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Fujii Y, Okabe I, Hatori A, Sah SK, Kanaujiya J, Fisher M, Norris R, Terasaki M, Reichenberger EJ, Chen IP. Skeletal abnormalities caused by a Connexin43 R239Q mutation in a mouse model for autosomal recessive craniometaphyseal dysplasia. RESEARCH SQUARE 2024:rs.3.rs-3906170. [PMID: 38405920 PMCID: PMC10889043 DOI: 10.21203/rs.3.rs-3906170/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Craniometaphyseal dysplasia (CMD), a rare craniotubular disorder, occurs in an autosomal dominant (AD) or autosomal recessive (AR) form. CMD is characterized by hyperostosis of craniofacial bones and flaring metaphyses of long bones. Many patients with CMD suffer from neurological symptoms. To date, the pathogenesis of CMD is not fully understood. Treatment is limited to decompression surgery. Here, we report a knock in (KI) mouse model for AR CMD carrying a R239Q mutation in CX43. Cx43KI/KI mice replicate many features of AR CMD in craniofacial and long bones. In contrast to Cx43+/+ littermates, Cx43KI/KI mice exhibit periosteal bone deposition and increased osteoclast (OC) numbers in the endosteum of long bones, leading to an expanded bone marrow cavity and increased cortical bone thickness. Although formation of Cx43+/+ and Cx43KI/KI resting OCs are comparable, on bone chips the actively resorbing Cx43KI/KI OCs resorb less bone. Cortical bones of Cx43KI/KI mice have an increase in degenerating osteocytes and empty lacunae. Osteocyte dendrite formation is decreased with reduced expression levels of Fgf23, Sost, Tnf-α, IL-1β, Esr1, Esr2, and a lower Rankl/Opg ratio. Female Cx43KI/KI mice display a more severe phenotype. Sexual dimorphism in bone becomes more evident as mice age. Our data show that the CX43R239Q mutation results in mislocalization of CX43 protein and impairment of gap junction and hemichannel activity. Different from CX43 ablation mouse models, the CX43R239Q mutation leads to the AR CMD-like phenotype in Cx43KI/KI mice not only by loss-of-function but also via a not yet revealed dominant function.
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Affiliation(s)
- Yasuyuki Fujii
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Iichiro Okabe
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Ayano Hatori
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Shyam Kishor Sah
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Jitendra Kanaujiya
- Department of Cell Biology, University of Connecticut Health, Farmington, CT, United States
| | - Melanie Fisher
- Department of Cell Biology, University of Connecticut Health, Farmington, CT, United States
| | - Rachael Norris
- Department of Cell Biology, University of Connecticut Health, Farmington, CT, United States
| | - Mark Terasaki
- Department of Cell Biology, University of Connecticut Health, Farmington, CT, United States
| | - Ernst J. Reichenberger
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
| | - I-Ping Chen
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine, University of Connecticut Health, Farmington, CT, United States
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Vozza I, Cristalli MP. COMPARATIVE ANALGESIC EFFECTS OF SINGLE-DOSE PREOPERATIVE ADMINISTRATION OF PARACETAMOL (ACETAMINOPHEN) 500 mg PLUS CODEINE 30 mg AND IBUPROFEN 400 mg ON PAIN AFTER THIRD MOLAR SURGERY. J Evid Based Dent Pract 2021; 21:101611. [PMID: 34922726 DOI: 10.1016/j.jebdp.2021.101611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Efficacy and rapid onset of postsurgical oral pain relief are critical to improve clinical outcomes and reduce the risk of excessive dosing with analgesic drugs. PURPOSE To compare analgesic effects of preoperative administration of paracetamol 500 mg plus codeine 30 mg in single-tablet and effervescent formulation to ibuprofen 400 mg, and placebo in the management of moderate to severe postoperative pain after mandibular third molar surgery. MATERIALS AND METHODS One hundred twenty healthy outpatients aged 15-29 years undergoing surgical removal of 1 bony impacted mandibular third molar were enrolled in this, single-center, prospective, randomized, triple-blind parallel-group, placebo-controlled, clinical trial. Study participants were randomly assigned to three treatment arms. According to the concealed allocation, each patient 30 minutes before surgery received paracetamol 500 mg plus codeine 30 mg (group APAP/COD), ibuprofen 400 mg (group IBU) or placebo (group PLA). Rescue therapy allowed in the postoperative period was paracetamol 500 mg plus codeine 30 mg in groups APAP/COD and PLA and ibuprofen 400 mg in group IBU. Patients recorded on Numerical Rating Scale-11 (NRS-11) the pain intensity, total number of postoperative-supplement medications and time of the first intake, until 12-hours after surgery and over extra 2 days, RESULTS: Over postoperative 3 days, patients in the APAP/COD group (2.33 ± 1.99) displayed significantly (P< .001) less pain intensity than IBU (3.43 ± 2.47) and placebo (3.57 ± 2.62) groups. The first-day postoperative pain was significantly (P < .001) higher in group PLA than in groups APAP/COD and IBU, but not between the latter 2 groups. However, at 2 hours postdose, the IBU group displayed average pain intensity lower than APAP/COD group (P> .05). On the next 2 days, pain intensity was significantly (P< .001) lower in group APAP/COD than in groups IBU and PLA but failed to reach statistical significance between groups IBU and PLA. Although the time to the first using rescue therapy was longer (445.88 ± 159.96 minute) in group IBU, compared to groups APAP/COD (392.67 ± 138.90 minutes) and PLA (323.00 ± 143.95 minutes), the number of supplemented tablets was significantly higher in group IBU (2.89 ± 2.13) than in groups APAP/COD (1.24 ± 1.79) (P= .001) and PLA (1.53 ± 1.67) (P = .008). No adverse events were registered for all groups. CONCLUSIONS Within the limits of the present study, over postoperative 3 days, a statistically significant intensity pain reduction and decreased rescue therapy consumption were recorded in the paracetamol-codeine group than to ibuprofen group. Nevertheless, lower pain intensity at 2 hours postdose and longer time using rescue therapy was found in the ibuprofen group without statistical significance. No adverse events occurred over the studied period.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy.
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza, University of Rome, Rome, Italy
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Teja Y, Nareswari I. Acupuncture Therapies for Addressing Post Odontectomy Neuropathy. Med Acupunct 2021; 33:358-363. [PMID: 35003505 DOI: 10.1089/acu.2020.1472] [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: 11/12/2022] Open
Abstract
Background: Third-molar extraction is a common oral surgical procedure that can cause complications. Although rare, nerve injuries that result in permanent neuropathy can occur and include a variety of complaints such as sensory disorders, taste-sensation disorders, speech articulation disorders, etc. Acupuncture is one of several nonpharmacologic therapies that has played a role in managing neuropathic lesions and has been proven to produce good results. Case: A 44-year-old woman with postodontectomy neuropathy developed paresthesia, dysarthria, xerostomia, dysgeusia, pain in the gums and lower right jaw, a chewing disorder, and cephalgia. Her numerical rating scale (NRS) results were: lower right gum pain, 3/10; numbness of the tongue, 4/10; and headache, 1/10. A physical examination revealed dysarthria, a decreased sense of sharpness and dullness in the right mandibular nerve branches, decreased right masseter muscle contractions, and tenderness on the right GB 20 point. Electromyography revealed partial functional lesions in the postganglion at the right fifth cranial nerve. She had body acupuncture therapy at GV 20, GB 20, ST 5, ST 6, ST 7, CV 23, LI 4, HT 5, ST 36, LU 7, and KI 6; ear acupuncture at the Parotid and Shenmen points; and treatment with the Tan Balance Method. Results: After 3 consecutive sessions of acupuncture therapy, this patient's symptoms were reduced. Conclusions: Acupuncture was helpful for reducing paresthesia, dysarthria, xerostomia, dysgeusia, gum and lower right jaw pain, a chewing disorder, and cephalgia in this patient with postodontectomy neuropathy. Clinical trials are needed to support the findings in this case.
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Affiliation(s)
- Yolanda Teja
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, DKI Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Daerah Istimewa Jakarta, Indonesia
| | - Irma Nareswari
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, DKI Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Daerah Istimewa Jakarta, Indonesia
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Barry E, Ball R, Patel J, Obisesan O, Shah A, Manoharan A. Retrospective evaluation of sensory neuropathies after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 134:e1-e7. [PMID: 34758933 DOI: 10.1016/j.oooo.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was to identify the incidence of inferior alveolar nerve (IAN) injury after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans and establish any risk factors that significantly increase the chances of sustaining an IAN injury. STUDY DESIGN This study is a retrospective analysis of outcomes after surgical extraction of 500 mandibular third molars over a 5-year period. All teeth showed signs of contact with or compression of the IAN on cone beam computed topography scans. RESULTS The overall incidence of IAN injury was 6.6%, with permanent neuropathies accounting for 1.8% within this high-risk cohort. Statistically significant factors shown to increase the risk of nerve injury included increasing age (P = .002), compression of the nerve evident on cone beam computed topography scan (P = .005), and buccal or interradicular position of the nerve (P = .042). CONCLUSIONS Results indicate a low incidence of IAN injury, particularly given the high-risk nature of all teeth that were extracted. It highlights the benefits of cone beam computed topography scans in surgical planning. These data are an important contribution to the existing literature and valuable in the consent procedure for patients undergoing surgical removal of mandibular third molars in contact with the IAN.
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Affiliation(s)
- Elizabeth Barry
- Oral Surgery, King's College Hospital, London, United Kingdom.
| | - Rebecca Ball
- Oral Surgery, King's College Hospital, London, United Kingdom
| | - Jashme Patel
- Oral Surgery, King's College Hospital, London, United Kingdom
| | | | - Aneesha Shah
- Oral Surgery, King's College Hospital, London, United Kingdom
| | - Andiappan Manoharan
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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Kim D, Doty RL. Positive Long-Term Effects of Third Molar Extraction on Taste Function. Chem Senses 2021; 46:6308464. [PMID: 34161573 DOI: 10.1093/chemse/bjab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Taste and other neurosensory defects have been reported postoperatively in a number of patients who have undergone mandibular third molar extraction (TME). Although the taste deficits are generally believed to resolve within a year, the long-term effects of TME remain unknown. We retrospectively examined the whole-mouth taste function of 891 individuals who had received TMEs, on average, more than 2 decades earlier, and 364 individuals who had not undergone TME. All had been extensively tested for chemosensory function at the University of Pennsylvania Smell and Taste Center over the course of the last 20 years. The whole-mouth identification test incorporated 2 presentations each of 5 different concentrations of sucrose, sodium chloride, citric acid, and caffeine. Analyses of covariance (age = covariate) found those with histories of TME to exhibit better overall test scores for all 4 taste qualities than nonoperated controls. Such scores were not associated with the time since the TME. In both groups, women outperformed men and function declined with age. The basis of this phenomenon, which requires confirmation from prospective studies, is unknown, but could reflect sensitization of CN VII nerve afferents or the partial release of the tonic inhibition that CN VII exerts on CN IX via central nervous system processes.
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Affiliation(s)
- Dane Kim
- School of Dental Medicine, 240 S. 40th Street, Philadelphia, PA 19104, USA.,Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Bigagnoli S, Greco C, Costantinides F, Porrelli D, Bevilacqua L, Maglione M. CBCT Radiological Features as Predictors of Nerve Injuries in Third Molar Extractions: Multicenter Prospective Study on a Northeastern Italian Population. Dent J (Basel) 2021; 9:dj9020023. [PMID: 33669928 PMCID: PMC7924829 DOI: 10.3390/dj9020023] [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: 01/18/2021] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.
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Affiliation(s)
- Stefano Bigagnoli
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Christian Greco
- Unit of Dentistry, Merano Hospital, via Giacomo Rossini 5, 39012 Merano, Italy;
| | - Fulvia Costantinides
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Davide Porrelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy;
| | - Lorenzo Bevilacqua
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
- Correspondence:
| | - Michele Maglione
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
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The Evaluation of Further Complications after the Extraction of the Third Molar Germ: A Pilot Study in Paediatric Dentistry. Healthcare (Basel) 2021; 9:healthcare9020121. [PMID: 33504054 PMCID: PMC7912446 DOI: 10.3390/healthcare9020121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Some authors suggest germectomy to prevent the impaction of mandibular third molars, which can cause anterior crowding. The aim of the study, conducted with 2 years of follow-up, was to clarify when the extraction of the germ of the third molar is optimal, together with possible post-operative complications. A new surgical approach was performed through the application of a combined suture, which can provide better wound healing. The study was performed on 25 patients with a mean age of 15.44 ± 2.06. Based on orthodontic and surgical indications, 46 germectomies were performed. Follow-ups were conducted after 1 week, 2 weeks, 4 weeks, 1 year and 2 years. All procedures were carried out by the same operator and were standardized. Data analysis was conducted using R-Software. Statistical evaluation used the chi-squared test and the Monte Carlo test. The level of significance was set as 0.05. Results showed that out of 46 germectomies, the prevalence of complications was 4.2% for two patients (8%). Both complications were observed in male patients. In the first case, the patient (at Nolla stage 7) showed delayed onset infections after four weeks; in the second case, the patient (at Nolla stage 6) showed bleeding immediately after surgery and suture. With reference to delayed onset infections, no statistically significant association was found among gender (χ2 = 0.719; p = 0.396), germ development stage (χ2 = 2.595; p = 0.658) or Winter's classifications (χ2 = 0.046; p = 0.829); similarly, no significant associations were found among bleeding, gender (χ2 = 0.719; p = 0.396), germ development stage (χ2 = 2.595; p = 0.658) or Winter's classification (χ2 = 0.046; p = 0.829). From our results, it is also possible to state that post-operative complications following germectomy of the mandibular third molar germ in adolescence occur in a significantly reduced percentage of patients, so this oral surgery treatment becomes a reliable surgical technique in adolescence.
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Cristalli MP. Effects of ibuprofen administration timing on oral surgery pain: A randomized clinical trial. Oral Dis 2021; 28:796-804. [PMID: 33486855 DOI: 10.1111/odi.13781] [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: 09/24/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the analgesic effect of ibuprofen 400 mg given 30 min before or immediately after third molars surgery under local anaesthesia. MATERIALS AND METHODS The single-centre, randomized, split-mouth, triple-blind, clinical trial involved 38 outpatients, for a total of 76 bilateral symmetrical fully bone impacted mandibular third molars. Each patient was undergone to separate surgical sessions for the right and left side, and ibuprofen was randomly administered 30 min before or immediately after the intervention. Study participants recorded pain intensity using Numerical Rating Scale-11, the timing of rescue therapy intake and overall tablets consumption over 3 days. RESULTS The overall pain intensity score was lower in the group receiving ibuprofen immediately after (3.13 ± 2.46) than before (3.58 ± 2.40) surgery, with statistically significant differences only on the second and third days. The mean time to the first using rescue therapy was longer in the postoperative (598.33 ± 422.62 min) than in the preoperative (406.25 ± 149.79 min) analgesic treatment group (p = .123). The number of supplemented ibuprofen tablets did not differ (p = .530) between both groups. CONCLUSIONS Within the limits of the present study, ibuprofen administration immediately after surgery seemed to be more effective than preoperative administration.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Rapaport B, Brown J. Systematic review of lingual nerve retraction during surgical mandibular third molar extractions. Br J Oral Maxillofac Surg 2020; 58:748-752. [DOI: 10.1016/j.bjoms.2020.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
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Staderini E, Patini R, Guglielmi F, Camodeca A, Gallenzi P. How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review. ACTA ACUST UNITED AC 2019; 55:medicina55030079. [PMID: 30917605 PMCID: PMC6473914 DOI: 10.3390/medicina55030079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. Materials and Methods: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. Results: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. Conclusions: Given the best evidence-based information regarding patients’ medical condition, we highlight the need to provide an ethical-based comprehensive approach in the diagnostic workflow and the assessment of treatment outcome.
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Affiliation(s)
- Edoardo Staderini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Romeo Patini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Federica Guglielmi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Andrea Camodeca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Patrizia Gallenzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
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