Comparison between Metronidazole and Chlohexidine Gel in Prevention of Dry Socket After Impacted Mandibular Third Molar Surgery: A Randomized Controlled Clinic Trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Introduction: Alveolar osteitis (dry socket) is one of the most common postoperative complications following impacted mandibular third molar surgery, with reported incidence ranging from 1% to 30% depending on risk factors and surgical difficulty (Blum, 2002; Bowe et al., 2011). It is characterized by premature disintegration of the blood clot, severe postoperative pain, and delayed wound healing. Several preventive measures have been proposed, including local antimicrobial agents such as metronidazole and chlorhexidine gel (Caso et al., 2005; Torres-Lagares et al., 2006). However, direct comparisons between these two agents remain limited in randomized clinical settings. Objective: To compare the effectiveness of topical metronidazole gel and chlorhexidine gel in preventing dry socket following surgical extraction of impacted mandibular third molars. Methods: In this randomized controlled clinical trial, patients undergoing impacted mandibular third molar surgery were randomly allocated into two groups. Group A received intra-alveolar metronidazole gel, while Group B received intra-alveolar chlorhexidine gel immediately after extraction. Patients were evaluated on postoperative days 2, 4, and 7 for incidence of dry socket, pain severity using a Visual Analog Scale (VAS), and other postoperative complications. Statistical analysis was performed using chi-square and independent t-tests, with significance set at p < 0.05. Results: The incidence of dry socket was lower in the chlorhexidine group compared to the metronidazole group. Chlorhexidine gel demonstrated a statistically significant reduction in dry socket occurrence (p < 0.05), consistent with previous reports highlighting its broad-spectrum antimicrobial and substantivity properties (Caso et al., 2005). Pain scores were also lower in the chlorhexidine group during the early postoperative period. Both interventions were well tolerated, and no major adverse reactions were observed.Conclusion: Chlorhexidine gel appears to be more effective than metronidazole gel in preventing dry socket following impacted mandibular third molar surgery. Its routine application may be recommended, particularly in high-risk patients, in line with existing evidence supporting chlorhexidine-based preventive strategies (Torres-Lagares et al., 2006)
Author: Nizam ul Mulk
Institution: Bolan University of Medical and Health Sciences
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7140928993