Prophylactic use of indomethacin for prevention of postsurgical complications after removal of impacted third molars

An Evaluation of the Effect of Using Irrigations at Different Temperatures on Pain, Edema, and Trismus during the Extraction of Bilateral Impacted Mandibular Third Molars: A Randomized Split-Mouth Clinical Trial

BACKGROUND AND AIM

The surgical extraction of impacted wisdom teeth is a standard practice in dentistry. Unfortunately, inflammatory reactions such as discomfort, edema, and trismus frequently jeopardize patients' well-being after the extraction of third molars. Saline solutions at room temperature (25°C) are routinely used in impacted tooth extraction. Refrigerated saline solutions were used to work with cold solutions, and as the refrigerator temperature was 4°C, this study was designed to have a cold solution temperature of 4°C. This study aimed to assess the influence of saline irrigation at various temperatures (4°C, 25°C) on postoperative edema, pain, and trismus after the extraction of impacted third molars.

MATERIALS AND METHODS

Eighteen patients with bilateral symmetrical mandibular impacted third molars were enrolled in this split-mouth, randomized, prospective, double-blind clinical trial. For each patient, one side was irrigated with a saline solution (% 0.9 isotonic sodium chloride) at 4°C (test), and the other side was irrigated with a saline solution at room temperature (25°C) (control). Pain, trismus, and facial edema were noted on the 2nd, 4th, and 7th days. A Mann-Whitney U-test was used to compare pairs, and a Wilcoxon signed-rank test was used to compare groups.

RESULTS

The two groups had no considerable differences in terms of pain levels and facial edema (P > 0.05). Regarding trismus, the maximum mouth opening for cold irrigation (4°C) was significantly higher than for room temperature irrigation (25°C) across all postoperative periods (P < 0.05).

CONCLUSION

Cold irrigation therapy (4°C) exerts beneficial effects more than room temperature (25°C) irrigation on the trismus after impacted mandibular third molar surgery.

Effect of time-dependent ibuprofen administration on the post operatory after impacted third molar extraction: a cross-over randomized controlled trial

PURPOSE

To evaluate time-dependent administration of ibuprofen in a lower third molar extraction model.

METHODS

Eleven patients requiring bilateral surgical removal of lower third molars were recruited and randomized into a blinded crossover randomized controlled trial. For 3 days after surgery, the control group was prescribed ibuprofen 400 mg every 8 h. On the other hand, the experimental group received also ibuprofen 400 mg at breakfast and lunch, replacing the dinner intake with a placebo. Pain measurements (Visual Analog Scale from 0 to 10) were recorded at baseline, 24, 48, and 72 h postoperatively. Facial swelling and trismus were also measured at baseline, 24, and 72 h postoperatively.

RESULTS

Postoperative swelling and pain perception did not show significative difference between the control and experimental groups at 24, 48, and 72 h. Trismus was significantly lower in the control group than in the experimental group at 72 h postoperatively (p = 0.008). Rescue medication consumption seemed to be comparable between groups.

CONCLUSION

Eliminating night time ibuprofen might be insignificant for pain control after third molar extraction.

Comparison of Manual (2D) and Digital (3D) Methods in the Assessment of Simulated Facial Edema

BACKGROUND

An edema assessment following dental surgeries is essential to improving the dental surgeon's technique and, consequentially, patient comfort.

PURPOSE

Two-dimensional (2D) methods are limited in analyzing 3-dimensional (3D) surfaces. Currently, 3D methods are used to investigate postoperative swelling. However, there are no studies that directly compare 2D and 3D methods. The goal of this study is to directly compare 2D and 3D methods used in the assessment of postoperative edema.

STUDY DESIGN AND SAMPLE

The investigators implemented a prospective, cross-sectional study with each subject serving as its own control. The sample was composed of dental student volunteers without facial deformities.

PREDICTOR VARIABLE

The predictor variable is the method used to measure edema. After simulating edema, manual (2D) and digital (3D) techniques were used to measure edema. The manual method used direct facial perimeter measurements. The two digital methods were photogrammetry using a smartphone (iPhone 11, Apple Inc, Cupertino, California), and facial scanning with a smartphone application (Bellus3D FaceApp, Bellus3D Inc, Campbell, California) [3D measurements] MAIN OUTCOME VARIABLE: The coefficient of variation (CV) (CV = standard deviation /mean) was used to assess homogeneity of edema measurements.

ANALYSIS

The Shapiro-Wilk and equal variance tests were applied to assess data homogeneity. Next, one-way analysis of variance was performed, followed by a correlation analysis. Finally, the data were submitted to Tukey's test. The statistical significance threshold was set at 5% (P < .05).

RESULTS

The sample was composed of 20 subjects aged 18-38 years. The CV showed higher values using the manual (2D) method (47%; 4.88% ± 2.99), compared with the photogrammetry method (18%; 8.55 mm ± 1.52) and the smartphone application (21%; 8.97 mm ± 1.93). A statistically significant difference was observed between the manual method values and those of the other two groups (P < .001). There was no difference between the facial scanning and photogrammetry groups (3D methods) (P = .778) CONCLUSION AND RELEVANCE: Both digital measuring methods (3D) demonstrated greater homogeneity than the manual method in analyzing facial distortions caused by the same swelling simulation. Therefore, it can be affirmed that digital methods may be more reliable that manual methods for assessing facial edema.

A Clinical Comparison of Er:YAG Laser, Piezosurgery, and Conventional Bur Methods in the Impacted Third Molar Surgery

Objective: The aim of this study is to investigate whether Er:YAG laser and piezosurgery methods can be an alternative to the conventional bur method. Background: The purpose of this study is to compare the postoperative pain, swelling, trismus and patient satisfaction between Er:YAG laser, piezosurgery device, and conventional bur methods that are used to remove bone barrier during extraction of the impacted lower third molar. Methods: Thirty healthy patients who have bilateral, asymptomatic, vertically impacted mandibular third molar teeth according to Pell and Gregory classification Class II and Winter Class B were selected. Patients were randomly divided into two groups. In 30 patients one side of the bony cover around the tooth was removed by the conventional bur technique, on the other side 15 patients were treated with the Er:YAG laser (VersaWave dental laser; HOYA ConBio) 200 mJ, 30 Hz, 4.5-6 W, noncontact mode, SP and R-14 handpiece tip, under air and saline solution, and 15 patients with the piezosurgery technique (VarioSurg Piezo; NSK) with frequency 20-100 kHz, 10-80% power range in Surgery (S), continuous mode, with SG17 and SG5 handpiece tip blade. Preoperative, 48th hour and 7th day measurements were made and recorded about pain, swelling, and trismus. At the end of the treatment, patients were asked to fill out a satisfaction questionnaire. Results: The pain observed at the postoperative 24th hour was statistically significantly lower in the laser group than in the piezosurgery group (p < 0.05). Only in the laser group swelling was seen with statistically significant differences between preoperative and postoperative 48th h (p < 0.05). Postoperative 48th h trismus value was seen as the highest in the laser group than others. Patient satisfaction was found to be higher in the laser and piezo technique compared with the bur technique. Conclusions: Er:YAG laser and piezo methods can be a good alternative to the conventional bur method when postoperative complications are compared. We believe that laser and piezo methods will be preferred for patients due to increased patient satisfaction. Clinical Trial Registration number: B.30.2.ANK.0.21.63.00/08 date: 28.01.10 no:150/3.

Therapeutic Efficacy of Bromelain in Alveolar Ridge Preservation

Most of research in regenerative oral surgery describes materials or techniques for increasing volumetric results for implant-supported prosthesis. The use of bio-materials in alveolar ridge preservation after tooth extraction commonly leads to a delayed recovery. Bromelain is an enzyme that belongs to a family of proteolytic enzymes derived from the stem of the pineapple plant (Ananas comosus) with effectiveness in decreasing the inflammation development and swelling. The present paper reports a prospective comparative study performed in order to test the possible use of oral bromelain 40 mg in alveolar ridge preservation. Evaluations were performed at three time points after the surgery: after 2 days (t1), after 7 days (t2) and after 14 days (t3). A statistically significant difference among patients that used bromelain and patients that used placebo resulted among the use of bromelain and lower Visual Analogue Scale (VAS) at t1 (r = -0.75, p = 0.0067), t2 (r = -0.90, p = 0.0001) and t3 (r = -0.8566, p = 0.0008). Bromelain therapy reported a statistically significant difference among patients that used bromelain and patients that used placebo even with regards to the use of bromelain and postoperative swelling at t1 (r = -0.79, p = 0.0034), t2 (r = -0.81, p = 0.0020) but not at t3 (r = -0.34, p = 0.2967). With the result of the present paper, and the poorness of contraindication of the investigated drug, bromelain may be suggested to be used for patients that undergo to alveolar ridge preservation after tooth extraction.

Is the degree of facial swelling after dental extraction sufficient to justify the current delays to radiotherapy mask production? A pilot evaluation of postextraction swelling using 3D photography

Background

Concern that facial swelling after dental extractions will spoil the fit of radiotherapy masks in head and neck cancer patients leads to the current practice of delay making of mask production (and therefore the start of radiotherapy) for several days or longer. However, there is little data on how extensive facial swelling is after dental extraction.

Aim

To assess the degree of facial swelling in a group of adult patients attending Newcastle Dental School for routine dental extractions.

Materials and Methods

Seventeen dental extraction patients underwent three‐dimensional photography using the 3dMDFace® system at 1‐week preop, immediately preop, and at 48‐h postop. We recorded demographic data, teeth extracted, and methods. Facial volume change was assessed using 3dMD Vultus® software. Two reviewers ran the data through the 3dMD Vultus® software independently. We used Student's t‐test to assess significance.

Results

Twelve patients were included in the final analysis. There was no significant difference in the difference between the two preoperative measurements and the preoperative versus postoperative difference (Wilcoxon signed‐rank test: Reviewer 1: p = .31. and Reviewer 2: p = .10). Thus, mean facial swelling was less than the threshold for significant swelling which was deemed to be 15 cm³.

Conclusion

Facial swelling following dental extraction may not be sufficient in itself to justify the current delays in mask production and subsequent delivery of radiotherapy. Further definitive studies are needed to optimize how dental extractions should be timed within head and neck cancer care pathways.

Clinical evaluation of single and repeated sessions of photobiomodulation with two different therapeutic wavelengths for reducing postoperative sequelae after impacted mandibular third molar surgery: a randomized, double-blind clinical study

The effects of the number of photobiomodulation (PBM) sessions on the postoperative inflammatory process remain controversial. The current literature comparing single and repeated PBM sessions is limited.

Efficacy of local hyaluronidase administration in guided bone regeneration surgery: a randomized controlled trial

Objectives

Hyaluronoglucosaminidase (hyaluronidase) increases the local intercellular permeability of the peripheral lymphatic channel and capillaries, which may help reduce edema. In the present study, the effects of hyaluronidase on postoperative edema and pain reduction were evaluated.

Materials and Methods

The study included 38 patients who underwent guided bone regeneration (GBR) surgery before implantation. Patients were randomly assigned to either the control group (n=20) or the test group (n=18). Hyaluronidase was injected into the GBR site of subjects in the test group. Postoperative edema was evaluated by measuring the distance between specific facial landmarks immediately after surgery (T1) and 2-4 days after surgery (T2). The degree of pain at T2 and at 10-14 days after surgery (T3) was assessed.

Results

In the test group, the degree of swelling was lower than in the control group, however, only two measurements, from the tragus to the mouth corner and from the outer canthus to the mouth corner, showed statistically significant differences (P=0.012 and P=0.001, respectively). The anti-edema effect of hyaluronidase was more effective in the maxilla than in the mandible. In the maxilla, the percentage of facial swelling was significant for three measurements. However, in the mandible, the percentage of facial swelling was significant for only one measurement. Low levels of pain that were similar at T2 and T3 were reported in both groups.

Conclusion

The results indicate the degree of swelling was lower in the test group and hyaluronidase appeared to be more effective in the maxilla. The degree of pain reduction was similar between groups. Further in vivo and randomized controlled trials with larger sample sizes are warranted.

Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions

OBJECTIVE

This study compared patient postoperative pain, swelling, and trismus after usage of rotary instruments, piezosurgery, and Er:YAG lasers in mandibular third-molar extraction.

MATERIALS AND METHODS

This prospective study was executed with class II and position B vertically impacted mandibular third molars. Patients were divided into three groups according to the osteotomy system used to remove retentive bone: rotary instruments, piezosurgery, and Er:YAG laser. Postoperative pain was evaluated using VAS questionnaires at 12 h, 24 h, 48 h, and 7 days after procedures. Trismus was evaluated by measuring the distance between the maxillary and mandibular incisors at maximum mouth opening, and comparing preoperative measurements with those for postoperative days 2 and 7. Analyses of swelling were carried out via a stereophotogrammetry system. Operation times were measured using a digital stopwatch from the initial incision to the final suture.

RESULTS

There were no statistically significant differences between the groups in terms of pain, trismus, or swelling (p > 0.05). Pain persisted more in the rotary instrument group 24 h later (0 ± 1.3; p = 0.001). The pain scores obtained after 48 h for the piezosurgery (1.81 ± 2.29) and rotary (2.2 ± 2.12) groups were observed at 24 h in the laser group (2.19 ± 1.52). The mean operation time was highest using the laser (19.1 ± 3.85 min; p = 0.001) and lowest using rotary instruments (9.88 ± 2.97 min; p = 0.001).

CONCLUSION

Piezosurgery and Er:YAG laser are good alternatives to rotary instrument systems in third-molar extraction, but both systems are slower than traditional rotary instruments.

Influence of operator's professional experience in the postoperative course after surgical extrac-tion of the impacted lower third molar: A pilot study

Background

Third molars are present in 96.6% of humans, although they do not always erupt completely. Between 9.5% and 73% of them remain impacted. Surgical removal of impacted third molars is the most common practice in oral and maxillofacial surgery. This procedure results in traumatism and, consequently, the postoperative phase will involve symptomatology. It is uncommon to find studies that directly relate postoperative symptomatology and the operator’s experience. The aim of this study was to determine the differences regarding postoperative symp-tomatology in patients undergoing the bilateral extraction of lower impacted third molars and according to the operator’s experience.

Material and Methods

A prospective cohort double-blind study was conducted in 50 healthy patients (100 molar extractions) to whom both lower third molars were removed by two dentists with different degree of professional experience. The extractions were randomly assigned with a split–mouth design. If an operator extracted the lower third molar on one side, the other operator extracted the contralateral one. The variables studied after four days of postoperative period were Pain (EVA scale), Inflammation and Trismus, in addition to intraoperative time and local anesthesia administered.

Results

Statistically significant differences were detected in the time of intervention and in trismus, since the most experienced operator always needed less time and caused higher degree of trismus. However, this does not entail more inflammation or pain in patients, so there are no relevant differences between operators with more or less experience (p>0.05).

Conclusions

The postoperative period is more favorable for the most experienced operator, although the results do not vary in a relevant manner between them.

Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

The Use of Low-Level Laser Therapy to Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis

PURPOSE

Surgical removal of third molars carries morbidity and significantly affects patients' quality-of-life. This study aims to investigate whether administration of low-level laser therapy (LLLT) is effective in reducing postoperative morbidity in patients undergoing surgical removal of mandibular third molars compared with placebo.

MATERIAL AND METHODS

A systematic review and meta-analysis involving a comprehensive search strategy implemented across 5 electronic databases. This was supplemented by hand searching and contacting international experts and grey literature. Titles, abstracts, and full articles were scrutinized for studies meeting the inclusion criteria. All randomized controlled trials comparing treatment group of LLLT with a placebo control group were eligible for inclusion. The outcomes variables were postoperative pain, swelling, and trismus. Risk of bias and methodological quality assessment was carried out. We pooled data statistically, and meta-analyses were carried out using a random-effects model.

RESULTS

Seventeen randomized controlled trials were included in this systematic review, all of which were considered to have a low risk of bias. Participants, aged 13 to 70 years, and 35% women, totaled 1064. Meta-analyses found significant reductions in standardized mean differences (SMDs) in swelling at day 2 and day 7 postoperatively (SMD, -0.611; 95% confidence interval, -0.968, -0.234 and SMD, -0.532; 95% confidence interval, -0.795, -0.269). There were nonsignificant reductions in SMD in pain and trismus at day 2 and day 7 postoperatively.

CONCLUSIONS

LLLT significantly reduces swelling after extraction of mandibular third molars compared with placebo. LLLT has not shown to reduce postoperative pain and trismus. LLLT does not cause adverse effects. There is currently insufficient evidence available, to promote the investment in LLLT vs the net clinical benefit. Randomized controlled trials with larger sample size and standardized study design and outcome measures are required, to make definitive recommendations to clinicians on its use on patients.

Efficacy of a topical gel containing chitosan, chlorhexidine, allantoin and dexpanthenol for pain and inflammation control after third molar surgery: A randomized and placebo-controlled clinical trial

BACKGROUND

The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery.

MATERIAL AND METHODS

A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n=72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product.

RESULTS

Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p=0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered 'good' in 22.2% for the CG and 97.2% for the EG (p<0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56±1,19) compared to the placebo group (3.25±1.6) (p=0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26±0.51) in comparison to the CG (0.56±0.67) (p=0.003).

CONCLUSIONS

The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal.

Autogenous Dentin Graft in Bone Defects after Lower Third Molar Extraction: A Split-Mouth Clinical Trial

Various biomaterials are currently used for bone regeneration, with autogenous bone being considered the gold standard material because of its osteogenic, osteoconductive, and osteoinductive properties. In recent years, the use of autogenous dentin as a graft material has been described. This split-mouth clinical trial assesses the efficacy of autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar extraction. Fifteen patients underwent bilateral extraction surgery (30 third molars) using dentin as a graft material on the test side, and leaving the control side to heal spontaneously, comparing the evolution of the defects by evaluating probing depth at three and six months post-operatively. Bone density and alveolar bone crest maintenance were also evaluated six months after surgery, and pain, inflammation, mouth opening capacity on the second and seventh days after surgery. Probing depth, radiographic bone density, and alveolar bone crest maintenance showed significant differences between the test and control sides. Autogenous dentin was found to be an effective biomaterial for bone regeneration after impacted lower third molar extraction.

Reliability of the Linear Measurement (Contact) Method Compared with Stereophotogrammetry (Optical Scanning) for the Evaluation of Edema after Surgically Assisted Rapid Maxillary Expansion

Many techniques have been developed to evaluate facial swelling after maxillofacial surgeries. Patients who undergo surgically assisted rapid maxillary expansion (SARME) develop facial edema more often than those who undergo minor oral surgeries. Reliable systems to assess soft tissue dimensions offer many advantages for documentation and treatment planning across surgical fields. (1) Background: The objective assessment of facial swelling is advantageous as it allows the evaluation of the effect of anti-inflammatory drugs. Therefore, this study aimed to compare the reliabilities of linear measurement method and optical scanning for the objective assessment of facial swelling after SARME. (2) Methods: Sixteen (12 women and 4 men) patients were enrolled. Linear measurements between guide points and facial scans were obtained for the left and right sides preoperatively and 1, 2, and 5 days after SARME. Preoperative values were subtracted from each post-operative value and the differences were compared between the two measurement methods. (3) Results: There were no statistically significant differences between the right and left sides at any time point in the measurements with either method. (4) Conclusions: Recently, stereophotogrammetry has been considered the first choice method for evaluating facial swelling. Furthermore, we found a strong correlation between volumetric analysis and linear measurement at all time points and for both sides.

ANALGESIC EFFECT OF INTRAVENOUS ASCORBIC ACID VERSUS ACELCOFENAC POST-TRANSALVEOLAR EXTRACTION: A CASE-CONTROL STUDY

One of the most important aspects of postsurgical care is finding an efficient way for the management of pain. Third molar extractions/surgical impaction is one of the most frequent surgical procedures in dental hospitals, and it is most often associated with postoperative complications like severe pain, oedema and reduced mouth opening. This study was aimed to evaluate the efficacy of 2 g intravenous (IV) vitamin C compared to 100 mg aceclofenac on postsurgical pain, swelling and trismus after the surgical removal of third molars. A total of 101 patients were recruited for the study, and theywere divided into two treatment groups; group A (n = 51) received 2 g IV vitamin C and group B (n = 50) received 100 mg aceclofenac. Pain intensity, facial swelling and mouth opening were assessed till day 3 post-surgically. Statistical analysis of pain intensity revealed that IV vitamin C performed slightly better but not significantly different (p>0.05) from aceclofenac group at the end of day 3. No significant difference for facial swelling and mouth opening between the two treatment protocols was seen (p>0.05). Our results concluded that both treatment groups were overall similar in analgesic efficacy, postoperative oedema and reduction in mouth opening. It was also determined that the method devised administering 2 g IV vitamin C intravenously was well suited to the treatment of postoperative pain, swelling and trismus following the surgical extraction of impacted third molars.

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split-mouth randomised clinical trial

BACKGROUND

Surgical removal of impacted mandibular third molar is one of the most frequently performed interventions in oral and maxillofacial surgery.

OBJECTIVES

To compare two different flap designs in terms of sequelae and quality of life following surgical removal of impacted third molars.

METHODS

This prospective, randomised, split-mouth clinical study involved patients referred for surgical removal of bilateral symmetrical impacted mandibular third molars. Envelope flap and modified triangular flap techniques were used. The effects of flap design on trismus, swelling, wound dehiscence, alveolar osteitis, haematoma, infection and quality of life were evaluated on post-operative days 3 and 7. Pain levels were assessed on post-operative days 1, 3 and 7.

RESULTS

Significant differences were determined between the two groups in terms of trismus, pain and wound dehiscence scores on post-operative day 3. However, on post-operative day 7, this difference was observed only in trismus. Statistically significant differences were also determined between the two groups on post-operative day 3 for social isolation and eating subscale scores as well as total quality of life score.

CONCLUSION

Based on the study findings, the modified triangular flap may be superior to the envelope flap in terms of pain, trismus, and wound dehiscence in the first 3 days after impacted third molar surgery and may have a better impact on quality of life during this process.

Effect of One-Suture and Sutureless Techniques on Postoperative Healing After Third Molar Surgery

PURPOSE

The wound closure technique for lower third molar surgery (LTMS) is an operative factor that influences wound healing and the occurrence of early postoperative complications. The present study investigated 2 closure techniques (partial closure using 1 suture and the suture-less technique) after use of a modified buccal envelope flap for LTMS.

MATERIALS AND METHODS

We performed a prospective, randomized, double-blind, split-mouth, controlled trial. Partial closure using 1 suture was compared with closure using the sutureless technique. The surgical sites were divided into 2 groups, group A (1 suture) and group B (sutureless). Each patient received both treatments at the same surgery. During the first postoperative week, all patients were asked to daily assess pain, facial swelling, and bleeding using self-assessment scales. All patients attended the follow-up appointment at 1 week to objectively assess facial swelling and wound healing and at 1 month to assess wound healing. An analysis of data was performed using the statistical package SPSS Statistics, version 24 (IBM Corp, Armonk, NY). A P value ≤ .05 was accepted as statistically significant.

RESULTS

A total of 37 patients with bilateral impacted third molars of similar surgical difficulty were recruited. Of the 37 patients, 34 successfully completed the study. The results showed a statistically significant difference between the 2 techniques in postoperative pain at days 5 (P = .046) and 6 (P = .034); socket healing at 1 week (P = .002) and 1 month (P = .014), and soft tissue healing at 1 week (P = .016).

CONCLUSION

We found the 1-suture technique for LTMS to be superior to the sutureless technique in the reduction of postoperative pain and improving wound healing during the early postoperative period. We found no difference between the 2 techniques in the reduction of postoperative swelling.

Lateral Sinus Floor Elevation Performed with Trapezoidal and Modified Triangular Flap Designs: A Randomized Pilot Study of Post-Operative Pain Using Thermal Infrared Imaging

Purpose: Post-operative pain and swelling are frequently observed after sinus lift procedures. The aim of the present study was the clinical evaluation of swelling and pain of two different sinus flap lift techniques using a visual analogue scale (VAS), verbal rating scale (VRS), and infrared thermal imaging (i.e., thermography). Materials Methods: A randomized controlled trial was conducted with 15 patients (30 sinuses in total) randomly allocated into two groups. For the sinuses of Group I a trapezoidal flap was used, while for Group II a modified triangular flap without anterior release was utilized. Postoperative pain was scored by means of a 100-mm VAS ranging from 0 (no pain) to 100 (worst pain imaginable), and was recorded at 2, 4, 6 and 14 days after surgery. Swelling was recorded by a verbal rating scale (VRS) and was classified into four categories: a score of 1 referred the absence of swelling, patients with intra-oral swelling in the surgical zone scored 2, any extra-oral swelling in the surgical zone scored 3, and intense swelling exhibited by extra-oral swelling extending beyond the surgical zone scored 4. The facial temperature was recorded before and after sinus augmentation, and at 2, 4, 6, and 14 days post-surgery to check the course of healing. Results: In Group I pain intensity was recorded at 2 days after surgery with a mean score of 38.67 ± 6.4 mm. Swelling was greater at 2 and 4 days, and was absent at day 6. The facial temperature difference before and after the procedure was 4.737 &deg;C ± 0.37. In Group II the pain score were lower than in Group I (p < 0.05). The score for swelling was 2 on the first and second days, and was reduced on day 4. After the second day the difference in temperature was significantly reduced as compared to the day of surgery (0.77 &deg;C); at 2 and 4 days no difference was registered. Conclusions: The results of this clinical study show the significant effectiveness of the modified triangular flap in the sinus lift procedure for reducing pain and swelling.

Masseter and temporalis muscle electromyography findings after lower third molar extraction

BACKGROUND

The main clinical application of electromyography is to detect abnormalities in muscle function, to assess muscle activity for purposes of recruitment, and in the biomechanics of movement.

OBJECTIVES

To analyze electromyography (EMG) findings for masticatory muscles during chewing following surgical extraction of lower third molars, and to determine any correlation between pain, inflammation, trismus, and the EMG data registered.

MATERIAL AND METHODS

This prospective study included 31 patients. Surface EMG was used to study masseter and temporalis muscle function before lower third molar extraction and 72 hours and seven days after surgery. Clinical variables, pain, inflammation, and trismus were registered before and after surgery.

RESULTS

Studying the area and size of the masticatory muscles, higher values were found for temporalis than masseter muscles, regardless of the surgical side, which points to the greater involvement of the temporalis muscle in mastication. Comparing the side where surgery had been performed with the non-surgical side, a sharp and statistically significant reduction in amplitude and area were noted on the surgical side reflecting major functional affectation. One week after surgery, amplitude and area had almost returned to base-line values, indicating almost complete recovery. While pain decreased progressively after surgery, inflammation peaked at 72 hours, while mouth opening reached a minimum at this time, returning to normality within the week.

CONCLUSIONS

Surgical extraction of lower third molars produces changes to electromyography activity that are more evident during the first hours after surgery and closely related to the intensity of pain suffered and the patient's inflammatory responses, although they are not related to mouth opening capacity.

Comparison of Surgical Outcome after Impacted Third Molar Surgery Using Piezotome and a Conventional Rotary Handpiece

Background and Aim:

One of the most commonly performed surgical procedures by oral and maxillofacial surgeons all over the world is the removal of impacted teeth. The most critical and important steps in third molar extraction are bone cutting or osteotomy. Many techniques are used for this purpose including chisels and mallet, rotary instruments, and ultrasonic-based bone cutting instruments. Piezotome is newer and innovative device for osteotomy based on piezoelectric vibrations. Piezotome is considered very efficient in performing osteotomy because of its selective cutting; being inert against soft tissues, including nerves and blood vessels. The aim of this study was to compare the surgical outcome of third molar surgery using conventional handpiece and piezotome with all other criteria remaining same for all the individuals.

Materials and Methods:

All patients reporting to the Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Mangalore, for impacted mandibular third molar removal were screened. A total of 30 patients with same Pederson difficulty index for bilateral impacted third molar were selected for the study. The study involved the use of piezotome on one side (Side A) and rotary technique (Side B) on the other side for osteotomy on the same patient with an interval of 1 month. Therapeutic management was same for both the sides. Operating time was recorded in each surgery. Patients were examined postoperatively on 1^st, 3^rd, and 7^th day and pain, edema, trismus, paresthesia, and dry socket were evaluated and compared on both the sides. Data collected were analyzed statistically.

Results:

The mean operating time was 48.13 min in piezotome (Side A) and 32.90 min in conventional handpiece (Side B) which was statistically significant (P < 0.001). Furthermore, there was statistically significant difference (P < 0.001) in the level of pain (P < 0.001), number of analgesics taken (P < 0.001), and trismus (P < 0.01) on 1^st, 3^rd, and 7^th days postoperatively. There was no statistically significant difference in edema between the two sides. Paresthesia was present in one patient (3.3%) in Side B, while no paresthesia was present in Side A. No incidence of alveolar osteitis was reported on both the sides.

Conclusion:

Operating time with piezotome was more than that of conventional handpiece, but the postoperative responses such as pain, trismus, and edema were less in piezotome. Hence, despite being a slower procedure, piezotome can be an effective alternative for osteotomy in impacted third molar surgery. We recommend using piezotome for bone cutting and conventional rotary handpiece for tooth sectioning in order to obtain favorable outcomes as well as decreasing the operating time.

Does the postoperative administration of antibiotics reduce the symptoms of lower third molar removal? A randomized double blind clinical study

Background

To date there is little scientific evidence that clarifies the therapeutic effect of antibiotics for managing the postoperative symptoms of impacted third molar surgery. The aim of this study was to evaluate the efficacy of antibiotic treatment for reducing non-infectious clinical symptoms.

Material and Methods

Patient data was collected from the patients´ medical records and the results were statistically evaluated with SPSS versión 21.0; SPSS, IBM; Chicago, IL, USA). This longitudinal prospective study consisted of a randomized simple-blind clinical assay of 293 patients attending the Department of Oral Medicine and Surgery, Faculty of Dentistry at the Complutense University of Madrid (Spain). The predictive variable evaluated was the effect of antibiotic treatment on non-infectious symptoms after third molar extraction. The variables evaluated were pain, swelling, and oral aperture.

Results

The 293 patients were divided into 2 groups: a control group of 147 patients treated with analgesics and anti-inflammatories after surgery and a study group of 146 patients, who were also administered antibiotics. Better outcomes were observed in the study group treated with antibiotics. Pain, swelling and oral aperture variables presented better results in the antibiotic group with statistically significant difference.

Conclusions

The results suggest that antibiotic administration decreases the post-operative non-infectious clinical symptoms of impacted third molar surgery. However, the prolonged administration of antibiotics had no real medical indications to justify their use and can cause serious health problems in the long term.

Key words:Antibiotic, post-operative, impacted lower third molar.

Autologous Platelet-rich Plasma after Third Molar Surgery

Aim and Objective:

The aim of this study is to compare the efficacy of autologous platelet-rich plasma (PRP) in the third molar impactions, with respect to: pain, swelling, healing, and periodontal status distal to the second molar in patients who need surgical removal of bilateral impacted mandibular third molars.

Materials and Methods:

Twenty-five patients of both sexes aged between 16 and 60 years who required bilateral surgical removal of their impacted third molars and met the inclusion criteria were included in the study. After surgical extraction of the third molar, primary closure was performed in the control group, whereas PRP was placed in the socket followed by primary closure in the case group. The outcome variables were pain, swelling, wound healing, and periodontal probe depth that were follow-up period of 2 months. Quantitative data are presented as mean. Statistical significance was checked by t-test.

Results:

There was a difference in the pain (0.071) and facial swelling (0.184), reduction between test and control on day 3, but it was not found to be significant. Periodontal pocket depth (0.001) and wound healing (0.001) less in case group compared with the control group was found to be significant.

Conclusion:

The use of PRP lessens the severity of immediate postoperative sequelae and decreases preoperative pocket depth.

Eventuality of Dexamethasone Injected Intra-massetrically on Post Operative Sequel Following the Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Study

OBJECTIVE

The objective of the study was to compare the efficacy of dexamethasone given intra-massetrically via intra buccal approach on postoperative sequele after surgical extraction of impacted mandibular third molars.

METHODOLOGY

Twenty patients, each of who required surgical extraction of a single impacted mandibular third molar under local anesthesia, were randomly set apart to one of the two groups of ten each. The experimental group received dexamethasone 8 mg injected to the masseter muscle intra buccally and the control group did not receive any steroid. Facial swelling and maximal inter-incisal distance were measured by an independent examiner preoperatively, and at 4th h, on the day of surgery, 2 and 7 postoperative days. Pain was measured from the patient's response to a visual analogue scale.

RESULTS

Patients were of the age range 18-40 years. Dexamethasone group showed significant reduction in swelling and pain compared with the control group at all intervals. Dexamethasone injected into the masseter muscle via intra buccal approach resulted in significantly less trismus than control on day one postoperatively.

CONCLUSION

Dexamethasone 8 mg given intra-massetrically through intra buccal approach is an effective way of minimizing swelling, trismus, and pain following surgical extraction of impacted mandibular third molars. It offers a simple, safe, painless, non-invasive and cost-effective treatment.

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

BACKGROUND

The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar.

MATERIAL AND METHODS

The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images.

RESULTS

Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other.

CONCLUSIONS

Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.

Effect of age, sex and level of surgical difficulty on inflammatory complications after third molar surgery

BACKGROUND

Patients' factors such as age and sex and surgical variables such as level of difficulty have been linked with surgical outcome in third molar surgery. The aim of this study was to determine the effect of these variables on inflammatory complications in patients undergoing third molar surgery.

METHODS

Patients referred to our institution for surgical extraction of their impacted lower third molar between January 2007 and December 2008 were the subjects of the study. Patients' demographics as well as types of impaction, indication and level of difficulty based on Pederson criteria were obtained. Post operative pain, swelling and mouth opening limitation were evaluated at day 1, day 2, day 3, day 5 and 1 week after the surgery and analyzed. A p value of less than 0.05 was considered significant.

RESULTS

A total of 150 patients aged 16-38 years (25.9 ± 4.47) met the inclusion criteria. Male accounted for 66 (44.0 %) while females were 84 (56.0 %), giving male to female ratio of 1:1.3. Age, sex and difficulty index had no effect on pain and trismus throughout the periods of postoperative evaluation (p > 0.05). Postoperative swelling was not affected by gender but patients above 25 years who had high scores of difficulty index had more facial swelling.

CONCLUSION

The results of this study shows that age, gender and the level of surgical difficulty have no effect on pain and mouth opening limitation after third molar surgery.

Laser vs bur for bone cutting in impacted mandibular third molar surgery: A randomized controlled trial

BACKGROUND

The aim of this study was to assess the feasibility of Er: YAG laser in bone cutting for removal of impacted lower third molar teeth and compare its outcomes with that of surgical bur.

MATERIALS & METHODS

The study comprised 40 subjects requiring removal of impacted mandibular third molar, randomly categorized into two equal groups of 20 each, who had their impacted third molar removed either using Er: YAG laser or surgical bur as per their group, using standard methodology of extraction of impacted teeth. Clinical parameters like pain, bleeding, time taken for bone cutting, postoperative swelling, trismus, wound healing and complications were compared for both groups.

OBSERVATION & RESULT

Clinical parameters like pain, bleeding and swelling were lower in laser group than bur group, although the difference was statistically not significant. However, postoperative swelling showed significant difference in the two groups. Laser group required almost double the time taken for bone cutting with bur. Trismus persisted for a longer period in laser group. Wound healing and complications were assessed clinically and there was no significant difference in both the groups.

CONCLUSION

Based on the results of our study, the possibility of bone cutting using lasers is pursued, the osteotomy is easily performed and the technique is better suited to minimally invasive surgical procedures. The use of Er: YAG laser may be considered as an alternative tool to surgical bur, specially in anxious patients.

Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars

AIM

The present study attempted the evaluation of Primary and secondary closure techniques after removal of impacted third molars in terms of healing, post-operative pain and swelling.

MATERIAL AND METHODS

60 patients with impacted mandibular third molars were randomly divided into two groups of 30. Panoramic radiographs were taken to assess degree of eruption and to asses 3rd molar angulations to the long axis of 2nd molar. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In group II a 5-6 mm wedge of mucosa distal to the second molar was removed & the flap was repositioned. Interrupted sutures were given, so as to form a triangular opening distal to second molar measuring about 5 × 5 mm. Swelling and pain were evaluated for 7 days after surgery with the VAS scale.

RESULTS

Study results showed that post operative Sequale were comparatively less in secondary closure group than the primary closure group. Pain showed statistically significant difference between two groups. Pain was less in secondary closure group from day 1 to day 7. Swelling & trismus was also significantly less in secondary closure group. Evaluation of the complications of these two techniques showed that delayed wound healing occurred in 66.6% of cases (20 cases out of 30) in secondary closure group where as dehiscence of suture line occurred in 33.33% of cases (10 out of 30) in primary closure group.

CONCLUSIONS

The results obtained in the present study enable us to conclude that, in cases of equal intra-operative difficulty, open healing of the surgical wound after removal of impacted third molars produces less post-operative swelling and pain than occurs with closed healing, by hermetically suturing the socket.

Efficacy of platelet rich plasma and hydroxyapatite crystals in bone regeneration after surgical removal of mandibular third molars

PURPOSE

This study evaluates the efficacy of platelet rich plasma (PRP) & porous hydroxyapatite crystals in bone regeneration after surgical removal of mandibular third molar with the help of radiographs and its comparison with control side.

MATERIALS AND METHODS

A total of 40 patients; both male and female aged between 18 and 35 years, who had impacted mandibular third molars were randomly selected for this study. Twenty patients were taken for control group and 20 patients for study group. The extraction socket of the study group was packed with PRP and hydroxyapatite granules and that of control group was sutured without PRP and hydroxyapatite. The bone density of both extraction sockets were evaluated radiographically using gray level histogram and compared periodically on immediate postoperative day, 1st and 3rd month postoperatively and postoperative sequelae of both the control group and study group in terms of oedema & pain or any other adverse reactions were also assessed.

RESULTS

Data suggested evidence of early bone formation and maturation radiographically in study group as compared to control group. The percentage of facial swelling was numerically greater on the control side as compared to the study side, Pain was also assessed with VAS and it was found that the severity of pain was equal in both study and control groups and the results were not significant.

CONCLUSION

This study clearly indicated a definitive improvement in the wound healing, increase in bone density, which signifies and highlights the use of PRP and hydroxyapatite granules, certainly as a valid method in inducing and accelerating bone regeneration.

Randomized double blind comparative study on the efficacy of Ibuprofen and aceclofenac in controlling post-operative sequelae after third molar surgery

OBJECTIVE

To compare the efficacy of Ibuprofen and Aceclofenac in controlling pain, swelling and trismus following removal of impacted mandibular third molar teeth. To assess the patient's acceptability of these drugs.

METHODS

The present double blind study was conducted on 60 adult patients for the surgical removal of impacted mandibular third molars. Drugs administered were Ibuprofen and Aceclofenac. Both the drugs were packed separately and coded with equal in number. After removal of impacted mandibular third molars, following parameters were studied: (1) Analgesic activity, (2) Maximum mouth opening, (3) Swelling.

RESULTS

The scores were recorded preoperatively and on 1st, 3rd, 5th and 7th postoperative day.

CONCLUSION

Ibuprofen has a marginal edge over Aceclofenac. Both the drugs were well accepted by the patients with no reported adverse effects.

The effect of low-level laser therapy on trismus and facial swelling following surgical extraction of a lower third molar

OBJECTIVE

The purpose of this study was to evaluate the effect of low-level laser therapy (LLLT) on postoperative trismus and edema after the removal of mandibular third molars.

MATERIALS AND METHODS

Thirty-two patients who were to undergo surgical removal of lower third molars were studied. Patients were randomly allocated to two groups, LLLT and placebo. Patients in the LLLT group received 12 J (4 J/cm(2)) low-level laser irradiation to the operative side intraorally 1 cm from the target tissue, and to the masseter muscle extraorally immediately after surgery. In the placebo group the handpiece was inserted into the operative side intraorally and was applied to the masseter muscle extraorally each for 1 min, but laser power was not activated. Inter-incisal opening and facial swelling were evaluated on postoperative days 2 and 7. Student's t-test used to analyze the data.

RESULTS

It was determined that the trismus and the swelling in LLLT group were significantly less than in the placebo group on postoperative days 2 and 7.

CONCLUSION

Within the limitations of this study it can be concluded that LLLT can be beneficial for the reduction of postoperative trismus and swelling after third molar surgery.

Efficacy of platelet rich plasma in bone regeneration after surgical removal of impacted bilateral mandibular third molars: pilot study

PURPOSE

This study was done to assess the efficacy of platelet rich plasma (PRP) in bone regeneration.

MATERIALS AND METHODS

20 patients having bilateral mandibular third molar impaction with similar angulations were included in the present study. The extraction socket was packed with PRP on one side and the other side was sutured without PRP. The bone density of both extraction sockets were evaluated radiographically using gray level histogram and compared periodically. Postoperative pain and edema were also assessed.

RESULTS

The result of the study shows rapid bone regeneration in the extraction socket treated with PRP when compared with the socket without PRP. Also there was less postoperative discomfort on the PRP treated side.

CONCLUSION

Within the limits of the present study it can be concluded that usage of PRP expedites bone regeneration, and reduces postoperative complications.

Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)--intraoral and extraoral--on trismus and facial swelling following surgical extraction of the lower third molar

The purpose of this study is to compare the effects of extraoral and intraoral low-level laser therapies (LLLT) on postoperative trismus and oedema following the removal of mandibular third molars. Forty-eight patients who were to undergo surgical removal of their lower third molars were studied. Patients were randomly allocated to one of three groups: extraoral LLLT, intraoral LLLT, or placebo. In the study, a Ga-Al-As diode laser device with a continuous wavelength of 808 nm was used, and the laser therapy was applied by using a 1 x 3-cm handpiece. The flat-top laser beam profile was used in this therapy. For both of the LLLT groups, laser energy was applied at 100 mW (0.1 W) for a total of 120 s (0.1 W x 120 s = 12 J). Patients in the extraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation, and the laser was applied at the insertion point of the masseter muscle immediately after the operation. Patients in the intraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation intraorally at the operation site 1 cm from the target tissue. In the placebo group (n = 16), the handpiece was inserted intraorally at the operation site and then was touched extraorally to the masseter muscle for 1 min at each site (120 s total), but the laser was not activated. The size of the interincisal opening and facial swelling were evaluated on the second and seventh postoperative days. At the second postoperative day, trismus (29.0 +/- 7.6 mm [p = 0.010]) and swelling (105.3 +/- 5.0 mm [p = 0.047]) in the extraoral-LLLT group were significantly less than in the placebo group (trismus: 21.1 +/- 7.6 mm, swelling: 109.1 +/- 4.4 mm). Trismus (39.6 +/- 9.0 mm [p = 0.002]) in the extraoral-LLLT group at the seventh postoperative day was also significantly less than in the placebo group (29.0 +/- 6.2 mm). However, at the seventh postoperative day in the intraoral-LLLT group, only trismus (35.6 +/- 8.5 [p = 0.002]) was significantly less than in the placebo group (29.0 +/- 6.2 mm). This study demonstrates that extraoral LLLT is more effective than intraoral LLLT for the reduction of postoperative trismus and swelling after extraction of the lower third molar.

Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery

INTRODUCTION

For reducing edema, trismus, and pain after impacted tooth surgery, some protocols are proposed but their relative effectiveness is controversial.

PURPOSE

The goal of this study was to evaluate and compare the effects of corticosteroids and rubber drain on the postoperative complications of impacted molar surgery.

PATIENTS AND METHODS

This study was carried out on 22 patients with bilateral symmetrical mandibular impacted third molars. For surgical removal of impacted teeth on one side of these patients, either rubber drain (11 cases) or perioperative corticosteroids (11 cases) were used (study group). The contralateral impacted teeth were removed routinely without using any drug or drain (control group). Facial edema, trismus, and pain perception of the study and control groups were recorded on the second and seventh postoperative days.

RESULTS AND DISCUSSION

This study showed that perioperative steroids reduce the trismus, facial swelling, and the severity of pain after third molar surgery. This study also revealed that the use of the drain reduces facial pain and trismus but has no effect on the facial swelling after impacted tooth surgery. Comparing the steroid and drain groups, we found that perioperative corticosteroids are more effective than the surgical drain in reducing postoperative pain and edema, but their effects on trismus are similar.

Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars

The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.

Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg)

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery. A total of 225 patients were randomized into three equal groups: placebo, prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg, and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days. A higher rate of infection (P=0.006) was found among patients receiving placebo (16%) than those receiving single-dose prophylaxis (5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P=0.011) of surgical procedure and incidence of subsequent infection was also observed. Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 (P=0.001). Logistic regression analysis revealed a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if ostectomy was not performed. Pre-emptive therapy with the oral sustained release amoxicillin/clavulanate formulation reduced the rate of subsequent infection in patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures and may be indicated in cases where ostectomy is not performed.

A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, crossover study

Diflunisal and lornoxicam are currently available non-steroidal anti-inflammatory drugs (NSAIDs) that have been shown to be effective to various degrees in pain relief when administered either pre-emptively or postoperatively. The pre-emptive analgesic efficacy of diflunisal 1000 mg was compared with that of lornoxicam 16 mg in 40 ASA I patients undergoing surgical removal of bilateral impacted third molars. The impacted third molar teeth on one side were removed at the first surgical appointment using one of the two drug regimens being assessed and the teeth on the contralateral side were removed at a second appointment using the alternate drug regimen; all operations were performed by the same surgeon. Acetaminophen up to 2000 mg daily was provided as rescue medication. The postoperative rescue analgesic consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 4, 6, 12 and 24h postoperatively. No statistically significant differences were found between groups with respect to rescue analgesic consumption and postoperative pain scores. Pre-emptive administration of both NSAIDs proved to be effective in the management of pain following the surgical removal of impacted third molar teeth.

The Effect of a Single Dose Prednisolone With and Without Diclofenac on Pain, Trismus, and Swelling After Removal of Mandibular Third Molars

PURPOSE

The purpose of this study was to evaluate the effect of a single intramuscular dose of prednisolone and the prednisolone-diclofenac combination on postoperative pain, trismus, and edema after the removal of third molars.

PATIENTS AND METHODS

Forty-five patients who were to undergo surgical removal of lower third molars were studied. Patients were divided into 3 groups. In the first group, each patient was given 25 mg prednisolone intramuscularly immediately after surgery. In the second group, each patient was given 25 mg prednisolone and diclofenac intramuscularly immediately after surgery, and in the third group, each patient was given sterile saline solution as control group. Postoperative pain was evaluated by visual analogue scale on the day of surgery. Facial swelling and trismus were evaluated on postoperative days 2 and 7. ANOVA was used to analyze these data.

RESULTS

Statistical analysis of the data indicated the prednisolone-diclofenac combination suppressed pain intensity in comparison with control (P < .05) at the 6-hour observation. Both the prednisolone and prednisolone-diclofenac combinations suppressed pain at the seventh postoperative hour in comparison with the control (P < .05). The prednisolone-diclofenac combination group also had a smaller loss of opening at postoperative days 2 and 7 in comparison with both the prednisolone and control groups (P < .05). Postoperative swelling was less in both the prednisolone and prednisolone-diclofenac combination groups, as compared with the control group (P < .05) at postoperative day 2. The prednisolone-diclofenac combination group also had a smaller swelling at postoperative day 7 in comparison with both the prednisolone and control groups (P < .05).

CONCLUSION

It was determined that the combination of a single dose of prednisolone and diclofenac is well-suited to the treatment of postoperative pain, trismus, and swelling after dental surgical procedures and should be used when extensive postoperative swelling of soft tissue is anticipated.

Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction

INTRODUCTION

Impacted third molar extraction causes considerable swelling in the days immediately following surgery. The aim of the present investigation was to evaluate the efficacy of methylprednisolone as a single 40-mg intramuscular dose in controlling the complications of impacted lower third molar surgical removal.

MATERIALS AND METHODS

Thirty-five patients were evaluated within the framework of a consecutive sampling and double-blind study with intrasubject measurements. Extraction comprised ostectomy with tooth sectioning of both lower third molars under local anesthesia. The study group received 40 mg of methylprednisolone injected into the gluteal region, while the controls received no such medication. In each individual one molar was randomly assigned to the study group and the other to the control series - with extraction of the two teeth being spaced 1 month apart. Evaluations were made of postoperative pain, trismus and swelling, and measurements were obtained for oral aperture and various distances (tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye) before surgery and 2-7 days after extraction. Statistical correlations were made based on the Student t-test for the comparison of means of related samples.

RESULTS

A statistically and clinically significant association was observed 2 days after surgery between methylprednisolone administration and increased oral aperture and diminished facial swelling. Likewise, less pain was recorded in the study group 6 h after surgery.

CONCLUSION

The results confirm the efficacy of methylprednisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.

Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial

The effect of endo-alveolar and sub-mucosal administration of dexamethasone sodium phosphate to prevent inflammatory sequelae after surgical removal of lower third molars was studied. Forty-three patients underwent bilateral extractions of lower third molars and were randomly assigned to receive either dexamethasone 4 mg (group A) or 10 mg (group B) as endo-alveolar powder or 10 mg as sub-mucosal injection (group C) unilaterally. The controlateral site served as control and did not receive any steroid administration. Facial edema, trismus and pain perception were evaluated at the 2nd and 7th postoperative day. A multivariate analysis revealed that treatment and ostectomy time were both significantly positively associated with the degree of postoperative trismus and edema. Other baseline classification variables (e.g., molar classification) were also predictive of the degree of change in all clinical parameters. Test sites treated (any steroid application) showed greater reductions in all clinical parameters recorded compared to control. No statistically significant differences were observed between the three test groups. Both sub-mucosal and endo-alveolar administration of dexamethasone are effective in reducing postoperative sequelae of surgical removal of lower wisdom teeth.

Analgesic efficacy of aceclofenac after surgical extraction of impacted lower third molars

The analgesic efficacy of aceclofenac in the control of pain after surgical extraction of impacted mandibular third molars was compared with its preoperative administration. Two groups of 20 patients each were medicated with 2 tablets of 100 mg aceclofenac taken orally either 1h before surgery or in the early postoperative period. All surgeries were performed by the same surgeon and the surgical technique was the same for all patients. Pain was assessed with a Visual Analogue Scale and a 0-4 Scale, as well as by counting the number of analgesic drug tablets taken after the surgery. Patients in the preoperative group took fewer tablets postoperatively and had a lower pain score both in the Visual Analogue Scale and the 0-4 Scale. This difference, however, was statistically significant only at 6h after surgery, which is the time of maximum pain for this surgical procedure. Aceclofenac was more efficient in controlling pain when administered before the surgery.