Advances in Minimally Invasive Approach for Impacted Mandibular Third Molar Extractions: From Incision Design to Dynamic Navigation.

Prophylactic surgical extraction of impacted third molars is a common practice throughout the world justified on the presumption that the risk of surgical morbidity increases with increasing age, among other reasons. The aim of this study was to analyze and compare surgical morbidity associated with third-molar extractions in young and aging populations. A review of records for all patients who underwent the surgical extraction of impacted third molars between April 2001 and June 2006 at the Lagos University Teaching Hospital was carried out. A total of 506 patients had surgical extractions of impacted third molars under local anaesthesia during the period of the study. Of these, 470 (92.9 percent) patients were below the age of 40 years (Group A) and 36 (7.1 percent) patients were 40 years of age and older (Group B). No incidences of severe intraoperative complications (excessive bleeding or mandibular fractures) were recorded in either group, but other postoperative complications were reported in 70 (13.8 percent) patients. Of these 70 patients, 65 (92.9 percent) were from Group A and 5 (7.1 percent) were from Group B, and their complications included infected socket, dry socket, paraesthesia, and buccal space abscess. No significant difference in post-operative complications following surgical removal of mandibular third molars was found between patients 40 years old and greater and those below age 40. Prophylactic surgical extraction of impacted mandibular third molars, based on the assumption that surgical morbidity increases with age, may not be justifiable. Age does not predispose patients who had surgical extraction of mandibular third molars above 40 years of age to any additional surgical complications when compared to patients below the age of 40 years receiving comparable treatment.

Influence of Oral Hygiene and Smoking on Pain and Swelling After Surgical Extraction of Impacted Mandibular Third Molars

Amoxicillin is the commonly prescribed antimicrobial for prevention of post-operative complications following surgical extraction of mandibular third molar. However recently, the use of macrolideantibiotics had been encouraged in dentistry. The aim of this study was to compare the efficacy of Amoxicillin and Azithromycin in preventing post-operative sequelae following third molar surgery. An open- labeled randomized controlled study was carried out in Department of Oraland Maxillofacial surgery, college of Dental Sciences and Hospital, Nepal Medical College (CODSHNMC), Attarkhel, Kathmandu, Nepal from May 2018 to June 2019. One hundred and twenty patients undergoing surgical extraction of impacted mandibular third molar were randomized by lottery method into two groups: Group A received Amoxicillin and Group B received Azithromycin. Both the groups were assessed postoperatively on 1st, 3rd and 7th days for post-operative complications- pain, swelling, trismus and pus discharge. The present study revealed no significant differences between the efficacy of Amoxicillin and Azithromycin in preventing postoperative sequelae following surgical extraction of impacted third molar. Amoxicillin and Azithromycin were therefore found to be equally effective. Thus, Azithromycin can be used as an alternative drug to Amoxicillin in case of resistance and intolerance to Amoxicillin.

Introduction: Surgical removal of mandibular third molars is one of the most frequent clinical tasks conducted by dental surgeons. This surgery is associated with the possibility of delayed and complicated soft-tissue and hard-tissue healing. Local incorporation of bioactive materials (such as growth factors and blood products) has been attempted to promote faster and better healing. Platelet-rich Fibrin (PRF) is the latest development among blood-derived products and is widely used to enhance hard and soft-tissue healing. Aim: To estimate the effect of PRF on soft-tissue and hardtissue healing following the surgical extraction of mandibular third molars. Materials and Methods: This prospective interventional study was carried out in the Department of Oral and Maxillofacial Surgery at Guru Nanak Institute of Dental Science and Research, Kolkata, West Bengal, India. The study was conducted between May 2022 and January 2024. Patients who required extraction of impacted mandibular third molars were divided into two groups (group I and group II) by alternate selection methods. PRF was placed in the empty sockets of group I patients following the surgical extraction of the third molar, while the sockets of group II patients were allowed to heal without PRF. Soft-tissue healing evaluation was performed using the parameters of the healing index on the 3rd, 7th, 14th, and 28th post-extraction days by two blind observers. Hard-tissue healing was evaluated using the Cone Beam Computed Tomography (CBCT) findings on the 1st month and 3rd month postoperatively. Changes in empty socket volume, Bone Density Units (BDU) of the new bone, and the type of new bone were analysed. Statistical analysis was carried out using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 26.0 (Armonk, NY: IBM Corp). A p-value of <0.05 was considered significant. Results: Twenty-six patients were included in the final analysis. They were equally divided into the interventional group (group I, with PRF) and the control group (group II, without PRF). The demographic data and difficulty index of group I were similar to those of group II. The corrected Chi-square test of independence was performed to compare soft-tissue healing. A highly significant association was found on the 3rd postoperative day (p-value=0.03), 14th postoperative day (p-value=0.013), and 28th postoperative day (p-value=0.002), indicating that group I consistently demonstrated improved healing compared to group II. The volume of the empty socket of the extracted third molar was measured using CBCT on the 1st and 3rd postoperative months. In both groups, the volume reduced significantly, but the reduction was more pronounced in group I than in group II (p-value <0.0001). The quality of bone formation (measured by BDUs) was significantly better in group I than in group II (p-value=0.043). However, the type of bone formation was similar for both groups. Conclusion: PRF appears to be beneficial and effective in promoting postoperative soft-tissue and hard-tissue healing following the surgical extraction of mandibular third molars.

Effect of tube drainage compared with conventional suturing on postoperative discomfort after extraction of impacted mandibular third molars

Extraction of mandibular third molars: proposal of a new scale of difficulty

This study aimed to assess the reliability of multidetector computed tomography (MDCT) in determining the surgical risk of the inferior alveolar neurovascular bundle in extractions of third molars. The sample comprised thirty-three individuals (63 third molars) who underwent preoperative evaluation by MDCT before extraction of impacted mandibular third molars. MDCT was used to determine the relationship between the roots of the third molars and the mandibular canal, and the course of the mandibular canal. Inferior alveolar nerve (IAN) exposure and the presence of hemorrhage were analyzed after removal of the teeth. IAN neurosensory deficit was recorded after 7 days. Clinical and MDCT findings were compared using Fisher's exact test (P < 0.05). There was a statistically significant association between IAN exposure and the tomographic relationship between the roots of third molars and the mandibular canal (P = 0.015). Conventionally, all cases of IAN neurosensory deficit and hemorrhage occurred when the roots of the third molar presented in an at-risk relationship with the mandibular canal, however, this association was not statistically significant (P > 0.05). A statistically significant association was found between the lingual course of the mandibular canal and IAN exposure (P = 0.03). MDCT is an effective tool for determination of the surgical risk to the inferior alveolar neurovascular bundle in extraction of mandibular third molars.

Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars

The Use of Chisels in the Extraction of Mandibular Third Molars: A Technique That May Prevent the Aerosolization of Severe Acute Respiratory Syndrome Coronavirus 2

Objective: This prospective study evaluated the impact of ozone gel, conventional PRF (C-PRF) and advanced PRF (A-PRF) on pain and trismus when applied after surgical extraction of impacted mandibular third molars. Materials and Methods: This study included 48 patients with impacted mandibular third molars. They were randomly divided into 4 groups, group I (control); didn’t receive any material in the socket, group II: sockets received ozone gel, group III: sockets received PRF while in group IV: sockets received A-PRF. Pain assessment using VAS, analgesics consumption, and maximum mouth opening were evaluated on day 1, day 3 and day 7 follow-up. Results: Less values of VAS pain scores were recorded in group II in comparison with the control group on day 1, day 3 and day 7 with a statistically significant difference of (P=0.018), (P=0.044) and (P=0.015) respectively. The analgesics consumption showed a statistically significant difference in group II compared to group I (P=0.020) and (P=0.021) on day 1 and day 3 respectively, but day 7 was statistically insignificant (P=0.165). Maximum mouth opening was statistically significant (P=0.042) on day3 in group II when compared with group I. Conclusion: The present study shows that ozone gel can be of paramount importance in minimizing post-operative symptoms as regard to pain and trismus following the extraction of impacted mandibular third molars and appears to improve patient’s relief and quality of life after surgery.

Introduction:Surgical extraction of impacted mandibular third molars is often associated with sequelae such as postoperative pain, facial edema, and limitation in mouth opening ability. These sequelae may result in changes in the patients’ lifestyle and quality of life (QoL).Aim:The aim of this study was to evaluate the effect of surgical extraction of impacted mandibular third molars on patients’ QoL in the immediate postoperative period (7 days).Materials and Methods:Ethical approval for this study was obtained from the Health Research and Ethics committee of the Lagos University Teaching Hospital. A total of 124 individuals with impacted mandibular third molars, who satisfied the inclusion criteria and consented to participate in this study, were included. The Oral Health Impact Profile-14 (OHIP-14) QoL questionnaire was used to assess QoL. QoL was assessed preoperatively (baseline) and on postoperative days (PODs) 1, 3, and 7. Maximal interincisal mouth opening, facial width, and pain were also reviewed at all evaluation points. Data analysis was done using the Statistical Package for Social Sciences (SPSS) for Windows (version 16.0, Chicago, IL, USA).Results:A total of 124 individuals were included in the final analysis. An age range of 18–51 years with a mean (±standard deviation) of 28.5 (7.4) years was observed. A male to female ratio of 1:1.5 was observed. The most frequently encountered type of impaction was the mesioangular impaction 51 (41.1%) and recurrent pericoronitis was the principal reason for extraction 53 (42.7%). The severity of the sequelae (pain, trismus, and facial edema) was maximal on the first POD. Patients’ overall QoL deteriorated sharply on the first POD and subsequently improved.Conclusion:Surgical extraction of mandibular third molars is associated with worsening of patients’ postoperative QoL in the immediate postoperative period. Prospective patients should be informed about this, and ways of reducing this untoward effect should be explored.

To assess the analgesia and side effects of codeine phosphate associated with paracetamol (test medication) as compared to paracetamol (control medication) after the extraction of impacted mandibular third molars. Forty-seven patients removed the right and left impacted mandibular third molars. After one surgery, patients took the test medication and after the other surgery, they took the control medication. Patients with exacerbated pain were prescribed to use the rescue medication instead of the medication initially administered and were included in the rescue group. They were evaluated for 7days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Poisson distribution. The side effects of these medications were assessed by the patient's complaints. A P value of < .05 was considered to be statistically significant. The mean score of the VAS of pain was not statistically different between test and control medications in the non-rescue group, but it was significantly greater in patients previously using paracetamol in the rescue group. The most common side effects reported in both groups, predominantly in patients using the test medication, were drowsiness, dizziness, and nausea. The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice to control the postoperative pain rather than paracetamol, but with more side effects, which are clinically acceptable.

Surgical extraction of impacted mandibular third molars is one of the most common oral and maxillofacial procedures and is frequently associated with postoperative pain, swelling, and limitation of mouth opening. Pharmacological agents such as corticosteroids and proteolytic enzymes are widely prescribed to minimize these complications; however, comparative evidence on their efficacy remains limited. Objective: To compare the effectiveness of methylprednisolone and serratiopeptidase in reducing postoperative pain, swelling, and trismus following surgical extraction of impacted mandibular third molars. Methods: A randomized controlled trial was conducted at the Department of Oral and Maxillofacial Surgery, Sandeman Provincial Hospital, Quetta, Pakistan, from December 2021 to June 2022. Ninety-six eligible patients were randomly allocated into two equal groups. Group A received oral methylprednisolone 4 mg every 8 hours, and Group B received oral serratiopeptidase 10 mg every 12 hours for five days postoperatively. Pain was assessed using a visual analogue scale, swelling was measured using standardized anatomical landmarks, and mouth opening was recorded using interincisal distance. Data were analyzed using SPSS version 23, with p ≤ 0.05 considered statistically significant. Results: Both groups were comparable in age, gender distribution, impaction side, and impaction classification. Methylprednisolone demonstrated significantly lower postoperative pain (1.3 ± 0.32 vs 7.3 ± 2.0, p &lt; 0.001) and greater improvement in mouth opening (1.3 ± 2.5 vs 7.2 ± 4.1, p &lt; 0.001) than serratiopeptidase. Serratiopeptidase showed relatively better reduction in postoperative swelling (p = 0.04). Similar outcome trends were observed among participants aged 23–30 years. Conclusion: Methylprednisolone was more effective in reducing postoperative pain and trismus, whereas serratiopeptidase provided superior reduction in swelling following third molar surgery. The predominant clinical requirement may guide the selection of either medication. Both agents appear safe and beneficial when used short-term in postoperative management.

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

Background/objective: The objective of this research was to evaluate how different antibiotic prophylaxis protocols influence the development of postoperative complications after the extraction of impacted mandibular third molars. Methods: This investigation was designed as a double-blind, randomized controlled trial. A total of eighty patients who fulfilled the inclusion criteria were randomly allocated to one of three treatment groups. Group 1 (n = 27) was administered 2 g of oral amoxicillin one hour prior to the procedure; Group 2 (n = 27) received 500 mg of oral amoxicillin every eight hours for five days following the surgery; and Group 3 (n = 26) was given 750 mg of oral amoxicillin every eight hours for the same postoperative period. The outcome variables measured were infectious complications, postoperative pain, postoperative inflammation, and others such as the rescue medication taken by the patient. Results: Two patients in each group showed signs of infection after the extraction of the impacted third molar (p = 0.412). No significant differences were observed in pain intensity between the different study groups, nor in the intensity of inflammation. No statistically significant differences were observed in the consumption or non-consumption of rescue analgesics. Conclusions: The results of the present study suggest that the preoperative administration of 2 g of amoxicillin in the extraction of impacted third molars in healthy patients could be sufficient to prevent infectious complications. The administration of postoperative doses of 500 mg every 8 h or 750 mg every 8 h does not generate benefits in patients in terms of postoperative pain or inflammation.