Be Aware of a Potential Pitfall in Oral and Dental Specimens: Alvogyl Fibers

Abstract

Alvogyl dressing is used to help control hemostasis, foster healing, and prevent complications after certain oral procedures. It is a paste composed of different antiseptic and analgesic substances, and fern-derived Penghawar djambi fibers that have styptic properties. It is claimed to be a resorbable and self-eliminating paste with little complications. However, some studies have demonstrated detrimental effects. We report 3 cases of postextraction nonhealing sockets after Alvogyl dressing. Histologically, they demonstrated residual Alvogyl fibers with foreign body giant cell stromal reaction and complications that were clinically confused with abscess, cysts, infections, and neoplastic lesions. Being unaware of their histopathologic appearances, the foreign bodies in 2 cases were initially confused with fungal hyphae, parasitic ova, vegetable material, and other surgical and nonsurgical materials. To add to our confusion, they were periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) positive, septated, spiked, and calcified. A history of Alvogyl dressing was retrospectively found. Learning from our mistakes and being aware of the histologic manifestations of Alvogyl fibers, the third case was correctly spotted. Because Alvogyl fibers are undissolvable and are not spontaneously eliminated, they may, if left for a long period, elicit tumefactive foreign body giant cell stromal and epithelial reactions that can be confused with inflammatory, infectious, and neoplastic lesions. Histologically, they can mimic infectious agents and noninfectious materials. Because history of dressing is not always provided, pathologists should be familiar with their histomorphologic features to avoid pitfalls and guide clinicians to correct diagnosis and management. In absence of history, certain histologic features are helpful hints.

Clinical effectiveness of orange peel polymethoxy-flavonoids rich fraction as a palatal dressing material compared to Alveogyl: randomized clinical trial

“…Eugenol, an essential oil extracted from various plants, including cloves, possesses exceptional pain-relieving qualities 43 . Alveogyl consistency is provided by the penghawar djambi, a byproduct of Cibotium barometz tree fibers 44 , 45 , which also offers hemostatic properties and ensures easy adherence to soft tissues in the correct dimensions 26 .…”

“…However, a few studies have suggested that Alveogyl might extend wound healing in alveolar osteitis treatment. Additionally, three reported cases indicated that Alveogyl caused an unexplained foreign body reaction 26 , 27 . Therefore, evaluating novel natural materials and comparing their effectiveness to the widely used Alveogyl is necessary.…”

Dental implants at sites of focal high and mixed density osseous lesions: Treatment strategies

“…Clinicians routinely rely on biomaterials for implant site development procedures 15,17,18 . However, investigators have associated various biomaterials with impaired healing and unfavorable outcomes in some patients 19–22 …”

“…15,17,18 However, investigators have associated various biomaterials with impaired healing and unfavorable outcomes in some patients. [19][20][21][22]…”

Clinical management of alveolar osteitis. A systematic review

“…An increased threshold for thermal pain as well as an increase in the production of adenosine triphosphate and anti-inflammatory cytokines ( 33 ). The advantages ( 25 , 31 , 34 - 36 ) and disadvantages ( 35 - 37 ) of each treatment are summarized in Table 4 .…”