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Bhatti Z, Patel S, Shah S, Shah N, Savani R, Chauhan S. Is Diclofenac Transbuccal Mucoadhesive Patch Superior to Oral Diclofenac for the Management of Postoperative Sequelae After Third Molar Surgery? J Oral Maxillofac Surg 2024:S0278-2391(24)00201-5. [PMID: 38615694 DOI: 10.1016/j.joms.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pain, swelling, and trismus are the most common sequalae following the surgical removal of mandibular third molars. They pose significant challenges for clinicians, prompting the exploration of efficacious management approaches. PURPOSE The purpose of this study was to assess the efficacy of transbuccal mucoadhesive patch of diclofenac sodium versus an oral tablet in controlling the aforesaid sequelae. STUDY DESIGN, SETTING, SAMPLE A prospective split-mouth, single-blinded study was conducted in the Department of Oral and Maxillofacial Surgery at AMC Dental College and Hospital, Ahmedabad. The study sample included patients of either sex, aged 18 to 45 years, requiring surgical removal of bilaterally symmetrical mandibular third molars under local anesthesia. Patients who had consumed analgesics within 24 hours prior to the procedure were excluded. PREDICTOR VARIABLE The primary predictor variable was the route of administration of nonsteroidal anti-inflammatory drug. The study group received transbuccal mucoadhesive patches containing 20 mg diclofenac sodium, whereas the control group received oral tablets of 50 mg. MAIN OUTCOME VARIABLE Postoperative pain, measured with visual analog scale, was the primary outcome variable, whereas swelling, mouth opening, onset of analgesic effect, and adverse events were assessed as secondary outcome variables. COVARIATES Two categories of covariates were considered. First, demographic: age and gender. Second, perioperative: pattern of impaction. ANALYSES Intergroup comparison was made using a paired sample t-test and an independent sample t-test, while intragroup differences were assessed with a one-way ANOVA and a paired t-test. P value ≤ .05 was considered statistically significant. RESULTS Out of 146 patients screened initially, the final study sample included 37 subjects with a mean age of 26.08 ± 5.09 years (21 (56.75%) males and 16 (43.25%) females). The study group exhibited a significantly lower postoperative pain score compared to the control group on days 0, 1, 2, and 3 postoperatively (P ≤ .05). No statistically significant difference was observed in reduction of facial swelling and improvement in mouth opening on 1st, 2nd, and 3rd days postoperatively between both the groups (P ≥ .05). The mean onset of analgesia was statistically significant in the study group (19.96 ± 5.40 minutes) compared to the control group (52.56 ± 6.33 minutes) (P < .001). CONCLUSION AND RELEVANCE Transbuccal mucoadhesive patch of diclofenac sodium offers effective pain control with quicker analgesia and fewer side effects compared to an oral tablet.
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Affiliation(s)
- Zenish Bhatti
- Resident, Department of Oral and Maxillofacial Surgery, AMC Dental College and Hospital, Ahmedabad, Gujarat, India.
| | - Shital Patel
- Reader, Department of Oral and Maxillofacial Surgery, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Swasti Shah
- Intern, Department of Oral and Maxillofacial Surgery, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Naiya Shah
- DMD Candidate, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rajan Savani
- Resident, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shyam Chauhan
- Resident, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
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Mukainaka Y, Sukegawa S, Kawai H, Nishida T, Miyake M, Nagatsuka H. Risk factors for post-extraction infection of mandibular third molar: A retrospective clinical study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101841. [PMID: 38521244 DOI: 10.1016/j.jormas.2024.101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Post-extraction infection is one of the most concerning complications of mandibular third molar extraction, which is the most common procedure in oral and maxillofacial surgery. We investigated risk factors for post-extraction infection by retrospectively analyzing 2,513 teeth/cases of mandibular third molar extraction (1,040 males, 1,473 females) performed at a single medical facility in Kobe, Japan from January 2014 to May 2022. The predictive variables were categorized as patient attributes, health status, and anatomic, pathological, and operative variables that may be associated with post-extraction infection. The outcome variable was the post-extraction infection rate. The post-extraction infection rate was 5.73 % (144 of the 2,513 teeth), and the mean age of the patients with a post-extraction infection was 41.76 ± 16.8 years. Our analyses also revealed that the postoperative infection rate was significantly increased in patients aged ≥36 years. A multivariate logistic regression analysis showed that the following variables were significantly associated with post-extraction infection: preoperative antibiotic administration (odds ratio [OR] 4.68, p < 0.001), postoperative paresthesia of the inferior alveolar nerve (OR 4.34, p < 0.001), intraoperative hemostatic procedure (OR 1. 74, p = 0.008), position of Pell and Gregory classifications (OR 1. 70, p < 0.001), Winter's classification (OR 1.28, p < 0.03), and age (OR 1.03, p < 0.001). Oral and maxillofacial surgeons should be aware of these risk factors.
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Affiliation(s)
- Yumika Mukainaka
- Department of Oral and Maxillofacial Surgery, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagata, Kobe, Hyogo 653-0013, Japan; Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tetsuya Nishida
- Department of Oral and Maxillofacial Surgery, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagata, Kobe, Hyogo 653-0013, Japan
| | - Minoru Miyake
- Department of Oral and Maxillofacial Surgery, Kagawa University School of Medicine, Kagawa 761-0793, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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James O, Oyeneyin AO, Adeyemi MO, Erinoso OA, Adekunle AA, Adeyemo WL. Neurosensory Deficits of Inferior Alveolar Nerve Following Impacted Mandibular Third Molar Extraction: Comparison of One-Stage Complete Extraction with Two-Stage Partial Coronectomy Surgical Technique. J Maxillofac Oral Surg 2023; 22:178-186. [PMID: 36703659 PMCID: PMC9871121 DOI: 10.1007/s12663-021-01601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Objectives Inferior alveolar nerve neurosensory deficit is a worrisome complication of surgical extraction of impacted mandibular third molars. A novel approach using two-stage partial coronectomy has been proposed as an alternative surgical procedure to reduce this complication. This study compared neurosensory deficits of inferior alveolar nerve following impacted mandibular third molar extraction using one-stage complete extraction with the two-stage partial coronectomy technique. Material and Methods Subjects with mesioangular or horizontal impacted mandibular third molar with an intimate relationship with inferior dental canal who met the inclusion criteria were recruited for the study. Subjects were divided into one-stage and two-stage partial coronectomy techniques. The subjects were evaluated for the presence of inferior alveolar neurosensory deficit, and the relationships of neurosensory nerve deficit with sex, age and type of impaction. Results Neurosensory deficit was observed in 5 subjects (7.8%), with all cases seen in the one-stage group. This difference was statistically significant (p = 0.03). The relationship between the incidence of neurosensory deficit and age, sex, type of impaction, surgical difficulty, operating time and root morphology was not statistically significant (p > 0.05). Conclusion Findings from this study suggest partial coronectomy compared to one-stage complete extraction reduces the incidence of Inferior alveolar nerve neurosensory deficit.
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Affiliation(s)
- Olutayo James
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Aliyu Ope Oyeneyin
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Michael Olayinka Adeyemi
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olufemi Akinwunmi Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital Ikeja, Lagos, Nigeria
| | - Adeola Adegbayi Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Verma DK, Bansal S, Pahari KC. Can Amoxicillin and Clavulanic Acid Impregnated Plaster of Paris Beads Serve as an Effective Alternative to Systemic Antibiotics for Third Molar Surgeries? A Split Mouth Randomized Clinical Trial. J Maxillofac Oral Surg 2022; 21:1015-1022. [PMID: 36274883 PMCID: PMC9474747 DOI: 10.1007/s12663-021-01621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose The present work was a pilot study undertaken to evaluate the effectiveness of amoxicillin and clavulanic acid impregnated plaster of paris beads for prevention of infection of third molar extraction sockets. Materials and Methods This was a prospective, randomized, split mouth clinical trial done on 16 patients (32 sites) who required surgical extraction of mandibular third molars. Control arm patients were given Tab. amoxicillin 500 mg with clavulanic acid 125 mg (Tab. Klavimed 625 mg, Indomed, India), thrice daily for 3 days after extraction, whereas test arm patients received Antibiotic Impregnated Microbeads (AIM), containing Amoxicillin 500 mg and Clavulanic Acid 100 mg placed in situ in the extraction socket. The primary outcome parameter was infection and the secondary outcome parameters were pain, trismus, swelling and wound healing. Results None of the patients in either group had post operative infection. There was no significant difference in pain intensity between the two groups (1st day p = 0.41; 3rd day p = 0.38, 7th day p = 0.37). Both the groups were also similar with respect to swelling (p = 0.596, 0.146, 0.871, 0.820 on 1st, 3rd, 7th, 15th post-op day ,respectively). Conclusion Amoxycillin with clavulanic acid impregnated PoP beads appears to be as effective as oral 3 day amoxicillin with clavulanic acid regime for prevention of 3 M socket infection.
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Affiliation(s)
- Dinesh Kumar Verma
- Department of Oral and Maxillofacial Surgery, Surendera Dental College and Research Institute, Sri Ganganagar, 335001 Rajasthan India
| | - Shallu Bansal
- Department of Oral and Maxillofacial Surgery, Surendera Dental College and Research Institute, Sri Ganganagar, 335001 Rajasthan India
| | - Kaushal Charan Pahari
- Department of Oral and Maxillofacial Surgery, Surendera Dental College and Research Institute, Sri Ganganagar, 335001 Rajasthan India
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Evaluation of Infection and Effective Factors in Impacted Mandibular Third Molar Surgeries: A Cross-Sectional Study. Int J Dent 2022; 2022:8934184. [PMID: 35572352 PMCID: PMC9095350 DOI: 10.1155/2022/8934184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/08/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aim. Some complications, including infection, may occur following the surgeries of impacted teeth. In order to reduce the risk of infection, it is necessary to evaluate the risk factors of infection after third molar surgeries. Although research has been published in this area, the risk factors and causes of infection are still unclear. This study aimed to investigate infection incidence and effective factors in hard tissue impacted mandibular third molar surgeries in the Iranian population. Materials and Methods. This cross-sectional study was performed on 148 patients. The incidence of infection was recorded one week, two weeks, and one month after surgery. Independent variables included age, gender, the presence of periapical radiolucent lesions measuring ≥3 mm, the caries of the adjacent second molar, education level of the surgeon, difficulty index, suture type, and flap type. The outcome variable was the incidence of infection. Results. Among the study subjects, 37.2% were male and 62.8% were female. The mean age was 25.24 ± 4.31 years at the time of surgery. Although early onset infection occurred in 3.4% of patients, none of them developed a delayed-onset infection during the four weeks after surgery. Pederson difficulty index (OR = 3.81,
) and the education level of the surgeon (OR = 0.14,
) were associated with postop infection. Conclusions. Based on the results of the current study, postop infection was rare. Furthermore, both the Pederson difficulty index and the education level of the surgeon could predict the risk of infection after impacted mandibular third molar surgeries.
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Effect of dexamethasone, ketoprofen and cold compress on postoperative sequelae in mandibular third molar surgery: A randomized clinical trial. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2021.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden. Clin Oral Investig 2021; 26:2073-2083. [PMID: 34596771 PMCID: PMC8816342 DOI: 10.1007/s00784-021-04189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022]
Abstract
Objectives To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences. Materials and methods Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality. Results The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs. Conclusions A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice. Clinical relevance Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04189-9.
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Daware SN, Balakrishna R, Deogade SC, Ingole YS, Patil SM, Naitam DM. Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study. J Family Med Prim Care 2021; 10:1712-1717. [PMID: 34123917 PMCID: PMC8144789 DOI: 10.4103/jfmpc.jfmpc_280_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/23/2019] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems. Aims and Objectives: This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications. Material and Methods: The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months. Results: This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal. Conclusion: Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.
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Affiliation(s)
- Surendra N Daware
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Ramdas Balakrishna
- Department of Oral and Maxillofacial Surgery, KLE Dental College and Hospital, Bangalore, Karnataka, India
| | - Suryakant C Deogade
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Yogesh S Ingole
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Sushant M Patil
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Dinesh M Naitam
- Department of Dentistry, Government Medical College and Hospital, Akola, Maharashtra, India
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Wanithanont P, Chaiyasamut T, Vongsavan K, Bhattarai BP, Pairuchvej V, Kiattavorncharoen S, Wongsirichat N. Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery. J Dent Anesth Pain Med 2021; 21:29-39. [PMID: 33585682 PMCID: PMC7871183 DOI: 10.17245/jdapm.2021.21.1.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Impacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae. METHODS This was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05. RESULTS Statistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05). CONCLUSION Compared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.
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Affiliation(s)
- Pavita Wanithanont
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kadkao Vongsavan
- Walailak University International College of Dentistry, Bangkok, Thailand
| | | | - Verasak Pairuchvej
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sirichai Kiattavorncharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Jeong YK, Ku JK, Baik SH, You JS, Leem DH, Choi SK. Classification of postoperative edema based on the anatomic division with mandibular third molar extraction. Maxillofac Plast Reconstr Surg 2021; 43:4. [PMID: 33469729 PMCID: PMC7815864 DOI: 10.1186/s40902-021-00291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Several investigations have been performed for a postoperative edema after extraction, but the results have been controversial due to low objectivity or poorly reproducible assessments of the edema. The aim of this study was to suggest a classification and patterns of postoperative edema according to the anatomical division associated with extraction of mandibular third molar as a qualitative evaluation method. Methods This study was conducted forty-four mandibular third molars extracted and MRI was taken within 48 h after extraction. The postoperative edema space was classified by MRI (one anatomic component—buccinator muscle—and four fascial spaces—supra-periosteum space, buccal space, parapharyngeal space, and lingual space), and evaluated independently by two examiners. The inter-examiner reliability was calculated using Kappa statistics. Results The evaluation of buccinator muscle edema showed good agreement and the fascial spaces showed constant high agreement. The incidence of postoperative edema was high in the following order: supra-periosteum space (75.00%), buccinator muscle (68.18%), parapharyngeal space (54.55%), buccal space (40.91%), and lingual space (25.00%). Conclusion Postoperative edema could be assessed clearly by each space, which showed a different tendency between the anatomic and fascial spaces.
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Affiliation(s)
- Yeong Kon Jeong
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Armed Forces Medical Command, Saemaul-ro 117, Bundang-gu, Seongnam-si, 13634, Republic of Korea
| | - Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Armed Forces Medical Command, Saemaul-ro 117, Bundang-gu, Seongnam-si, 13634, Republic of Korea.
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Seek You
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Dae Ho Leem
- Department of Oral and Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University, Jeonju, Republic of Korea
| | - Sun-Kyu Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
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Effect of St. John's wort oil and olive oil on the postoperative complications after third molar surgery: randomized, double-blind clinical trial. Clin Oral Investig 2020; 25:2429-2438. [PMID: 33057887 DOI: 10.1007/s00784-020-03639-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This multicenter study aimed to evaluate the effects of St. John's wort oil and virgin olive oil on the postoperative complications and compare this with chlorhexidine gluconate plus benzydamine hydrochloride mouthwash after the removal of impacted third molar. METHODS A total of 90 patients in need of impacted third molar surgery were included in this study. All included patients were randomly divided into 3 groups. The patients in group 1 received St. John's wort oil; the patients in group 2 received virgin olive oil, and those in group 3 received mouthwash containing chlorhexidine gluconate plus benzydamine hydrochloride. The self-reported pain and difficulty during jaw function, trismus, facial swelling, number of analgesics used during first postoperative week, and postoperative periodontal condition including plaque accumulation, bleeding on probing, and periodontal pocket depth were compared between the groups. RESULTS No significant differences were found regarding the study variables. CONCLUSIONS The data of the present study supports that the use of essential oils provides efficient alternative to the gold standard chlorhexidine gluconate mouthwash in reducing postoperative complications and improving healing process without adverse effects after surgical removal of impacted third molars. CLINICAL RELEVANCE The use of essential oils showed similar results as the chlorhexidine gluconate mouthwash regarding swelling, mouth opening, pain, need for rescue medication, infectious complications (i.e., alveolar osteitis), and periodontal healing. Therefore, essential oils can be an alternative to routine mouthwashes to ensure oral hygiene after impacted third molar surgery.
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Ito T, Toriumi T, Otake K, Okuwa Y, Tanaka S, Arai Y, Kurita K, Honda M. Performance of Schwann cell transplantation into extracted socket after inferior alveolar nerve injury in a novel rat model. J Oral Sci 2020; 62:402-409. [PMID: 32863317 DOI: 10.2334/josnusd.19-0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
An inferior alveolar nerve (IAN) injury is a common clinical problem that can affect a patients' quality of life. Cellular therapy has been proposed as a promising treatment for this injury. However, the current experimental models for IAN injury require surgery to create bone windows that expose the nerve, and these models do not accurately mimic human IAN injuries. Therefore, in this study, a novel experimental model for IAN injury has been established in rats. Using this model, the effects of Schwann cells and their role in the recovery from IAN injuries were investigated. Schwann cells were isolated from rat sciatic nerves and cultured. The first molar in the mandible was extracted and the IAN was immediately injured for 30 min by inserting an insect pin. Then, the Schwann cells or culture medium were transplanted into the extracted sockets of the cell and injury groups, respectively. After the surgery, the cell group displayed significantly increased sensory reflexes in response to mechanical stimulation, regenerated IAN width, and myelin basic protein-positive myelin sheaths when compared with the injury group. In conclusion, a novel animal experimental model for IAN injury has been developed that does not require the creation of a bone window to evaluate the impacts of cell transplantation and demonstrates that Schwann cell transplantation facilitates the regeneration of injured IANs.
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Affiliation(s)
- Tatsuaki Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Taku Toriumi
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Keita Otake
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Yuta Okuwa
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Sho Tanaka
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Yoshinori Arai
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Masaki Honda
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
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Pansard HB, Prado MC, Marchi GF, Sfreddo CS, Skupien JA. The Impact of Prior Use of Corticosteroid to Dental Extraction on Oral Health-Related Quality-of-Life and Clinical Outcomes: A Randomized Clinical Trial. J Oral Maxillofac Surg 2020; 78:2153.e1-2153.e9. [PMID: 32916132 DOI: 10.1016/j.joms.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the impact of prior use of corticosteroids before dental extractions on oral health-related quality-of-life (OHRQoL). METHODS A randomized and triple-blind (patient, surgeon, and examiner) clinical trial was designed. The individuals were randomly allocated to 2 groups: test and placebo. In the test group, 2 capsules of 4 mg dexamethasone were administered orally. In the placebo group, subjects received 2 capsules with the same characteristics. In both groups, the administration took place 1 hour before the procedure. OHRQoL was assessed by the Brazilian version of Oral Health Impact Profile 14 (OHIP-14). The OHIP-14 questionnaire and the assessment methods for clinical parameters were collected preoperatively and postoperatively. Multilevel linear regression models fitted the associations between preoperative use of corticosteroids and overall and domain-specific OHIP-14 scores over time. RESULTS One hundred fourteen patients were selected for the study; however, 21 were excluded for not returning to postoperative control on the seventh day, resulting in 93 patients assessed (test = 44 and placebo = 49). The pain had a negative impact on OHRQoL (P < .01); however, the use of the drug had no statistically significant influence on OHRQoL (P = .62) and the clinical outcomes of pain (P = .63), mouth aperture (P = .05), and edema (P = .69). CONCLUSIONS The use of the 8 mg dexamethasone administered orally before the procedure was not effective on the improvement of the quality-of-life of patients undergoing dental extraction. However, using the medication seems to result in an improvement in the postoperative period of patients who had impacted teeth. Further research involving the analysis of OHRQoL must be performed, and other dosages and means of administration must be tested.
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Affiliation(s)
- Heitor B Pansard
- MD Student, Health and Life Sciences Master's Student by the Franciscan University (UFN), Santa Maria, RS, Brazil
| | - Mayara C Prado
- MD Student, Health and Life Sciences Master's Student by the Franciscan University (UFN), Santa Maria, RS, Brazil
| | - Gabriel F Marchi
- Private Practitioner, Specialist in Bucco Maxillofacial Surgery and Traumatology, Santa Maria, RS, Brazil
| | - Camila S Sfreddo
- Professor, Dental School Professor of the Franciscan University (UFN), Santa Maria, RS, Brazil
| | - Jovito A Skupien
- Department Head, Health and Life Sciences Master's and Dental School of the Franciscan University (UFN), Santa Maria, RS, Brazil.
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14
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Goutzanis L, Chatzichalepli C, Avgoustidis D, Papadopoulos P, Donta C. Extraoral surgical removal of an ectopic impacted third molar of the mandible. Report of a case. J Clin Exp Dent 2020; 12:e615-e619. [PMID: 32665824 PMCID: PMC7335602 DOI: 10.4317/jced.56602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Abstract
Intraoral approach for the removal of impacted third molars represents a common surgical procedure for the specialized clinician. However, in some cases such as ectopic third molars, extraoral surgical removal seems to be inevitable. We present a step by step case of a 56 year old woman with an ectopic third molar of the lower jaw along with a cystic lesion, which were surgically removed by a submandibular approach. Postoperative clinical course was uneventful and there were no signs of facial nerve paresis. In such cases, appropriate preoperative planning must be made based on careful study of radiographic imaging and clinical examination. The more conservative technique that would minimize adjacent anatomic structures risk should be the surgical technique of choice. Key words:Ectopic third molar, mandible, cyst, extraoral approach.
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Affiliation(s)
- Lampros Goutzanis
- DDS, MD, MSc, PhD(Dent), PhD(Med), Assistant professor of Oral and Maxillofacial Surgery - Dental School, National and Kapodistrian University of Athens, Greece
| | - Chara Chatzichalepli
- DDS, MSc, Postgrad in Dentoalveolar Surgery - Dental School, National and Kapodistrian University of Athens, Greece
| | | | - Panagiotis Papadopoulos
- MD, DDS, Oral and Maxillofacial Surgeon - Dental School, National and Kapodistrian University of Athens, Greece
| | - Catherine Donta
- DDS, PhD, Associate Professor - Dental School, National and Kapodistrian University of Athens, Greece
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15
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Evaluation of intravenous prophylaxis antibiotics for third molar extraction under general anesthesia. Odontology 2020; 108:681-687. [DOI: 10.1007/s10266-020-00492-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
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16
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Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 78:515-527. [PMID: 31883443 DOI: 10.1016/j.joms.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery. MATERIALS AND METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the inception date to November 2018. Randomized and nonrandomized controlled trials were included if they had met certain inclusion and exclusion criteria. The predictor variable was the flap design, envelope or triangular. The outcome variables were operation time, pain, trismus, alveolar osteitis (AO) incidence, wound dehiscence, and swelling. The methodologic quality assessment was performed in accordance with the Cochrane Collaboration guidelines. The meta-analysis was performed using Review Manager, version 5.2. RESULTS A total of 21 studies were included for qualitative synthesis, 18 of which were included in the meta-analysis. The use of envelope flaps required less operation time than triangular flaps (P < .00001; I2 = 9%). In the Pell and Gregory A and B subgroups, envelope flaps were associated with a significantly lower visual analog scale score at 3 (P = .05, I2 = 0%) and 7 (P = .02; I2 = 0%) postoperative days and with a greater postoperative interincisal distance at 7 postoperative days (P = .04; I2 = 0%). In contrast, envelope flaps were associated with a greater AO incidence in the subgroup of split-mouth randomized controlled trials (P = .001; I2 = 0%). CONCLUSIONS Envelope flaps required a shorter operation time than triangular flaps and were associated with less postoperative pain and trismus when applied to impacted mandibular third molars of Pell and Gregory Class A or B. In contrast, triangular flaps were associated with a decreased incidence of AO compared with envelope flaps.
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17
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Pain Control by Novel Route of Gifted Choice Against Peroral Route. J Maxillofac Oral Surg 2019; 18:339-344. [PMID: 31371871 DOI: 10.1007/s12663-017-1001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022] Open
Abstract
Introduction Pain after surgical extraction of third molars has been a nemesis for oral surgeons with clinicians, thus striving for an analgesic modality. NSAIDs are among the most widely used therapeutic classes of analgesics. Transbuccal diclofenac sodium patches have been developed as an innovative drug delivery system using buccal mucosa as a gifted choice, hence overcoming first pass metabolism and offering the advantage of sustained drug delivery with reduced incidence of systemic adverse effects. Aim A comparative study was conducted to evaluate the efficacy of diclofenac sodium for pain control, administered via the far-fetched and gifted novel route through the transbuccal patch and by ever popular per oral route and also to assess the adverse effects vis-à-vis for transbuccal diclofenac patch and oral diclofenac following extraction of bilaterally symmetrical impacted mandibular third molars under local anaesthesia. Methodology Thirty healthy subjects of both the sexes in the age of 12 to 50 years with asymptomatic bilaterally symmetrical mandibular third molars underwent extraction under LA. It is a split-mouth study, i.e. after the extraction of tooth on one side, diclofenac sodium (50 mg) via oral route was given and then in another visit, when the same patient is comfortable and asymptomatic, extraction on contralateral side was executed and transbuccal patched diclofenac sodium (20 mg) was applied. Pain was measured on visual analog scale and verbal rating scale by the patient for 3 days and adverse effects if any were noted. Result Statistical analysis showed that transbuccal diclofenac sodium was significantly efficacious when compared to the drug administered orally. Also, statistically significant results were obtained in percentage reduction in pain from 1st to 3rd postoperative day in transbuccal group. No significant difference is seen for adverse reactions. Conclusion Transbuccal diclofenac sodium patch is more efficacious and can be used for pain control.
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Retana A, Emery RW, Keir V. Removal of Impacted Supernumerary Teeth Using a Dynamic Surgical Navigation System: A Case Report. J Oral Maxillofac Surg 2019; 77:1130-1134. [PMID: 30738066 DOI: 10.1016/j.joms.2019.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 11/26/2022]
Abstract
Removal of impacted supernumerary teeth can present a unique set of challenges to the dentoalveolar surgeon. Complications associated with these challenges have been well documented in the literature. The use of dynamically guided surgical navigation technology for the removal of impacted supernumerary teeth has the potential to mitigate these challenges and improve clinical outcomes. Although not a currently Food and Drug Administration-approved indication, the use of dynamic surgical navigation systems for the removal of impacted supernumerary teeth will be elucidated in this case report.
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Affiliation(s)
- Armando Retana
- Oral and Maxillofacial Surgeon, Capital Center for Oral and Maxillofacial Surgery, Washington, DC
| | - Robert W Emery
- Senior Attending Surgeon, Department of Oral and Maxillofacial Surgery, Washington, Hospital Center, Washington, DC
| | - Victoria Keir
- Resident, Department of Dental Medicine and Oral and Maxillofacial Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY.
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Cigerim L, Kaplan V. Evaluation of the analgesic efficacies of Dexketoprofen Trometamol and Dexketoprofen Trometamol + Thiocolchicoside combinations in the impacted third molar surgery: Randomised clinical trial. Med Oral Patol Oral Cir Bucal 2019; 24:e114-e122. [PMID: 30573719 PMCID: PMC6344008 DOI: 10.4317/medoral.22590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 11/27/2018] [Indexed: 12/03/2022] Open
Abstract
Background Postoperative pain is one of the most common complications. The aim of this study is to evaluate the analgesic efficacies of dexketoprofen trometamol and two different dosages of dexketoprofen trometamol + thiocolchicoside combination in the impacted third molar tooth operation. Material and Methods This randomized, double-blind study included 75 patients who did not have any disease. Patients were assigned to 3 groups. Group 1 received 25 mg dexketoprofen trometamol + 4 mg thiocholchicoside, Group 2 received 25 mg dexketoprofen trometamol +8 mg thiocholchicoside, and Group 3 received 25 mg dexketoprofen trometamol. In each group, the analgesic medication was administered twice a day, starting 1 hour before the operation. The level of pain was assessed with VAS. Results Patient age varied from 18 to 36 years. Of all patients, 59.2% (n=42) were female and 40.8% (n=29) were male. Drug side effects were observed in 28.17% (n=20) of the patients. Mean 24th hour VAS score was lower in dexketoprofen trometamol + 8 mg thiocolchicoside group compared to dexketoprofen trometamol group (p<0.05). There was no statistically significant difference between the three groups regarding drug side effects (p>0.05). Conclusions Dexketoprofen trometamol + 8 mg thiocolchicoside combination has higher analgesic efficacy compared to dexketoprofen trometamol. More studies are needed to interpret the analgesic and anti-inflammatory effects of thiocholchicoside + dexketoprofen trometamol combination. Key words:Analgesic, dexketoprofen trometamol, thiocolchicoside, third molar surgery.
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Affiliation(s)
- L Cigerim
- Van Yuzuncu Yil University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Van, TURKEY,
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20
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Sukegawa S, Yokota K, Kanno T, Manabe Y, Sukegawa-Takahashi Y, Masui M, Furuki Y. What are the risk factors for postoperative infections of third molar extraction surgery: A retrospective clinical study? Med Oral Patol Oral Cir Bucal 2019; 24:e123-e129. [PMID: 30573720 PMCID: PMC6344007 DOI: 10.4317/medoral.22556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 12/05/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aimed to identify (1) the predilection site of postoperative infection after third molar extraction surgery, (2) risk factors associated with postoperative infection, and (3) the cause of the difference between delayed- and early-onset infections. MATERIALS AND METHODS This retrospective study included 1010 patients (396 male, 614 female) who had ≥1 third molars extracted (2407; 812 maxilla, 1595 mandible). The risk factors were classified as attributes, general health, anatomic, and operative. Outcome variables were delayed- and early-onset infections. RESULTS Postoperative infection was completely absent in the maxilla, and all infections occurred in the mandible, with a probability of 1.94% (31/1595). Bivariate analysis for postoperative infection showed depth of inclusion and intraoperative hemostatic treatment to be significantly associated with the development of infections. Bivariate analysis for delayed- and early-onset infections showed simultaneous extraction of the left and right mandibular third molars to be prominent risk factors. CONCLUSIONS Postoperative infection occurs mainly in the mandible, and that in the maxilla is very rare. The risk of postoperative infection in the mandible was found to be related to the depth of inclusion and intraoperative hemostatic treatment. Simultaneous extraction of the left and right mandibular third molars appear to increase the risk of delayed-onset postoperative infection.
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Affiliation(s)
- S Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, Kagawa 760-8557, Japan,
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Wang D, Lin T, Wang Y, Sun C, Yang L, Jiang H, Cheng J. Radiographic features of anatomic relationship between impacted third molar and inferior alveolar canal on coronal CBCT images: risk factors for nerve injury after tooth extraction. Arch Med Sci 2018; 14:532-540. [PMID: 29765439 PMCID: PMC5949900 DOI: 10.5114/aoms.2016.58842] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/27/2016] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The present study was aimed to identify the radiographic signs between impacted third molar root and inferior alveolar canal (IAC) on cone-beam CT (CBCT) images as risk factors and prognostic predictors associated with inferior alveolar nerve (IAN) damage following tooth removal. MATERIAL AND METHODS A retrospective clinical study was performed involving 136 patients with 257 impacted lower third molars from January 2013 to December 2014. The neurosensory function of the lower lip and chin was subjectively evaluated and assessed by neurosensory tests before and after surgery. The preoperative CBCT data were retrieved and analyzed to identify the radiographic signs associated with postoperative IAN injury. RESULTS The overall incidence of IAN injury in our patient cohort was 13.2%. Multiple radiographic features on coronal CBCT images including contact between IAC and root, IAC position relative to root, IAC shape and cortication status were found to be significantly associated with IAN damage (p < 0.05, χ2 test). Furthermore, buccolingual position, teardrop/dumbbell shape and cortication status of IAC were identified as independent prognostic predictors for IAN damage. CONCLUSIONS Our findings indicate that radiographic signs including direct contact between IAC and root, buccal/lingual IAC position relative to root, teardrop/dumbbell shape and cortication absence of the IAC on presurgical CBCT images are associated with high risk of IAN injury and postoperative neurosensory disturbance.
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Affiliation(s)
- Dongmiao Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Medical University, Nanjing, China
| | - Tangyi Lin
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Yanling Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Chao Sun
- Department of Oral and Maxillofacial Radiology, Nanjing Medical University, Nanjing, China
| | - Lianfeng Yang
- Department of Oral and Maxillofacial Radiology, Nanjing Medical University, Nanjing, China
| | - Hongbing Jiang
- Department of Oral and Maxillofacial Surgery, Nanjing Medical University, Nanjing, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, Nanjing Medical University, Nanjing, China
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Comparison of Clinical Efficacies of Preoperatively Initiated Naproxen Sodium–Codeine Phosphate in Combination, Diclofenac Potassium, and Benzydamine Hydrochloride for Pain, Edema, and Trismus After Extraction of Impacted Lower Third Molar: A Randomized Double-Blind Study. J Oral Maxillofac Surg 2018; 76:495-502. [DOI: 10.1016/j.joms.2017.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 08/02/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022]
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Edward J, Aziz MA, Madhu Usha A, Narayanan JK. Comparing the Efficiency of Two Different Extraction Techniques in Removal of Maxillary Third Molars: A Randomized Controlled Trial. J Maxillofac Oral Surg 2017; 16:424-429. [PMID: 29038624 DOI: 10.1007/s12663-016-0935-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 06/17/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Extractions are routine procedures in dental surgery. Traditional extraction techniques use a combination of severing the periodontal attachment, luxation with an elevator, and removal with forceps. A new technique of extraction of maxillary third molar is introduced in this study-Joedds technique, which is compared with the conventional technique. METHODS AND MATERIAL One hundred people were included in the study, the people were divided into two groups by means of simple random sampling. In one group conventional technique of maxillary third molar extraction was used and on second Joedds technique was used. Statistical analysis was carried out with student's t test. RESULTS Analysis of 100 patients based on parameters showed that the novel joedds technique had minimal trauma to surrounding tissues, less tuberosity and root fractures and the time taken for extraction was <2 min while compared to other group of patients. CONCLUSION This novel technique has proved to be better than conventional third molar extraction technique, with minimal complications. If Proper selection of cases and right technique are used.
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Affiliation(s)
- Joseph Edward
- Department of Oral and Maxillo facial Surgery, Azeezia College of Dental Science and Research, Diamond Hills, Meeyannur, Kollam, 691537 India
| | - Mubarak A Aziz
- Department of Oral and Maxillo facial Surgery, Azeezia College of Dental Science and Research, Diamond Hills, Meeyannur, Kollam, 691537 India
| | - Arjun Madhu Usha
- Department of Oral and Maxillo facial Surgery, Azeezia College of Dental Science and Research, Diamond Hills, Meeyannur, Kollam, 691537 India
| | - Jyothi K Narayanan
- Department of Oral and Maxillo facial Surgery, Azeezia College of Dental Science and Research, Diamond Hills, Meeyannur, Kollam, 691537 India
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Reiland MD, Ettinger KS, Lohse CM, Viozzi CF. Does Administration of Oral Versus Intravenous Antibiotics for Third Molar Removal Have an Effect on the Incidence of Alveolar Osteitis or Postoperative Surgical Site Infections? J Oral Maxillofac Surg 2017; 75:1801-1808. [DOI: 10.1016/j.joms.2017.03.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017; 75:1124-1135. [DOI: 10.1016/j.joms.2017.01.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/15/2022]
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Teshome A. The efficacy of chlorhexidine gel in the prevention of alveolar osteitis after mandibular third molar extraction: a systematic review and meta-analysis. BMC Oral Health 2017; 17:82. [PMID: 28526078 PMCID: PMC5437629 DOI: 10.1186/s12903-017-0376-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alveolar osteitis is a very painful and distressing condition for a patient who has recently undergone a tooth extraction and has led dental professionals to search for preventive measures. The aim of this meta-analysis to determine the effect of chlorhexidine (CHX) gel on the incidence of alveolar osteitis after mandibular third molar extraction. METHODS Studies were searched for on electronic search engines using Medline (PubMed), Cochrane central, Scopus and advanced Google Scholar from May 2015 to December 2015. Randomized controlled trial studies with a history of mandibular third molar extraction, along with the administration of topical chlorhexidine gel were included. The risk of bias of the selected articles was assessed using the Cochrane risk of bias assessment tool. RevMan 5.3 Software was used to analyze the pooled effect. I2 was calculated to determine heterogeneity and a funnel plot was used to check the risk of bias. Subgroup analysis was also done based on the presence of confounding factors (smoking, oral contraceptive etc.) and on split mouth design. RESULTS Out of 52 articles, ten met the inclusion criteria. 862 participants were involved in the selected studies with a mean age range from 24.15 ± 5.02 to 36.65 ± 11. The overall RR was 0.43 (95% CI: 0.32, 0.58, p < 0.00001). Three studies used a split-mouth design to check the effect of chlorhexidine gel in the prevention of alveolar osteitis incidence. There was a pooled effect of 0.29 (95% CI: 0.16, 0.50) for the intervention group in the split mouth design studies. A stratified analysis was done to check the effect of CHX gel in patients with confounding factors and a significant reduction of AO incidence was found; 0.60 (95% CI: 0.41, 0.87; p = 0.05) in the intervention. There was no reported adverse reaction. The heterogeneity (I2) was 40%. The funnel plot showed that there was no significant publication bias. CONCLUSION This meta-analysis suggests that CHX gel is superior to a placebo in reducing the incidence of alveolar osteitis after mandibular third molar extraction.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, P.O.BOX: 196, Ethiopia.
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Emery RW, Korj O, Agarwal R. A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars. J Oral Maxillofac Surg 2017; 75:1591-1600. [PMID: 28419843 DOI: 10.1016/j.joms.2017.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE We performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS). MATERIALS AND METHODS A retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation. RESULTS All 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case. CONCLUSIONS We present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery.
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Affiliation(s)
- Robert W Emery
- Senior Attending Surgeon, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC
| | - Oxana Korj
- Chief Resident, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC.
| | - Ravi Agarwal
- Program Director, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC
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Boonsiriseth K, Latt MM, Kiattavorncharoen S, Pairuchvej V, Wongsirichat N. Dexamethasone injection into the pterygomandibular space in lower third molar surgery. Int J Oral Maxillofac Surg 2017; 46:899-904. [PMID: 28318872 DOI: 10.1016/j.ijom.2017.02.1266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/26/2016] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
The objective of this study was to evaluate the effects of 8mg dexamethasone injection into the pterygomandibular space on the postoperative sequelae of lower third molar surgery. A prospective, randomized, controlled, split-mouth study was designed involving 62 lower third molar extractions (31 patients). Prior to surgery, the study group received 2ml of 4mg/ml (8mg) dexamethasone injection through the pterygomandibular space following local anaesthesia; the control group received 2ml normal saline injection. Facial swelling, mouth opening, pain on a visual analogue scale (VAS), and the number of analgesics consumed were assessed. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P<0.05. There was a significant reduction in swelling on day 2 postoperative in the dexamethasone group. Mouth opening was also significantly greater on day 2 in the dexamethasone group. The VAS pain score was significantly lower on the day of the operation and first postoperative day in the dexamethasone group, but did not differ significantly between the groups on the other postoperative days. The injection of 8mg dexamethasone into the pterygomandibular space was effective in reducing postoperative swelling, limited mouth opening, and pain following impacted lower third molar extraction.
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Affiliation(s)
- K Boonsiriseth
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - M M Latt
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand; Insein General Hospital, Insein Township, Yangon, Myanmar
| | - S Kiattavorncharoen
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - V Pairuchvej
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - N Wongsirichat
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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MILETO TN, AZAMBUJA FG. Low-intensity laser efficacy in postoperative extraction of third molars. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1981-863720170001000023084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT The search for means that enable a better quality of life for postoperative patients should be incessant. The surgical extraction of third molars can result in potential complications such as pain, swelling and trismus, along with discomfort in the recovery phase. Therefore, this narrative review was to analyze, from systematic reviews and randomized clinical trials, the use of low level laser therapy as influencer the clinical state after third molar surgery. Scientific articles were searched through PubMed and Science Direct database. In spite of the evaluated studies have cited the effectiveness of laser therapy such as tissue repair, anti-inflammatory and analgesic, variety of analysis models and diversity of dosimetry leaves a gap on their true efficacy. Based on the research conducted, we suggest the adjuvant use of diode laser GaAlAs with 810 nm (λ), 100 mW constant power and 4 J/cm2 of energy, intra and extra oral form at least three sections to minimize possible occurrences of third molar surgery.
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Al-Hamed FS, Tawfik MAM, Abdelfadil E. Clinical effects of platelet-rich fibrin (PRF) following surgical extraction of lower third molar. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sjdr.2016.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yadav P, Pruthi PJ, Nawal RR, Talwar S, Verma M. Saving the 2(nd) Molar from the 3(rd) Is it Really the Guilt of the Tilt? J Clin Diagn Res 2016; 10:ZC17-9. [PMID: 27437353 DOI: 10.7860/jcdr/2016/13555.7727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Clinicians often relate the distal caries in second molars to angulated third molars, which if left undetected can lead to gross decay that may further require removal of the tooth. Due to this fact, many third molars are advised for prophylactic removal to prevent decay in the second molar. But this approach would only be justified when the incidence of decay/loss of second molar due to third molar are reasonably high. We sought to determine incidence of caries experience and also sequel extraction in second molars associated with the third molars. AIM The study was conducted to answer the basic question that whether the incidence of caries and subsequent extraction of second molar due to angulated third molars is high enough to justify the prophylactic removal of third molar or not. MATERIALS AND METHODS This study was conducted on radiographic records of 1187 patients. The effect of tilted third molar on the second molar was measured in relation with three parameters namely level & position of third molar with respect to second molar and the distribution among arches. RESULTS The results indicated that out of total number of teeth examined only 5.4% of maxillary and 9.6% of mandibular second molars were affected by tilted third molars. Further, only 2.2% of mandibular and 2.9% of maxillary second molars were indicated for extraction. The data was statistically insignificant. CONCLUSION It was concluded that distal caries in second molars is not very common. It may be present in some cases of third molar impactions and prophylactic removal of these impacted teeth may not be considered appropriate.
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Affiliation(s)
- Pankaj Yadav
- Senior Resident, Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences , New Delhi, India
| | - Preeti Jain Pruthi
- Senior Resident, Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences , New Delhi, India
| | - Ruchika Roongta Nawal
- Associate Professor, Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences , New Delhi, India
| | - Sangeeta Talwar
- Professor and Head of Department, Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences , New Delhi, India
| | - Mahesh Verma
- Professor and Head of Department, Department of Prosthodontics, Maulana Azad Institute of Dental Sciences , New Delhi, India
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Latt MM, Kiattavorncharoen S, Boonsiriseth K, Pairuchvej V, Wongsirichat N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. J Dent Anesth Pain Med 2016; 16:95-102. [PMID: 28879301 PMCID: PMC5564088 DOI: 10.17245/jdapm.2016.16.2.95] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 01/03/2023] Open
Abstract
Background Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery. Methods A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo. Results The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences. Conclusions Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.
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Affiliation(s)
- Maung Maung Latt
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.,Insein General Hospital, Yangon, Myanmar
| | | | - Kiatanant Boonsiriseth
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Ghaeminia H, Hoppenreijs TJM, Xi T, Fennis JP, Maal TJ, Bergé SJ, Meijer GJ. Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial. Clin Oral Investig 2016; 21:71-83. [PMID: 26922634 PMCID: PMC5203820 DOI: 10.1007/s00784-016-1751-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Objectives The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. Material and methods A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher’s exact test. Results A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. Conclusion Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. Clinical relevance Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Th J M Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J P Fennis
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Oral and Maxillofacial Surgery, ZBC Private Clinic Nijmegen, Groenewoudseweg 315, 6524 TX, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Implantology & Periodontology, Radboud University Medical Center, Phillips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands
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Wang WQ, Chen MYC, Huang HL, Fuh LJ, Tsai MT, Hsu JT. New quantitative classification of the anatomical relationship between impacted third molars and the inferior alveolar nerve. BMC Med Imaging 2015; 15:59. [PMID: 26643322 PMCID: PMC4672479 DOI: 10.1186/s12880-015-0101-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Before extracting impacted lower third molars, dentists must first identify the spatial relationship between the inferior alveolar nerve (IAN) and an impacted lower third molar to prevent nerve injury from the extraction. Nevertheless, the current method for describing the spatial relationship between the IAN and an impacted lower third molar is deficient. Therefore, the objectives of this study were to: (1) evaluate the relative position between impacted lower third molars and the IAN; and (2) investigate the relative position between impacted lower third molars and the IAN by using a cylindrical coordinate system. METHODS From the radiology department's database, we selected computed tomography images of 137 lower third molars (from 75 patients) requiring removal and applied a Cartesian coordinate system by using Mimics, a medical imaging software application, to measure the distribution between impacted mandibular third molars and the IAN. In addition, the orientation of the lower third molar to the IAN was also measured, but by using a cylindrical coordinate system with the IAN as the origin. RESULTS According to the Cartesian coordinate system, most of the IAN runs through the inferior side of the third molar (78.6 %), followed by the lingual side (11.8 %), and the buccal side (8.9 %); only 0.7 % is positioned between the roots. Unlike the Cartesian coordinate system, the cylindrical coordinate system clearly identified the relative position, r and θ, between the IAN and lower third molar. CONCLUSIONS Using the cylindrical coordinate system to present the relationship between the IAN and lower third molar as (r, θ) might provide clinical practitioners with a more explicit and objective description of the relative position of both sites. However, comprehensive research and cautious application of this system remain necessary.
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Affiliation(s)
- Wei-Quan Wang
- School of Dentistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
| | - Michael Y C Chen
- School of Dentistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Dentistry, China Medical University and Hospital, Taichung, 404, Taiwan.
| | - Heng-Li Huang
- School of Dentistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
| | - Lih-Jyh Fuh
- School of Dentistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Dentistry, China Medical University and Hospital, Taichung, 404, Taiwan.
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan.
| | - Jui-Ting Hsu
- School of Dentistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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Isiordia-Espinoza MA, Aragon-Martinez OH, Martínez-Morales JF, Zapata-Morales JR. Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2015; 53:796-804. [PMID: 26316017 DOI: 10.1016/j.bjoms.2015.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review and meta-analysis was to assess the risk of surgical wound infection and the adverse effects of amoxicillin in healthy patients who required excision of third molars. We identified eligible reports from searches of PubMed, Medline®, the Cochrane Library, Imbiomed, LILACS, and Google Scholar. Studies that met our minimum requirements were evaluated using inclusion and exclusion criteria and the Oxford Quality Scale. Those with a score of 3 or more on this Scale were included and their data were extracted and analysed. For evaluation of the risk of infection the absolute risk reduction, number needed to treat, and 95% CI were calculated. For evaluation of the risk of an adverse effect the absolute risk increase, number needed to harm, and 95% CI were calculated using the Risk Reduction Calculator. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, and estimates of risk (OR) and 95% CI were calculated using the Review Manager 5.3, from the Cochrane Library. A significant risk was assumed when the lower limit of the 95% CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that there was no reduction in the risk of infection when amoxicillin was given before or after operation compared with an untreated group or placebo. In conclusion, this study suggests that amoxicillin given prophylactically or postoperatively does not reduce the risk of infection in healthy patients having their third molars extracted.
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Affiliation(s)
- M A Isiordia-Espinoza
- Departamento de Farmacología, Facultad de Odontología, Universidad Autónoma de Baja California, Mexicali, Mexico.
| | - O H Aragon-Martinez
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, S.L.P., Mexico
| | - J F Martínez-Morales
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, S.L.P., Mexico
| | - J R Zapata-Morales
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
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Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: a review - based on a hierarchical model of evidence. Dentomaxillofac Radiol 2015; 44:20140189. [PMID: 25135317 DOI: 10.1259/dmfr.20140189] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A radiographic examination of mandibular third molars is meant to support the surgeon in establishing a treatment plan. For years panoramic (PAN) imaging has been the first choice method; however, where an overprojection is observed between the third molar and the mandibular canal and when specific signs suggest a close contact between the molar and the canal, CBCT may be indicated. The present review provides an evaluation of the efficacy of CBCT for assessment of mandibular third molars using a six-tiered hierarchical model by Fryback and Thornbury in 1991. Levels 1-3 include studies on low evidence levels mainly regarding the technical capabilities of a radiographic method and the diagnostic accuracy of the related images. Levels 4-6 include studies on a higher level of evidence and assess the diagnostic impact of a radiographic method on the treatment of the patient in addition to the outcome for the patient and society including cost calculations. Only very few high-evidence studies on the efficacy of CBCT for radiographic examination of mandibular third molars exist and, in conclusion, periapical or PAN examination is sufficient in most cases before removal of mandibular third molars. However, CBCT may be suggested when one or more signs for a close contact between the tooth and the canal are present in the two-dimensional image-if it is believed that CBCT will change the treatment or the treatment outcome for the patient. Further research on high-evidence levels is needed.
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Affiliation(s)
- L H Matzen
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
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Badenoch-Jones EK, Lynham AJ, Loessner D. Consent for third molar tooth extractions in Australia and New Zealand: a review of current practice. Aust Dent J 2015; 61:203-7. [PMID: 26031850 DOI: 10.1111/adj.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Informed consent is the legal requirement to educate a patient about a proposed medical treatment or procedure so that he or she can make informed decisions. The purpose of the study was to examine the current practice for obtaining informed consent for third molar tooth extractions (wisdom teeth) by oral and maxillofacial surgeons in Australia and New Zealand. METHODS An online survey was sent to 180 consultant oral and maxillofacial surgeons in Australia and New Zealand. Surgeons were asked to answer (yes/no) whether they routinely warned of a specific risk of third molar tooth extraction in their written consent. RESULTS Seventy-one replies were received (39%). The only risks that surgeons agreed should be routinely included in written consent were a general warning of infection (not alveolar osteitis), inferior alveolar nerve damage (temporary and permanent) and lingual nerve damage (temporary and permanent). CONCLUSIONS There is significant variability among Australian and New Zealand oral and maxillofacial surgeons regarding risk disclosure for third molar tooth extractions. We aim to improve consistency in consent for third molar extractions by developing an evidence-based consent form.
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Affiliation(s)
- E K Badenoch-Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - A J Lynham
- Medical Engineering Research Facility, Queensland University of Technology, Chermside, Brisbane, Queensland, Australia
| | - D Loessner
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Rakhshan V. Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg 2015; 41:59-65. [PMID: 25922816 PMCID: PMC4411729 DOI: 10.5125/jkaoms.2015.41.2.59] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 12/01/2022] Open
Abstract
The extraction of third molars is a common task carried out at dental/surgery clinics. Postoperative pain is one of the two most common complications of this surgery, along with dry socket. Knowledge of the frequent risk factors of this complication is useful in determining high-risk patients, planning treatment, and preparing the patients mentally. Since the risk factors for postoperative pain have never been summarized before while the risk factors for dry socket have been highly debated, this report summarizes the literature regarding the common predictors of postextraction pain. Except for surgical difficulty and the surgeon's experience, the influences of other risk factors (age, gender and oral contraceptive use) were rather inconclusive. The case of a female gender or oral contraceptive effect might mainly be associated with estrogen levels (when it comes to dry socket), which can differ considerably from case to case. Improvement in and unification of statistical and diagnostic methods seem necessary. In addition, each risk factor was actually a combination of various independent variables, which should instead be targeted in more comprehensive studies.
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Affiliation(s)
- Vahid Rakhshan
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran. ; Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 5:e1. [PMID: 25635208 PMCID: PMC4306319 DOI: 10.5037/jomr.2014.5401] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/22/2014] [Indexed: 01/20/2023]
Abstract
Objectives The purpose of this study was to systematically review the comprehensive overview of literature data about injury to the inferior alveolar nerve after lower third molar extraction to discover the prevalence of injury, the risk factors, recovery rates, and alternative methods of treatment. Material and Methods Literature was selected through a search of PubMed electronic databases. Articles from January 2009 to June 2014 were searched. English language articles with a minimum of 6 months patient follow-up and injury analysis by patient’s reporting, radiographic, and neurosensory testing were selected. Results In total, 84 literature sources were reviewed, and 14 of the most relevant articles that are suitable to the criteria were selected. Articles were analyzed on men and women. The influence of lower third molar extraction (especially impacted) on the inferior alveolar nerve was clearly seen. Conclusions The incidence of injury to the inferior alveolar nerve after lower third molar extraction was about 0.35 - 8.4%. The injury of the inferior alveolar nerve can be predicted by various radiological signs. There are few risk factors that may increase the risk of injury to the nerve such as patients over the age of 24 years old, with horizontal impactions, and extraction by trainee surgeons. Recovery is preferable and permanent injury is very rare.
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Affiliation(s)
- Rafael Sarikov
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
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Jolly SS, Rattan V, Rai SK. Intraoral management of displaced root into submandibular space under local anaesthesia -A case report and review of literature. Saudi Dent J 2014; 26:181-4. [PMID: 25382952 DOI: 10.1016/j.sdentj.2014.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 02/10/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
Accidental displacement of an impacted third molar, either a root fragment, crown, or the entire tooth, is a rare complication that occurs during exodontia. The most common sites of dislodgment of an impacted mandibular third molar fragment are the sublingual, submandibular, and pterygomandibular spaces. Removal of a displaced root tip from these spaces may be complex due to poor visualization and limited access. A thorough evaluation of all significant risk factors must be performed in advance to prevent complications. This paper reports the case of a patient who presented with a mandibular third molar root that was displaced into submandibular space. The case was managed intraorally under local anaesthesia and review of the literature.
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Affiliation(s)
| | - Vidya Rattan
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
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Cortes ARG, No-Cortes J, Cavalcanti MGP, Arita ES. An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up. Imaging Sci Dent 2014; 44:171-5. [PMID: 24944969 PMCID: PMC4061303 DOI: 10.5624/isd.2014.44.2.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/01/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022] Open
Abstract
One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.
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Affiliation(s)
| | | | | | - Emiko Saito Arita
- Department of Oral Radiology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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A Clinicoradiographic and Pathological Study of Pericoronal Follicles Associated to Mandibular Third Molars. J Craniofac Surg 2014; 25:e283-7. [DOI: 10.1097/scs.0000000000000712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases. Clin Oral Investig 2014; 19:149-57. [DOI: 10.1007/s00784-014-1222-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Jung YH, Cho BH. Prevalence of missing and impacted third molars in adults aged 25 years and above. Imaging Sci Dent 2013; 43:219-25. [PMID: 24380060 PMCID: PMC3873309 DOI: 10.5624/isd.2013.43.4.219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/17/2013] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence of missing and impacted third molars in people aged 25 years and above. MATERIALS AND METHODS The study sample of 3,799 patients was chosen randomly from patients who visited Pusan National University Dental Hospital and had panoramic radiographs taken. The data collected included presence and impaction state, angulation, and depth of impaction of third molars, and radiographically detected lesions of third molars and adjacent second molars. RESULTS A greater percentage of men than women retained at least one third molar. The incidence of third molars decreased with increasing age. The incidence of partially impacted third molars greatly declined after the age of 30. Vertically impacted maxillary third molars and horizontally impacted mandibular third molars were most frequent in all age groups. Among the maxillary third molars, those impacted below the cervical line of the second molar were most frequent in all age groups, and among the mandibular third molars, deeply impacted third molars were most frequent in those aged over 40. Dental caries was the most common radiographic lesion of the third molars. Mesioangularly impacted third molars showed radiographic lesions in 13 (9.5%) adjacent maxillary second molars and 117 (27.4%) mandibular second molars. CONCLUSION The number of remaining third molars decreased and the percentage of Class C depth increased with age. Caries was the most frequent lesion in third molars. Partially impacted mesioangular third molars showed a high incidence of caries or periodontal bone loss of the adjacent second molar. Regular oral examination will be essential to keep asymptomatic third molars in good health.
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Affiliation(s)
- Yun-Hoa Jung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yansan, Korea
| | - Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yansan, Korea
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Selvi F, Dodson TB, Nattestad A, Robertson K, Tolstunov L. Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars. Br J Oral Maxillofac Surg 2013; 51:868-73. [PMID: 24012054 DOI: 10.1016/j.bjoms.2013.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/08/2013] [Indexed: 12/15/2022]
Abstract
Our aim was to answer the question: "Among patients at high risk of injury to the inferior alveolar nerve (IAN) after removal of 3rd molars, what factors are associated with postoperative neurosensory deficits?" We organized a retrospective, two-center study and enrolled a group of subjects who were at increased risk of injury to the IAN after removal of 3rd molars because radiographic findings indicated a risk on panoramic radiography that was high enough to warrant preoperative computed tomography (CT). The primary outcome variable was postoperative injury to the IAN. We used descriptive, bivariate, and multivariate analyses to assess the significance of differences, and probabilities of less than 0.05 were accepted as significant. We studied 149 subjects who had 235 3rd molars removed. Their mean (SD) age was 31 (11) years and 25/235 (11%) of 3rd molars were associated with injury to the IAN. In the multiple logistic regression model, increasing age (odds ratio (OR) 1.05, 95% CI 1.01-1.1, p=0.04), female sex (OR 5.3, 95% CI 1.6-16.9, p=0.005), and the size (mm) of the cortical perforation in the inferior alveolar canal (IAC) viewed on the coronal CT cut (OR 1.3; 95% CI 1.0-1.6, p=0.03) were associated with an increased risk of postoperative injury to the IAN. Age, sex, and the size of the perforation in the IAC on the coronal CT were associated with an increased risk of injury to the IAN. These findings may help to guide recommendations for treatment of patients at high risk of injury to the IAN during removal of 3rd molars.
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Affiliation(s)
- Firat Selvi
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.
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Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2013; 4:e1. [PMID: 24422029 PMCID: PMC3886113 DOI: 10.5037/jomr.2013.4201] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/11/2013] [Indexed: 01/07/2023]
Abstract
Objectives The purpose of present
article was to review impacted mandibular third molar aetiology, clinical
anatomy, radiologic examination, surgical treatment and possible complications,
as well as to create new mandibular third molar impaction and extraction
difficulty degree classification based on anatomical and radiologic findings
and literature review results. Material and Methods Literature
was selected through a search of PubMed, Embase and Cochrane electronic
databases. The keywords used for search were mandibular third molar, impacted
mandibular third molar, inferior alveolar nerve injury third molar, lingual
nerve injury third molar. The search was restricted to English language
articles, published from 1976 to April 2013. Additionally, a manual search
in the major anatomy and oral surgery journals and books was performed.
The publications there selected by including clinical and human anatomy
studies. Results In total 75 literature
sources were obtained and reviewed. Impacted mandibular third molar aetiology,
clinical anatomy, radiographic examination, surgical extraction of and possible
complications, classifications and risk factors were discussed. New mandibular
third molar impaction and extraction difficulty degree classification based
on anatomical and radiologic findings and literature review results was
proposed. Conclusions The classification
proposed here based on anatomical and radiological impacted mandibular third
molar features is promising to be a helpful tool for impacted tooth assessment
as well as for planning for surgical operation. Further clinical studies
should be conducted for new classification validation and reliability evaluation.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Povilas Daugela
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
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Decorso postoperatorio in pazienti con terzi molari inclusi trattati con due diverse tecniche osteotomiche rotanti. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Iglesias-Martin F, Infante-Cossio P, Torres-Carranza E, Prats-Golczer VE, Garcia-Perla-Garcia A. Ectopic third molar in the mandibular condyle: a review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17:e1013-7. [PMID: 22926463 PMCID: PMC3505695 DOI: 10.4317/medoral.17864] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 01/04/2012] [Indexed: 12/02/2022] Open
Abstract
Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle.
Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients.
Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined.
Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery.
Key words:Third molar, ectopic tooth, condyle, mandible.
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Affiliation(s)
- Fernando Iglesias-Martin
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain
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Wang Y, He D, Yang C, Wang B, Qian W. An easy way to apply orthodontic extraction for impacted lower third molar compressing to the inferior alveolar nerve. J Craniomaxillofac Surg 2012; 40:234-7. [PMID: 21641229 DOI: 10.1016/j.jcms.2011.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 04/30/2011] [Accepted: 05/03/2011] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To study the results of an easy orthodontic extraction method for impacted lower third molar removal which had roots compressing to the inferior alveolar nerve (IAN). PATIENTS AND METHODS Forty patients were divided into two groups according to their desire. Orthodontic traction group (n=20) had brackets or mini bone screws on the antagonist maxillary molars as anchorage for orthodontic traction from 3 to 10 weeks until the roots' tip was away from the IAN, the tooth was then removed. Traditional extraction group (n=20) had the tooth removed immediately by the same surgeon. Post-operative results were compared between the two groups. RESULTS All 20 patients in the orthodontic extraction group had their lower impacted third molar removed easily without lower lip numbness after surgery, while 5 patients in the traditional extraction group had transient IAN injury and went away 1 week later. There were no anchorage teeth and adjacent mandibular second molar loose or displacement. CONCLUSION Application of orthodontic brackets or mini bone screws on the antagonist maxillary molars is an easy way for orthodontic extraction of impacted lower third molar with roots' tip compressed to the IAN. It is an effective way to avoid IAN injury during tooth extraction.
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Affiliation(s)
- Yong Wang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Zhi Zao Ju Road #639, Shanghai, China
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Charan Babu HS, Reddy PB, Pattathan RKB, Desai R, Shubha AB. Factors influencing lingual nerve paraesthesia following third molar surgery: a prospective clinical study. J Maxillofac Oral Surg 2012; 12:168-72. [PMID: 24431835 DOI: 10.1007/s12663-012-0391-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/02/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this prospective study was to evaluate the incidence and various risk factors influencing the sensory deficit in case of lingual nerve injury (LNI) in individuals whose impacted mandibular third molars are surgically removed under local anesthesia. MATERIALS AND METHODS The study was based on the data collected prospectively from a random group of 100 patients who underwent surgical removal of bony impacted lower third molar in a dental hospital. Details of the patient, reason for extraction, type of impaction, method of surgery and signs and symptoms of nerve injury are recorded. Neurosensory testing was done to evaluate the LNI at 1 week, 1 months, 3 months and 6 months interval. Comparison was carried out using Chi square test. For all tests a P < 0.05 was considered significant. RESULTS The incidence of LNI was 4 % and of temporary in nature which recovered well within 6 months postoperatively. The age of the patient above 26 years, lingual flap retraction, depth of impaction (red line ≥10 mm) and duration of surgery above 30 min were the significant factors for causing LNI. CONCLUSIONS The age of the patient, depth of impaction, lingual flap retraction and longer duration of surgery are significant risk factors for LNI during mandibular third molar surgery. Greater care should be taken to avoid the morbidity and patients should be informed well ahead about the probable complications.
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Affiliation(s)
- H S Charan Babu
- Department of Oral and Maxillofacial surgery, Pacific Dental College & Hospital, Debari, Udaipur, 313024 Rajasthan India
| | - Praveen B Reddy
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, MP India
| | - Rajesh Kumar B Pattathan
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College & Hospital, Davangere, Karnataka India
| | - Rajendra Desai
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences and Hospital, Davangere, Karnataka India
| | - A B Shubha
- Department of Pediatric Dentistry, Pacific Dental College & Hospital, Udaipur, Rajasthan India
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