Alvogyl Dental Dressing: A Potential Cause of Complicated Postextraction Non-healing Sockets: A Clinicopathologic Study of 7 Cases

Background: Packing a socket is a common practice to control hemostasis, promote healing and prevent complications after difficult tooth extractions. Alvogyl is a paste composed of different substances. Active ingredients ensure antiseptic and analgesic effects, while the inactive ingredient, the fern-derived Penghawar djambi fibers have styptic effects. It is claimed to be a resorbable and self-eliminating paste with little complications. Purpose: To investigate the occurrence and types of complications in postextraction nonhealing sockets after application of Alvogyl and to determine if the fibrous component is resorbable and self-eliminating. Methods: We performed a retrospective chart review over four years of 40 patients with a history of tooth extractions. Results: We found seven patients with nonhealing sockets and a history of Alvogyl dental dressings. Some developed complications (alveolar osteitis, abscess, sinus formation, bony erosion and gingivitis) that prevented subsequent tooth implants. Histologically, three cases showed foreign body giant cell reactions with variably shaped membranous fibrous components that were initially confused as fungal hyphae or parasitic ova. Conclusion: Dentists and oral surgeons should be aware of these potential complications associated with Alvogyl and the fact that it is non resorbable and not always a self-eliminating oral paste. Pathologists should also be aware of the histological appearances of this foreign material to avoid a diagnostic pitfall and incorrect management since the history of dental dressings is not always provided.