Effect of hyaluronic acid gel with and without metronidazole on healing of extraction sockets in diabetic patients-a randomized controlled study.

BACKGROUND: Diabetic patients are associated with a series of post extraction complications, such as delayed healing, greater risk of infections, persistent pain, dry socket and delayed bone formation. There is paucity of studies which indicate the influence of glycemic index and antibiotic prophylaxis in prevention of complications after minor surgical procedures. Various adjuncts such as hydrogels, curcumin and platelet gels are used in the extraction socket to augment healing, minimize complications and promote bone regeneration. AIM: To assess the effect of hyaluronic acid gel with and without metronidazole on wound healing in post extraction sockets of diabetic patients. METHODOLOGY: A double blind randomized controlled study was conducted at FDS, RUAS, Bengaluru, India. Diabetic patients indicated for simple extraction of mandibular molars were randomly divided into two groups and prescribed oral metronidazole 1 h prior to extraction. After extraction, 1% hyaluronic acid gel was placed in the sockets of patients in Group A and Group B received 1% hyaluronic acid gel with 5% metronidazole. Soft tissue healing was assessed after one week using wound healing index and photographs of the socket with AutoCAD program. Pain was assessed by VAS. Hard tissue healing was evaluated radiologically using CBCT scans taken immediately after extraction and after one month and analyzed in the 3D slicer software. Pain was assessed by VAS, number of rescue analgesics, complications if any. RESULTS: There was no statistically significant difference in hard and soft tissue healing and pain scores between the two groups. However, it was statistically significant between the two-time intervals within each group. CONCLUSION: In patients with short term glycemic control, use of a single dose of oral metronidazole prior to extraction and placement of 1% hyaluronic acid gel in the extraction socket resulted in uneventful healing with evidence of bone formation at one month. Addition of 5% metronidazole to the gel seems to have no added advantage. CLINICAL TRIAL NUMBER: Not registered.