Assessment of complications in third molar surgery performed by resident surgeons: A comprehensive analysis

Prevalence and Risk Factors of Post-Extraction Complications in a Western Australian Tertiary Dental Hospital: A Retrospective Cross-Sectional Study

OBJECTIVES

Dental extractions are routine procedures, yet they carry a risk of post-operative complications that can negatively affect patients' quality of life. This study aimed to identify patient-, tooth- and clinician-related risk factors associated with post-extraction complications at Western Australia's only tertiary dental hospital, to inform clinical decision-making and improve outcomes by identifying high-risk groups.

METHODS

A retrospective audit of patient records was conducted using data from individuals who underwent dental extractions during the audit period. Extracted variables included demographic details, medical history (e.g., smoking status, diabetes, hypertension), extraction characteristics (e.g., simple vs. surgical, tooth location) and clinician factors (e.g., level of training, anaesthesia type). Post-operative complications were identified through clinical follow-up notes. Descriptive and inferential statistical analyses were used to determine significant associations.

RESULTS

The overall post-extraction complication rate was 11.0%. The most common complications were persistent post-operative pain (4.1%) and alveolar osteitis (3.4%). Statistically significant patient-related risk factors included smoking, uncontrolled diabetes and hypertension. Surgical extractions and mandibular tooth removals were associated with higher complication risks. Extractions performed by students and those conducted under general anaesthesia were also linked to increased complications.

CONCLUSIONS

Approximately 1 in 10 patients experienced post-operative complications. Identifying modifiable risk factors and minimising surgical complexity may reduce adverse outcomes. Operator experience and anaesthesia choice should be considered during preoperative planning.

CLINICAL RELEVANCE

This study highlights the importance of structured preoperative risk assessment that integrates medical comorbidities, extraction complexity and operator training level. Tailoring surgical planning and post-operative monitoring based on individual risk profiles may improve clinical outcomes, reduce avoidable complications and support safer, more effective delivery of care in tertiary and teaching settings.

Two decades of dental malpractice litigations in Türkiye: a retrospective matched cohort study analyzing legal and clinical outcomes

BACKGROUND

This methodological study aims to provide a comprehensive database of dental malpractice cases in Türkiye over the past 20 years, with a focus on the patterns of malpractice claims across different specialties and settings, as well as the characteristics of the events that give rise to litigation. The study also seeks to clarify to raise awareness of patient safety among dental practitioners to enhance care quality and liability risk management by providing insights into the legal outcomes of malpractice cases.

METHODS

A total of 100 dental malpractice claims spanning 23 years (2000-2023) were included in this retrospective, matched cohort study. The cases were categorized into four groups: Malpractice; Complication; Undetermined; and Unresolved. The analysis focused on various legal and clinical variables, including the type of dental treatment, the physician's level of duty, the presence of auxiliary healthcare personnel, the type of healthcare institution, the legal outcome of the case (decision, settlement, and compensation status), the reasons for filing the malpractice claim, and the appointment of expert witnesses. Data were analyzed using the chi-square test and Fisher's Exact Test, with statistical significance set at p < 0.05.

RESULT

The majority of cases were related to prosthodontics (31%) and oral surgery (24%), followed by oral diagnosis (14%), implantology (12%), orthodontics (9%), endodontics (5%), restorative dentistry (2%), pedodontics (2%), and periodontology (1%). The most common reason for malpractice claims was incorrect treatment (88%), followed by incomplete treatment (33%), misdiagnosis (32%), patient fault (21%), treatment delays (19%), lack of follow-up (16%), failure to obtain informed consent (10%), delays in diagnosis (3%), document forgery (3%), and infectious disease (2%).

CONCLUSION

This study highlights the importance of thorough planning, assessments, and preventive measures in dental practice, particularly in prosthodontics, oral surgery, and implantology, which involve invasive procedures, prolonged treatments, and high costs-factors that contribute to higher patient dissatisfaction and increased malpractice risks. Addressing these factors through improved oversight and decision-making could reduce the frequency of litigation and minimize legal disputes.

Efficacy of Platelet-Rich Plasma in Post-extraction Healing of Mandibular Third Molars: A Clinical and Radiographic Evaluation

INTRODUCTION

Healing of extraction sockets is a critical factor in oral and maxillofacial surgery, particularly when preserving alveolar bone and periodontal stability is essential. Platelet-rich plasma (PRP), an autologous concentrate of growth factors, has gained attention for its potential to enhance bone regeneration and soft-tissue healing. This study aimed to evaluate the clinical and radiographic outcomes of PRP application in extraction sockets after impacted mandibular third molar surgery.

MATERIALS AND METHODS

Forty patients who underwent impacted mandibular third molar extraction were divided into two groups according to clinical decision-making in conjunction with patient preference: the PRP group, in which PRP was applied in the extraction socket, and the non-PRP group, which received standard post-extraction care. Clinical parameters, including probing depth and wound closure, and radiographic assessments of alveolar bone level and bone density were recorded at baseline, one month, three months, and six months postoperatively.

RESULTS

The application of PRP resulted in significant improvements in alveolar bone preservation and periodontal health, with a notable reduction in probing depth compared to the non-PRP group. Although PRP did not show a significant difference in bone density between the groups, a sustained increase over time suggested a positive effect on bone remodeling. PRP also accelerated wound healing, with initial dehiscence observed, but improved closure by day seven, indicating a biphasic influence on tissue repair.

CONCLUSION

PRP demonstrated potential benefits in enhancing soft and hard tissue healing after mandibular third molar extraction. Its ability to promote periodontal stability and wound closure suggests its clinical utility for oral surgical procedures. However, larger randomized controlled trials with extended follow-up are needed to establish standardized protocols and confirm their long-term efficacy.

Health-Related Quality of Life with Iatrogenic Inferior Alveolar Nerve Injuries Treated with Photobiomodulation: A Comparative Study

Background/Objectives: Photobiomodulation therapy (PBM) creates a biostimulatory or modulatory effect, promoting tissue regeneration and improving patients' health-related quality of life (HRQoL). PBM has shown promise as an effective treatment and management strategy for peripheral nerve injuries, including inferior alveolar nerve (IAN) damage. This study aims to assess the impact of PBM on HRQoL in patients with iatrogenic IAN injuries. Methods: A prospective study was implemented to investigate the research question. PBM treatments were administered weekly, with patient discharge contingent upon either complete recovery or stabilization of associated signs and symptoms. HRQoL was assessed using the EQ-5D-5L questionnaire at the initial and final appointments. Results: The study included 71 participants, divided into 3 groups based on etiology: inferior third molar surgery, mandibular orthognathic surgery, and dental implant surgery. The results showed a widespread reduction of symptoms along with a statistically significant improvement (p < 0.001) across four of the five dimensions of the EQ-5D-5L questionnaire, as well as in patients' perceived health levels in both Groups I and II. Group III patients also demonstrated a notable improvement; however, due to the small sample size, statistical analysis was not conducted for this group. Conclusions: PBM demonstrated a comparable ability to enhance HRQoL and alleviate symptoms in patients with IAN injuries within different etiologies. These findings underscore the effectiveness of the protocol used in this study and highlight potential avenues for expanding research in this field.