Dry Socket Research Articles

Are There Differences in the Causes and Complications of Mandibular Third Molar Extraction in Older Patients Compared to Younger Patients?

BackgroundAlthough most impacted third molars (ITM) are extracted in the teens and early 20s, some undergo extractions after their 40s. It is unclear whether the reasons for extraction, the degree of impaction, and complications differ in patients in an older age group compared with a younger age group. PurposeThe purpose of this study was to measure the association between age and 1) reason for extraction and 2) postoperative complications. Study design, setting, sampleThis was a retrospective cohort study of patients who had undergone surgical extraction of at least one mandibular ITM at a single institution. We excluded 1) age under 20 years, 2) follow-up period of less than 1 week, and 3) tooth extraction under general anesthesia. Predictor variableThe primary predictor variable was age, classified into 3 groups (20s:20-29; 30s:30-39; over 40s: 40 and greater). Outcome variableThe primary outcome variables were reason for extraction (prophylactic or symptomatic) and presence of complications. The secondary outcome variable was type of complication (post-operative infection, dry socket, neurosensory disturbance, presenting pain over 1 month, retained root requiring secondary treatment). CovariatesThe covariates were sex, laterality of ITM, and difficulty of extraction as measured by the difficulty index, a measure based on depth, orientation, and ramus relationship/space available, with a higher score indicating greater difficulty. AnalysesChi-square test was performed to analyze the association of categorical outcome variables and covariates. Level of statistical significance was set at P<0.05. ResultsOf a total of 831 eligible subjects, there were 555 (66.8%), 159 (19.1%), and 117 (14.1%) in 20s, 30s and over 40s age groups, respectively. The percentage of symptomatic extraction of ITM was significantly higher in the over 40 age group compared with the 20s group (92.3% vs. 69.4%, (p<0.001). Complication rate also significantly differed between over 40s group and the 20s group (7.7% vs. 1.8%, p<0.001). Difficulty index and indications for ITM extraction were significantly different between groups (p<0.001). ConclusionSymptoms, difficulty, and complications related to ITM increase at over 40 years of age. This should be taken into consideration during the joint clinical decision-making process with patients with ITM.

Immunological Study for Interleukin-5 and GM-CSF for Complications Post-Wisdom Teeth Extraction

Abstract Background: Wisdom teeth extraction is one of the most common operations conducted in dental clinics and the most common duty performed in oral and maxillofacial surgery clinics. Complications from this treatment are common, including dry socket, postoperative discomfort, delayed healing, postoperative infection, hematoma, edema, and trismus. Objectives: The purpose of this study is to quantify the proinflammatory interleukin-5 (IL-5) and granulocyte-macrophage colony-stimulating factor before extraction in saliva by ELIZA technique from patients who visit the clinic to extract wisdom tooth to study its impact on problems following extraction. Materials and Methods: A total of 100 saliva study samples (50 cases and 50 control), 44 males and 56 females, aged 19–65 years, were referred to the surgical clinic, College of Dentistry, University of Babylon specialized dentistry centers, and private clinics in Hillah city, Iraq, to determine the levels of preoperative IL-5 and GM-CSF by ELIZA technique. Results: There were no major differences between females and males in both groups, according to the findings of this study. In comparison to the healthy subjects, however, patients showed higher significant differences in measuring (IL-5) and (GM-CSF) concentrations (366.81 ± 17.8, 12.26 ± 1.3) (P ≤ 0.05) by using the ROC test IL-5 and GM-CSF showed (cutoff 146.42, sensitivity 90%, specificity 82%), (cutoff 4.04, sensitivity 84%, specificity 72%). Conclusion: proinflammatory IL-5 and GM-CSF were shown to be higher in patients with complications following wisdom teeth extraction than it was in control; highly level of IL-5 and GM-CSF may Predict complications following extraction.

Effectivity of Mengkudu (Morinda citrifolia) Fruit Extract in Inhibiting the Growth of Streptococcus viridans Causing Dry Socket Post Extraction

Background: Post-extraction wound healing usually proceeds but sometimes has problems and causes complications in the form of a dry socket. Streptococcus viridans bacterial infection is one of the causes of dry socket, therefore prevention of infection can be done by providing antibiotic or antibacterial (antiseptic) therapy. Noni fruit (Morinda citrifolia) contains many phenols, saponins, and alkaloids that can potentially be antibacterials. Objective: This study aims to determine the effectiveness of noni (Morinda citrifolia) extract against Streptococcus viridans bacteria in post-extraction sockets. Methods: This type of research is a laboratory experiment with Post test only control group design, where this study uses the Kirby-Bauer diffusion method with Streptococcus viridans bacteria samples and uses noni fruit extract (Morinda citrifolia) with concentrations of 3.125%, 6.25%, 12.5%, 25%, and 50%; Positive control Chlorhexidine digluconate 0.2%; And negative control DMSO. Results: The data analysis using Kruskal-Wallis showed a p-value of 0.000 on inhibition, which showed that noni fruit extract could inhibit the growth of Streptococcus viridans bacteria. Conclusion: Noni fruit extract (Morinda citrifolia) effectively inhibits the growth of Streptococcus viridans bacteria with an effective dose of 50%, but the antibacterial activity is still below the activity of Chlorhexidine gluconate 0.2%.

Investigation of alveolar osteitis and the effectiveness of laser treatment: a unified Meta-analysis and review of the literature

BackgroundPost-tooth extraction, dry socket is a frequently encountered complication, causing substantial pain and hindering the healing process. Conventional approaches to manage this condition have traditionally involved the use of antiseptic dressings to diminish bacterial presence and facilitate healing. This study aims to assess the efficacy of laser therapy in the symptomatic treatment of alveolitis.MethodsA literature search was conducted on PubMed, Embase, Scopus, Google Scholar, Web of Science, focusing on publications from 1998 to 31/01/2024 using relevant keywords. The combination of “laser” and “dry socket” was executed through the boolean connection AND.ResultsAt the conclusion of the study, a total of 50 studies were identified across the three search engines, with only three selected for the current systematic study and meta-analysis. The meta-analysis indicated that laser treatment proves effective in addressing alveolitis compared to Alvogyl. However, the correlation between the two was not highly significant.ConclusionThese findings suggest that laser therapy may serve as a viable alternative to traditional treatments for dry socket. This minimally invasive procedure has the potential to alleviate pain and promote healing with fewer associated side effects.”

Effect of platelet-rich fibrin on the recovery after third molar surgery: A systematic review and meta-analysis

This meta-analysis aimed to elucidate the effects of platelet-rich fibrin (PRF) on the recovery of alveolar bone after surgical removal of the mandibular third molars.PubMed, Cochrane Library, Web of Science, and Embase databases were searched from the inception to February 2023 for relevant studies on the application of PRF after the extraction of impacted mandibular third molars, with the language limited to English. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias tool was adopted for quality evaluation, and Stata 15.0 was used for statistical analysis. A total of 33 randomized controlled trials were included in the present study. Following surgical removal of the mandibular third molars, 1139 tooth sockets were filled with PRF, while 1138 sockets were sutured after conventional saline irrigation. The meta-analyses showed that PRF can relieve pain [(RR 0.454; 95% CI 0.23, 0.891); (SMD −0.74; 95% CI −0.97, 0.52)], improve swelling (SMD −1.48; 95% CI −1.90, −1.06), alleviate trismus (SMD −0.35; 95% CI −0.51, −0.19), reduce dry socket (SMD −0.18; 95% CI −030, −0.05), and promote bone tissue healing (SMD 2.34; 95% CI 0.18, 4.51). The current study confirms that PRF can reduce some postoperative complications. Local application of PRF after lower third molar extraction is a viable method for relieving pain and swelling, reducing the incidence of dry socket and trismus, and increasing bone density. However, whether it can promote soft tissue healing remains unclear. For patients undergoing complicated surgical extraction, local application of PRF into the sockets might be a good option.

Residual enamel removal to improve outcomes of mandibular third molar coronectomy: A single-center retrospective cohort study

This study aimed to analyze post-coronectomy complications, chronological root survival rate (success rate) using Kaplan–Meier analysis, and postoperative radiographic signs for root extraction. A total of 555 mandibular third molar coronectomies were clinically and radiologically evaluated (mean follow-up period, 27.2 months; range, 1 month to 10.5 years). Complications were observed in 22 (4.0%) cases. Temporary inferior alveolar nerve damage was observed in one (0.2%) case, and 21 (3.8%) retained roots required extraction between 1 and 64 months after coronectomy due to dry socket (two cases, 0.4%), primary non-wound closure (10 cases, 1.8%), secondary root exposure (seven cases, 1.3%), and submucosal root eruption (two cases, 0.4%). Residual enamel after coronectomy was more significantly found on 13 (61.9%) of 21 extracted roots than on 30 (5.6%) of 534 surviving roots. Kaplan–Meier analysis revealed an overall survival rate of 93.8% at 5 years and 92.2% at 10 years. The 5-year survival rates differed significantly (p < 0.001) between the enamel-free (97.0%) and residual enamel-attached (58.3%) roots. The Cox proportional hazards model showed a hazard ratio of 20.87 (95% confidence interval, 8.58–50.72). The long-term outcomes of coronectomy were satisfactory, and a higher success rate is expected when the enamel is completely removed during coronectomy.

Effect of Ozone Gel on Postoperative Sequelae after Surgical Removal of Impacted Lower Third Molars.

Background and objectives: the study aims to evaluate the efficacy of ozone gel in reducing pain, swelling, trismus and also to evaluate soft tissue healing and dry socket after surgical removal of impacted lower third molars. Methods: the current study enrolled 50 patients divided randomly in to two equal groups, Group I (study group) received ozone gel intra-socket and oral placebo postoperatively and Group II (control group) received a systemic antibiotic. Clinical examination includes assessment of maximal mouth opening on the day of surgery, panoramic x-ray was used for evaluation of the location and configuration of impacted lower third molars, surrounding bone, mandibular canal and adjacent tooth. Pain and swelling were assessed by visual analogue scale (VAS) and recorded daily for one week by the patients, dry socket was checked at 3rd day postoperatively, maximal mouth opening also was checked at 3rd and 7th day postoperatively and soft tissue healing was checked at 7th day postoperatively. Results: Results showed statistical significance difference regarding pain and swelling and there was no statistically significant difference regarding maximal mouth opening (trismus), dry socket and soft tissue healing in Group I (study group). Conclusion: This study concluded that the use of ozone gel was effective in the reduction of postoperative pain and swelling but it was not effective in reducing trismus, dry socket and soft tissue healing after surgical removal of impacted lower third molars. Keywords: Ozone Gel, Impaction, Third Molar Surgery, Pain, Swelling, Trismus, Dry Socket, Soft Tissue Healing.

Assessment of risk factors of dry socket

Assessment of risk factors of dry socket

The Effect of Snakehead Fish (Channa striata) Extract on Dry Socket Wound Healing: TGF-β1 Expression in Rats Model

Background: Dry socket or alveolar osteitis is a condition characterized by the breakdown of blood clots due to excessive fibrinolysis activity, which disrupts the wound healing process. Consumption of nutrition-rich foods such as snakehead fish (Channa striata) rich in albumin, omega-3 fatty acids, vitamins, minerals, and striatin may accelerate delayed wound healing. This study aimed to analyze the role of snakehead fish extract on the expression of TGF-β1 in the healing of dry socket wounds after tooth extraction in Wistar rats. Methods: This study was an in vivo study with a posttest-only control group design. Forty-five Wistar rats were divided into five groups: snakehead fish extract groups with doses of 1/2, 1, 2, 4 times human dose, and a negative control. The lower left incisor teeth of the rats were extracted, then dry socket was induced with adrenaline using a paper point. On days 3, 7, and 14, TGF-β1 expression was assessed using immunohistochemical staining. Results: This study showed significant difference in TGF-β1 expression on days 3, 7, and 14. TGF-β1 expression was higher in the treatment groups than the control (p&lt;0.05). Conclusion: Administration of snakehead fish extract increased TGF-β1 expression. These findings underline the complex interaction between snakehead fish extract and TGF-β1 expression.

Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review.

Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.

Analysis of Different Treatment Approaches to Prevent Alveolar Osteitis

Alveolar Osteitis (AO) is a complication that can arise after tooth extraction. It refers to a socket following extraction that lacks epithelium, blood clot, and has an exposed bony surface, often causing intense and radiating pain. Objectives: To determine the incidence of AO among different treatment groups undergoing tooth extraction. Methods: A prospective comparative study was conducted. Patients were enrolled and allocated into treatment groups: Control, Saline Irrigation, and chlorhexidine (CHX) Rinse. Outcome measures included the incidence of AO. Statistical analysis was performed to compare outcomes between treatment groups. Results: The overall occurrence rate of dry socket was 14.22%, with the highest incidence observed in patients who received saline irrigation. Conversely, the use of chlorhexidine rinse once postoperatively resulted in the lowest incidence rate. Conclusions: It was concluded that post-operative use of chlorhexidine rinse shows a promising and favorable outcome in preventing AO among patients. However, this study does not support the justification for irrigation with saline. Further well-designed clinical trials are necessary to validate these findings.

The Impact of Smoking on Oral Health: A Systematic Review

The nexus between smoking and oral health is a significant concern in dental medicine, impacting millions worldwide. Smoking, often linked to various systemic health issues, also plays a critical role in the prevalence and severity of oral health conditions. These include but are not limited to tooth decay, periodontal disease, and the increased risk of oral cancer. The consequences of smoking on oral health extend beyond mere esthetics, affecting the success rates of dental implants, the healing process after teeth are removed, and contributing to conditions such as dry socket and dental caries. Understanding the comprehensive impact of smoking on oral health is vital for public health initiatives and individual preventive measures.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review.

The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention. The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase. The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2). This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration. L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

The success rates and outcomes of mandibular third molar coronectomy: 167 cases

PurposeThe purpose of this study was to assess success rates and to report complications of coronectomy of mandibular third molars (M3M), including intra-operative failure, pain, infection, dry socket, inferior dental alveolar (IAN) and lingual nerve (LN) injuries and re-operation rates.MethodsRetrospective analysis of 167 coronectomies completed between January 2017 to December 2022 was undertaken.ResultsThe success of coronectomy was 93%. Intra-operative failure was reported to be 3.6% (n = 8). Complications accounted for pain (15%, n = 24), infection (9%, n = 15) and dry socket (3.6%, n = 6). Three patients required removal of M3M root at 3 months (n = 2) and 24 months (n = 1), accounting for 1.8% re-operation rate. A total of number of patients who suffered a nerve injury was 12; three of these were permanent (LN – 1.2%, n = 2; IAN – 0.6%, n = 1), nine were temporary (IAN – 1.2%; n = 2, LN – 2.4%; n = 4; site not specified – 1.8%, n = 3). No patients with intra-operative failure and re-operation suffered IAN or LN injury post-operatively.ConclusionCoronectomy offers a successful strategy for management of high risk M3M. The treatment outcomes can be improved with careful case selection and adjusting surgical technique, including assessment of root morphology, incomplete crown sectioning technique and avoidance of lingual retraction. Reporting of coronectomy success as a factor of surgical outcome, presence or absence of permanent IAN injury, persistent symptoms or any other long-standing complications (such as LN injury), and the need for re-operation accounting for root migration status may be a useful tool to measure coronectomy outcomes.

Partially Edentulous Arches and Bilateral Mandibular Fracture: Application of Condensation-Silicone Bite Block-Splint, Mandibulo-Maxillary Fixation Screws, and Elastics for Intraoral Immobilization

Each mandibular fracture is unique. It requires individual treatment solutions due to different number of fracture sites, fracture terms, level of dislocation, presence/absence of the infection, number, location, and condition of teeth, etc. Management of jaw fractures in partially edentulous arches are even more complicated and typically can involve assistance of a dental technician. Published English language literature lacks information about application of condensation silicone (C-silicone) bite block-splint with mandibulo-maxillary fixation (MMF) screws and elastics for management of bilateral mandibular fracture. This is why we present this novel technique developed by our team based on fracture treatment in a 38-year-old male partially edentulous patient. Also, we introduce a Kyiv’s Modification of the Kennedy Classification System of the partially edentulous arches useful for mandible fracture cases. The Kennedy–Kyiv Classification System considers the non-treated teeth roots as supporting locking points (temporary additional retention points) that increase the stability of the bite block-splint and decrease probability of micromovements. Moreover, it contraindicates extracting such teeth roots immediately before the block-splint fixation as extraction of such roots can provoke the alveolar osteitis upon the fracture site(s) healing and immobilization period what will increase the risk of the block removal for the treatment of osteitis. A review of published MMF techniques and appliances designed for mandible fracture treatment is performed. Multiple appliances for partially and totally edentulous mandibles are considered as well as for the dentulous jaws. The Gunning-type splints and its modifications were considered. An in-chair fabrication of C-silicone bite block-splint and its combined application with MMF screws and elastics is a novel alternative for the Gunning splint. This appliance allows to decrease the time typically required for the Gunning splints fabrication, decreases number of the involved specialists, decreases cost of treatment, and easy for performance.

To assess knowledge and awareness regarding treatment of dry socket among interns

Objectives: A painful dental condition known as a dry socket (also known as alveolar osteitis) can occasionally develop after the extraction of a tooth. A dry socket occurs when the blood clot at the site of the tooth extraction dislodges before it has healed. The idea of treating dry sockets with medication-related combined treatment is relatively new. Many drugs have the ability to treat dry sockets. The study aimed to assess the knowledge regarding the combined treatment of dry socket among interns. Material and Methods: This cross sectional study was carried out at a dental college to evaluate the knowledge and awareness of dental students regarding treatment of dry socket. Results: The statistical analysis showed significance in knowledge about the combined treatment of dry socket. The participants had basic knowledge regarding various aspects of dry socket except recent advances.. Female interns showed more knowledge than male counterparts however, due to the unequal number of male and female participants the difference is not statistically significant. Basic knowledge regarding dry socket management was satisfactory however, awareness regarding newer advances needs to be improved. Conclusion: It is strongly recommended that the students should update their knowledge using continuing education programmes, journal articles so that they can manage this clinical condition effectively.

Standardized clinical evaluation of dry anophthalmic socket syndrome in a real-world approach

PurposeTo assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. Methods62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. ResultThe anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). ConclusionMost anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms.

Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study.

Background Third molar extraction is a routine oral surgical procedure that is often complicated by the development of a dry socket (alveolar osteitis). This prospective observational study aimed to investigate the prevalence of dry sockets and identify associated risk factors and causes, contributing to a comprehensive understanding of the postoperative outcomes of oral surgery. Methods This study employed a prospective observational design with a 12-month follow-up period. Participants aged 18-40 years scheduled for third molar extraction were included, whereas those with coagulopathies, pregnant or lactating women, patients with vitamin deficiencies, and individuals on medications affecting healing were excluded. Data collection involved comprehensive assessments at baseline, intraoperative details, and postoperative evaluations at 48 hours, one week, and two weeks. Statistical analyses included descriptive statistics, chi-square tests, t-tests, or Mann-Whitney U tests, and logistic regression for the risk factor analysis. Results A total of 238 participants with diverse demographic characteristics were enrolled in this study. The prevalence of dry sockets increased progressively from 20.6% at 48 hours to 41.2% at two weeks post-extraction. Smoking, poor oral hygiene, and surgical technique emerged as significant risk factors, with corresponding odds ratios of 6.41 (95% CI: 2.86-14.36, p < 0.001), 9.53 (95% CI: 2.12-42.84, p = 0.003), and 3.27 (95% CI: 2.08-5.15, p < 0.001), respectively. Pain intensity, measured using a Visual Analog Scale, gradually decreased from 48 hours to two weeks post-extraction. Conclusion This study provides valuable insights into the prevalence and risk factors associated with dry sockets following third molar extractions. Smoking, poor oral hygiene, and poor surgical techniques were identified as significant contributors, emphasizing the importance of preoperative counseling and targeted interventions.

Post-Operative Complications Following Third Molar Extraction in Qassim Region Saudi Arabia: A Retrospective Study

Third molar surgery is one of the most common dental procedures that can be done in the outpatient clinic. Extraction complications can be very mild, like discomfort or mild pain, or severe, like a mandibular fracture. The study aims to investigate postoperative complications after a third molar extraction in the oral surgery dental clinic at Qassim University. This retrospective study analyzed postoperative complication rates following third molar extractions performed at dental clinics in Qassim, Saudi Arabia, between August 2022 and March 2023. Descriptive statistics characterized the sample, and comparative analysis evaluated relationships between complications and factors like gender, age, and surgical aspects. Ethical approval was granted, and sensitive patient information remained confidential. A total of 199 third morals were extracted from 70 patients with an average of 2.8 teeth per patient. More mandibular third molars were removed (55.8%) from the patients who participated compared to maxillary third molars extractions (44.2%). The results indicated that the rate of postoperative complications ranged from 2.5% to 64.7%. The most frequent postoperative complications were pain (64.7%), followed by swelling or edema (55.5%), trismus (32.8%), and dry socket (9.2%). This study’s postoperative complication rate of 10.4% following third molar surgery was consistent with other reports. Younger patients and mandibular extractions presented higher complication risks. Regional outcome data can guide clinicians locally to optimize preoperative planning and techniques, reducing risks for those undergoing this standard dental procedure.

Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

BackgroundSeveral measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF). PurposeThis study compared the effects of three modifications of PRF (Leukocyte-PRF, Advanced-PRF, and Advanced-PRF+) on the side effects of impacted M3 removal. Study design, setting, and sampleThis double-blinded randomized controlled trial was conducted at the Oral Surgery department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease. Independent variableThe independent variable was the PRF product grouped into four categories (control, leukocyte-PRF, advanced-PRF, and advanced-PRF+). Study subjects were randomly distributed among the four groups. Main outcome variablesThe main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 post-surgery. CovariatesAge, sex, duration of surgery, and side of surgery were the covariates. AnalysesChanges at different time points were analyzed using repeated-measures ANOVA. Pairwise comparisons were performed if significant. P-values≤.05 were considered statistically significant. ResultsThe sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P>.05). A-PRF and A-PRF+ had significantly better healing index than L-PRF on the third day (P=.02, P=.01). All the study groups significantly reduced VAS pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF+ had significantly lower VAS scores than L-PRF on the second day (P=.003, P=.02). No significant difference was found in maximum mouth opening during follow-up sessions (P=.2). Study groups had less facial swelling on days 2 and 3 than the control group (P<.05). ConclusionL-PRF, A-PRF, and A-PRF+ can improve postoperative outcomes after M3 removal, but may not impact trismus. A-PRF and A-PRF+ may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF+ have comparable results.