Le fort I osteotomy with or without concomitant removal of upper third molars: A prospective cohort study of intraoperative findings, related complications, and level of pterygomaxillary separation after down-fracture

The main objective of our study was to assess the clinical implications of concomitant intraoperative removal of maxillary third molars (M3M) with the Le Fort I osteotomy 'twist' technique (LF1twist). A prospective comparative study was carried out regarding the necessity of bone trimming around the pedicle, intra- and postoperative complications, surgery time, and the level of pterygomaxillary junction (PMJ) separation following LF1twist with concomitant intraoperative removal of M3M (test group) versus LF1twist alone (control group). Outcome parameters were assessed from clinical and radiographic measurements. In total, 100 surgery sites were included (50 in each group). The mean surgery time was 53.4 ± 7.8 min, with nonsignificant differences between groups. The frequency of intraoperative complications was negligible, with no significant differences between groups - though all bleeding events (n = 4) occurred when M3M was not removed concomitantly. No postoperative complications were recorded. Percentages of disarticulations occurring at the PMJ were similar in both groups. In conclusion, the results demonstrate that removal of M3M in conjunction with LF1twist does not imply additional surgery time, or differences regarding the level of PMJ separation or perioperative complications. Furthermore, the concomitant procedure reduces the amount of maxillary and palatal bone in the disjunction area, which facilitates down-fracture and field clearing for maxillary repositioning.

Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing

PURPOSE

To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars.

MATERIAL AND METHODS

A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique.

RESULTS

A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020).

CONCLUSION

The results obtained support concomitant molar extraction with BSSO as a feasible option.

Effect of mandibular third molars on crowding of mandibular teeth in patients with or without previous orthodontic treatment: a systematic review and meta-analysis

OBJECTIVES

To assess the scientific evidence related to the role of the mandibular third molars on the late crowding of the lower anterior teeth in patients with or without previous orthodontic treatment. The secondary outcomes included changes in mandibular arch width and arch length.

MATERIALS AND METHODS

The databases PubMed, Scopus, ProQuest, and Google Scholar were searched from inception until April 2022. The included papers were studies evaluating the role of mandibular third molars on crowding of mandibular anterior teeth in patients of any age and gender, with mandibular third molars impacted or semi-impacted or erupted. Predetermined and prepiloted data collection forms were used to record the necessary information.

RESULTS

Thirteen observational studies were included in the present systematic review. Most of them were assigned an overall risk of bias of moderate risk while the rest of them were at high risk. Four studies found an association between the presence of mandibular third molar and mandibular incisor crowding. Finally, seven studies were included in the quantitative analysis. Three different meta-analyses were conducted: for patients (a) with or (b) without previous orthodontic treatment and (c) in combination for patients with and without previous orthodontic treatment. According to the pooled results of all three meta-analyses, random effects model yielded a significant benefit for those without third molars compared to those with third molars regarding crowding, mean Little's irregularity index and mean arch length.

CONCLUSIONS

Lower third molars may contribute to mandibular crowding and lower arch constriction. Further prospective research of high quality is needed to clarify the impact of third molars on anterior mandibular crowding.

Preoperative imaging in third molar surgery - A prospective comparison of X-ray-based and radiation-free magnetic resonance orthopantomography

This study aimed to compare preoperative data relevant to third molar surgery based on radiographic orthopantomography (OPG) and orthopantomogram-like MR images (MR-OPG), using five different MR protocols. X-ray-based OPG and OPG-like MRI reconstructions from DESS, SPACE-STIR, SPACE-SPAIR, T1-VIBE-Dixon, and UTE sequences were acquired in 11 patients undergoing third molar surgery, using a 15-channel mandibular coil. Qualitative (image quality, susceptibility to artifacts, positional relationship, contact/non-contact of the inferior alveolar nerve (IAN), relationship to maxillary sinus, IAN continuity, root morphology) and quantitative (tooth length, retromolar distance, distance to the IAN, and distance to the mandible margin) parameters of the maxillary and mandibular third molars were assessed regarding inter-reader agreement and quantitative discrepancies by three calibrated readers. Radiation-free MR-OPGs generated within clinically tolerable acquisition times, which exhibited high image quality and low susceptibility to artifacts, showed no significant differences compared with X-ray-based OPGs regarding the assessment of quantitative parameters. UTE MR-OPGs provided radiographic-like images and were best suited for assessing qualitative preoperative data (positional relationship, nerve contact/non-contact, and dental root morphology) relevant to third molar surgery. For continuous and focal nerve imaging, DESS MR-OPG was superior. MR-OPGs could represent a shift towards indication-specific and modality-oriented perioperative imaging in high-risk oral and maxillofacial surgery.

Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study

OBJECTIVE

To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial.

METHODS

From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality.

RESULTS

For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters.

CONCLUSION

This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT.

CLINICAL SIGNIFICANCE

This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.

Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial

BACKGROUND

Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery.

METHODS

This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro-Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX).

RESULTS

Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063).

CONCLUSION

Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov - NCT05830747 retrospectively recorded-Date of registration: 26/04/2023.

Dermatoglyphic Patterns in Patients Having Impacted and Erupted Third Molars-A Comparative Study

Background

The dermatoglyphics have been used in several researches for predicting various pathologies of oral cavity like periodontitis, dental caries, impacted teeth, mal-occlusion, developmental defects such as cleft lip and palate, and potentially malignant disorders. Impacted teeth may be associated with various pathologies such as caries, pericoronitis, dentigerous cysts, and keratocystic odontogenic tumors; therefore, predicting impacted teeth through dermatoglyphic patterns can help in diagnosis and future treatment planning of such event.

Aims and Objectives

The aim and objective of the study were to evaluate and compare various dermatoglyphic patterns in the patients with the impacted maxillary and/or mandibular third molar (group 1) and patients having erupted maxillary and/or mandibular third molar (group 2).

Materials and Methods

This study comprised totally 300 patients, which were divided into two groups, according to erupted or impacted maxillary and/or mandibular third molar visiting outpatient department, who fulfilled the selection criteria for the study. After a comprehensive clinical examination, dermatoglyphic patterns were recorded from the same individuals. Panoramic radiographs were taken to confirm the diagnosis. Data collected were entered in the spreadsheet and analyzed. For all tests, P value was set at <0.05 and was considered statistically significant.

Result

There was statistical significance noted in frequencies of whorl pattern in patients of group 1 and loop pattern in patients of group 2.

Conclusion

This study concluded that dermatoglyphic patterns can be used to assess the prevalence of impacted wisdom teeth.

Kissing molars class III detected at a young age

BACKGROUND

Kissing molars (KMs) is defined as a state in which the apex of two impacted molars face opposite directions and the occlusal surfaces touch each other and the crown is in one follicle. Class III KMs have been reported previously; however, reports on class III KMs in young people (< 18 years of age) are limited.

CASE PRESENTATION

Here, we present the case of KMs class III confirmed at an early age, supported by a review of the literature. The patient was a 16-year-old female and experienced discomfort in the left molar of the lower jaw and visited in our department. We diagnosed KMs based on an impacted teeth on the buccal side, near the lower jaw wisdom teeth, and a cyst-like low-density area observed around the crown of both teeth, as revealed by computed tomography. We decide to extract the tooth and enucleate the cyst under local anesthesia as the patient experienced discomfort due to occlusion. Furthermore, the cyst-like structure removal and tooth extraction including tooth root were necessary as the patient had KM class III, possibly inducing complicated malocclusion. Although no previous reports recommended timing for KMs tooth extraction, we propose that extraction at an early stage is important regardless of age especially in class III cases.

CONCLUSIONS

We report a case of KM class III detected at an early age.

Third molars in the orthodontic therapeutic decision]

Introduction

Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans.

Material and Method

The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management.

Results

The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration.

Discussion

In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars.

Conclusion

Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.

Is it worth applying self-irrigation after third molar extraction? A randomised controlled trial

In this study, we aimed to examine the effectiveness of self-irrigation following the extraction of mandibular third molars. A randomised controlled clinical trial was conducted with 155 patients who had undergone extraction of a mandibular third molar. The irrigation group was instructed to self-irrigate the extraction socket with tap water using a syringe three times a day, starting seven days after the tooth extraction. The incidence of complications and mouth opening, halitosis, plaque/gingival index, and oral health-related quality of life (OHRQoL) were measured. The irrigation group showed a lower incidence of complications than the non-irrigation group. The halitosis, plaque, and gingival scores were lower by mean (SD) 19.66 (5.19), 0.58 (0.06), and 0.62 (0.08), respectively, in the irrigation group than in the non-irrigation group (p = 0.0001). A greater amount of food packing was associated with higher halitosis, plaque, and gingival scores and poorer OHRQoL (p < 0.05). Further, more frequent irrigation was associated with lower halitosis, plaque, and gingival scores and better OHRQoL (p ≤ 0.016). Self-irrigation of the extraction socket using a syringe containing tap water is a very effective method for keeping the extraction socket clean. This technique reduced halitosis, improved plaque and gingival indices, and increased OHRQoL.

Unexpected variation of human molar size patterns

A tenet of mammalian, including primate dental evolution, is the Inhibitory Cascade Model, where first molar (M1) size predicts in a linear cline the size and onset time of the second (M2) and third (M3) molars: a larger M1 portends a progressively smaller and later-developing M2 and M3. In contemporary modern Homo sapiens, later-developing M3s are less likely to erupt properly. The Inhibitory Cascade Model is also used to predict molar sizes of extinct taxa, including fossil Homo. The extent to which Inhibitory Cascade Model predictions hold in contemporary H. sapiens molars is unclear, including whether this tenet informs about molar initiation, development, and eruption. We tested these questions here. In our radiographic sample of 323 oral quadrants and molar rows from contemporary humans based on mesiodistal crown lengths, we observed the distribution of molar proportions with a central tendency around parity (M1 = M2 = M3) that parsed into 13 distinct molar size ratio patterns. These patterns presented at different frequencies (e.g., M1 > M2 > M3 in about one-third of cases) that reflected whether the molar row was located in the maxilla or mandible and included both linear (e.g., M1 < M2 < M3) and nonlinear molar size ratio progressions (e.g., M1 > M2 < M3). Up to four patterns were found in the same subject's mouth. Lastly, M1 size alone does not predict M3 size, developmental timing, or eruption; rather, M2 size is integral to predicting M3 size. Our study indicates that human molar size is genetically 'softwired' and sensitive to factors local to the human upper jaw vs. lower jaw. The lack of a single stereotypical molar size ratio for contemporary H. sapiens suggests that predictions of fossil H. sapiens molar sizes using the Inhibitory Cascade Model must be made with caution.

Surgical experience and patient morbidity after third molar removal

OBJECTIVES

The present study aimed to assess differences in patients' postoperative morbidity after third molar removal in relation to the surgeon's level of experience and other intraoperative factors.

MATERIAL AND METHODS

Patients admitted for prophylactic removal of asymptomatic third molars were prospectively followed up on day 3 and 10 after surgery in the context of the M3BE-study. Uni- and multivariable logistic regression was performed to assess the associations between surgeon's (in)experience and postoperative discomfort. Other contributing factors were gender, age, extraction method (osteotomy or not), and number of extractions and involved jaws.

RESULTS

In total, 7 senior surgeons and 28 surgical residents operated 2560 patients (8672 third molars). Differences in postoperative morbidity on day 3 and 10 after surgery were small. The results showed no significant associations between surgeon's inexperience and postoperative discomfort (pain, trismus, swelling), except for persistent pain (day 10; OR 1.468; p = 0.0016). No effect was observed on the occurrence of postoperative nerve complications. It was shown that postoperative morbidity was more dependent on factors like age, gender, number of extractions and intraoperative osteotomy.

CONCLUSION

We may conclude that patient recovery following third molar removal is affected by other factors than surgical experience. However, surgical residents seemed to cause significantly more persisting pain problems 10 days after surgery.

The effect of Instagram posts related to #Wisdomteeth on patients

OBJECTIVES

This study aims to assess the quality of the posts about wisdom teeth on Instagram in terms of patients benefit.

METHODS AND MATERIALS

The #Wisdomteeth hashtag was searched on Instagram. The first 200 posts were reviewed. 50 posts were included in this study. Upload sources were categorized as health care professionals, health companies and individuals users. Post types were categorized as patient's experience, educational and scientifically erroneous. The posts were evaluated under eight titles for evaluating the usefulness score. The usefulness scores of the posts were classified as poor, moderate and excellent. Kruskal-Wallis test and Chi² test was used for data. Significance level was accepted as P < 0.05 RESULTS: The usefulness score was between 0 and 2, with a mean of 0.16. There were no statistically significant differences between upload sources and usefulness score (p = 0.328). There were no statistically significant differences between the usefulness score and the number of comments (p = 0.126).

CONCLUSION

The results of the study showed that Instagram posts do not contain reliable information for patients.

Wisdom teeth, periodontal disease, and C-reactive protein in US adults

OBJECTIVES

The study aim was to evaluate the associations among the presence of wisdom teeth (third molars, M3), periodontal disease, and serum C-reactive protein (CRP) in the US adult population, thus to generate population-based evidence to inform heart disease prevention and dental care.

STUDY DESIGN

We performed secondary data analysis of the 2009-2010 National Health and Nutrition Examination Survey (NHANES), and included 3752 people aged 30 years and older who participated in the periodontal examination.

METHODS

Descriptive analyses were performed to determine the prevalence of M3 presence, periodontal disease, and elevated CRP. Multivariate logistic regression modeling was used to determine the association between M3 presence, periodontal disease, and elevated CRP.

RESULTS

The prevalence of M3 presence, periodontal disease (probing periodontal pockets depth (PPD)≥ 4 mm), and elevated serum C-reactive protein level (≥5 mg/L) was 39%, 41%, and 19% respectively. M3 presence was highest among men, younger adults, Blacks and Hispanics compared to Non-Hispanic Whites, those who did not attend college, and people with low incomes (P < 0.001). M3 presence, adjusted for sociodemographic and health characteristics, was independently associated with periodontal disease (adjusted [Adj.] odds ratio [OR] 1.61, 95% confidence interval [CI] 1.31, 1.97), and periodontal disease was independently associated with elevated serum CRP (Adj. OR 1.35, 95% CI 1.06, 1.73), but we did not find M3 presence associated with elevated serum CRP (Adj. OR 1.02, 95% CI 0.79, 1.31).

CONCLUSIONS

We observed expected associations between M3 presence and periodontal disease, and periodontal disease and elevated CRP. However, M3 presence alone is not associated with elevated CRP. Further research into cardiovascular health hazards related to the retention of wisdom teeth is needed, including examining possible relationships with other inflammatory factors.

Effect of drain application on postoperative complaints after surgical removal of impacted wisdom teeth-a randomized observer-blinded split-mouth clinical trial

OBJECTIVES

The aim of this randomized observer-blinded split-mouth-study is to objectively assess the influence of a rubber drain on postoperative swelling using 3D face scans as measurement method and additionally evaluate pain, trismus and complications after the osteotomy of lower third molars.

MATERIAL AND METHODS

Seventy-two patients with symmetrically impacted lower wisdom teeth were recruited. Before the operation, patients rated pain using the visual analogue scale, the interincisal distance was measured, and 3D face scans were taken with an optical scanner. Each patient underwent two procedures which were at least 30 days apart. On one side, a rubber drain was inserted randomly before closure, the contralateral control side was closed without drainage. On the third and tenth postoperative day, face scans to quantify the swelling, pain evaluation and trismus measurements were performed. Due to loss of follow-up, 32 patients were excluded which resulted in 40 out of 72 patients remaining in the study.

RESULTS

There was no statistical difference in using a drain on swelling and trismus on the third and tenth day (p > 0.05). Pain was slightly worse on the third day on the treatment side, but the difference was not significant (p > 0.05). We observed no differences in the number of wound infections.

CONCLUSIONS

The insertion of a rubber drain does not have any influence on swelling, pain or trismus and has no impact on the number of wound infections.

CLINICAL RELEVANCE

The use of a rubber drain cannot be recommended as no reduction of postoperative discomfort was detected.

The Use of Premolar Extractions With Orthodontic Treatment Does not Guarantee an Improved Eruption Potential of Third Molars

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Influence of orthodontic premolar extraction therapy on the eruption of the third molars: A systematic review of the literature. Brezulier D, Fau V, Sorel O. J Am Dent Assoc 2017;148(12):903-12.

SOURCE OF FUNDING

Information not available.

Application and evaluation of coronectomy in Switzerland

Coronectomy is the intentional partial removal of a tooth. Thereby the crown of the tooth is removed and the roots are left in place. Compared to the complete operative removal of a wisdom tooth, the incidence of inferior alveolar nerve injury (IANI) is lower. The aim of this study is a survey on the use and acceptance of wisdom tooth coronectomy in Switzerland. An anonymous questionnaire was sent to 266 dentists specialized in oral surgery or maxillofacial surgeons; 58.3% of the questionnaires were returned and could be assessed. The statistical analysis was performed using Fisher’s exact test. The technique was classified as «non-reliable» by 51.6% of the respondents. In cases manifesting a high risk of IANI, 40.6% offered the patient a coronectomy. In a tooth exhibiting a high risk of IANI, 69.0% could envisage to perform a coronectomy instead of a complete operative removal. The technique was not used by 54.8%. A significantly larger proportion of study participants who specialized in or after the year 2005 (p < 0.05) rated the technique as “reliable”. The same applied to respondents who specialized in Bern (p < 0.05) and those who already had used coronectomy (p < 0.001). In conclusion, our results show that the majority of maxillofacial and oral surgeons reject coronectomy. In view of recent studies, this attitude should be reconsidered.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.

Coronectomy: Partial Odontectomy or Intentional Root Retention

Coronectomy is considered in patients older than 25, where there is an intimate relationship between the roots of a retained lower third molar (occasionally second or first molars) and the inferior alveolar nerve, in noncontraindicated circumstances. It may be used on younger patients with a medium to high risk of inferior alveolar nerve damage. The decision to use this technique is made with the aid of cone-beam computed tomography scans. Short- to medium-term success rate is excellent, but long-term studies are not yet available. The technique is gaining wider acceptance, although there are differences in the indications and actual technique used within and between countries.

[Comparison of two opioids with different kinetics for intravenous analgesia in outpatient multiple third molar avulsions]

INTRODUCTION

We had for aim to compare the effects of intra-operative opioid analgesia according to the drug kinetics.

PATIENTS AND METHODS

We conducted a prospective, controlled, randomized, double-blinded trial including 60 patients scheduled for ambulatory multiple third molar avulsion. The general anesthesia, performed with propofol and analgesia was a target-controlled infusion of either remifentanil or sufentanil. The anesthesia was set to reach an optimal bispectral index and adjusted to a clinical target throughout the procedure. The main endpoints were: postoperative request for morphine and other opioids; postoperative pain; postoperative adverse effects of opioids.

RESULTS

In the post-operative care unit (French acronym PACU), patients who received remifentanil were extubated earlier (17 vs. 26 min.), but had more pain and required twice more morphine for analgesia (6 vs. 3 mg), than those who had received sufentanil. However, the need for post-surgery oral opioid intake was greater in the sufentanil group, so the overall postoperative opioid consumption and patient satisfaction were identical in both groups. The time spent in the PACU was also identical for both groups.

DISCUSSION

Using an ultra-short kinetic opioid such as remifentanil does not seem useful, since the shorter delay before extubation is compensated by a greater need for morphine in the PACU.