Removal of Horizontally Impacted Mandibular Third Molars Using the Three-Piece or T-Shaped Tooth Sectioning Method

Abstract

BackgroundThe extraction of horizontally impacted mandibular third molars (HM3) can be a complicated surgery. Appropriate tooth sectioning methods can reduce the operation time and postoperative complications. PurposeThe current study compares operative time and postoperative pain between HM3 removed using the three-piece or T-shaped tooth sectioning techniques. Study design, setting, sampleA randomized single-blind prospective clinical trial on HM3 extraction was carried out between June and December 2022 in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University. Patients with local or systemic infection, poor oral hygiene and systemic disease were excluded. Predictor variableThe predictor variable was the tooth sectioning method. The subjects were randomized to three-piece or T-shaped group. Main outcome variablesThe primary outcome variables were the operative time and postoperative pain measured using a visual analogue scale (VAS). The secondary outcome variables were the rates of primary bleeding, mouth opening reduction (MOR), swelling, patient satisfaction measured using a VAS and quality of life measured using a postoperative symptom severity (PoSSe) scale. CovariatesThe covariates included age, sex, side and classification of HM3, and the relationship of HM3 to the inferior alveolar nerve (IAN) canal. AnalysesThe data were analyzed using the independent samples t-test, paired t-test, chi-square and rank sum test. A significance level set at P < 0.05. ResultsThe sample included 60 patients in the three-piece group and 66 patients in the T-shaped group. The operative time of the three-piece group (14.73 ± 3.21 min) was shorter than that of the T-shaped group (19.25 ± 4.29 min) (P < 0.05). On day 3 and 7, VAS of pain were 2.24±1.89 and 0.15±0.40 in the three-piece group , and 3.95±2.44 and 0.48±0.68 in the T-shaped group (P < 0.05). The VAS of patient satisfaction in three-piece group (6.05±1.29) was better than T-shaped group (4.90±1.05) on day 7 (P < 0.05). Conclusion and RelevanceThe three-piece tooth sectioning for HM3 removal was associated with shorter duration, slighter postoperative symptoms and higher patient satisfaction, and may be considered as a recommended practice for dentists.