Extraction Of Lower Third Molars Research Articles

Comparison of different flap designs in soft tissues periodontal healing after lower third molars extraction: a descriptive review

The purpose of this descriptive review was to assess post-operative periodontal outcomes of adjacent molar sites after the extraction of lower third molars, comparing different surgical techniques. The electronic search strategy was conducted on different databases (PubMed, Scopus, and Web of Science) fitting the following selection criteria: clinical human studies (RCTs, retrospective and prospective); studies comparing different flap designs (e.g., envelope, triangular, and trapezoidal flaps) for surgical extraction of lower 3rd molars; studies assessing clinical outcomes of periodontal healing at adjacent molar sites. Studies included had to present a minimum follow-up of 1 month and at least variations of probing pocket depth (PPD) at 2nd molar site between baseline and follow-up. The search strategy considered a total of 148 records: based on the predetermined eligibility criteria, 24 articles were read, and 9 were finally identified. Regarding the primary outcome considered (PPD at 2nd molar site), no significant differences in its reduction between baseline and follow-up were found comparing different flaps designs. However, the greatest clinical attachment loss (CAL) was generally reported using a trapezoidal flap. Considering the heterogeneity of studies included, after 1 to 6 months of follow-up, no substantial evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

Revolutionizing orthodontics: Effective management of Class III skeletal malocclusion using innovative buccal shelf bone screws

The advent of the temporary anchorage devices has revised the envelope of discrepancy in modern orthodontic practice. Orthodontic camouflage is opted in situations where the patient is reluctant to have an invasive orthognathic surgical procedure and the associated risks or where, by the use of temporary anchorage devices, the orthodontic envelope can be expanded, and optimal orthodontic result can be obtained non surgically. In such cases, TAD’s can be used to obtain an acceptable orthodontic result with a cusp to fossa posterior relation, an optimal aesthetic outcome, and a functional occlusion. This case report showcases a camouflage treatment of a Class III non-growing patient treated by use of TAD’s, to cause clockwise rotation of maxillo- mandibular occlusal complex for achieving optimum molar relation, facial esthetics, and function.A case of skeletal and Angle’s Class III malocclusion is presented where orthodontic camouflage was carried out to deliver optimal orthodontic results. This was achieved effectively by in toto distalization of the lower arch. This was brought about with the use of two extra alveolar TAD’s placed in the buccal shelf region of the lower arch. Two 2 x 12 mm bone screws were used, after space creation by extraction of lower third molars bilaterally, and elastic chains was the chosen force delivery system. Here in toto distalization of the lower arch was achieved to end in an Angle’s class I molar and canine relationship with normal overjet and overbite. Total treatment duration was of 17 months.Challenging skeletal malocclusions can be treated non surgically by effective use of TAD’s and correct and efficient use of biomechanics.

Edema and Trismus Assessment After Applying Kinesiotape With the Web Strip Technique Compared With Cryotherapy: A Randomized Clinical Trial.

Extraction of impacted third molars is one of the most common oral surgeries performed in the dental clinic, which is often accompanied by many complications such as edema and trismus. Many methods have been used to alleviate these complications, such as drugs or physical therapy. Kinesiotape (KT) has recently spread as a popular physical method for eliminating complications after surgical extraction of lower third molars after its long-term use in sports medicine and injuries of the musculoskeletal system. The current study aimed to study the effect of using KT (Kinesio® Holding Corporation, Albuquerque, NM, USA) on both edema and trismus after impacted third molar extraction. This study was designed as a randomized controlled clinical trial using the split-mouth technique and included 25 patients with radiographically symmetrical lower third molars from patients. All surgical extractions were performed by a single surgeon under sterile conditions according to the standard surgical protocol after that one group applied KT and the other group applied cryotherapy. Edema and trismus were measured in the first five days. Data was collected and analyzed by SPSS software (IBM Corp., Armonk, NY, USA). The mean change in the total linear facial measurements in the experimental group (Kinesio Group) was 12.32 mm three days after surgery, and then this value decreased to 6.80 mm, while the average increase in the control group (Cryo Group) was 17.00 mm after three days, then the value decreased to 9.68 mm five days after surgery. Regarding the changes in the amount of maximum mouth opening after surgery, the results were similar between the Kinesio Group and the Cryo Group, as there were no significant differences between the two groups (P<0.05). This study concluded that KT was superior to cryotherapy when studying edema. The current study also concluded that the mouth opening was similar between the two study groups.

Postoperative Complications of Third Molar Surgical Extraction in a Malaysian Sample

The most common impacted teeth in adults are the mandibular third molars which frequently require surgical extraction. There are many factors contributing to the occurrence of postoperative complications, one of which is surgeon’s experience. Hence, this study aimed to determine the prevalence of postoperative complications of third molar extractions by different level of surgical experience. Methods: A retrospective study was conducted in Kulliyyah of Dentistry, International Islamic University Malaysia. A total of 112 cases were collected from the records of surgical extraction of lower third molars performed by dental students, dental officers and specialists, collected data was transferred into special case sheets and analyzed using IBM SPSS 23. Results: From 112 cases, 64(57.1%) had presented with postoperative complications. The highest prevalence of postoperative complications was in dental students’ group 38 out of 62 patients (61.3%), followed by specialists’ group 20 out of 39 patients (51.3%) and dental officers’ group 6 out of 11 patients (51.6%). Meanwhile, the common complications observed were pain (33.9%), swelling (20.5%), trismus (12.5%), paresthesia (6.3%) and bleeding (3.0%). Conclusions: There is no statistically significant correlation between the postoperative complications and the level of surgeons’ experience.

Como o uso de fibrina rica em plaquetas pode beneficiar as exodontias de terceiros molares mandibulares?

Surgery for the removal of third molars is a surgical procedure commonly performed in Dentistry. It is associated with inflammatory events and possible complications, being more evident after the removal of lower molars, since in most cases there is a need for more invasive approaches. It is essential for the dentist to minimize such effects, providing a more peaceful postoperative period with less morbidity for the patient. In this context, platelet-rich fibrin (PRF) was developed, which is considered a platelet aggregate obtained by centrifugation of the patient's own blood and proposes to minimize inflammatory effects, accelerate healing and repair processes, and reduce postoperative complications. A literature review on the effect of L-PRF in sockets after the removal of mandibular third molars was conducted, evaluating its efficacy on pain, swelling, trismus, and healing. A bibliographic survey was performed on the PubMed, Web of Science, and Elsevier databases, using the following descriptors: 'platelet rich fibrin', 'third molar', and 'surgery', limiting to articles written in English published from 2013 to 2023. Thus, we have a current scientific overview of the real effect of using this platelet aggregate in the extraction of lower third molars. The studies reviewed, for the most part, showed positive results in improving pain, swelling, trismus, and healing.

Oral maxillofacial surgeons and Orthodontists' perceptions about anterior inferior crowding and indications of mandibular third molar extraction.

There are still many doubts about anterior inferior crowding and indications of mandibular third molar extraction, although it is very studied subject in the literature. The aim of this study was to evaluate the perceptions of oral maxillofacial surgeons (OMFSs) and orthodontists about anterior inferior crowding and indications of mandibular third molar extraction. A web-based survey was developed and sent to professionals in order to collect their opinion about the fact that third lower molars cause crowding and questions about the indication of third molars for orthodontic treatment. Descriptive analysis was performed and Chi-square or G tests were applied with a 95% confidence interval. The study included a total of 218 participants, of whom 115 were OMFSs and 103 were orthodontists. The results showed that 56.5% of OMFSs and 35.0% of orthodontists believe that the lower third molars cause anterior inferior crowding (p<0.001). A total of 91.3% of OMFSs and 70.9% of orthodontists indicate the extraction of lower third molars to aid orthodontic treatment (p<0.001). It can be concluded that in being an oral maxillofacial surgeon, a higher odds ratio is observed to consider that lower third molars cause dental crowding compared to those who are orthodontist. The indication of exodontia of lower third molars for orthodontic treatment was more frequent among OMFSs when compared to orthodontists.

Depth and proximity of third molars to the inferior alveolar canal in panoramic radiographs of a Latin American population

Introduction: extraction of lower third molars involve the possible occurrence of complications such as injury of the content of the Inferior Alveolar Canal. Methods: a cross-sectional study was conducted with a sample of 6488 lower molar records of digital panoramic radiographs of patients from 6 Latin American countries from 2010-2015. The variables studied were the depth of lower third molar according to the Pell and Gregory classification, and the proximity of a third molar to the Inferior Alveolar Canal that was evaluated according to the proposed classification, based on a modification of the Langlais et al classification.20 Descriptive and bivariate statistical analyses were performed. Results: in terms of the proximity, the highest frequency was Intact with 27.45%(n=1781). Regarding the depth of the lower third molar, the most frequent were the Position B with 46.90%(n=3043) and Position A with 46.75%(n=3033). The proximity and depth of the lower third molar had statistical difference according to age(p&lt;0.01) and sex (p&lt;0.001). The overall proximity of the lower third molar to the Inferior alveolar canal, according to depth was 37.52%(n=1766) in Position A, in Position B it was 54.51%(n=2566) and Position C was 7.97%(n=375) and had association between variables(p&lt;0.001). Conclusions: taking into consideration the modified classification of Langlais et al.20, lower third molars are close to the Inferior Alveolar Canal, and according to the Pell and Gregory classification for the depth, the most frequent positions are A and B. In addition, proximity and depth were associated with each other, and with the co-variables country, age, and sex.

Effectiveness of the use of therapeutic bandage method in the third molar surgery: a randomized, controlled, single-blind, split-mouth

Objective: Extraction of semi-impacted or impacted, lower, third molars is one of the most performed procedures in the maxillofacial surgery, and inherent to it, there may be post-operative inflammatory response. Among the most common factors related to this response, pain, swelling, and trismus are the main ones. In this sense, therapeutic bandage has been used in the post-operative physiotherapy for several specialties so that muscular functions can be fully resumed and swelling, muscle spasms and pain reduced. Materials and Methods: The randomized, split-mouth, clinical trial was to assess 20 post-operative patients who underwent extraction of lower third molars with therapeutic bandage. Seven days after the extraction, swelling and trismus were the variables evaluated and pain was assessed according to the visual analogue scale (VAS). The Student’s t-test was used for comparison at significance level of 5% (α = 0.05). Results: With the results found, it was not possible to state that the therapeutic bandage protocol used in this study, given the evaluated signs and symptoms, were favorable, even providing greater comfort to patients. Conclusion: Therefore, we suggest that further studies should be performed in order to develop a protocol for application of therapeutic bandage for stomatognathic system. Clinicaltrials.gov NCT03393533. 12/05/2017 retrospectively registered.

Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal.

The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars. Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7. Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction. Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.

Effect of concentrated growth factor (CGF) on postoperative sequel of completely impacted lower third molar extraction: a randomized controlled clinical study

BackgroundThe surgical extraction of impacted third molars is one of the most common procedures in oral and maxillofacial surgery, which associated with several postoperative complications. The aim of this clinical trial was to estimate the implication of concentrated growth factor (CGF) on postoperative sequelae after the completely impacted lower third molar extraction.Materials and methodsA total of 74 sides of 37 participants who had completely bilateral impacted lower third molars were enrolled in this split-mouth, randomized single‑blind, clinical trial. Surgical extraction was undertaken on both sides of the mandible. Randomization was achieved by opaque, sealed envelopes. The postoperative outcomes including wound healing, swelling and pain were clinically assessed at different-time intervals(1st, 3rd and 7th days). A p-value < 0.05 was considered statistically significant.ResultsThe wound healing index was significantly better in the test sides (P = 0.001). Regarding the facial swelling, the test sides had significantly less values than the control sides, particularly on the 1st (1.01 ± .57 vs. 1.55 ± .56) and 3rd days (1.42 ± 0.8 vs. 2.63 ± 1.2) postoperatively. Nonetheless, the swelling was disappeared within the 7th day in both sides. The pain scores of visual analog scale were no a statistically significant difference between both sides on the 1st day, meanwhile, the pain scores were significantly lower in the test sides compared with the control sides, especially on the 3rd (P = 0.001) and 7th days (P < 0.001) postoperatively.ConclusionThe application of CGF following the surgical extraction of lower third molar has accelerated the healing of soft tissues as well as reduced postoperative sequelae such as swelling and pain. Therefore, the CGF could be promoted among clinicians during the lower third molar surgical extraction.Trial registration: This study was registered with the TCTR identification number TCTR20210325002 on 25/03/2021 at Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF). Also it was ethically approved from the institutional ethics committee at the Hospital of Stomatology, Xian Jiaotong University, Xian, China (No: 032), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.

Periodontal Healing after Lower Third Molars Extraction: A Clinical Evaluation of Different Flap Designs.

Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

Influence of the anesthetic modality on the development of neurological injury after lower third molar extraction: A systematic review of the literature.

The aim of this study was to determine if the risk of neurological injury to the inferior alveolar nerve (IAN) and the lingual nerve (LN) following the extraction of lower third molars is affected by the anesthetic modality (local anesthesia (LA) vs. general anesthesia (GA)). A systematic search was performed through the PubMed, Scopus, Cochrane Library, and Web of Science databases; furthermore, a manual search was performed by analyzing the references of full-text articles. From a total of 309 studies (collected after the removal of duplicates), 6 studies were selected. Of these, 4 reported a correlation between GA and nerve damage, while the other 2 did not show an obvious association. The level of bias in the studies was also calculated. Only 2 studies showed a medium risk of bias, while 4 studies showed a high risk of bias; no study showed a low risk of bias. Four of the 6 studies highlighted a higher incidence of IAN and LN injury following the extractions performed under GA. Although no scientific evidence is yet available, due to the scarcity and the limited quality of the studies in the literature, considering the risk–benefit ratio, LA should be the first choice in lower third molar surgery.

Effect of the association of infra-red and red wavelength photobiomodulation therapy on the healing of post-extraction sockets of third lower molars: a split-mouth randomized clinical trial.

The aim of this study was to evaluate the effect of photobiomodulation therapy (PBMT) with the association of red and infra-red laser therapy in the healing of the post-extraction sockets of third lower molars. Twenty patients were submitted to extraction of lower third molars and the post-extraction sockets were treated using two different approaches in a randomized split-mouth design: The test side received the PBMT with red (λ 660nm) and infra-red laser therapy (λ 808nm) and the control side was not irradiated. The PBMT was applied immediately and 3 and 7days after the surgical procedure. Post-extraction socket healing was assessed by the bone repair score, bone density, and fractal dimension analysis 7 and 90days after the surgical procedure, using cone-beam computed tomography images. Additionally, clinical analyses were performed 3, 7, 14, 30, and 90days after the surgical procedure, considering the occurrence of pain, edema, and bleeding, as well as the quality of the oral mucosa repair, assessed using a visual analogue scale. The clinical analysis showed that PBMT reduced edema and improved the repair of oral mucosa at 7days after surgery, while the tomographic analysis showed no significant differences between groups. Dual-wavelength PBMT improved the post-operative clinical course in patients undergoing lower third molar extraction, without altering bone repair.

Effectiveness of Laser Therapy and Laser Acupuncture on Treating Paraesthesia After Extraction of Lower Third Molars

Objective: This randomized clinical trial evaluated the sensitive return of the lower alveolar nerve (LAN) using two photobiomodulation therapy (PBMT) techniques, after the extraction of lower third molars or implant surgery. Materials and methods: Sixty participants with sensory impairment of LAN were randomly divided into three groups (n = 20): group C-systemic medication (control-ETNA®, 01 capsule, 8/8 h, 30 days); group laser therapy (LT) (808 nm, 100 mW, 40 sec/point, 4 J/point, intra/extraoral, irradiation following nerve path); group laser acupuncture (LA) (same parameters as the LT group, applied at six acupuncture points on the affected side (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). The following evaluations were performed, at predetermined times: general perception of paresthesia, thermal perception, vibratory mechanical perception, two-point discrimination, pain perception, and tactile perception. Data were analyzed by two-way analysis of variance (ANOVA), followed by the Tukey, except for the two-point discrimination, which was analyzed using the chi-square test. Results: In general and thermal perception, both PBMTs had better results than control; regarding cold perception, only the LT group was statistically superior to control. LA presented inferior results of neural regeneration for tests of perception of pain and tactile at the lip, and of tactile perception at the chin. In the other tests, there was no statistical difference among the groups. Conclusions: LT and the conventional drug treatment had the same effectiveness and both were superior to LA for the treatment of paresthesia of the LAN after oral surgeries.

Knowledge Attitude and Practice of General Practitioners and Interns Toward Late Mandibular Incisors Crowding; A Cross sectional study in Saudi Arabia.

Objective: This study aimed to assess and compare the knowledge and awareness of dental interns and general practitioners in Saudi Arabia about late mandibular incisor crowding. Materials and methods: This is a cross-sectional study which was conducted between June 2020 and July 2020 in Saudi Arabia and it observed dental practitioners. Results: A total of 275 subjects were included in this study; 172 (62.5%) were dental interns, 157 (57.1%) were females and 211 (76.7%) dentists were aged between 23-26 years. While most general practitioners and dental interns have heard about late mandibular incisors crowding, the majority continue to abstain from not recommending extraction of lower third molar as a means of prevention. Around half of the respondents, 134 (48.7%), claimed that the eruption of lower third molars is a possible causative factor. A greater percentage of general dental practitioners, 32 (31.1%) believed that there is a correlation between late mandibular incisors crowding and cases of relapse after an orthodontic treatment. Moreover, male participants were more knowledgeable of the fact that cases may worsen if not treated (P = 0.019). The knowledge of lower third molars eruption (P = 0.002) and unerupted/impacted lower third molars (P = 0.034) ability to cause late mandibular incisors crowding and the prophylactic extraction of the lower third molars (P = 0.009) were also significantly differed across the various age groups. Conclusion: Late mandibular incisor crowding is one of the main clinical issues in dental practice which has been subject to decreased awareness among dentists. Keywords:Dentists, knowledge, late mandibular incisor crowding, Saudi Arabia.

Novel strategy to predict high risk of inferior alveolar nerve injury during extraction of lower third molars based on assessment of computed tomographic images of multiple anatomical features

Preoperative assessment is essential to prevent inferior alveolar nerve (IAN) injury during surgical extraction of the lower third molar (LM3). Here, we aimed to establish an assessment system to predict IAN injury during surgical extraction of the LM3. We conducted a retrospective cohort study on 115 patients diagnosed as ‘high-risk’ based on our previous risk assessment method involving three anatomical features of the inferior alveolar canal using computed tomographic (CT) images. We evaluated the occurrence of neurosensory impairment in these high-risk patients, and its association with novel anatomic features based on CT images. Neurosensory impairments were observed in 19 patients (16.5%). The inferior alveolar canal major diameter (p < 0.0001) and lingual bone thickness (p = 0.0039) were significantly associated with the occurrence of neurosensory impairment during LM3 extraction. Receiver operating characteristic curves were used to determine cut-off values of these quantitative factors to specifically predict IAN injury. Preoperative risk assessment with quantitative factors based on anatomical features observed on CT images may facilitate more appropriate surgical planning for patients at a high risk of IAN injury.

Is the role of Coronectomy procedures expanding?

Extractions of lower third molars carry risk to the inferior alveolar nerve (IAN), varying from 0.42% to 7.8%. Risk varies between the operating skills of individuals. The cost of medicolegal litigation settlement in these cases have been sky rocketing. Coronectomy is an alternative procedure increasingly accepted world-wide to reduce the risk of nerve injuries. Increasing use of cone beam computed tomography (CBCT) aids assessment of the relationship of the IAN and roots in providing treatment planning to reduce the risk of nerve trauma. This retrospective study presents, patients who underwent coronectomy from 2012-2020 and analyses the post-coronectomy pain, migration of roots and follow-up of patients with comorbidities and/or decayed teeth. A total of 5,497 lower third molars were removed. In the cohort of 1,543 (28.06%) teeth removed in outpatient under local anaesthesia, 109 (1.98%) were coronectomies and of 3,954 (71.93%) removed under general anaesthesia, 305 (5.54%) were coronectomies. The outcome of this study demonstrates: ● coronectomy is a safe and viable technique for the surgical management of wisdom teeth at high risk of neurosensory loss. ● Intra pulpal deposition of local anaesthetic intraoperatively reduced the post coronectomy pain significantly. ● The modification in surgical technique does reduce the post-surgical complications such as wound dehiscence. ● Migration of roots does occur but to quantify the amount is challenging. ● Follow-up results with patients with comorbidities and decayed teeth are encouraging and wider acceptance need to be seen in future.

Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis.

The aim of this study is to verify whether the diagnostic accuracy of cone beam computed tomography (CBCT) is superior to panoramic radiography (PR) in predicting inferior alveolar nerve (IAN) exposure during the lower third molar extraction. Eight electronic databases were searched up to September 2020. Studies that evaluated the accuracy (sensitivity, specificity, positive-predictive value, and negative predictive value) of both imaging methods were included. The gold standard was the visualization of the IAN exposure during the extraction of lower third molars. The gray literature was also used to include any other paper that might meet the eligibility criteria. The meta-analysis was performed with OpenMeta-Analyst and ReviewManager v.5.3 software. The methodology of the studies was evaluated using QUADAS-2. Among the search, three studies met all the eligibility criteria and were included in the qualitative and quantitative synthesis. The meta-analysis was conducted with all included studies. Accuracy values for CBCT were 95.1% for sensitivity (p=0.666) and 64.4% for specificity (p<0.001). For PR sensitivity and specificity, we observed 73.9% (p=0.101) and 24.8% (p<0.001), respectively. Both exams were reliable for detecting positive cases of exposure of the IAN. However, CBCT had a better performance compared to PT in predicting IAN exposure during surgery. To better understand the CBCT accuracy in predicting the IAN exposure during surgery, since this event can increase the likelihood of IAN injury and, consequently, cause neurosensory disturbances.

Comparison of using platelets rich fibrin versus mineralized plasmatic matrix platelets concentrates after surgical extraction of lower third molar.

Abstract Objectives: this current study attempted the evaluation of the effect of using platelets rich fibrin and mineralized plasmatic matrix platelets concentrates after surgical extraction of lower third molar. Materials and Methods: A total of 40 requiring extraction of at least one mandibular non-restorable impacted wisdom tooth. (n=40). The samples were divided into two main groups (20 each) (Group A) extraction of mandibular impacted wisdom tooth and socket was filled using platelets rich fibrin (PRF) and (Group B) extraction of mandibular impacted wisdom tooth with application of mineralized plasmatic matrix (MPM) and platelet-rich fibrin for socket preservation. Participants were evaluated at 1st, 3rd and7th day, 6 months postoperative. Data were statistically analyzed using IBM SPSS software version 20.0. (Armonk, NY: IBM Corp). Results: This study showed At 7th day, MPM group showed a significant higher maximum mouth opening measurement than PRF group. At 6 months, postoperatively MPM group showed a significant higher bone density measurement than PRF group and showed a less percentage of change in density measurement than PRF group. Conclusion: MPM not only enhances the rate of new bone formation, but also increases the quality (density) of the newly formed bone

Do immediate intramuscular co-administration of diclofenac and dexamethasone or extraoral ice pack application have any influence on pain perception and oral health related quality of life (OHRQoL) following trans-alveolar extraction of impacted mandibular third molars? A comparative study in a Saudi Arabian sub-population

Pain perception and QoL are fundamental enquiries patients wants to know regarding trans-alveolar extraction of lower third molar. The current study hopes to compare the influence of co-administration of diclofenac+dexamethasone and icepack on pain and QoL after trans-alveolar surgery of lower third molar. This was a prospective study of patients referred for trans-alveolar extraction of mandibular third molar teeth under local anesthesia. Patients were randomly assigned into Group A (co-administered IM Dexamethasone 8 mg and IM Diclofenac 75 mg in office) and Group B (ice packs extra-orally). Assessment of pain was carried out using the numerical pain rating scale. Validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHRQoL) was used to evaluate the QoL pre and on the POD's. A total of 78 patients equally distributed into Groups A and B were the study participants. The mean age was 31.6 ± 6.4 years (Group A: 32.5 ± 5.5 and Group B: 30.8 ± 7.2, range 20–48years). The M:F ratio was 1:1.1. Better pain reduction was observed in Group A which became significant (p = 0.019) on POD 3. Domain scores was better in the Group A patients at the body function level (p = 0.016) and personal level (p = 0.013) at POD 1 and body function level (p = 0.044) at POD 3. Overall QoL scores was also better in the Group A with significant difference (p = 0.025) on POD 1. Pain perception, domain and overall QoL scores continues to improves throughout the review period with better improvement in the Group A.