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Fehlhofer J, Fernandez-Ulrich C, Wohlers A, Kesting MR, Rau A, Buchbender M. A Retrospective Analysis of Postoperative Abscess Formation Following Wisdom Tooth Removal and Their Clinical Condition and Localization. J Contemp Dent Pract 2023; 23:1079-1084. [PMID: 37073929 DOI: 10.5005/jp-journals-10024-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
AIM As a common procedure in oral surgery, the removal of wisdom teeth (3M) is associated with a variety of postoperative complications. This study reports of deep tissue abscesses after the removal of 3M in correlation to several factors. MATERIALS AND METHODS Patients between 2012 and 2017 with removed 3M were retrospectively evaluated in terms of clinical condition and localization and thus assigned tog A (removal of asymptomatic 3M) or group B (removal of symptomatic 3M). Moreover, they were analyzed in terms of abscesses after the removal and correlation with various parameters: localization of the abscess, general diseases, perioperative antibiotic treatment, number of days from removal of the tooth to abscess formation, and postoperative complications after primary abscess incision. RESULTS About 82 patients (male n = 44, female n = 38) were included, with 88 wisdom teeth removed and postoperative abscesses. Postoperative abscesses occurred more frequently in group B (n = 53) with n = 29 in IIB localization, without a significant correlation. Patients in this group were older, and there were more surgical abscess incisions needed, despite a longer treatment with oral and intravenous antibiosis that correlated with neurologic diseases and age. Younger patients reported significantly more pain. CONCLUSIONS Detection of potential 3M pathologies at an early and asymptomatic stage is essential to avoid postoperative complications following 3M removal. Additional prospective studies are necessary to develop corresponding guidelines. CLINICAL SIGNIFICANCE Wisdom tooth extraction is the most common operation in oral surgery, and therefore, adequate risk evaluation is still required.
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Affiliation(s)
- Jakob Fehlhofer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Fernandez-Ulrich
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Aron Wohlers
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marco R Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, University of Greifswald, Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany, Phone: +49 9131 8533614, e-mail:
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Azab M, Ibrahim S, Li A, Khosravirad A, Carrasco-Labra A, Zeng L, Brignardello-Petersen R. Efficacy of secondary vs primary closure techniques for the prevention of postoperative complications after impacted mandibular third molar extractions: A systematic review update and meta-analysis. J Am Dent Assoc 2022; 153:943-956.e48. [PMID: 36030117 DOI: 10.1016/j.adaj.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/15/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this systematic review was to determine whether secondary closure (SC) or primary closure (PC) is better at preventing postoperative complications after impacted mandibular third-molar extraction. TYPES OF STUDIES REVIEWED The authors sought randomized controlled trials comparing the effects of PC and SC on pain, swelling, trismus, infection, and bleeding after impacted mandibular third-molar extraction. Screening, data extraction, and risk of bias assessments were conducted independently and in duplicate. The reviewers pooled results across studies using a random-effects meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS This review identified 785 unique citations and included 40 trials. Compared with PC, SC was found to have trivial benefits for pain at day 7 and trismus within 1 week (moderate certainty). The incidence of infection and bleeding did not differ importantly between techniques (moderate certainty). However, SC is probably associated with less swelling on day 1 (standardized mean difference, -0.98; 95% CI, -1.22 to -0.73; moderate certainty) and day 3 (standardized mean difference, -0.87; 95% CI, -1.16 to -0.59; moderate certainty). There was very low certainty evidence for pain on days 1 and 3 and low certainty evidence for swelling on day 7. CONCLUSIONS AND PRACTICAL IMPLICATIONS Clinicians choosing between closure techniques should be aware that SC probably imparts an important benefit only for swelling at days 1 and 3. There seems to be a trivial difference between the techniques in other outcomes.
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Surin W, Chatiketu P, Hutachok N, Srichairatanakool S, Chatupos V. Pain intensity and salivary α‐amylase activity in patients following mandibular third molar surgery. Clin Exp Dent Res 2022; 8:1082-1091. [PMID: 35801257 PMCID: PMC9562728 DOI: 10.1002/cre2.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to compare the levels of pain and salivary α‐amylase (SAA) in patients before and after mandibular third molar surgery. Materials and Methods Patients were divided into asymptomatic and symptomatic groups and were then identified by the analgesic drug taken throughout the 2‐week study. The visual analog scale (VAS) was employed to evaluate the severity of pain experienced by a given subject before treatment, when the anesthetic wore off, in the morning, and at night for a period of 1 week. Saliva was collected from the mouth floor of the subjects and the levels of SAA activity were measured at indicated times. Results The levels of postoperative pain were higher than those of pretreatment pain (p < 0.05), but were not necessarily different between the two groups. The pain levels were positively correlated with SAA activities in both groups (p < 0.05). There was no difference between the number of analgesics taken by the two groups and the postoperative complications observed during the study. A significant correlation was observed between the VAS pain scale and SAA activities. Conclusion SAA would be a simple effective biomarker for the objective assessment of pain intensity in patients who have undergone mandibular third molar surgery.
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Affiliation(s)
- Wanvipa Surin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Chiang Mai University Chiang Mai Thailand
| | - Piyanart Chatiketu
- Department of Family and Community Dentistry, Faculty of Dentistry Chiang Mai University Chiang Mai Thailand
| | - Nuntouchaporn Hutachok
- Department of Biochemistry, Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | | | - Vuttinun Chatupos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Chiang Mai University Chiang Mai Thailand
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Iwanaga J, Kunisada Y, Masui M, Obata K, Takeshita Y, Sato K, Kikuta S, Abe Y, Matsushita Y, Kusukawa J, Tubbs RS, Ibaragi S. Comprehensive review of lower third molar management: A guide for improved informed consent. Clin Anat 2020; 34:224-243. [DOI: 10.1002/ca.23693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Fukuoka Japan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Masanori Masui
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kotaro Sato
- Department of Oral and Maxillofacial Surgery Nagoya University Graduate School of Medicine Nagoya Japan
| | - Shogo Kikuta
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yushi Abe
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yuki Matsushita
- University of Michigan School of Dentistry Ann Arbor Michigan USA
- Department of Clinical Oral Oncology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Structural & Cellular Biology Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System New Orleans Louisiana USA
- Department of Anatomical Sciences St. George's University St. George's Grenada
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, Renton T, Dickson R. Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-116. [PMID: 32589125 PMCID: PMC7336222 DOI: 10.3310/hta24300] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed. OBJECTIVE The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars. METHODS Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care. RESULTS The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group's lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out. LIMITATIONS Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking. CONCLUSIONS The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy. FUTURE WORK Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037776. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Juliet Hounsome
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Gerlinde Pilkington
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - James Mahon
- Coldingham Analytical Services, Berwickshire, UK
| | - Angela Boland
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Eleanor Kotas
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Tara Renton
- Oral Surgery, Dental Hospital, King's College London, London, UK
| | - Rumona Dickson
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
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Singh V, Garg A, Bhagol A, Savarna S, Agarwal SK. Photobiomodulation Alleviates Postoperative Discomfort After Mandibular Third Molar Surgery. J Oral Maxillofac Surg 2019; 77:2412-2421. [DOI: 10.1016/j.joms.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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Effect of the Surgeon's Dominant Hand on Postoperative Periodontal Status of Adjacent Molars After Removal of Lower Third Molars. J Oral Maxillofac Surg 2019; 77:912-919. [DOI: 10.1016/j.joms.2018.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/30/2018] [Accepted: 12/15/2018] [Indexed: 11/24/2022]
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Liu J, Hua C, Pan J, Han B, Tang X. Piezosurgery vs conventional rotary instrument in the third molar surgery: A systematic review and meta-analysis of randomized controlled trials. J Dent Sci 2018; 13:342-349. [PMID: 30895143 PMCID: PMC6388871 DOI: 10.1016/j.jds.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/22/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background/purpose The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae. Different instruments such as piezosurgery and conventional rotary handpiece have been used to decrease such adverse events. There are controversial results from randomized controlled trials evaluating the effects of Piezosurgery in the mandibular third molar extraction, compared with conventional rotary instrument. This study was performed to determine the impact of piezosurgery versus conventional rotary instrument on postoperative reactions after extraction. Materials and methods A systematic review and meta-analysis was performed to combine relevant RCTs results. Results Five RCTs were eligible for this study, enrolling a total of 402 patients. Compared with conventional rotary instrument, pain score at 6 or 7 days and mouth opening at 1 day after surgery was significantly lower in Piezosurgery group (SMD -0.33, 95% CI: −0.56 to −0.10, P = 0.005), as well as swelling score at 7 days after surgery (SMD -1.95, 95% CI: −3.22 to −0.67, P = 0.003). Furthermore, mouth opening at 1 day after surgery was significantly better in patients treated with Piezosurgery (SMD 0.84, 95% CI: 0.19 to 1.49, P = 0.01). However, more operation time will be required for Piezosurgery (MD 6.23, 95% CI: 3.32 to 9.14, P < 0.0001). With regard to analgesic dosage, pooled results from two RCTs suggested there were no significant differences between Piezosurgery and conventional rotary instrument (SMD -1.45, 95% CI: −4.39 to 1.49, P = 0.33). Conclusion There might be some advantages on third mandibular molar extraction with piezosurgery compared to conventional rotary instrument. More multi-centre trials are required to get more conclusive results.
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Affiliation(s)
| | | | | | | | - Xiufa Tang
- Corresponding author. State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillary Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China. Fax: +028 85501428.
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Dos Santos Pereira R, da Silva JR, Bonardi JP, Hochuli-Vieira E. Lower third molar displaced to lateral pharyngeal space after mandibular angle fracture: a case report. Oral Maxillofac Surg 2018; 22:231-233. [PMID: 29455344 DOI: 10.1007/s10006-018-0673-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Abstract
The removal of displaced dental elements from deep anatomical spaces is a condition that requires the knowledge of the region and skills to perform the procedure. The lateral pharyngeal space contains important structures such as the internal carotid artery and close proximity with the cranium basis. The aim of this paper is to report a clinical case of a lower third molar displaced to the lateral pharyngeal space after a mandibular angle fracture and its treatment by surgical intervention. The tooth was removed under general anesthesia by direct approach and the fracture was reduced and fixed with a plate and screws. This case report illustrates the importance of an immediate procedure to avoiding severe complications and further damage to important anatomical structures.
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Affiliation(s)
- Rodrigo Dos Santos Pereira
- Department of Surgery and Clinic Integrated, Araçatuba Dental School, UNESP, José Bonifácio Street, number 1193, Araçatuba, São Paulo, CEP 16015-050, Brazil
| | - Jonathan Ribeiro da Silva
- Department of Surgery and Clinic Integrated, Araçatuba Dental School, UNESP, José Bonifácio Street, number 1193, Araçatuba, São Paulo, CEP 16015-050, Brazil
| | - João Paulo Bonardi
- Department of Surgery and Clinic Integrated, Araçatuba Dental School, UNESP, José Bonifácio Street, number 1193, Araçatuba, São Paulo, CEP 16015-050, Brazil.
| | - Eduardo Hochuli-Vieira
- Department of Surgery and Clinic Integrated, Araçatuba Dental School, UNESP, José Bonifácio Street, number 1193, Araçatuba, São Paulo, CEP 16015-050, Brazil
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Dawdy J, Halladay J, Carrasco-Labra A, Araya I, Yanine N, Brignardello-Petersen R. Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars. J Am Dent Assoc 2017; 148:887-902.e4. [DOI: 10.1016/j.adaj.2017.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022]
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Wang D, He X, Wang Y, Zhou G, Sun C, Yang L, Bai J, Gao J, Wu Y, Cheng J. Topographic relationship between root apex of mesially and horizontally impacted mandibular third molar and lingual plate: cross-sectional analysis using CBCT. Sci Rep 2016; 6:39268. [PMID: 27991572 PMCID: PMC5171861 DOI: 10.1038/srep39268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/21/2016] [Indexed: 11/08/2022] Open
Abstract
The present study was aimed to determine the topographic relationship between root apex of the mesially and horizontally impacted mandibular third molar and lingual plate of mandible. The original cone beam computed tomography (CBCT) data of 364 teeth from 223 patients were retrospectively collected and analyzed. The topographic relationship between root apex and lingual plate on cross-sectional CBCT images was classified as non-contact (99), contact (145) and perforation (120). The cross-sectional morphology of lingual plate at the level of root apex was defined as parallel (28), undercut (38), slanted (29) and round (4). The distribution of topographic relationship between root apex and lingual plate significantly associated with gender, impaction depth, root number and lingual plate morphology. Moreover, the average bone thickness of lingual cortex and distance between root apex and the outer surface of lingual plate were 1.02 and 1.39 mm, respectively. Furthermore, multivariate regression analyses identified impaction depth and lingual plate morphology as the risk factors for the contact and perforation subtypes between root apex and lingual plate. Collectively, our findings reveal the topographic proximity of root apex of impacted mandibular third molar to the lingual plate, which might be associated with intraoperative and postoperative complications during tooth extraction.
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Affiliation(s)
- Dongmiao Wang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China
| | - Xiaotong He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Yanling Wang
- Department of oral prosthodontics, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Guangchao Zhou
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Chao Sun
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Lianfeng Yang
- Department of Oral and Maxillofacial Radiology, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Jianling Bai
- Department of Biomedical Statistics, College of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Jun Gao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China
| | - Yunong Wu
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, China
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Picard M, Pham Dang N, Mondie JM, Barthelemy I. Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum After Third Molar Extraction. J Oral Maxillofac Surg 2015; 73:2286.e1-3. [PMID: 26341684 DOI: 10.1016/j.joms.2015.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/07/2015] [Accepted: 07/31/2015] [Indexed: 11/18/2022]
Abstract
Third molar extraction is one of the most common interventions in dental and maxillofacial surgery. Complications are frequent and well documented, with swelling, pain, bleeding, infection, and lingual or alveolar nerve injury being the most common. This report describes a case of subcutaneous extensive emphysema and pneumomediastinum that occurred 4 days after extraction of an impacted right mandibular third molar. The management and etiology of this case and those reported in the literature are discussed.
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Affiliation(s)
- Maxime Picard
- Maxillofacial Surgeon and Physician, Maxillofacial Department, CHU Estaing, Clermont-Ferrand, France.
| | - Nathalie Pham Dang
- Maxillofacial Surgeon and Physician, Maxillofacial Department, CHU Estaing, Clermont-Ferrand, France
| | - Jean Michel Mondie
- Maxillofacial Surgeon and Professor, Maxillofacial Department, CHU Estaing, Clermont-Ferrand, France
| | - Isabelle Barthelemy
- Maxillofacial Surgeon and Professor, Maxillofacial Department, CHU Estaing, Clermont-Ferrand, France
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13
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Huang Z, Huang Z, Wang Y, Hu W, Fan S, Zhang D, Chen W. Removal of the residual roots of mandibular wisdom teeth in the lingual space of the mandible via endoscopy. Int J Oral Maxillofac Surg 2015; 44:400-3. [DOI: 10.1016/j.ijom.2014.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/09/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
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14
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Bouloux GF, Busaidy KF, Beirne OR, Chuang SK, Dodson TB. What is the risk of future extraction of asymptomatic third molars? A systematic review. J Oral Maxillofac Surg 2014; 73:806-11. [PMID: 25631864 DOI: 10.1016/j.joms.2014.10.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/28/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of our report was to determine clinically whether young adults who elect to retain their asymptomatic third molars (M3s) have a risk of undergoing 1 or more M3 extractions in the future. MATERIALS AND METHODS To address our clinical question, we designed and implemented a systematic review. The studies included in the present review were prospective, had a sample size of 50 subjects or more with at least 1 asymptomatic M3, and had at least 12 months of follow-up data available. The primary study variables were the follow-up duration (in years) and the number of M3s extracted by the end of the follow-up period or the number of subjects who required at least one M3 extraction. The annual and cumulative incidence rates of M3 removal were estimated. RESULTS Seven studies met the inclusion criteria. The samples sizes ranged from 70 to 821 subjects, and the follow-up period ranged from 1 to 18 years. The mean incidence rate for M3 extraction of previously asymptomatic M3s was 3.0% annually (range 1 to 9%). The cumulative incidence rate for M3 removal ranged from 5% at 1 year to 64% at 18 years. The reasons for extraction were caries, periodontal disease, and other inflammatory conditions. CONCLUSIONS The cumulative risk of M3 extraction for young adults with asymptomatic M3s is sufficiently high to warrant its consideration when reviewing the risks and benefits of M3 retention as a management strategy.
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Affiliation(s)
- Gary F Bouloux
- Associate Professor and Residency Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Kamal F Busaidy
- Associate Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Health Sciences Center, Houston, TX
| | - O Ross Beirne
- Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Sung-Kiang Chuang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Harvard University School of Dental Medicine, Boston, MA
| | - Thomas B Dodson
- Professor and Chair, Department of Oral and Maxillofacial Surgery; Associate Dean for Hospital Affairs, University of Washington School of Dentistry, Seattle, WA
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Wang R, Cai Y, Zhao YF, Zhao JH. Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review. Aust Dent J 2014; 59:372-4. [PMID: 24819410 DOI: 10.1111/adj.12186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedical Engineering of Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y Cai
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - YF Zhao
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - JH Zhao
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
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17
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Is Adjuvant Laser Therapy Effective for Preventing Pain, Swelling, and Trismus After Surgical Removal of Impacted Mandibular Third Molars? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2012; 70:1789-801. [DOI: 10.1016/j.joms.2012.01.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 11/22/2022]
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Secondary Versus Primary Closure Techniques for the Prevention of Postoperative Complications Following Removal of Impacted Mandibular Third Molars: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Oral Maxillofac Surg 2012; 70:e441-57. [DOI: 10.1016/j.joms.2012.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 03/06/2012] [Indexed: 11/20/2022]
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Guillén-Paredes P, Novoa-Juiz V, Carrasco-González L. Asymptomatic pneumomediastinum after wisdom tooth extraction. Arch Bronconeumol 2012; 48:217-8. [PMID: 22405576 DOI: 10.1016/j.arbres.2012.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/17/2012] [Accepted: 01/21/2012] [Indexed: 10/28/2022]
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Romeo U, Galanakis A, Lerario F, Daniele GM, Tenore G, Palaia G. Subcutaneous emphysema during third molar surgery: a case report. Braz Dent J 2011; 22:83-6. [PMID: 21519655 DOI: 10.1590/s0103-64402011000100015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.
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Affiliation(s)
- Umberto Romeo
- Department of Oral Sciences, Sapienza, University of Rome, Italy.
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Yamada T, Ishihama K, Yasuda K, Hasumi-Nakayama Y, Ito K, Yamaoka M, Furusawa K. Inferior alveolar nerve canal and branches detected with dental cone beam computed tomography in lower third molar region. J Oral Maxillofac Surg 2011; 69:1278-82. [PMID: 21256640 DOI: 10.1016/j.joms.2010.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 06/07/2010] [Accepted: 07/01/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the course of the inferior alveolar nerve and its branches, the detectable branches were investigated with dental cone beam computed tomography (CBCT). MATERIALS AND METHODS Patients in whom the lower third molar (M3) and inferior alveolar nerve canal showed overlapping in the initial panoramic image were included. One hundred twelve impacted lower M3s were extracted after examination with dental CBCT. The detection ratio, the course of the branches, and their relation with the M3 were retrospectively investigated. RESULTS One hundred fifty-five branches were observed in 106 cases (94.6%, 106/112) around the M3. Most branches coursed under the M3 (55.5%, 86/155), and 85 branches (54.8%, 85/155) were in contact with the M3. The inferior alveolar nerve canal and branch(es) were mostly in contact with the M3 (57.5%, 61/106). CONCLUSIONS Dental CBCT can detect most tubular structures representing branches in the impacted lower M3 region.
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Affiliation(s)
- Takahisa Yamada
- Department of Oral and Maxillofacial Surgery, Matsumoto Dental University, Shiojiri, Nagano, Japan
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22
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Öhman D, Björk Y, Bratel J, Kristiansson C, Johansson P, Johansson JE, Brune M, Hasséus B. Partially erupted third molars as a potential source of infection in patients receiving peripheral stem cell transplantation for malignant diseases: a retrospective study. Eur J Oral Sci 2010; 118:53-8. [DOI: 10.1111/j.1600-0722.2009.00705.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Al-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg 2009; 67:856-61. [PMID: 19304046 DOI: 10.1016/j.joms.2008.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 08/14/2008] [Accepted: 09/05/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was undertaken with the null hypothesis that in patients, fully denate or with 1 or 2 teeth missing and older than 25 years, mastication does not affect late mandibular fracture after surgical removal of impacted third molars (M3s) associated with no gross pathology. MATERIALS AND METHODS Five hundred sixty patients, fully dentate or with 1 or 2 teeth missing and older than 25 years who had no gross pathology associated with their impacted lower M3s, were recruited in this study. They were operated on under local anesthesia using a standard technique and randomly assigned into 2 groups for nonroutine (NR group) and routine (R group) postoperative instructions. In the NR group, patients were postoperatively educated in the possibility of mandibular fracture and were given an emphasis on the necessity of limiting mastication to a soft diet for 4 weeks. In the R group, patients were given no such education or emphasis. Patients were followed up for 2 months, and data concerning patients' age and gender; tooth position, angulation, and depth; date and site of surgery; and occurrence of late mandibular fracture were recorded and statistically analyzed. A value of P less than .05 was considered statistically significant. RESULTS In no patient group was there a late mandibular fracture recorded. All patients completed the follow-up period, and most of the R group patients had normal eating habits 10 to 14 days after surgery. In no patient group was there a statistically significant difference in relation to gender (P = .735), site of surgery (P = .552), class horizontal space available (P = .427), class highest portion of the M3 crown (P = .424), angulations of the teeth (P = .925), and severity of impaction (P = .445). CONCLUSIONS In patients, fully dentate or with 1 or 2 teeth missing and older than 25 years who have no jawbone atrophy and no systemic problems that may impair bone strength, mastication seems not to affect late mandibular fracture after surgical removal of impacted M3s associated with no gross pathology. The remote possible risk of the late fracture shown in our patients indicates the need for no special precautions.
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Affiliation(s)
- Fouad A Al-Belasy
- Professor of Oral and Maxillofacial Surgery, Dean, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
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Yalcin S, Aktas İ, Emes Y, Atalay B. Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report. ACTA ACUST UNITED AC 2008; 105:e29-31. [DOI: 10.1016/j.tripleo.2007.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 08/21/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg 2007; 65:1909-21. [PMID: 17884515 DOI: 10.1016/j.joms.2007.03.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 03/01/2007] [Accepted: 03/01/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE We conducted a synthetic quantitative review of the published clinical trials on the effectiveness of antibiotic prophylaxis in third molar surgery. MATERIALS AND METHODS Electronic databases were searched for randomized controlled trials. The primary outcome variables included alveolar osteitis (AO) and surgical wound infection. The extracted data were analyzed using a meta-analytical program with a random-effect model. Number needed to treat (NnT) was calculated. RESULTS A total of 2,932 patients randomized in 16 clinical trials reported AO as an outcome. AO occurred in 84 of 1,350 patients in the treatment group, a frequency of 6.2%; and in 228 of 1,582 patients in the control group, a frequency of 14.4%. Systemic antibiotic therapy was effective in reducing the risk of AO (odds ratio [OR], 2.175) with an NnT of 13. A total of 2,396 patients randomized in 12 clinical trials reported wound infection as an outcome. Wound infection occurred in 44 of 1,110 patients in the treatment group, a frequency of 4%; and in 78 of 1,286 patients in the control group, a frequency of 6.1%. Systemic antibiotic therapy was effective in reducing the risk of wound infection (OR, 1.794) with an NnT of 25. Antibiotics reduced the risk of AO and wound infection only when first dose was given before surgery. CONCLUSIONS Systemic antibiotics given before the surgery were effective in reducing the frequencies of AO and wound infection after third molar surgery.
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Affiliation(s)
- Yan-Fang Ren
- Eastman Dental Center, University of Rochester, Rochester, NY 14620, USA.
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Chuang SK, Perrott DH, Susarla SM, Dodson TB. Age as a Risk Factor for Third Molar Surgery Complications. J Oral Maxillofac Surg 2007; 65:1685-92. [PMID: 17719384 DOI: 10.1016/j.joms.2007.04.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 04/28/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to estimate the frequency of complications after third molar (M3) surgery, with age as the primary risk factor. PATIENTS AND METHODS This was a prospective cohort study of a sample of subjects having at least 1 M3 extracted as part of the American Association of Oral and Maxillofacial Surgeons' Age-Related Third Molar Study. The predictor variables were categorized as demographic, health status, anatomic, and pathological. The outcome variable was overall complications, including both intraoperative and postoperative complications. Appropriate univariate and bivariate statistics were computed. A multiple logistic regression model was used to evaluate the simultaneous effects of multiple covariates. RESULTS The study sample was comprised of 4,004 subjects having a total of 8,748 M3s removed. The mean age was 39.8 +/- 13.6 years, with 245 subjects (6.1%) age 25 and younger. Approximately half of the subjects were female. The overall complication rate was 19%. In bivariate analyses, age above 25 years, gender, American Society of Anesthesiologists classification, number of preoperatively identified risk factors for complication, impaction level of M3, evidence of periodontal disease, preoperative infection, and evidence of any pathology associated with M3 were associated with complications (P <or= .15). In the multiple regression model, age above 25 years was associated with an increased risk of complications (odds ratio = 1.5; P = .05). CONCLUSIONS The results of these analyses suggest that increased age (>25 years) appears to be associated with a higher complication rate for M3 extractions.
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Affiliation(s)
- Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA 02114, USA.
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Kunkel M, Kleis W, Morbach T, Wagner W. Severe Third Molar Complications Including Death—Lessons from 100 Cases Requiring Hospitalization. J Oral Maxillofac Surg 2007; 65:1700-6. [PMID: 17719386 DOI: 10.1016/j.joms.2007.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 11/15/2006] [Accepted: 04/07/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE In this study we investigated patients that were hospitalized due to third molar (M3) complications. Specifically we analyzed frequency, age distribution, and outcome with respect to the M3 clinical status. PATIENTS AND METHODS We set up a prospective cohort study and included 100 subjects admitted for management of acute M3-associated complications. The clinical status of the M3 was defined as 1) prophylactic M3 removal, 2) therapeutic (nonelective) M3 removal, or 3) M3 present at the time of admission. Outcome variables were clinical infection markers (C-reactive protein, leukocyte counts) and economic parameters (treatment costs, length of hospital stay, and days of disability). Nonparametric tests were used for comparison of subpopulations (surgical vs nonsurgical, prophylaxis-related vs nonprophylaxis-related). RESULTS One third of the 100 patients were age 40 or older. Overall 80 severe infections, 11 mandibular fractures, 3 nerve injuries, 5 tooth/root luxations, and 1 postoperative hemorrhage were noticed. Twenty-seven complications resulted from prophylactic surgery, 44 from nonelective removal, and 29 from pericoronitis. Postoperatively, a 77-year-old male patient hospitalized with nonelective removal sustained fatal myocardial infarction. Treatment costs were 260,086 euro (mean 2,608 euro/case); total days of disability were 1,534. The postsurgical complications showed higher C-reactive protein values compared with pericoronitis-induced complications. CONCLUSIONS Within the catchment area of our institution, the majority of complications requiring hospitalization resulted from diseased third molars or their removal. Side effects of observational strategies such as the shifting of complications to higher ages deserve future attention.
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Affiliation(s)
- Martin Kunkel
- Department of Oral and Maxillofacial Surgery, University of Mainz, Mainz, Germany.
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Ren YF, Malmstrom HS. Rapid quantitative determination of C-reactive protein at chair side in dental emergency patients. ACTA ACUST UNITED AC 2007; 104:49-55. [PMID: 17482849 DOI: 10.1016/j.tripleo.2007.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 12/22/2006] [Accepted: 01/01/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this study was to quantitatively determine, at chair side, the serum C-reactive protein (CRP) levels in dental emergency patients. STUDY DESIGN Quantitative CRP test was performed at chair side in 40 patients with acute alveolar abscess (AAA), acute periodontal abscess (APA), and alveolar osteitis (AO) at the time of dental emergency treatment and 1 week after. CRP levels were compared between groups and before and after treatments using ANOVA and Fisher's Exact tests. RESULTS Serum CRP levels were greater than 5 mg/L in 30 (75%) of the 40 patients. At 1-week follow-up, the decline in CRP levels was evident in the AAA group (P < .05), but not statistically significant in the APA and AO groups (P > .05). CONCLUSION Serum CRP levels are often elevated in patients with odontogenic infections and postoperative complications. Rapid reduction in serum CRP levels was likely to occur following successful treatment of AAA, but less likely to occur in APA and AO.
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Affiliation(s)
- Yan-Fang Ren
- University of Rochester, Eastman Dental Center, Rochester, NY 14620, USA.
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