Abstract
Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.
Highlights
The presence of third molars is common in humans, and M3s are frequently found to be fully or semi- impacted in the bone [1]
After the extraction of a M3 the socket is generally healed spontaneously by formation of new bone, several clinical parameters may affect the level of bony healing, and surgical removal of third molars has been associated with the risk of having persistent or developing new periodontal defects on the distal aspect of the adjacent M2 [5]
The results of the present prospective case series indicate that the use of an alloplastic grafting material, consisting of β-TCP and calcium sulfate (CS), resulted in significant bone gain and effectively prevented periodontal defect on the distal aspect of M2, when used for treating osseous defects after the surgical removal of mesioangular or horizontal M3s in patients older than 26 years
Summary
The presence of third molars is common in humans, and M3s are frequently found to be fully or semi- impacted in the bone [1]. The presence of a M3 that failed to erupt or is partially erupted may cause a plethora of problems, and indications for M3s removal include acute or chronic infection, pain, caries, prevention or repair of periodontal defects, pathology associated with cystic degeneration and/or neoplastic transformation of the dental follicle, and facilitation of orthodontic treatment [2,3]. After the extraction of a M3 the socket is generally healed spontaneously by formation of new bone, several clinical parameters may affect the level of bony healing, and surgical removal of third molars has been associated with the risk of having persistent or developing new periodontal defects on the distal aspect of the adjacent M2 [5]. One of the most important factors seems to be the age of the patient at the time of M3 removal and younger patients (age < 25) have a higher probability of uneventful healing [2,3]
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