Effects of lower third molar extraction on attachment level and alveolar bone height of the adjacent second molar

Autologous and Heterologous Minor and Major Bone Regeneration with Platelet-Derived Growth Factors

AIM

This review aims to explore the clinical applications, biological mechanisms, and potential benefits of concentrated growth factors (CGFs), autologous materials, and xenografts in bone regeneration, particularly in dental treatments such as alveolar ridge preservation, mandibular osteonecrosis, and peri-implantitis.

MATERIALS AND METHODS

A systematic literature search was conducted using databases like PubMed, Scopus, and Web of Science, with keywords such as "bone regeneration" and "CGF" from 2014 to 2024. Only English-language clinical studies involving human subjects were included. A total of 10 studies were selected for qualitative analysis. Data were processed through multiple stages, including title and abstract screening and full-text evaluation.

CONCLUSION

The findings of the reviewed studies underscore the potential of the CGF in enhancing bone regeneration through stimulating cell proliferation, angiogenesis, and extracellular matrix mineralization. Autologous materials have also demonstrated promising results due to their biocompatibility and capacity for seamless integration with natural bone tissue. When combined with xenografts, these materials show synergistic effects in improving bone quantity and quality, which are crucial for dental implant success. Future research should focus on direct comparisons of different techniques, the optimization of protocols, and broader applications beyond dental medicine. The integration of CGFs and autologous materials into routine clinical practice represents a significant advancement in regenerative dental medicine, with the potential for improved patient outcomes and satisfaction.

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

Can concentrated growth factor prevent postoperative complications of impacted third molar surgery? A split-mouth randomized double-blind trial

OBJECTIVES

The purpose of the present study was to evaluate the effect of concentrated growth factor (CGF) on prevention of postoperative complications in the impacted third molar extraction.

MATERIALS AND METHODS

A total of 25 healthy patients with symmetrical bilaterally impacted third molars (50 extraction sites) were enrolled in this split-mouth, randomized, double-blind clinical trial. Third molar extractions were performed in both sites of the mandible at the same appointment. Randomization was performed using a coin toss to choose the test and control sites. CGF was placed in the extraction socket and the socket was sutured (test group), while the contralateral socket was only sutured (control group). Each patient acted as their own control. The primary outcome were pain assessed by visual analog scale (VAS) and facial swelling on the1st, 3rd and 7th postoperative days. The secondary outcomes were bone healing in extraction sockets through alveolar bone height (ABH) and alveolar bone density (ABD) evaluated by cone beam computed tomography (CBCT) immediately after extraction and in the 3rd and 6th months.

RESULTS

Twenty-five patients (12 female, 13 male; mean age 29.17) with bilateral impacted third molars participated in the study. A statistically significant reduction in pain was determined on the 3rd and 7th postoperative days in the CGF sites compared to the control sites while no statistically significant difference was found between the groups on the 1st postoperative day (3rd day, p = 0.009; 7th day, p = 0.039). There were no statistically significant differences in facial swelling and bone healing between the test and control groups at different time intervals, although the data obtained were slightly favoring the CGF group (p > 0.05). There were no serious adverse effects such as infection, alveolitis, paraesthesia, fracture through the follow-up period in all of the cases.

CONCLUSION

The study has demonstrated the effect of CGF on relieving the severity of pain after the third molar extraction.

CLINICAL RELEVANCE

Placement of CGF in the extraction socket could relieve postoperative pain and reduce patient discomfort after the third molar extraction. CGF is recommended during the third molar extraction due to its good biological effects, low cost and simple preparation procedures.

TRIAL REGISTRATION NUMBER

ChiCTR2300077819.

The Accuracy of Bone Assessment Distal to Lower Second Molars Using Panoramic Radiography: A Systematic Review and Meta-Analysis

Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar.

Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is to compare changes in bone level distal to the mandibular second molar (MSM) in patients with an extracted IMTM versus non-extracted IMTM using OPG. Methods: In this retrospective case-control study, 160 orthopantomograms (OPGs) of 80 patients who attended Dental Hospital of the University of Barcelona (HOUB) were randomly selected. Participants were stratified into a study group and control group. Results: Males and females experienced bone gain in the study group and bone loss in the control group. However, the difference in bone-level change was not statistically significant regarding gender in the study group. Within the study group, the age group of 29-39 years demonstrated significant (p-value = 0.042) bone gain after extraction compared to other age groups. However, the control group demonstrated bone loss in all age groups in which the difference is not statistically significant (p-value 0.794). Conclusions: Bone improvements distal to the MSM were observed after the extraction of an IMTM compared to when an IMTM was not extracted.

To Study the Impact of Tooth Sectioning on Postoperative Pain, Swelling and Trismus After Surgical Extraction of Impacted Mandibular Third Molars

AIM

To study the impact of tooth sectioning on postoperative pain, swelling, and trismus after surgical extraction of impacted mandibular third molars.

MATERIALS AND METHODS

The present research was conducted on a sample of 100 individuals who were in good health. The participants had an average age of 28 years and were seeking treatment at the Department of Oral and Maxillofacial Surgery for the extraction of impacted mandibular third molars. The participants were allocated randomly to one of the two experimental conditions. The patients in Group A are receiving a surgical procedure to remove the mandibular third molar without the need for tooth sectioning. The study focuses on patients classified as Group B who are having a surgical procedure for the extraction of the mandibular third molar using dental sectioning.

RESULTS

The Group B patients saw a notable decrease in pain intensity on the third and seventh days after the surgery. The mean difference in pain scores was 4.15±0.54 and 1.69±0.11, respectively, indicating statistically significant findings with a p-value of less than 0.05. The study observed statistically significant differences in swelling between the 1st, 3rd, and 7th postoperative days for group II. The mean differences were recorded as 149.85±5.86, 119.25±4.22, and 107.52±, respectively. The significance level was determined to be P<0.05. The study observed that the degree of mouth opening in Group B exhibited a significant rise on the 3rd and 7th postoperative days, with a mean difference of 40.87±3.69 and 43.15±3.29, respectively, as compared to Group A. This difference was found to be statistically significant, with a p-value of less than 0.05.  Conclusion: The findings of our research indicate that the technique of sectioning the tooth is the preferable approach for surgical extraction of impacted third molars, as it effectively reduces the occurrence of post-operative problems.

Influence of inflammation on bleeding and wound healing following surgical extraction of impacted lower third molars

OBJECTIVE

This study aimed to investigate the effect of inflammatory states following impacted lower third molar (ILTM) surgery regarding postoperative bleeding and wound healing.

METHODS

The study included patients who underwent extraction of ILTMs associated with or without inflammatory conditions. Post-extraction bleeding and wound healing were assessed. In addition, mean grey values (MGVs) of alveolar bone and bone height using an orthopantomography radiograph were analyzed.

RESULTS

A total of 376 patients were enrolled; 171 pericoronitis, 51 pulpitis, 44 chronic periapical periodontitis, 36 chronic periodontitis, and 74 control. The bleeding score in the control group was significantly lower than in the periapical periodontitis and periodontitis groups. Excellent wound healing for control, pericoronitis, pulpitis, periapical periodontitis, and periodontitis groups was (78.38%, 35.67%, 70.59%, 70.45%, and 33.33%, respectively). Patients with pericoronitis and periodontitis had significantly poorer wound healing (P < 0.01). The MGV in periapical periodontitis and periodontitis was considerably lower than in the control group.

CONCLUSIONS

The inflammatory conditions associated with ILTMs increase the risk of bleeding. So suturing with the placement of local hemostatic agents over a pressure pack alone is recommended. The poorest wound healing was in localized gingival inflammation. Furthermore, MGV was affected by age and was lower with periapical periodontitis.

Effects of Flap Design on the Periodontal Health of Second Lower Molars after Impacted Third Molar Extraction

The purpose of this study was to compare the envelope flap and triangular flap for impacted lower third molar (M3) extraction and their effects on the periodontal health of adjacent second molars (M2). A population of 60 patients undergoing M3 extraction with the envelope flap (Group A) or triangular flap (Group B) was analyzed, comparing probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) recorded at six sites (disto-lingual, mid-lingual, mesio-lingual, disto-vestibular, mid-vestibular, and mesio-vestibular) before (T⁰) and 6 months after extraction (T¹). There was a statistically significant mean difference in PPD and CAL at two sites, disto-vestibular (dv) and disto-lingual (dl), between values recorded before and 6 months after surgery for either Group A or Group B. Furthermore, for the same periodontal records, at 6 months after surgery, a statistically significant difference was recorded between younger and older patients, implying that the healing process was more beneficial for younger patients. No significant differences were found between the two groups (A and B) in PPDdl, PPDdv, CALdl, and CALdv, confirming that the mucoperiosteal flap design does not influence the periodontal healing process of second molars.

Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery.

MATERIALS AND METHODS

Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors.

RESULTS

Fourteen studies were included in the quantitative synthesis. At 6 months, the PPD reduction was 1.06 mm (95% CI, 0.72 to 1.39 mm) and the remaining PPD was 3.81 mm (95% CI, 3.00 to 4.62 mm). Baseline PPD was strongly correlated with the remaining PPD at 6 months (p < 0.001, adjusted R² = 70.05%).

CONCLUSIONS

Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6 months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects.

CLINICAL RELEVANCE

This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.

Influence of a novel suturing technique on periodontal health of mandibular second molar following impacted third molar surgery: a split-mouth randomized clinical trial

BACKGROUND

Surgical extraction of the third molar is the most common surgical procedure in the oral surgery field and is associated with several complications. This study aimed to compare the effects of a newly presented suturing technique with the routine suture after surgical removal of the third molar on the postoperative complications.

MATERIALS AND METHODS

This randomized clinical trial was designed as a split-mouth double-blinded investigation. Twenty patients were involved in the current study. After the surgical removal of the third molar, the new suturing technique was used to close the wound on one side of the patient randomly (case side), and the other side was sutured by the routine simple interrupted stitches (control side). Pain, edema, trismus, pocket depth, and the attachment loss of the distal of the second molar were assessed following the surgery. The data were statistically analyzed and compared between the sides.

RESULTS

Pain and edema following the surgery in the control side were significantly less than in the case side. The pocket depth and the gingival attachment loss of the distal aspect of the second molar in the case side were significantly less than in the control side. No case of dry socket was observed in the case side.

CONCLUSION

It seems that the newly presented suturing technique is able to keep the wound margins close to each other and may be helpful in reducing the periodontal complication of the second molar following the surgical removal of the impacted third molars.

A Pilot Retrospective Study on the Effect of Bone Grafting after Wisdom Teeth Extraction

This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups.

Association of Oral Hygiene and Periodontal Health with Third Molar Pericoronitis: A Cross-Sectional Study

Background

Pericoronitis is a painful inflammatory condition commonly associated with third molar teeth. The purpose of this study was to investigate the relationship between oral hygiene and periodontal health status and the presence of pericoronitis in semi-impacted third molar teeth.

Methods

A cross-sectional study was conducted, and 54 patients having at least one mandibular vertically semi-impacted third molar tooth with or without pericoronitis were consecutively enrolled. Subjects with pericoronitis and subjects with healthy third molars were selected according to symptoms in the gingiva overlying semi-impacted third molar teeth. Periodontal health status and oral hygiene were evaluated with the measures of plaque index (PI), gingival index (GI), and total number of sites with a probing depth (PD) ≥ 4 mm. The clinical data collected in this study was analyzed with Mann–Whitney U test using SPSS 20.0 package program.

Results

The PI scores were found to be significantly higher in patients with pericoronitis (p < 0.05). Although the GI scores and PD scores were higher in patients with pericoronitis, the difference did not reach statistical significance when compared with those in healthy subjects (p > 0.05).

Conclusion

The findings obtained in this study suggest that the amount of dental plaque was positively associated with third molar pericoronitis. Gingival and periodontal health conditions were similar between patients with and without pericoronitis. Improving oral hygiene and controlling dental plaque may help prevent third molar pericoronitis.

Comparative evaluation of bone regeneration with platelet-rich fibrin in mandibular third molar extraction socket: A randomized split-mouth study

Purpose:

Platelet-rich fibrin (PRF) is a new platelet concentrate concept consisting of an autologous fibrin gel having accumulation of platelets and the released cytokines in a fibrin clot. The study aims to evaluate the efficacy of autologous PRF in accelerating bone regeneration and repair in fresh third molar extraction sockets. The investigators hypothesized the cicatricial properties and accumulation of growth factors in a single clot which will improve bone density and quality.

Materials and Methods:

PRF results from a natural and progressive polymerization occurring during centrifugation. Two groups were made with bilaterally impacted third molar patients. PRF was obtained and surgical extraction was carried out under aseptic conditions. Quantitative data are presented as mean. Statistical significance was inferred at P < 0.05.

Results:

Results obtained were evaluated statistically and found a significant difference between the groups in improvement in alveolar bone density of regenerate measured radiographically. The study demonstrates a faster bone formation in the extracted sockets with PRF as compared to control.

Conclusion:

PRF proved to be an autologous biomaterial with useful features that allowed efficient postextraction bone defect filling and faster bone regeneration.

Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes

PURPOSE

The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal.

PATIENTS AND METHODS

Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05.

RESULTS

From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (-0.50 ± 0.61 mm, P = .001), 60 months (-0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (-0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL-6 months: -0.37 ± 0.59 mm, P = .004; BL-60 months: -0.67 ± 0.55 mm, P < .0001; 6 to 60 months: -0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes.

CONCLUSIONS

Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.

Acemannan-induced tooth socket healing: A 12-month randomized controlled trial

Background/purpose

Natural compounds have become alternatives for bone regeneration. Acemannan, the main polysaccharide extracted from Aloe vera, has been demonstrated as a promising osteoinductive material in vitro and in vivo. This clinical study investigated the effect of acemannan on tooth socket healing.

Materials and methods

Thirty-five otherwise healthy patients, 18–25 years old and diagnosed with horizontal or vertical partial impaction of the lower third molars, were enrolled in this randomized controlled trial. After removing the teeth, the sockets randomly received one of the following treatments: spontaneous blood-clotting (control), 20 mg acemannan sponge, or 50 mg acemannan sponge. Cone-beam computed tomography of the mandible was performed immediately (baseline), and at 3-, 6-, and 12-months postoperatively; the data were analyzed using the OsiriX MD program. Bone healing in the socket was determined measuring the socket volume. One-way ANOVA was used to analyze the differences within each group and between groups.

Results

Thirty-five patients with 43 partially impacted lower third molars participated in this study. No patients exhibited alveolar osteitis or secondary infection. Compared with baseline, all groups showed significant reduction in socket volume at all observation time-points (p < 0.05). The 50 mg acemannan group had a significantly greater reduction in socket volume compared with the control at all postoperative time-points (p < 0.05). The 20 mg group had a significantly greater reduction in socket volume compared with the control at 3-months postoperatively (p < 0.05).

Conclusion

We conclude that acemannan increases bone healing at 3-, 6-, and 12-months after removal of partially impacted mandibular third molars.

Computer-aided three-dimensional assessment of periodontal healing distal to the mandibular second molar after coronectomy of the mandibular third molar: a prospective study

Background

The periodontal healing distal to the mandibular second molar (M2M) after coronectomy of the M3M has shown controversial results. We aimed to combine a digital method with cone-beam computed tomography (CBCT) and estimate periodontal healing of M2M after M3M coronectomy. An accurate and stable indicator in three dimensions was also explored tentatively.

Methods

Patients with a M3M in contact with the inferior alveolar canal were included. CBCT was applied immediately after coronectomy (baseline) and 6-months later. Data were investigated with digital software for registration. Previously reported and coronectomy-related factors were included for univariate and multivariate analyses.

Results

A total of 181 patients (213 M3Ms) completed 6-month follow-up. Significant reduction in the distal intra-bony defect (DBD) depth of the M2M was shown (1.28 ± 1.24 mm, P < 0.001). DBD depth of the M2M at baseline was the most influential factor (r = 0.59), followed by preoperative M3M condition, age, rotation and migration of the root complex. Remaining enamel (OR = 6.93) and small retromolar space (0.67) contributed to re-contact of the root complex and M2M. Bone volume regenerated in the distal 2 mm was associated significantly with DBD-depth reduction (r = 0.74, P < 0.001).

Conclusions

Bone volume regenerated in the distal 2 mm of the M2M denoted stability of distal periodontal healing of the M2M. DBD depth at baseline was the most influential factor for healing of a DBD of the M2M after M3M coronectomy. The remaining enamel and a small retromolar space could contribute to re-contact of the root complex and the M2M.

Trial registration

China Clinical Trial Center, ChiCTR1800014862. Registered 10 February 2018,

Prevention of Periodontal Pocket Formation after Mandibular Third Molar Extraction Using Dentin Autologous Graft: A Split Mouth Case Report

Surgical extraction of the third molar can often result in the development of a periodontal pocket distal to the second molar that could delay the healing, and the socket could be colonized by bacteria and lead to secondary abscesses, or it may cause mobility or hypersensitivity. The aim of this case report is to assess the efficacy of a dentin autograft in the prevention of periodontal dehiscences after the surgical extraction of the third molar, obtained by the immediate grinding of the extracted tooth. A healthy 18-year-old male patient underwent surgery of both impacted mandibular molars: right postextractive socket was filled with grinded dentin; then, the left one was filled with fibrin sponge. The patient was followed up for six months, and clinical and radiographic assessment were performed: measurements of plaque index (PI), bleeding on probing (BOP), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD) were done before surgery and repeated at 90 and 180 days after the extractions. Measurements made at six months after the surgery revealed that the grafted site was characterized by a minor depth of the pocket if compared with the nongrafted site, with no clinical/radiographic signs of complications.

Prevalence of periodontitis and caries on the distal aspect of mandibular second molar adjacent to impacted mandibular third molar: A guide for oral health promotion

Objectives

Pericoronitis of mandibular third molars is commonly encountered in our day to day practice. Most of the case extraction becomes mandatory. This study was carried out to find the incidence of periodontitis on the distal aspect of the second molar adjacent to impacted third molar.

Materials and Methods

A total of 400 patients were included in the study. Patient selection was randomly done. Whoever came with a chief complaint of pain in the third molar area were included in the study. They were evaluated both clinically and radiographically with an orthopantomogram. Patients' age, gender, type of impaction, presence or absence of bone loss, type of bone loss, and presence or absence of caries was evaluated radiographically and noted.

Results

Periodontitis was observed in 39% of the cases and caries in 26% of the cases.

Conclusions

These percentages are alarming and could be used to prophylactically extract the impacted third molars and thereby promoting the oral health of the individual.

The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex

The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.

Periodontal Status of the Adjacent Second Molar after Impacted Mandibular Third Molar Surgical Extraction

OBJECTIVE

The purpose of this study was to evaluate the change in periodontal status of the adjacent second molar of the impacted mandibular third molar after surgical extraction and its association with the third molar condition in the presurgical stages, including position, eruption level, and local complications.

MATERIALS AND METHODS

The study was based on a 6-month follow-up of 38 patients (19 males and 19 females; Mean age: 21.89 ± 2.74) recruited consecutively after surgical extraction of an impacted lower third molar. The third molar's presurgical position, eruption level, and local complications were examined. Periodontal status, including Plaque Index (PI), Gingival Index (GI), and gingival bleeding on probing (BOP), of the teeth in the adjacent sextant was clinically evaluated. The pocket depth (PD) and the distance between the epithelial attachment and the adjacent second molar's occlusal surface were clinically measured; and the distance between the alveolar bone crest and cementoenamel junction (AC-CEJ) of the adjacent second molar was evaluated by the periapical film. All measures were recorded at the time of surgery and 1, 3, and 6 months after surgery.

RESULTS

The values of PI, GI, BOP, PD, and EA-OS were significantly reduced after 1, 3, and 6 months compared to baseline data. The AC-CEJ was decreased after 1 month but significantly increased after 3 and 6 months. Presurgical local complications of the impacted third molar mostly were significantly associated with the periodontal status of the adjacent sextant.

CONCLUSION

There was a significant improvement of periodontal conditions of the second molar and adjacent sextant after impacted third molar surgery.

Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars

BACKGROUND

The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction.

METHODS

Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters.

RESULTS

Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0 mm) and disto-lingual (T0-5.4/T1-3.2 mm) sites. The average attachment gains at T1 were 1.9 and 2 mm, respectively (P < 0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD ≥ 4mm at baseline healed at 6 months recall without periodontal pockets. Older age (mean 55 years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7 mm was more likely to be associated with PPD ≥ 4 mm 6 months postextraction (P < 0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4 mm after healing (OR = 41.4; 95% CI = 10.9 to 156.5, P < 0.05).

CONCLUSION

Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.

Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial

Silk mat originates from the cocoon of the silkworm and is prepared by a simple method. The material has been used for guided bone regeneration (GBR) in animal models. In this study, the silk mat used for a clinical application was compared with a commercially available membrane for GBR. A prospective split-mouth, randomized clinical trial was conducted with 25 patients who had bilaterally impacted lower third molars. High-density polytetrafluoroethylene (dPTFE) membrane or silk mat was applied in the extraction socket randomly. Probing depth (PD), clinical attachment level (CAL), and bone gain (BG) were measured at the time of extraction (T0) and then at three months (T1) and six months after extraction (T2). There was no missing case. GBR with silk mat was non-inferior to GBR with dPTFE for PD reduction at T1 and T2 (pnon-inferiority < 0.001). PD and CAL were significantly decreased at T1 and T2 when compared with those at T0 in both membrane groups (p < 0.001). BG at T2 was 3.61 ± 3.33 mm and 3.56 ± 3.30 mm in the silk mat group and dPTFE group, respectively. There was no significant complication from the use of silk mat for the patients. The results for patients undergoing GBR with silk mat for third-molar surgery were non-inferior to GBR with dPTFE for PD reduction.

Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis

Background

The mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction.

Methods

Four series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson’s difficulty index (DI) and RID.

Results

A large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID.

Conclusions

Additional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.

Impact of mandibular third molar extraction in the second molar periodontal status: A prospective study

Aim:

The aim of the present study was to assess the periodontal condition and sensitivity of second mandibular molars after the extraction of the adjacent third molar, while also assessing the quality of life of the patients.

Materials and Methods:

Twenty-three healthy patients were assessed in terms of probing depth, gingival height, gingival thickness, dental sensitivity, plaque index and bleeding on probing (adjacent second mandibular molar), before the surgical procedure, as well as 60 and 180 days after the surgery. The following data were also recorded and measured: the position and size of the impacted teeth; the size of the alveoli after surgery and the quality of life of the patient.

Results:

Significant differences were found for probing depth and gingival height before and after 180 days. The plaque index increased significantly after surgery (P = 0.004), as did bleeding on probing. No significant difference was found for the quality of life. The size of the third molar extracted was correlated with bleeding on probing 180 days after the surgery.

Conclusion:

An improvement was noted in the periodontal condition of the second mandibular molars after the extraction, based on the assessments of probing depth and gingival height. The position of the third molar affected the periodontal condition of the second mandibular molar. No alterations were recorded for dental sensitivity or the quality of life after the extraction.

[Consequences of impacted wisdom teeth extraction on the periodontal environment of second molars. A pilot study]

INTRODUCTION

Wisdom teeth extraction is a common procedure, generally considered as safe by patients. However, complications are possible, especially periodontal ones. The aim of this study was to evaluate the frequency and the consequences of periodontal complications at the level the 2nd molars after extraction of the wisdom teeth.

MATERIAL AND METHODS

A single-center retrospective observational multi-operator study was conducted at the university hospital of Besançon - France. The files of all the adult patients who underwent extraction of four impacted wisdom teeth by mean of a standardized surgical technique between November 2012 and November 2014 and who could be followed 1 year postoperatively at least and that precisely mentioned the periodontal status of the surgical sites were included. Postoperative complications, gingival and plaque indexes according to Loë and Silness, periodontal attachment level and periodontal second molar probing were recorded. The main judgment criterion was the occurrence of a periodontal complication in the second molar areas.

RESULTS

The files of 20 patients (15 women - 5 men), operated on by five different surgeons, met the inclusion criteria. Two patients suffered from dry socket at one of the avulsion sites. No patient had a gingival or plaque index greater than 2. No gingival recession or periodontal pocket over 4mm was found.

DISCUSSION

Extraction of impacted third molars in young healthy adults didn't have any impact on the second molars periodontal environment in our study. Literature suggests that surgical technique greatly influences the occurrence and the extent of periodontal sequelae.

Evaluation of two flap designs on the mandibular second molar after third molar extractions

BACKGROUND

The extraction of third molars is associated with some clinical outcomes and periodontal problems. It is imperative to note that the type of incision used in the surgery for the removal of the impacted third molar is critical. The design of the flap influences the healing of the surgically created defect and damage to the distal periodontal area of the adjacent second molar. However, till date, there have been conflicting reports on the influence of different flap designs used for the surgical removal of impacted third molars.

AIM

The present study aimed to comparatively evaluate the clinical outcomes and periodontal status of the adjacent second molar, when two different flap designs, namely, the envelope and the modified triangular flap designs were used.

MATERIALS AND METHODS

Sixty female patients with bilateral impacted third molars completed the study with envelope flap on one side and modified triangular flap design on the other side of the mandible for third molar removal. Clinical parameters including pain, dehiscence and swelling were assessed postoperatively and periodontal probing depth (PPD) on the distal aspect of adjacent second molar were assessed both pre- and post-operatively.

RESULTS

The results were assessed on 1, 3 and 8 days for pain using visual analog scale. The subjective perception of swelling was evaluated on 3, 7 and 15 days postoperatively in a similar manner. The results of the periodontal parameters were evaluated both preoperatively and 3 months postoperatively, with cautious exploration using a University of North Carolina (UNC)-15 periodontal probe. The statistically significant results for swelling and PPD were noted for the two flap groups using the Chi-square test (P < 0.05).

CONCLUSION

The study revealed that the modified triangular flap had lesser postoperative PPDs and dehiscence. The envelope flap was better when swelling was analyzed. The pain scores, though slightly higher for the modified triangular flap group, were not statistically significant.

Surgical removal of third molars and periodontal tissues of adjacent second molars

OBJECTIVES

The aim of this study was to investigate the effect of mandibular third-molar (M3) removal on periodontal health of adjacent second molars (M2). Probing pocket depths (PPD) and probing attachment levels (PAL) have been described for primary outcome. As cofactors involved, gender, complications, two suture materials and two types of impaction were chosen as secondary outcomes.

MATERIALS AND METHODS

Seventy-eight patients (49 female; mean age: 16.0 ± 2.0 years) with 78 asymptomatic impacted mandibular M3 were included in this study. Plaque and gingival indices, PPD and PAL were recorded prior and 6 months after surgery. Impacted teeth were classified as either fully impacted (completely within in the bone) or submucosal (fully covered by oral mucosa).

RESULTS

Average baseline PPD was reduced from 3.3 mm to 2.6 mm after 6 months (p < 0.05). Average PAL was reduced from 3.0 to 2.5 mm (p < 0.05). Preoperative PPD ≥ 4 mm at the distolingual and distobuccal sites was positively correlated with clinical improvement (PPD: p < 0.05; PAL: p < 0.05). The impaction class was also identified as positive cofactor for PPD (p = 0.039), but not for PAL.

CONCLUSIONS

Young patients may benefit from an early removal of mandibular M3, especially in the presence of certain cofactors.

Incidence of root canal treatment of second molars following adjacent impacted third molar extraction

Background/purpose

The aim of this study was to evaluate the incidence of requirement for root canal treatment of adjacent second molars following the surgical extraction of an impacted third molar.

Materials and methods

The dental records of 6323 consecutive patients who had impacted third molars removed surgically were evaluated and the incidence of postoperative root canal treatment requirement of adjacent second molars was determined. Patients who required root canal treatment of neighboring second molars were accepted as the study group, while the remaining patients were accepted as a control group. Sex, age at the time of the operation, localization of third molar, the depth of impaction, angulation of the tooth, and the professional experience of the surgeon performing the operation were evaluated from patient records.

Results

The incidence of requirement of root canal treatment for second molars following a neighboring impacted third molar extraction was 0.17% (11/6323) and invariably occurred in the mandible. The mean age of the study group was found to be significantly higher than the control group (31 years vs. 23 years). The years of professional experience of the surgeons was significantly lower in the study group than in the control group.

Conclusion

Although the incidence is minimal, iatrogenic subluxation injuries occurring during the surgical removal of impacted third molars can lead to pulpal complications and a requirement for root canal treatment of adjacent second molars.

Periodontal healing after 'orthodontic extraction' of mandibular third molars: a retrospective cohort study

In this study we investigated periodontal healing of mandibular second molars following 'orthodontic extraction' of adjacent impacted third molars, under the null hypothesis that there would be no difference in probing pocket depths (PPD) and clinical attachment levels (CAL) at the distal aspect of second molars before and after treatment. A retrospective survey was conducted of 64 patients who consecutively underwent 'orthodontic extraction' of mandibular third molars in close anatomical relationship with the mandibular canal from January 1997 to January 2011. Age, smoking habit, and PPD and CAL at the distal aspect of second molars before and after treatment were recorded. A statistically significant difference was found in PPD and CAL before and after treatment for the overall sample and for the sample classified by age (>25 or ≤25 years), smoking habit (smoker or non-smoker), and type of third molar impaction (horizontal, mesioangular, or vertical). Median PPD and CAL reductions amounted to 6mm and 5mm, respectively. The null hypothesis was rejected and orthodontic extraction proved to be indicated for those impacted mandibular third molars at high risk of a postoperative periodontal defect at the distal aspect of the adjacent second molar.

Radiological infrabony defects after impacted mandibular third molar extractions in young adults

PURPOSE

To estimate the prevalence of infrabony defects and their healing at the distal aspect of mandibular second molars (M2s) after extraction of impacted mandibular third molars (M3s).

MATERIALS AND METHODS

This prospective clinical study included 22 young healthy patients (21.03 ± 4.51 yr old). Thirty-seven surgical extractions of high-risk periodontal and mesioangular impacted M3s in close contact with adjacent M2s were performed. Radiographic bone height (RBH), radiographic infrabony defects (RIDs), and bone loss (BL) were recorded at baseline and 3, 6, and 12 months after surgery. RBH and RIDs were measured from the tip of a periodontal gauge to the root apex and to the cementoenamel junction of the M2, respectively; BL was calculated by dividing the length of the M2 root into thirds and categorized as slight, moderate, or severe.

RESULTS

Only 26 extracted teeth were included in all radiographic assessments. Mean RID size at baseline was 4.54 ± 1.87 mm. At 12 months, an average recovery of 2.80 ± 2.36 mm (P < .001) was recorded, for a mean RID size of 1.78 ± 1.65 mm. Statistically significant differences in RBH and RIDs were found at all assessments (P < .05). Improved bone healing was registered during the postoperative period, with higher values during the first 3 months (1.3 mm; P < .01). Most RIDs of at least 4 mm associated with moderate or slight BL decreased to no larger than 3 mm without BL. For moderate BL, the bone gain pattern was gradual and continuous, whereas for slight BL, the pattern was variable.

CONCLUSIONS

In young healthy patients, a high-risk periodontal impacted M3 leads to an RID of at least 4 mm associated with slight or moderate BL at the distal aspect of the M2, which decreases to no larger than 3 mm 12 months after surgery. Bone healing is clinically and statistically significant at 12 months, with the most notable changes at the first 3-month follow-up.

Removal of symptomatic third molars may improve periodontal status of remaining dentition

PURPOSE

To assess the impact of third molar removal on the periodontal status of adjacent second molars and teeth more anterior in the mouth in patients with mild symptoms of pericoronitis.

PATIENTS AND METHODS

Healthy patients with mild symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for a study approved by the institutional review board. The subset analyzed in this study had all 4 third molars removed. Data were collected at enrollment and at least 3 months after surgery. Full-mouth periodontal probing was conducted at 6 sites per tooth. A probing depth of at least 4 mm (PD4+) was considered an indicator for periodontal pathology. The presence of a PD4+ on the distal of second molars (D2Ms) or anterior to the D2Ms, the number of PD4+s, and extent scores (percentage of PD4+s of all possible probing sites) were assessed at the patient and jaw levels. The association between patients' pre- and postsurgical periodontal status was assessed using the McNemar exact test. The level of significance was set at .05.

RESULTS

The median age of the 69 patients was 21.8 years (interquartile range, 20.2 to 25.2 yr). Forty-five percent were men, and 57% were Caucasian. Significantly more patients (88%) had at least 1 D2M PD4+ at enrollment compared with after surgery (46%; P < .01). D2M extent scores decreased from 31.5 at enrollment to 11 after surgery. Significantly more patients (61%) had at least 1 PD4+ anterior to the D2M at enrollment compared with after surgery (29%; P < .01). Extent scores anterior to the D2M decreased from 2.0 at enrollment to 0.6 after surgery.

CONCLUSIONS

Removal of third molars in patients with mild pericoronitis symptoms improved the periodontal status of the D2Ms and teeth more anterior in the mouth.

Mandibular second molar periodontal healing after impacted third molar extraction in young adults

PURPOSE

To estimate the prevalence of preoperative periodontal defects and analyze 12-month spontaneous healing on the distal aspect of the mandibular second molar (M2) after impacted mandibular third molar (M3) extraction.

MATERIALS AND METHODS

This prospective clinical study was conducted in 25 healthy young patients (21.03 ± 4.38 yr old) with 40 extractions of higher-risk periodontal impacted M3s. Plaque and gingival indexes, recession, bleeding on probing, probing depth (PD), and attachment level were recorded before surgery and at 3, 6, and 12 months after surgery at 5 sites on the distal aspect of the M2.

RESULTS

The initial mean PD was 5.70 ± 3.80 mm, with the deepest mean PD at the lingual side. At 12 months, a mean PD average of 3.77 ± 2.86 mm was recorded, with a total average recovery of 1.93 ± 2.46 mm (P < .001), that was higher at 3 months (-1.62 mm, P < .001). The PD and attachment level improvements were statistically significant (P < .001) and nearly clinically significant from baseline to 12-month follow-up and from the buccal to the lingual side of the distal aspect of the M2.

CONCLUSIONS

Impacted M3s adjacent to M2s lead to periodontal defects that are deepest at the lingual side and almost recover at 12 months after extraction. The first 3 months is considered the cutoff for periodontal healing. Young adults with high-risk periodontal M3 impactions may benefit from early extraction, which increases spontaneous periodontal healing.

Repeatability and accuracy of a paralleling technique for radiographic evaluation of distal bone healing after impacted third molar surgery

OBJECTIVES

The purpose of this study was to investigate the repeatability and radiographic accuracy of an intraoral paralleling technique to evaluate periodontal bone healing on the distal surface of the second mandibular molar (2 Mm) after impacted third mandibular molar (3 Mm) surgical extraction.

METHODS

In order to estimate the variation in different radiographs, three replicas were made, each from 2 Mm, totalling 69 radiographic radicular longitude (RRL) recordings. One operator performed the periapical radiographs in a standard manner, utilizing a modified posterior film holder for the radiographic technique of parallelism, applied on the posterior region with the X-ray beam focused on the centre of 2 Mm. These radiographic recordings of the same region were obtained on three different and separate occasions, over a 12 month evaluation period after surgical extraction of the impacted 3 Mm. The RRL variable was measured and recorded three times by the same operator, with side-by-side comparison of three posterior periapical radiographs, irrespective of when the assessments were performed.

RESULTS

There were no statistically significant differences between the three replica recordings (p = 0.969). The correlations between the three sets of measurements were evaluated and found to be highly associated (intraclass correlation reliability coefficient = 0.90) and statistically significant (p≤0.05). The median and mean error of the radiographic technique evaluated was ±0.257 mm and ±0.347 mm, respectively.

CONCLUSIONS

The radiographic technique described permits standardization in periapical radiographs with a high repeatability and accuracy in posterior radiographic records (distal surface of 2 Mm) over a postoperative evaluation period of 12 months.

Effect of removing an impacted mandibular third molar on the periodontal status of the mandibular second molar

PURPOSE

The aim of this study was to evaluate the change in the periodontal status of mandibular second molars after surgical extraction of adjacent impacted lower third molars.

MATERIALS AND METHODS

The study was based on a 1-year follow-up of 48 patients (20 men and 28 women) recruited consecutively after the extraction of an impacted lower third molar. Panoramic radiographs were obtained and clinical examinations were carried out at baseline to determine the periodontal status (probing depth and dental plaque and gingival indices) both for the second molar and for the 4 posterior sextants. After surgical removal of the impacted mandibular third molars, all patients were assessed at 3, 6, 9, and 12 months for changes in periodontal status.

RESULTS

The periodontal health of the second molar was found to improve gradually after third molar surgery in all clinical parameters. Probing depth was gradually reduced by about 0.6 mm quarterly, until a final depth of 2.6 ± 0.8 mm was attained. The relative risk of having a plaque index and gingival index coded as 0 (healthy) or 1 (minor problems) was about 10 times higher at the end of the follow-up than at baseline for both indices. The periodontal status of the 4 posterior sextants also improved gradually. Molar depth, according to the Pell and Gregory classes and types, seemed to be the main factor modulating both the baseline probing depth and the change in probing depth during follow-up.

CONCLUSIONS

Our results suggest that the initial periodontal breakdown established on the distal surfaces of the second molars and in the periodontal health of the 4 posterior sextants can be significantly improved 1 year after surgical removal of the ipsilateral lower third molar.

Treatment of intrabony defects after impacted mandibular third molar removal with bioabsorbable and non-resorbable membranes

BACKGROUND

Mandibular second molar (M2) periodontal defects after third molar (M3) removal in high-risk patients are a clinical dilemma for clinicians. This study compares the healing of periodontal intrabony defects at distal surfaces of mandibular M2s using bioabsorbable and non-resorbable membranes.

METHODS

Eleven patients with bilateral probing depths (PDs) ≥6 mm distal to mandibular M2s and intrabony defects ≥3 mm, related to the total impaction of M3s, were treated with M3 extraction and covering of the surgical bone defect with a bioabsorbable collagen barrier on one side and a non-resorbable expanded polytetrafluoroethylene (ePTFE) barrier contralaterally. The PD, clinical attachment level (CAL), M2 mobility, and furcation class probing were evaluated preoperatively and 3, 6, and 9 months postoperatively. Intraoral periapical radiographs were taken immediately preoperatively and 3 and 9 months postoperatively.

RESULTS

Both treatment modalities were successful. At 9 months, the mean PD reduction was 5.2 ± 3.9 mm for bioabsorbable sites and 5.5 ± 3.0 mm for non-resorbable sites; the CAL gain was 5.9 ± 3.3 mm and 5.5 ± 3.4 mm, respectively. The outcome difference between the two sites for PD and CAL did not differ statistically (P >0.05) at any assessment time.

CONCLUSION

Bioabsorbable collagen membranes in guided tissue regeneration treatment of intrabony defects distal to the mandibular M2 obtained the same marked PD reductions and CAL gains as non-resorbable ePTFE membranes after M3 extraction.

Recovery after third-molar surgery: the effects of age and sex

INTRODUCTION

In this study, we assessed the effects of age and sex on quality-of-life recovery after third-molar surgery.

METHODS

Healthy subjects scheduled for removal of third molars were recruited at multiple sites for this study. Each patient was given a condition-specific instrument to be completed each postsurgery day for 14 days. Lifestyle and oral-function recovery were assessed by using a 5-point Likert-type scale. Recovery was defined as the number of days until the patient reported no or little trouble. Recovery from pain was defined as the number of days until no medications were taken. For each quality-of-life item, a Cox regression analysis was performed to assess the effects of age and sex on recovery after controlling for surgical-procedure variables.

RESULTS

Nine hundred fifty-eight subjects treated at 9 academic centers and 12 community practices were enrolled. Except for ability to open the mouth, recovery for all quality-of-life items for those 21 years or older significantly (P < 0.02) lagged behind recovery for younger subjects. Recovery for female subjects was significantly longer than for male subjects for all outcomes (P < 0.01).

CONCLUSIONS

Patients older than 21 and those who are female should be informed before removal of all 4 third molars that their oral function, lifestyle, and pain recovery will be prolonged compared with those who are younger and male.

Second molar periodontal inflammatory disease after third molar removal in young adults

PURPOSE

To assess the prevalence of periodontal inflammatory disease on the distal side of second molars after third molar removal and the association between presurgical and surgical variables and postsurgical periodontal outcomes.

PATIENTS AND METHODS

Data before and after surgery from 2 studies approved by an institutional review board were used. In 1 study, 26 subjects had 4 asymptomatic third molars and in the other 49 subjects had at least 1 mandibular third molar with symptoms of pericoronitis. Full-mouth periodontal probing data, 6 sites per tooth, were obtained as a measurement of periodontal status before and after surgery. A probing depth (PD) ≥4 mm on either of the 2 possible probing sites on the distal side of any second molar (D2M) served as an indicator of periodontal inflammatory disease; periodontal health was defined as all D2M PD <4 mm. Cochran-Mantel-Haenszel row mean score tests compared the subjects' postsurgical periodontal status (all D2M PD <4 mm and at least 1 D2M PD ≥4 mm) with respect to age and time intervals, and the Fisher exact test was used to compare ethnicity, gender, and clinical data at surgery. The McNemar test was used to assess the discordance between subjects' pre- and postsurgical periodontal status. The level of significance was set at .05.

RESULTS

Of the 75 subjects, 52% were women and 65% were white. The median age at surgery was 23.6 years (interquartile range, 20.9 to 26.6 years). At enrollment, 53 of 75 subjects (71%) had at least 1 D2M PD ≥4 mm. Subjects were significantly more likely to have an improved D2M periodontal status after surgery than a deteriorated status (P < .01). Fewer subjects, 17 of 75 (24%), had at least 1 D2M PD ≥4 mm after surgery. D2M PD ≥4 mm was more likely after surgery if presurgical D2M was PD ≥4 mm (P < .01). Gender, ethnicity, age, presurgical symptoms, and data estimating the extensiveness of surgery were not significantly associated with postsurgical D2M periodontal outcomes.

CONCLUSIONS

After third molar removal, periodontal inflammatory disease on the distal of D2Ms was detected significantly less often. None of the variables examined except for presurgical presence of D2M PD ≥4 mm were significantly associated with postsurgical D2M periodontal inflammatory disease.

Effect on pocket depth and attachment level of manual versus ultrasonic scaling of lower second molars following lower third molar extraction: a randomized controlled trial

OBJECTIVE

The objective of this study was to compare the effect on periodontal health of ultrasonic versus manual scaling of the lower second molar (L2M) root surface following surgical extraction of mesioangular lower third molars (L3M).

STUDY DESIGN

Randomized single-blind clinical trial to compare the effectiveness of ultrasonic scaling of the L2M (experimental group) and manual scaling and root planing (control group) after surgical extraction of the corresponding L3M.

RESULTS

Forty-three subjects were enrolled, 69.8% completing the study. The postoperative bony defect on the distal surface of the L2M was significantly reduced for both treatment groups (P = .001). Despite a higher reduction of intrabony defect being observed in the ultrasonic group, the difference was not significant (P = .17) at 6 months. Furthermore, there was also no statistically significant correlation (P > .05) between the postoperative pocket depth and the treatment group (ultrasonic or manual).

CONCLUSIONS

Pocket depth and depth of the intrabony defect were similar in both experimental and control groups.

Bone resorption in incompletely impacted mandibular third molars and acute pericoronitis

Acute pericoronitis (AP) arises frequently in incompletely impacted mandibular third molars, but it remains unknown whether bone resorption in aging is associated with acute inflammation of the third molar. We conducted an experiment to compare the ratio of bone resorption to root length in the distal surface of the second molar (A), the proximal surface (B), and distal surface (C) in mesio-angular, incompletely impacted third molars in 27 young and 58 older adults with AP and 77 young and 79 older adults without a history of AP. Bone resorption in A, B, and C in older adults with AP demonstrated a significantly higher ratio when compared to those without AP, whereas there was no difference between those with and without AP in young adults except for B in women. However, there were no differences between bone resorption in B with AP in young and older women, and between bone resorption in C with AP in young and older adults. These indicate that AP and bone resorption are associated with incompletely impacted mandibular third molars in older adults.

Extraction versus nonextraction management of third molars

Surgical removal of impacted third molars is the most commonly performed procedure by oral and maxillofacial surgeons. The removal of diseased or symptomatic third molars has not been an issue of controversy. The risk of surgery and associated complications are justified and uniformly accepted by most surgeons when the teeth are associated with chronic or acute pathologic processes, including caries, nonrestorable teeth, fractured roots, resorption, associated pathologic conditions (cysts, tumors), periapical abscesses, odontogenic infections, osteomyelitis, removal before reconstructive or ablative surgery, and radiation therapy.

Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions

PURPOSE

This investigation compared the effects of different flap designs on the periodontal health status of the mandibular second molar after the extraction of the adjacent impacted third molar.

PATIENTS AND METHODS

Eighteen patients aged 16 to 32 years who required removal of bilateral impacted mandibular third molars were included in this study. The periodontal health of the second molar was evaluated preoperatively and at 1 week, 2 weeks, 4 weeks, and 12 months postoperatively. The third molars were removed by using the 3-cornered flap on the left side of the jaw and modified Szmyd flap on the right side.

RESULTS

The mean probing depth (PD) at distal and buccal sites was significantly different between the flaps at 1 week, 2 weeks, and 4 weeks postoperatively (P < .05). There were no significant differences in preoperative and 1 year postoperative mean PD between the 2 flaps (P > .05). There was no significant difference in mean clinical attachment level between the flap sites at 1 year (P > .05).

CONCLUSION

The modified Szmyd flap, which leaves intact gingiva around the second molar, has better primary periodontal healing than the 3-cornered flap after surgical removal of the fully impacted mandibular third molar.

Review of flap design influence on the health of the periodontium after mandibular third molar surgery

The purpose of this study is to review the effect of flap design in terms of periodontal status of the preceding second molar after lower third molar surgery. Impacted lower third molar surgery may result in periodontal complications on the distal surface of the adjacent second molar. Flap design that is used during impacted third molar surgery is important to prevent those complications. Several different flap techniques, mainly envelope, triangular (vertical) flaps, and their modifications have been developed to minimize those complications. Each technique has some advantages as well as disadvantages. It is also reported that the selection of a flap design does not seem to have a lasting effect on the health of periodontal tissue. The effect of the type of flap used for lower third molar surgery on the periodontal status of the second molar, as well as the factors that may influence this outcome, has been uncertain. The decision to use on one or the other of the flaps should be based on surgeon's preference.