prior to activation to reach body temperature ( 37c ) . finally the formed gel was placed in the socket with help of gelatin sponge [ figures 2 and 3 ] . pre - operative status on day 0 the day 0 status of the dry socket being prepared for the placement of gelatin sponge with prgf patients in group a were treated with this gel placed in the socket . observation was noted on 1 , 2 , 3 , 7 , and 15 days postoperatively for pain and healing [ figure 4 ] . the 7 day status of socket treated with gelatin sponge soaked in prgf zinc oxide eugenol dressing was done in group b cases after proper cleaning and irrigation of the socket without local anesthesia . observation was noted on 1 , 2 , 3 , 7 and 15 days postoperatively for pain and healing . in group c , i.e. , control group , patients were treated only by irrigation with saline without any other manipulation of the socket or any medicament . the pain was measured on a visual analog scale as follows : 1  slight pain on socket manipulation 2  moderate pain on socket manipulation 3  severe pain on socket manipulation 4  slight continuous pain even in relaxed state 5  moderate continuous pain even in relaxed state 6  severe continuous pain even in relaxed state 7  pt . irritated with pain , not able to relax 8  unbearable pain , patient eagerly seeks for relief . the healing was measured on a scale as follows : 0  no healing , no clot formation 0.5  clot formed / seen 1.5  1/2 of socket epithelialized and covered 2  2/3 of socket epithelialized and covered 2.5  epithelialization almost complete , wound closed 3  socket appears closed with normal mucosa coverage . the data were processed with statistical package for social sciences ( spss ) version 15.0 for windows statistical software ( spss inc . , chicago , il , usa ) . probability level of p < 0.05 was considered statistically significant . the total number of patients included in this study was 45 , which includes 26 females and 19 males . a and b , there was no significant difference of age , the mean being 31.05 , 32.57 , and 31.98 years respectively . age distribution in groups a , b , and c table 2 shows sex wise distribution of patients suffering from dry socket . in groups a , b , and c ; it was found that there was equal distribution of sex in both the groups . gender distribution in groups a , b , and c tables 3a and b show that probability is less than 0.0001 . table 4 shows pain reduction is more rapid in group b than in groups a and c from day 1 to day 7 but the change is non - significant at day 15 in all the groups . the results of an analysis of variance statistical test comparison of pain among different groups comparison of change in pain in groups a and b tables 5a and b show that probability is less than 0.0001 . this suggests that there were significant differences in treatment outcomes in different groups [ figures 24 ] . table 6 shows healing is faster in group a than in group b at day 1 , day 2 , day 3 , day 7 , and it was significant ; whereas at day 15 , change is non - significant in both the groups . the results of an analysis of variance statistical test healing comparison between groups comparison of healing in groups a and b the disease had female predilection , the cause may be the use of oral contraceptives . the mean age was reported to be 31.05 years in group a , 32.57 years in group b , and 31.98 years in group c , which are close to the age group reported in the literature . the rationale for using prgf along with gelatin sponge was based on previous studies , which showed the potential of prgf in the process of bone healing . alpha granules of platelets include a high concentration of growth factors such as plateled derived growth factor ( pdgf ) , tissue growth factor ( tgf ) , platelet derived endothelial growth factor ( pdegf ) , platelet derived angiogenesis factor ( pdaf ) , interstitial growth factor igf-1 , and platelet factor 4 ( pf-4 ) . these factors increase tissue vascularity through increased angiogenesis , chemotaxis of macrophages and fibroblasts , increased granulation tissue production and epithelialization , enhanced osteogenesis . these might also act antimicrobial effect and provide with an immediate surgical chemostatic agent that is biocompatible , effective and safe . recent reports have suggested that more rapid epithelialization , denser and mature bone with better - organized trabeculae and greater bone regeneration occurs with platelet rich plasma . gelatin sponge may act as a scaffold and as a good carrier of osteoblasts due to its flexibility , biocompatibility , and biodegradability . different studies had reported the use of platelet - rich plasma prp in extraction socket . we had reported the contributing effect of prgf along with gelatin sponge in the socket healing . in our study , healing is faster in group a as compared to group b. these findings of better healing in group a may be supported by the previous studies of prgf . resolution of pain is earlier in group b as compared to group a , which may be due to the obtundant nature of eugenol . the use of prgf along with gelatin sponge significantly enhances the healing of dry socket as compared to zinc oxide eugenol or irrigation only ; but in terms of pain relief , zinc oxide eugenol dressing was more effective than others . in this study , disease was observed to have female predilection and the mean age was found to be 31.5 years . our study data indicated that with the use of prgf along with gelatin sponge frequent visits and time may be saved . the combination of gelatin sponge along with prgf seems to accelerate socket healing due to the growth factors incorporated in the prgf and scaffold forming capability of gelatin sponge . however , a long - term randomized study with bigger sample size and control is required to determine the effectiveness of prgf along with gelatin sponge . this is a first endeavor of this kind and is expected to stimulate further exploration into the deeper aspects of advantages of prgf along with gelatin sponge in the healing of dry socket .
purpose : the aim of this study was to report a comparison between the zinc oxide eugenol dressing and plasma rich in growth factor ( prgf ) with gelatin sponge in the treatment of dry socket.materials and methods : this study comprised of 45 patients of dry socket in the span of one year . 
 the patients were randomly divided into three groups on the basis of treatments : group a ( prgf with gelatin sponge ) , group b ( zinc oxide eugenol group ) , and group c ( irrigation with sterile saline only ) . the clinical progress was noted at 1st , 2nd , 3rd , 7th , and 15th day after the treatment.results:patient's healing was better in group a than in group b but symptomatic pain relief was faster in group b. group c fared worst in both aspects.conclusion:we conclude that prgf with gelatin sponge might be a treatment of choice in the management of dry socket .