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

The efficiency of two different synthetic bone graft materials on alveolar ridge preservation after tooth extraction: a split-mouth study

BACKGROUND

Alveolar Bone loss occurs frequently during the first six months after tooth extraction. Various studies have proposed different methods to reduce as much as possible the atrophy of the alveolar ridge after tooth extraction. Filling the socket with biomaterials after extraction can reduce the resorption of the alveolar ridge. We compared the height of the alveolar process at the mesial and distal aspects of the extraction site and the resorption rate was calculated after the application of HA/β-TCP or synthetic co-polymer polyglycolic - polylactic acid PLGA mixed with blood to prevent socket resorption immediately and after tooth extraction.

METHODS

The study was conducted on 24 extraction sockets of impacted mandibular third molars bilaterally, vertically, and completely covered, with a thin bony layer. HA/β-TCP was inserted into 12 of the dental sockets immediately after extraction, and the synthetic polymer PLGA was inserted into 12 of the dental sockets. All sockets were covered completely with a full-thickness envelope flap. Follow-up was performed for one year after extraction, using radiographs and stents for the vertical alveolar ridge measurements.

RESULTS

The mean resorption rate in the HA/β-TCP and PLGA groups was ± 1.23 mm and ± 0.1 mm, respectively. A minimal alveolar bone height reduction of HA/β-TCP was observed after 9 months, the reduction showed a slight decrease to 0.93 mm, while this rate was 0.04 mm after 9 months in the PLGA group. Moreover, the bone height was maintained after three months, indicating a good HA/β-TCP graft performance in preserving alveolar bone (1.04 mm) while this rate was (0.04 mm) for PLGA.

CONCLUSION

The PLGA graft demonstrated adequate safety and efficacy in dental socket preservation following tooth extraction. However, HA/β-TCP causes greater resorption at augmented sites than PLGA, which clinicians should consider during treatment planning.

Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar

The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.

Pre-Operative Oral Health-Related Quality of Life in Patients Attending Surgical Removal of Mandibular Third Molar Teeth

The study aimed to measure the pre-operative oral health-related quality of life (OHRQoL) and to identify patient and teeth pathologies associated with worse OHRQoL among patients attending mandibular third molar tooth extraction. Data were collected preoperatively from 199 patients attending surgical removal of their mandibular third molar. To that end, we measured the Oral Health Impact Profile-14 (OHIP-14) and analyzed its association with: (1) demographics; (2) health-related behaviors such as smoking, alcohol consumption, physical activity, and dietary habits; (3) Plaque Index (PI); (4) Decay, Missing, and Filled Teeth (DMFT); and (5) clinical characteristics related to third molar extraction, such as the indication for extraction, tooth angulations, and radiographic pathology. The mean age of the study population was 21.5 ± 3.2 years and the mean OHIP-14 global score was 22.5 ± 8.3. The present study identified patient and teeth profiles that are associated with worse pre-operative OHRQoL in patients attending mandibular third molar extraction. The “vulnerable patient” profile includes poor health-related behaviors, particularly the performance of physical activity less than once a week (p = 0.028). The “disturbing teeth” profile includes higher plaque scores (p = 0.023) and specific characteristics of the third molar teeth, such as pericoronitis (p = 0.027) and radiolucency around third molars in panoramic radiography (p < 0.001). These findings support the hypothesis that OHRQoL is a complex phenomenon which is associated with the patient’s health-related behaviors as well as with specific tooth pathologies.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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