Effect of Photobiomodulation Therapy with Three Wavelengths of Diode Laser on Proliferation and Survival of Stem Cells Derived from Impacted Third Molar Follicles

To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Trismus (4.61 ± 0.26cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Surgical extraction of third molars is a common oral and maxillo-facial surgery procedure frequently associated with postoperative complications, such as pain, swelling, and trismus. Photobiomodulation (PBM), also known as Low-Level Laser Therapy (LLLT), involves the use of low-intensity laser to promote tissue healing, reduce inflammation, and relieve pain. This study evaluated the effectiveness of PBM following surgical extraction of mandibular third molars. This was a prospective, multicenter, randomized, triple-blind clinical trial conducted across five Italian centers. Seventy-nine patients were randomly assigned to a test group (PBM) or control group (no PBM). PBM was delivered immediately after surgery and on the following two days, using a multiband diode laser (445, 660, and 970nm). Primary outcomes were postoperative pain, facial swelling, and trismus. Secondary outcomes included health-related quality of life and analgesic consumption. Covariates included patient age, gender, the extracted tooth and the impaction classification according to Pell & Gregory and Winter. The time of the surgical procedure, measured in seconds from incision to final suture, was also documented. Descriptive statistics were calculated for all variables. Normality was assessed using the Shapiro-Wilk test, and homogeneity of variances was evaluated using Levene's test. Between-group comparisons for continuous outcomes were performed using Student's t-test or the Mann-Whitney U test, depending on data distribution. Categorical variables were analyzed with chi-square or Fisher's exact test. A p-value< 0.05 was considered statistically significant. No statistically significant differences were found between groups for any of the measured outcomes. However, trends favored the PBM group, particularly regarding reduced pain and improved quality of life. The study was powered to detect a large effect size (Cohen's d=0.8); therefore, the lack of statistical significance suggests that any true effect, if present, is likely smaller than this threshold. Further studies with larger sample sizes and standardized protocols are needed to explore smaller yet clinically relevant effects.

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 &lt;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 &lt;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.

Effects of Midazolam/Low-Dose Ketamine Conscious Intravenous Sedation on Pain, Swelling, and Trismus After Surgical Extraction of Third Molars

To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars. Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared. Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used. Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

Third molars have been described as different from other teeth in the oral cavity. They have the highest rate of developmental abnormalities and, most importantly, are last in the eruption sequence. We investigated reasons for third molar teeth extraction in patients attending the outpatient oral surgery clinic of the Lagos University Teaching Hospital, Nigeria. A retrospective review of patients who had third molar extractions between January 2001 and June 2006 was conducted. Data retrieved and analysed were: age and sex of patients, indication for extractions, type of teeth extracted, technique of extractions (surgical and non-surgical) and angulations of impaction in case of impacted lower third molars. A total of 1763 patients (mean age +/-SD, 33.74+/- 13.3 years; range 15 - 92 years) had their third molars extracted during the period. Majority (58%) of them were females. Surgical extraction was carried out in 506 (28.7%) patients while 1257 (71.3%) patients had non-surgical extractions. Caries and its sequela (63.2%) was the major reason for teeth extraction followed by recurrent pericoronitis (26.3%) and periodontitis (9.2%). Only 11 (0.6%) cases were removed for prophylactic reason. Patients who had their teeth removed for caries were significantly younger than those for periodontitis (P=0.000) but older than those for pericoronitis (P=0.000). Caries and periodontal diseases occurring in relatively older age group were the major reasons for non-surgical extraction of third molars while recurrent pericoronitis occurring in relatively younger age was the major reason for surgical extraction of impacted third molars. Prophylactic surgical extraction of third molars is not a common practice in our environment.

BackgroundThis study aimed to assess the effect of extraoral 940 nm low-level diode laser on pain, edema, and trismus following surgical extraction of impacted mandibular third molars.Materials and methodsThis split-mouth, randomized, placebo-controlled clinical trial evaluated 25 patients with bilaterally impacted mandibular third molars. One side of the jaw was randomly assigned to the laser and the other side to the control group. The laser quadrant received 940 nm diode laser irradiation (0.5 W, 10 J/cm2, continuous-wave mode, 20 s) at three points in the master muscle in contact mode immediately after surgical extraction of third molar. The third molar in the placebo quadrant was extracted after 2 weeks by the same surgeon using the same standard approach. The pain score was measured at 2 and 7 days postoperatively using a visual analog scale (VAS). To assess trismus, the distance between the incisal edges of the upper and lower central incisors was measured in maximum opening. To assess edema, the distance between the tragus and chin point was measured before and immediately after surgery and after 2 and 7 days. Data were analyzed using t-test, ANOVA, and Bonferroni test.ResultsThe mean pain score in the first 7 days was significantly lower in the laser group (P < 0.05). Edema and trismus were the same in both groups (P > 0.05). Number of analgesics taken was significantly lower in the laser group (P < 0.05).ConclusionSingle-session irradiation of 940 nm diode laser can effectively decrease pain following third molar extraction surgery.Trial registration number: IRCT20141209020258N91 on 29/12/2018.

Effect of opaque eye coverage on anxiety in candidates for surgical removal of impacted third molars: a randomized clinical trial

Background:One of the most critical and crucial steps in surgical extraction is cutting the bone or osteotomy, for which many techniques are used, e.g., chisels and mallet, rotary instruments, and ultrasound bone-cutting instruments. If they are not used judiciously, they can be hazardous.Objectives:To assess the efficiency of piezosurgery unit over micromotor while performing surgical extraction of lower third molars by assessing the time taken for the surgery and measuring postoperative parameters such as pain, trismus, and swelling.Materials and Methods:Thirty patients having bilateral impacted third molars with the same difficulty index were selected for the study. One side surgical removal was done using micromotor and other side by piezosurgery with an interval of 15 days. After each surgery, time taken to finish was measured and patients were followed up on postoperative days 1, 3, 5, 7, and 15 for assessing pain, trismus, and swelling. Data obtained were statistically analyzed.Results:The mean time taken for the micromotor group is 37.90 min whereas by the piezosurgery group is 54.63 min, showing a statistically significant difference (P < 0.001). Furthermore, there is statistically significant difference (P < 0.001) in the level of pain, trismus, and swelling on postoperative days 1, 3, 5, and 7. Even the intragroup comparison of piezosurgical group for trismus and swelling showed no statistically significant difference on postoperative day 7, indicating faster recovery of trismus and swelling. On postoperative day 15, there was no difference in any parameter in both groups indicating complete symptom-free recovery in both groups.Conclusion:It takes more time to perform surgical extraction of third molars when piezosurgical unit is used. Despite that, it causes less pain postoperatively with faster improvement in trismus and quicker reduction in swelling.

Impaction of the third molar teeth is a common disorder which often necessitates their removal. After third molar surgery, the common postoperative sequelae are pain, trismus, and buccal swelling. Our study sought to evaluate the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus after surgical extraction of impacted mandibular 3rd molars. Over a period of 22 months (December 1, 2016-September 30, 2018), 44 patients in the age group of 18-40 years, who required surgical extraction of impacted third molar and met the inclusion criteria were recruited. After surgical extraction of the third molar, only primary closure was performed in the control group (22 Group), whereas PRF was placed in the socket followed by primary closure in the study group (22 patients). The outcome variables were pain, swelling, and maximum mouth opening were measured with a follow-up period of 1 week. The application of PRF in the study group lessens the severity of immediate postoperative sequelae such as pain, swelling, and trismus compared to the control group. The treatment outcomes and postoperative sequel were better in the PRF group as compared to other control group on days 1, 3, and 7 postoperatively.

Evaluation of Treatment Outcome After Impacted Mandibular Third Molar Surgery With the Use of Autologous Platelet-Rich Fibrin: A Randomized Controlled Clinical Study

To evaluate the effect of ice pack therapy on oral health-related quality of life (OHRQoL) following third molar surgery. All consecutive subjects who required surgical extraction of lower third molars and satisfied the inclusion criteria were randomly allocated into two groups. Subjects in group A were instructed to apply ice packs directly over the masseteric region on the operated side intermittently after third molar surgery. This first application was supervised in the clinic and was repeated at the 24-h postoperative review. Subjects in group A were further instructed to apply the ice pack when at home every one and a half hours on postoperative days 0 and 1 while he/she was awake as described. Group B subjects did not apply ice pack therapy. Facial swelling, pain, trismus, and quality of life (using Oral Health Impact Profile-14 (OHIP-14) instrument) were evaluated both preoperatively and postoperatively. Postoperative scores in both groups were compared. A significant increase in the mean total and subscale scores of OHIP-14 was found in both groups postoperatively when compared with preoperative value. Subjects who received ice pack therapy had a better quality of life than those who did not. Subjects whose postoperative QoL were affected were statistically significantly higher in group B than in group A at all postoperative evaluation points (P<0.05). Statistically significant differences were also observed between the groups in the various subscales analyzed, with better quality of life seen among subjects in group A. Quality of life after third molar surgery was significantly better in subjects who had cryotherapy after third molar than those who did not have cryotherapy. Cryotherapy is a viable alternative or adjunct to other established modes of improving the quality of life of patients following surgical extraction of third molars.

Objectives:This study aimed to compare the sling and single interrupted sutures regarding dehiscence, probing pocket depth (PPD), and clinical attachment loss (CAL) of adjacent second molars after surgical extraction of impacted or semi-impacted mandibular third molars.Materials and Methods:This randomized clinical trial, with a split-mouth design, involved 25 patients with similar bilateral impaction of their mandibular third molars. The same surgeon performed surgical procedures, including a triangular flap and osteotomy. After surgical extraction of third molars, the distal surface of the flap was sutured with sling sutures on one side and single interrupted sutures on the other side. The allocation of suture type to the side of the jaw was random, and the patient was blinded to it. Patients were examined for dehiscence after 7 and 14 days. The PPD and CAL were recorded at the baseline and after 17 weeks. Data were analyzed using the Wilcoxon signed-rank test and generalized estimating equation (GEE) regression model.Results:The sling suture was significantly superior regarding the improvement of PPD (P=0.041) and CAL (P=0.016). The dehiscence was significantly smaller in the single interrupted suture group 7 days postoperatively (P=0.059). This difference was not significant 14 says postoperatively (P=0.852).Conclusion:The results of this study show that the sling suture was superior to the single interrupted suture regarding PPD and CAL. However, the technique of suturing does not seem to have a significant long-term effect on wound dehiscence.

Effectiveness of virtual reality as a distraction on anxiety and pain during impacted mandibular third molar surgery under local Anesthesia

Abstraction of wisdom teeth or impacted third molar under local anaesthesia is one of the most frequent interventions by an oral and maxillofacial surgeon. The abstraction of the third molar is usually followed by the release of liberation and consequent trismus, pain, and swelling due to the area of the third molar being highly vascularized and rich in loose connective tissue. Objective of the study was to evaluate the anti-inflammatory effect of ascorbic acid following surgical extraction of the third molar. The current study was carried out Armed Forces Institute of Dentistry, Rawalpindi, from October to December 2022. This was a cross-sectional observational study. Fifty participants who required surgical extraction of the impacted third molar were included in the study via non-probability purposive sampling and were segregated equally into two groups, i.e., Group A and Group B, comprising twenty-five participants in each group. Group A received amoxicillin with clavulanic acid (625 mg) thrice a day and metronidazole (400 mg) twice daily. In comparison, Group B received amoxicillin with clavulanic acid (625 mg) thrice daily, ascorbic acid (500 mg) twice daily, and metronidazole (400 mg) twice daily. Both groups received naproxen sodium as per requirement (550 mg). Pain, facial swelling, and C reactive protein concentration were evaluated until the 7th postoperative day. There was a reduction in pain and facial swelling in both groups, but in the ascorbic acid group, there was more reduction in pain and facial swelling compared to the control group. However, the difference between the two groups in reducing pain and facial swelling was statistically significant (p<0.01). There was a reduction in CRP in both groups, but in the ascorbic acid group, there was more reduction in CRP 2.35 (1.60-5.30) compared to the control group 2.6 (0.86-5.03). However, the difference between the two groups in reducing C reactive protein concentration was statistically insignificant (p>0.05). Our study concluded that ascorbic acid significantly reduced inflammation and C reactive protein, so ascorbic acid should be used as an adjuvant supplement with other conventional drugs.