Extraction Of Impacted Third Molars Research Articles

UNRAVELING THE OUTCOMES: A RETROSPECTIVE ANALYSIS OF ABERRANTLY POSITIONED IMPACTED THIRD MOLAR EXTRACTIONS

In the realm of dentistry, the extraction of third molars occupying abnormal positions poses a formidable challenge. These enigmatic teeth, deviating from their anticipated anatomical location, demand meticulous evaluation and specialized approaches to ensure their successful removal. Intriguingly, the evaluation of such cases has remained unexplored in the context of Kazakhstan until now. Aim: The objective of this study is to examine the occurrence of mandibular third molar impaction and its correlation with factors such as impaction type, impaction side, age, and gender among patients. Methods: A retrospective review was conducted on the medical records of 2351 patients who underwent surgical extraction of impacted mandibular third molars. Results: The findings revealed a remarkable prevalence of mesioangular impaction (56.15%) in the lower third molars. The highest number of patients were observed in the age group of 18–30 years (25.05%), and a majority of cases involved the left side (75.75%). A notable female predominance (66.35%) was also observed. The most frequent indication for surgical removal was recurrent pericoronitis (24.25%). Conclusion: This pioneering study in Kazakhstan provides insights into extraction success for impacted third molars. It reveals a remarkable prevalence of mesioangular impaction in the lower molars, predominantly on the left side with a notable female predominance. Recurrent pericoronitis is the primary reason for surgical removal. Early removal of symptomatic impacted molars prevents future complications, but careful patient selection is crucial. Further research is needed to understand these findings in the Kazakhstani population.

Computer-Guided Bone Lid Technique for Surgical Extraction of Deeply Impacted Mandibular Third Molars: A Technical Report

The extraction of mandibular impacted third molars is one of the most common procedures in oral surgery. One of the extraction methods consists of the preparation of a buccal bone lid to obtain access and remove the tooth. This technique aims to reduce bone loss, promote bone healing distal to the second molar, and increase the accessibility to the impacted tooth, particularly in cases of concomitant pathologies or proximity to the mandibular canal. The procedure benefits from the application of 3D printing technologies to produce cutting guides that, combined with piezosurgery, allow deeply impacted third molar extractions with excellent preoperative planning and extreme localisation precision, as well as predictable repositioning and fixation of the bone lid. The objective of this article is to present two clinical cases of the application of the bone lid technique to extract deeply impacted third molars using 3D printed guides with different designs and piezosurgery.

Correlation of Blood Pressure, Heart Rate and Pain with Anxiety, and Importance of its Prevention in Surgery of Impacted Third Molars Under Local Anesthesia

Aim: To examine whether there is a correlation between blood pressure, heart rate, and pain with the level of preoperative and postoperative anxiety in surgery of impacted third molars under local anesthesia. Subjects and Methods: In the study, which included adult patients of both sexes with an indication for surgical extraction of impacted third molars, research parameters were measured as follows: 1st measurement (day of examination) - blood pressure, heart rate, preoperative anxiety with Spielberger’s State-Trait Anxiety Inventory (STAI); 2nd measurement (immediately before the intervention) - blood pressure, heart rate, preoperative anxiety with STAI; 3rd measurement (day after intervention) - blood pressure, heart rate, postoperative anxiety with STAI, postoperative pain with visual analog scale. Results: The values of preoperative and postoperative anxiety and the measured parameters of blood pressure, heart rate, and postoperative pain were statistically significantly positively correlated with each other during all measurements. Conclusion: In order to increase the satisfaction of both the patient and the ordinarius, and to prevent possible complications in this type of oral surgical intervention, it would be useful to consider adequate therapy in order to prevent the development of anxiety, considering the confirmed correlation with the measured parameters.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve.

Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. All IMM3s were extracted easily without symptoms of IAN injury after extraction. Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

EFFICACY OF SUBLINGUAL VERSUS ORAL PIROXICAM IN MANAGEMENT OF POST-SURGICAL PAIN, SWELLING AND TRISMUS AFTER LOWER 3RD MOLAR SURGERY- A RANDOMIZED CONTROL CLINICAL TRIAL

Background of the study: Third molar surgical removal is a common procedure in oral and maxillofacial surgery, causing moderate to severe pain, swelling, and trismus. Postoperative pain control improves patient recovery and oral function, with commonly used analgesics including Ibuprofen, Aceclofenac, Ketorolac, Tramadol, Paracetamol, Nalbuphine, Nimusulide, and Buprenorphine. Aim and Objective: The study compares oral and sub-lingual Piroxicam for managing post-surgical pain after extraction of impacted third molars, focusing on analgesia onset, pain intensity, swelling, and trismus degree. Materials and method: A randomized control trial was conducted on 30 patients who underwent surgical removal of mandibular impacted third molars. The patients were divided into two groups: Group I (Study) and Group II (Control). All patients underwent the procedure by a single surgeon. Post-operative medications were prescribed according to the study design, with Piroxicam 20mg administered sub-lingually (Group I) and 20mg orally (Group II). The parameters were assessed and measured for both groups, and the results and statistical analysis were compared. Result: The results revealed that the inter-group difference for the post-operative symptoms evaluated using a t-test for Equality of means by comparing the pre-op, POD 2, POD 7 values was statistically significant. Mean onset time taken and pain perception by Group I (Sub-lingual) in the first dose was 32.3 minutes and for Group II was 51.21 minutes which was established to be significantly (P<0.05) low for the sub-lingual group by statistical analysis. Conclusion: The study found that the sublingual route of administering Piroxicam had a faster onset of action and better analgesia postoperatively compared to the oral route. This is crucial for patients and surgeons to improve compliance and comfort post-operatively after impaction surgery, as potent analgesics are essential for effective pain management.

Comparison of the Efficacy of Corticosteroids With Enzymatic Agents in the Postoperative Sequelae for Lower Third Molar Surgery: A Prospective Study.

Introduction The presence of impacted third molars is a prevalent problem associated with varying degrees of difficulty in extraction and potential consequences, including pain, swelling, and trismus. According to studies, enzymatic combinations, such as bromelain, rutoside, trypsin, and serratiopeptidase, are known to have a very promising role in reducing inflammation and promoting wound healing. This study compared natural enzymatic agents with corticosteroids for postoperative pain, swelling, and trismus in the impacted lower third molar surgery. Objectives The present study aimed to compare the efficacy of prednisolone, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain, and serratiopeptidase in the postoperative sequelae after surgical extraction of impacted mandibular third molars. The primary objective was to assess the difference in swelling between the three groups. The secondary objectives were to assess the difference inpostoperative painand trismus between the three groups. Materials and methods A total of 150 patients who presented to the department of oral and maxillofacial surgery for surgical removal of an impacted mandibular third molar with a moderately difficult score of 5-7 in the Pederson difficulty index were chosen for a prospective study. Patients were categorized into three groups based on the postoperative drug prescribed. In group 1, prednisolone 10 mg was prescribed;in group 2, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was prescribed;and in group 3, serratiopeptidase 15 mg was prescribed. All patients were prescribed a combination drug of aceclofenac 100 mg and paracetamol 325 mg twice daily as a standard analgesic. Swelling, pain, and trismus in each patient were recorded preoperatively and at postoperative day one and day seven.The Friedman test was employed to evaluate the variation in pain levels within the groups over time, while the Kruskal-Wallis test was utilized to investigate the disparity in pain levels between the groups. The difference in swelling and trismus within the groups across the timeline was measured by repeated measures analysis of variance (ANOVA), and the difference in swelling and trismus between the groups was measured by one-way ANOVA.A p-value below 0.05 was deemed to be statistically significant. Results Group 1 showed less swelling, pain, and trismus on both postoperative dayone and day seven compared to group 2 and group 3, which was a statistically significant difference (P < 0.05). It was found that swelling, pain, and trismus measurements in postoperative dayone and day seven in group 2 were comparatively less than in group 3.Neither group demonstrated any side effects or other complications during the follow-up period. Conclusion It can be concluded that the use of prednisolone postoperatively following surgical removal of the mandibular third molar provided better relief with regardto pain, trismus, and swelling compared to the enzymatic agents. Among enzymatic agents, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papainwas better in reducing pain, trismus, and swelling than serratiopeptidase drug.

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6–9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Comparison of the effects of two different styles of orally prescribing prednisolone on postoperative sequelae of surgical extraction of an impacted mandibular third molar: a single-blind randomized study.

Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don't have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.

Impact of Suturing Techniques on the Periodontal Health Status of Mandibular Second Molar After Extraction of Fully Impacted Third Molars

Mandibular third molars are appeared to be the most common congenitally impacted teeth the fact that may cause many problems in different fields of dentistry. surgical removal of the impacted tooth seems to be the only solution for these problems. An important complication to address is the risk of developing periodontal breakdown ( loss of attachment) and deep periodontal pocket on the distal aspect of the adjacent mandibular second molar after surgical removal of third molar. The aim of the present study is to evaluate and compare the effect of 4 suturing techniques: (Simple loop , Figure 8 suture, Anchor suture and Closed anchor suture) on the periodontal health status on the distal aspect of the adjacent mandibular second molar after surgical removal of lower impacted third molar.Forty patients having fully impacted mandibular third molars were enrolled in this study and divided to 4 groups (Group A: Simple loop , Group B: Figure 8 suture, Group C: Anchor suture and Group D: Closed anchor suture), each group consisted of 10 patients. Surgical extraction of impacted third molars were carried out for them. Probing pocket depth (PPD) and clinical attachment level (CAL) were recorded preoperatively and 6 months after surgery. On 6 months after surgery the mean values of PPD and CAL were significantly increased on the distal surface of the adjacent mandibular second molar in simple loop &amp; figure 8 techniques. On the other hand, no significant difference has been noticed between anchor &amp; closed anchor techniques in comparison with preoperative values. After 6-months, PPD and CAL values of were significantly higher in thesimple loop and figure 8 techniques compared to anchor andclosed anchor techniques. The present study concluded that closedanchor suture &amp; anchor suture techniques are preferable to closethe flaps in surgical removal of impacted mandibular third molarsto maintain a good health status on the distal side of the adjacentmandibular second molar.

Radiological findings associated with postoperative wound infection after extraction of impacted mandibular third molar: A retrospective study

IntroductionStudies directly relating radiological findings to the risk of postoperative wound infection (PWI) in impacted mandibular third molars (M3) are limited and poorly understood. This study aimed to clarify the radiological risk of PWI. Materials and methodsTwenty-six patients who developed PWI after M3 extraction were retrospectively analyzed using orthopantomography (OPG) and computed tomography (CT) before M3 extraction to determine the association between M3 impaction status and PWI. These were compared with an equal number of non-infected groups. Moreover, the possibility of assessing the same risk in OPG as in CT imaging was examined. ResultsMultivariate analysis identified class III and position B of the Pell and Gregory classification system as independent risk factors for PWI. On CT, an axial overlap distance (AOD) >3.5 mm was significantly associated with PWI. Furthermore, the sagittal overlap distance (SOD) and AOD of the OPG were significantly greater in group III-B. A strong positive correlation was observed between SOD and AOD. ConclusionThese results indicate that class III, position B, and an AOD >3.5 mm may be novel risk factors for M3 PWI. The strong correlation between SOD and AOD suggests that the risk assessment for PWI can be performed by evaluating OPG alone.

Pre-emptive Single Dose of Intramasseteric Administration of Dexamethasone Versus Methylprednisolone in Surgical Extraction of Impacted Mandibular Third Molars: Prospective Split-Mouth, Randomised Triple Blinded Clinical Study.

The study aims to contribute in reducing postoperative sequelae and to determine the optimal corticosteroid for reducing postoperative inflammation, pain, swelling, wound healing and quality of life in patients undergoing surgical extraction of impacted mandibular third molars. The study included 191 patients who presented to the Department of Oral and Maxillofacial Surgery at Thai Moogambigai Dental College and Hospital in Chennai with bilateral impacted mandibular third molars that needed surgical removal. The effects ofpre-emptivesingledose ofdexamethasone and methylprednisolone on pain, oedema, trismus, wound healing, and quality of life after surgical extraction of impacted lower third molars were investigated. There was no statistical difference between the two steroids, with both achieving identical levels of wound healing and quality of life. On the third postoperative day, there was a statistically significant difference, with methylprednisolone providing clinically superior results in mouth opening and reduction of swelling. However, by the fifth day, both corticosteroids had exhibited identical improvement. Compared to 8 mg of dexamethasone, 40 mg of methylprednisolone administered as a single preemptive dosage in the intrammaseteric region was associated with enhanced quality of life, a reduction in pain and edema, and almost normal mouth opening.

A Prospective Study to Compare the Effects of Preemptive Piroxicam and Oral Dexamethasone on Edema, Trismus and Pain in Third Molar Surgery: A Randomized Controlled Trial

Abstract Introduction: Surgical extraction of impacted third molars is an increasingly common procedure but is associated with postoperative sequelae such as pain, swelling, and trismus. This study aims to compare the effects of preemptive piroxicam and oral dexamethasone on pain, swelling and trismus following third molar surgery. Materials and Methods: A prospective randomized study consisting of 31 patients requiring lower third molar surgery were selected. They were randomly allocated to two treatment groups, oral dexamethasone (8 mg) and oral piroxicam (20 mg). The overall analgesic efficacy and anti-inflammatory effect of the two drugs were assessed postoperatively after 24, 48, 72 h, and on day 7 for pain, swelling, and trismus. Results: The difference in the mean scores of piroxicam group and dexamethasone group was statistically significant with the dexamethasone group showing better analgesia at the end of 24 h, 48 h, and 72 h done using Mann–Whitney U test. The swelling was compared between the two groups using an independent t-test. These results were statistically significant and dexamethasone was more effective at return to normal preoperative measurements 1-week postsurgery. When the mouth opening at day 7 was compared with the preoperative values, subjects in the piroxicam group showed a decrease of 0.18 ± 0.13, and those in the dexamethasone group showed a decrease of 0.05 ± 0.13 showing that dexamethasone group was significantly closer to returning to normal mouth opening at the end of 1 week post-surgery using independent t-test. Conclusion: We can conclude that the use of 8 mg oral dexamethasone 1 h preoperatively leads to a more comfortable and pain-free period for patients who undergo wisdom teeth removal, within its limitations.

Physiological parameters of dental fear and anxiety in adults related to surgical extraction of impacted third molars

Background/Aim: Dental fear and anxiety (DFA) are psychological phenomena normally arising and developed in the dental office during various kinds of dental procedures and interventions. The most usual stressors for the DFA appearance are those related to dental pain, no matter if the pain has already been caused, or potentially will be committed. There are a few main dental pain-provoking factors related to endangering body integrity in the oral cavity, and tooth extraction is the strongest one. The research aimed to observe, notify, and analyze physiological parameters of DFA in adults related to oral surgical therapy procedures of removing impacted third permanent molars. Material and Methods: After inclusive selection 500 patients entered into the study. The study protocol included preoperative assessment of DFA presence with Corah's Dental Anxiety Scale (CDAS) on examination day, preoperative assessment of physiological parameters on examination day and operative day before the treatment, as well as their postoperative assessment followed by evaluation of postoperative pain, on the day after the treatment. Results: The results of our research indicated that an increase in DFA led to increased values of the measured physiological parameters for all preoperative measurement days. The postoperative decrease in the physiological parameters values could be explained by the fact that the oral-surgical procedure was completed, so the psychological burden of the patients was also less. Conclusions: Patients with higher values of the DFA presence have also declared more postoperative pain.

Instruments for anxiety analysis and the utility of its assessment in oral surgical interventions under local anesthesia in patients undergoing four operative procedures

Introduction: Fear of intervention in the oral cavity is declared as dental fear and is defined as a specific form of anxiety. The reaction to oral-surgical intervention will also depend on the feeling the patient acquires about the operator, but the positive experience also plays an important role.Aim: The aim is to evaluate differences between the sexes and the influence of experience from a previous oral surgical intervention on a similar subsequent intervention.Material and methods: In the research, anxiety was assessed using Corah's Dental Anxiety Scale (DASR) and Spielberger's State-Trait Anxiety Inventory (X1 and X2). The study included adult patients of both sexes with an indication for surgical extraction of impacted third permanent molars. Preoperative and postoperative anxiety was assessed: 1st measurement (day of examination) - DASR, and STAI (X1 and X2); 2nd measurement (immediately before the intervention) – STAI (X1 and X2); 3rd measurement (day after the intervention) – STAI (X1 and X2).Results: Preoperatively determined high levels of general, immediate, and dental anxiety decreased before the surgical procedure itself and were significantly reduced in the postoperative period. The downward trend continued in line with the positive experience. Women had higher anxiety scores than men for all monitored parameters. The use of the STAI scales to assess anxiety by dental practitioners is on par with other well-known anxiety assessment instruments, such as the DASR. Conclusion: In order to increase patient satisfaction and to prevent possible complications in such oral-surgical procedures, it would be useful to consider adequate therapy for high anxiety.

Development and validation of machine learning based prediction model for postoperative pain risk after extraction of impacted mandibular third molars

BackgroundPredicting postoperative pain risk in patients with impacted mandibular third molar extractions is helpful in guiding clinical decision-making, enhancing perioperative pain management, and improving the patients’ medical experience. This study aims to develop a prediction model based on machine learning algorithms to identify patients at high risk of postoperative pain after tooth extraction. MethodsWe conducted a prospective cohort study. Outpatients with impacted mandibular third molars were recruited and the outcome was defined as the NRS (Numerical Rating Scale) score of peak postoperative pain within 24 h after the operation ≥7, which is considered a high risk of postoperative pain. We compared the models built using nine different machine learning algorithms and conducted internal and time-series external validations to evaluate the model's predictive performances in terms of the area under the curve (AUC), accuracy, sensitivity, specificity, and F1-value. ResultsA total of 185 patients and 202 cases of impacted mandibular third molar data were included in this study. Five modeling variables were screened out using least absolute selection and shrinkage operator regression, including physician qualification, patient self-reported maximum pain sensitivity, OHI–S–CI, BMI, and systolic blood pressure. The overall performance of the random forest model was evaluated. The AUC, sensitivity, and specificity of the prediction model built using the random forest method were 0.879 (0.861–0.891), 0.857, and 0.846, respectively, for the training set and 0.724 (0.673–0.732), 0.667, and 0.600, respectively, for the time series validation set. ConclusionsThis study developed a machine learning-based postoperative pain risk prediction model for impacted mandibular third molar extraction, which is promising for providing a theoretical basis for better pain management to reduce postoperative pain after third molar extraction.

The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study

BackgroundThe injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM).MethodsThis retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher’s exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher’s exact test.ResultsThere were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8).ConclusionsRoot orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.

Effect of chlorhexidine gel on the prevention of alveolar osteitis and post‐operative pain following transalveolar extraction of impacted mandibular third molars: A randomized study

AbstractObjectiveThis study aimed to compare the efficacy of 0.2% chlorhexidine gel with warm saline mouth rinse (WSMR) in the prevention of alveolar osteitis (AO) following transalveolar impacted mandibular third molar (IMTM) extraction after accounting for surgical operative confounding factors.Materials and MethodsWe conducted a parallel design randomized study. Participants were consenting adults randomly assigned to 0.9% WSMR and 0.2% chlorhexidine gel (administered twice daily post‐operatively) groups. All participants were followed up daily post‐operatively for one week. The primary outcome was an incidence of AO, assessed using Blum's criteria. Fischer's exact tests and regression models were used to investigate the effect of interventions on AO.ResultsOne hundred participants were enrolled in the study, with 50 participants in each group. A higher incidence of AO was observed in the WSMR group than the chlorhexidine group (16% vs. 2%, p = 0.01). However, after adjusting for duration of extraction (aOR: 0.18; 95% CI: 0.02, 1.71) and bone operating time (aOR: 0.16; 95% CI: 0.02, 1.47), the difference was not statistically significant.ConclusionsIn conclusion, the study demonstrates that the application of the 0.2% chlorhexidine gel was not significantly more effective in preventing AO compared with the use of WSMR following transalveolar IMTM extraction after controlling for operative factors.

The Effect of Platelet-Rich Fibrin on Post-Operative Inflammatory Sequelae after Mandibular Third Molar Surgery: A Randomized Controlled Trial

Background: Surgical extraction of impacted mandibular third molars is commonly associated with post-operative inflammatory sequelae, causing distress to patients and affecting their quality of life. This study aimed to investigate the effect of using autologous platelet-rich fibrin (PRF) on post-operative pain, facial swelling, and trismus following mandibular third molar surgery.&#x0D; Methods: In this single-blinded prospective randomized controlled trial, 90 participants aged 18-35 years were enrolled. Eligible patients underwent surgical extraction of impacted mandibular third molars under local anesthesia between October 2017 and June 2018 at the Oral and Maxillofacial Surgery clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants were randomly assigned to either the PRF group or the non-PRF group. PRF was placed in the extraction socket of the PRF group, while the non-PRF group received a blood clot. Post-operative pain, facial swelling, and trismus were measured as outcomes. Longitudinal data analysis using generalized estimating equations was employed, adjusting for confounding factors, with statistical significance set at p &lt; 0.05.&#x0D; Results: The PRF group exhibited significantly lower pain scores (3.02 mm; p &lt; 0.001), reduced facial swelling (0.55%; p = 0.01), and decreased trismus (4.52%; p = 0.05) compared to the non-PRF group.&#x0D; Conclusion: Placement of PRF in the extraction socket following mandibular third molar surgery resulted in decreased post-operative pain, facial swelling, and trismus. These findings suggest that PRF may have a beneficial impact on the inflammatory outcomes of third molar surgeries.&#x0D; &#x0D;

CHARACTERISTICS OF THE GINGIVAL EPITHELIUM OF CHILDREN’S THIRD MOLARS AT DIFFERENT STAGES OF ROOT FORMATION

Extraction of impacted and dystopic third molars is a rather traumatic manipulation accompanied by a large bone defect and wound infection. Therefore, it is advisable to perform hermectomy, which has a number of advantages over typical and atypical methods of tooth extraction. An important stage of any surgical intervention is the postoperative period, which is characterized by a certain duration and the presence of complications, which is due, among other things, to the regenerative potential of tissues, especially epithelial tissues. Aim of the study is to evaluate the condition of the gingival epithelium in the area of third molars in children who have to have these teeth extracted for orthodontic reasons, taking into account the stage of tooth formation, i. e. its root.Material and Methods. Third molar extraction for orthodontic indications was performed in 95 children aged 11 to 18 years.Clinical and radiologic examinations were performed in three groups: Group I (n=30) – children aged 11-13 years; Group II(n=35) – children aged 13-16 years, and Group III (n=30) – children aged 16-18 years. During surgery, gingival tissue was taken from the adjacent areas for examination. The material was fi xed, dehydrated, and paraffi n- embedded for histologic processing. Immunohistochemical techniques were performed according to the manufacturer’s protocols. Specifi cally, immunohistochemical detection of Ki-67 antigen was performed with primary antibodies against it. Digital copies of the images were analyzed using the specialized computer program ImageJ v1.52 (freeware, USA). The obtained digital data were statistically processed.The digital data obtained were statistically processed. A preliminary test for normality of the distribution was carried outusing the Shapiro- Wilks method. According to this criterion, the hypothesis of normality of the distribution was not rejectedfor all the statistical samples studied (at the signifi cance level of p=0.05), so we used mainly parametric methods of statistical analysis: calculation of the arithmetic mean and its error, unpaired two-sided Student’s t-test. However, because the statistical samples were small, the non-parametric Mann- Whitney test was used in addition to the Student’s t-test.The study was conducted as part of the complex research work of the Department of Pediatric Dentistry of the Bukovinian State Medical University on the topic «Development of methods of prevention and treatment of the main dental diseases in children, taking into account the risk factors of their development» (state registration number: 0121U110122). The conducted research complied with bioethical norms, as stated in the conclusions of the Bioethics Commission of the Bukovinian State Medical University (№ 1 dated 17.09.2020).Conclusions. Thus, the histological and immunohistochemical study of the gingiva in the area of the third molar allows usto conclude that during the formation of the root of this tooth, a number of changes occur in the epithelial cover of the gingiva, namely: an increase in the number of epithelial layers with a decrease in their proliferative activity. The obtained data indicate a decrease in the regenerative potential of the multilayered squamous epithelium with increasing age of the child and the degree of third molar formation, which is refl ected in the clinical picture of the course of surgical intervention.

Microbiological and Clinical Assessments of Suture Materials and Cyanoacrylate Application in Impacted Third Molar Surgeries: A Scoping Review.

The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing complications. This scoping review aimed to assess the clinical and microbiological aspects of various suture materials and cyanoacrylates. Unlike existing studies, we included more articles and comprehensively compared suture materials. Articles published in languages other than English; duplicate studies; studies deemed irrelevant for the specific research questions, including those analyzing different supplementary treatments or not corresponding to the abstract's content; ex vivo or experimental animal studies; studies lacking approval from an ethics committee; and narrative reviews, systematic reviews, or systematic and meta-analysis reviews were excluded. Thus, only 17 studies, published between 2000 and 2023, were included in the search. Suture techniques varied among surgeons, with debates on primary and secondary closure methods. A comparison of different suture materials and their effects on wound healing, infection rates, and other factors was described. Cyanoacrylate has also been used as an alternative to traditional sutures. Microbiological analysis showed varying bacterial adhesion based on the suture material, with silk sutures retaining more microbes than PTFE sutures. Clinical assessments have revealed differing inflammatory responses that affect wound healing and complications. Cyanoacrylate has emerged as a promising alternative to traditional sutures, owing to its rapid polymerization and early healing. However, the choice of suture material in impacted third molar surgery remains controversial, considering microbiological factors and clinical outcomes. More extensive randomized clinical trials are required to better understand the effect of suture materials on surgical outcomes and potential improvements. This study could enhance the safety and effectiveness of this common oral surgical procedure.