Extraction Of Lower Third Molars Research Articles

The Effects of Transcutaneous and Intraoral Low-Level Laser Therapy After Extraction of Lower Third Molars: A Randomized Single Blind, Placebo Controlled Dual-Center Study.

The surgical removal of impacted third molars is one of the most common procedures performed by oral and maxillofacial surgeons. The purpose of this study is to determine whether either transcutaneous or intraoral low-level laser therapy (LLLT) reduces postoperative pain and assists in the healing of mandibular third molar extraction. This randomized, placebo controlled, single-blind, split-mouth design study was conducted on 60 patients with full bony impacted similar position mandibular third molars bilaterally. The patients were divided into two groups of 30 each: transcutaneous LLLT and intraoral LLLT and the other side of each group treated with nonactive laser (60 teeth). The laser treatment consisted of administering laser energy immediately before and after the extraction procedure with gallium aluminum arsenide (GaAlAs) 830 nm diode lasers. Postoperative pain and healing of the sockets were compared in transcutaneous and intraoral group with placebo for 1 week following the extraction. Descriptive and bivariate statistics was computed, and the p-value was set at 0.05. Intraoral LLLT application resulted in a statistically significant reduction of postoperative pain in comparison with transcutaneous laser group and placebo. The unhealed socket numbers were compared in two groups at seventh day and no differences were observed. The results of this study suggest that single-session intraoral LLLT is more effective than extraoral application for reducing postoperative pain. It was postulated that the differences between skin and mucosa could have effect on the results. Although intraoral use would allow closer application to the surgical site, the size of some laser devices precludes their use intraorally.

Coronectomy revisited

As an alternative to extraction of lower third molars with an established high risk to the inferior dental nerve coronectomy offers a safe alternative. The evidence that is emerging is quite positive and in general shows good outcomes when compared to extraction. As there is less radiation associated with cone-beam computed tomography (CT) than standard CT it has become more justifiable to assess third molars using this technology. This has allowed more accurate assessment of third molars and therefore it is likely in time coronectomy will become a much more routine procedure. Further research is required as there is little evidence in terms of long-term studies. The present study presents my experience of coronectomies performed under local and general anaesthetics. This paper also discusses the changes in indications as well as the procedure outlined in the past literature.

Masseter and temporalis muscle electromyography findings after lower third molar extraction.

BackgroundThe main clinical application of electromyography is to detect abnormalities in muscle function, to assess muscle activity for purposes of recruitment, and in the biomechanics of movement.ObjectivesTo analyze electromyography (EMG) findings for masticatory muscles during chewing following surgical extraction of lower third molars, and to determine any correlation between pain, inflammation, trismus, and the EMG data registered.Material and MethodsThis prospective study included 31 patients. Surface EMG was used to study masseter and temporalis muscle function before lower third molar extraction and 72 hours and seven days after surgery. Clinical variables, pain, inflammation, and trismus were registered before and after surgery.ResultsStudying the area and size of the masticatory muscles, higher values were found for temporalis than masseter muscles, regardless of the surgical side, which points to the greater involvement of the temporalis muscle in mastication. Comparing the side where surgery had been performed with the non-surgical side, a sharp and statistically significant reduction in amplitude and area were noted on the surgical side reflecting major functional affectation. One week after surgery, amplitude and area had almost returned to base-line values, indicating almost complete recovery. While pain decreased progressively after surgery, inflammation peaked at 72 hours, while mouth opening reached a minimum at this time, returning to normality within the week.ConclusionsSurgical extraction of lower third molars produces changes to electromyography activity that are more evident during the first hours after surgery and closely related to the intensity of pain suffered and the patient’s inflammatory responses, although they are not related to mouth opening capacity. Key words:Third molar surgery, electromyography, pain, inflammation, trismus, masticatory muscles.

Effect of pre-operatory low-level laser therapy on pain, swelling, and trismus associated with third-molar surgery.

BackgroundThe extraction of impacted third molars is commonly associated to pain, edema, trismus, limited jaw opening and movements. The aim of this retrospective study is to verify if pre-surgical low-level laser therapy (LLLT) associated with the extraction of impacted lower third molars could add benefits to the postoperative symptoms respect LLLT performed only after surgery.Material and MethodsData from 45 patients subjected to a surgical extraction of lower third molars were pooled and divided into three groups. Patients that received only routine management were inserted in the control group. Group 1, were patients that received LLLT immediately after surgery and at 24 hours. In group 2 were included patients treated with LLLT immediately before the extraction and immediately after the end of the procedure. Data were analyzed using linear regression and descriptive statistics.ResultsBoth laser-treated groups were characterized by minor events of post-surgery complications of pain, edema, trismus. The use of NSAIDs in the first 24 hours was significantly inferior in Group 2.ConclusionsPre-surgical LLLT treatment seems to increase the analgesic effect of LLLT. However, trismus and edema were reduced in both laser treated groups, independently from the period of irradiation. Key words:Laser, LLLT, pain, surgery, extraction, third molars, wisdom teeth.

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

Aim:The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar.Materials and Methods:Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome.Results:Parameters assessed in this study were – mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1st, 3rd, and 7th postoperative day. Comparing both groups pain scores with (P < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference (P = 0.002).Conclusion:The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery.

Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study.

Background. Different surgical variables are assumed to play a role in postoperative course after lower third molar extraction. The aim of study was to assess whether flap design and duration of surgery can influence acute postoperative symptoms and signs after lower third molar extraction. Methods. Twenty-five patients scheduled for lower third molar extraction were included in this study and randomly assigned to two groups in terms of flap design: group A (envelope flap) and group B (triangular flap). Swelling and trismus were assessed before and after surgery on days 0, 2 and 7. Pain was assessed for seven days after surgery. Maximum postoperative pain was chosen as the main outcome variable. ANOVA was used to assess differences between the groups regarding maximum postoperative pain, trismus and swelling at 2- and 7-day intervals. Pearson's correlation coefficient was used to assess correlation between duration of surgery and postoperative symptoms and signs. Results. No significant difference was found between the two flap designs for any postoperative symptoms and signs. The duration of surgery was found to be correlated with both trismus (r = -0.44, P = 0.04) and swelling (r = 0.59, P = 0.004) as assessed 2 days after surgery. No associations were found between duration of surgery and maximum postoperative pain and trismus and swelling at 7-day interval. Conclusion. Within the limits of the present study, the duration of surgery, and not the flap design, affected the acute postoperative symptoms and signs after lower third molar extraction.

Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses.

Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years. Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson's Chi-square, Fisher's exact, or Mann-Whitney U-tests as appropriate. P <0.05 was considered statistically significant. The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648). Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.

下顎第三大臼歯抜去を契機に発見された下顎骨動静脈奇形の1例

下顎第三大臼歯抜去を契機に発見された下顎骨動静脈奇形の1例

Orthodontic extrusion with followed surgical extraction of high-risk lower third molar

lower third molar with sings that indicates high risk of postoperative complications. Materials and methods: We represent an orthodontic extrusion followed by surgical extraction of lower third molar. For precise diagnostics and approach to suitable method of treatment we used standard panoramic radiograph and CBCT. As a method of surgical treatment we chose assisted orthodontic extraction with individually manufactured ring with soldered bar, fixed to tooth 47. Results: In our clinical case we achieved traction of the impacted lower third molar to safe distance from the mandibular canal. On the second stage of the treatment we performed a classic odontectomy without affect or damaging the IAN. Conclusion: The classic odontectomy is surgical method with high risk of damaging the IAN when the impacted tooth is very close to the mandibular canal. The orthodontic extraction like an alternative surgical method of high-risk lower third molars is preventive method, by which there is minimal risk of damaging the nerve during the surgery. The orthodontic extrusion makes the following surgical extraction a safe and secure method for the patient.

Are different imaging methods affecting the treatment decision of extractions of mandibular third molars?

To find the differences between treatment decisions of lower impacted third molars among experts of oral and maxillofacial surgery according to panoramic radiographic and CBCT findings. A retrospective analysis of 62 panoramic radiographs and CBCT of lower third molars evaluated for treatment decisions by 9 independent experts of oral and maxillofacial surgery. Differences in interpretation of the panoramic radiography were found between surgeons. The absence of radiological signs suspected for risk to the inferior alveolar nerve lead to the decision of extraction according to panoramic radiography without CBCT (p < 0.01). The presence of those signs lead to referral to CBCT by surgeons before treatment but did not change their decision. Treatment decision for surgical treatment of the lower third molar can be accepted without CBCT findings. The use of CBCT is popular before extraction of lower third molars. We found that it has a little effect on the treatment decision of the surgical intervention in comparison to panoramic radiography.

Concentration of secretory sIgA immunoglobulin in saliva of patients following surgical extraction of lower third molar and application of a cycle of laser biostimulation treatments

Concentration of secretory sIgA immunoglobulin in saliva of patients following surgical extraction of lower third molar and application of a cycle of laser biostimulation treatments

Clinical effects of platelet-rich fibrin (PRF) following surgical extraction of lower third molar

Abstract Objective The purpose of this study was to assess the effect of platelet-rich fibrin (PRF) on postoperative pain, analgesic consumption, soft tissue healing and socket complications following the extraction of mandibular third molars. Methods A total number of 50 impacted third molars were surgically removed from 47 patients (13 males and 34 females; with a mean age of 25.24 ± 7.04 years). PRF clots were placed in the extraction sockets of patients included in the study group, while the sockets remained empty in the control group. The variables assessed were pain, analgesic consumption, soft tissue healing and socket complications encountered during the first postoperative week. Results In the study group, a significantly less pain was recorded in the fifth, sixth and seventh postoperative days ( P = 0.041, 0.031 and 0.005 respectively). Patients included in the study group also significantly consumed less analgesics for the second, third, sixth and seventh postoperative days ( P = 0.019, 0.039, 0.045 and 0.020 respectively). PRF significantly reduced the incidence of alveolar osteitis ( P = 0.037) but not the infected or inflamed sockets ( P = 1.00 and 0.312 respectively). No significant difference was observed between PRF and control groups regarding soft tissue healing ( P = 0.187). Conclusion PRF could reduce alveolar osteitis, pain, and analgesic consumption following removal of impacted mandibular third molars.

Comparative Assessment of the Effect of Ibuprofen and Etodolac on Edema, Trismus, and Pain in Lower Third Molar Surgery: A Randomized Clinical Trial

To compare the efficacy of ibuprofen (IBU) and etodolac (ETO) for controlling pain, edema, and trismus after extraction of lower third molars. Twenty adolescents and adults with 2 impacted mandibular-third molars (in similar positions) were selected for the study. Patients were randomly assigned either to the IBU group (600mg of IBU 3 times a day for 3days) or to the ETO group (300mg of ETO 3 times a day for 3days). Drugs were administered immediately after dental extraction. During the first 2days after extraction, swelling was more pronounced in the IBU group than in the ETO group (P= .033). Seven days after surgery, there was no difference in the degree of edema between the groups. At the 2- and 7-day evaluation points, mouth opening was significantly more reduced in the IBU group than in the ETO group (P < .05). After the first 6hours, the ETO group had more effective pain relief (P < .05), but after this time point, both groups reported similar degrees of relief. Compared with the IBU group, the ETO group had a lower need for administration of additional rescue analgesics. After extraction of impacted lower third molars, we found that swelling, trismus, and pain were more effectively controlled with ETO than with IBU.

Electromyographic Study of the Masseter Muscle After Low-Level Laser Therapy in Patients Undergoing Extraction of Retained Lower Third Molars

La cirugia para extraccion del tercer molar mandibular retenido es uno de los procedimientos mas realizados en el campo de la cirugia maxilofacial. Durante este procedimiento, el trauma quirurgico puede causar dano a la funcion de los musculos involucrados en los movimientos mandibulares, entre ellos el musculo masetero. Con el objetivo de acelerar la recuperacion postoperatoria, son utilizados muchos recursos de fisioterapia, incluyendo la terapia con laser. El objetivo de este estudio fue analizar la actividad electrica del musculo masetero tratado con laser de baja intensidad (LBI) despues del trauma quirurgico. Se realizaron evaluaciones del musculo masetero en una muestra de 60 pacientes, a traves de electromiografia de superficie en cuatro momentos: preoperatorio inmediato, postoperatorio a los 7, 14 y 21 dias. Los pacientes fueron divididos en dos grupos: 1 - grupo no tratado con LBI en el postoperatorio; 2 - grupo tratado con LBI (810 nm; 10 J/cm2) en el postoperatorio inmediato y a los 3, 6 y 9 dias tras cirugia. Al septimo dia tras cirugia el 23,3 % de los pacientes del grupo tratado con LBI presentaron recuperacion de su actividad muscular equivalente a lo presentado en el preoperatorio inmediato, frente a solo el 3,3 % del grupo no tratado. En el dia 14, el 73,3% de los pacientes tratados presentaron rehabilitacion funcional, frente al 6,7% del grupo no tratado y en el vigesimo primer dia, el 80% frente al 10% del grupo no tratado. En el dia 14 postoperatorio la actividad electrica del musculo masetero tratado con LBI despues del trauma quirurgico fue compatible con una condicion de recuperacion funcional completa. Los hallazgos de este estudio electromiografico indicaron que el LBI es un eficiente metodo fisioterapico para estimular la recuperacion funcional del musculo masetero tras cirugia de terceros molares mandibulares retenidos.

Predictive factors of difficulty in lower third molar extraction: A prospective cohort study.

BackgroundSeveral publications have measured the difficulty of third molar removal, trying to establish the main risk factors, however several important preoperative and intraoperative variables are overlooked.Material and MethodsA prospective cohort study comprising a total of 130 consecutive lower third molar extractions was performed. The outcome variables used to measure the difficulty of the extraction were operation time and a 100mm visual analogue scale filled by the surgeon at the end of the surgical procedure. The predictors were divided into 4 different groups (demographic, anatomic, radiographic and operative variables). A descriptive, bivariate and multivariate analysis of the data was performed.ResultsPatients’ weight, the presence of bulbous roots, the need to perform crown and root sectioning of the lower third molar and Pell and Gregory 123 classification significantly influenced both outcome variables (p< 0.05).ConclusionsCertain anatomical, radiological and operative variables appear to be important factors in the assessment of surgical difficulty in the extraction of lower third molars. Key words:Third molar, surgical extraction, surgical difficulty.

Postsurgical consequences in lower third molar surgical extraction using micromotor and piezosurgery

Background:One of the most critical and crucial steps in surgical extraction is cutting the bone or osteotomy, for which many techniques are used, e.g., chisels and mallet, rotary instruments, and ultrasound bone-cutting instruments. If they are not used judiciously, they can be hazardous.Objectives:To assess the efficiency of piezosurgery unit over micromotor while performing surgical extraction of lower third molars by assessing the time taken for the surgery and measuring postoperative parameters such as pain, trismus, and swelling.Materials and Methods:Thirty patients having bilateral impacted third molars with the same difficulty index were selected for the study. One side surgical removal was done using micromotor and other side by piezosurgery with an interval of 15 days. After each surgery, time taken to finish was measured and patients were followed up on postoperative days 1, 3, 5, 7, and 15 for assessing pain, trismus, and swelling. Data obtained were statistically analyzed.Results:The mean time taken for the micromotor group is 37.90 min whereas by the piezosurgery group is 54.63 min, showing a statistically significant difference (P < 0.001). Furthermore, there is statistically significant difference (P < 0.001) in the level of pain, trismus, and swelling on postoperative days 1, 3, 5, and 7. Even the intragroup comparison of piezosurgical group for trismus and swelling showed no statistically significant difference on postoperative day 7, indicating faster recovery of trismus and swelling. On postoperative day 15, there was no difference in any parameter in both groups indicating complete symptom-free recovery in both groups.Conclusion:It takes more time to perform surgical extraction of third molars when piezosurgical unit is used. Despite that, it causes less pain postoperatively with faster improvement in trismus and quicker reduction in swelling.

Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature.

BackgroundCoronectomy is an alternative to complete removal of an impacted mandibular third molar. Most authors have recommended coronectomy to prevent damage to the inferior alveolar nerve during surgical extraction of lower third molars. The present study offers a systematic review and metaanalysis of the coronectomy technique.Material and MethodsA systematic review and meta-analysis was performed based on a PubMed and Cochrane databases search for articles published from 2014 and involving coronectomy of mandibular third molars located near the inferior alveolar nerve canal, with a minimum of 10 cases and a minimum follow-up period of 6 months. After application of the inclusion and exclusion criteria, a total of 12 articles were included in the study.Results and DiscussionCoronectomy results in significantly lesser loss of sensitivity of the inferior alveolar nerve and prevents the occurrence of dry socket. No statistically significant differences were observed in the incidence of pain and infection between coronectomy and complete surgical extraction. After coronectomy, the remaining tooth fragment migrates an average of 2 mm within two years.ConclusionsCoronectomy is indicated when the mandibular third molar is in contact with the inferior alveolar nerve and complete removal of the tooth may cause nerve damage. Key words:Coronectomy, included third molar, inferior alveolar nerve injury.

Effectiveness of intra-alveolar chlorhexidine gel in reducing dry socket following surgical extraction of lower third molars. A pilot study.

BackgroundDry socket is one of the most studied complications in dentistry and several studies have sought an effective and safe method for its prevention and treatment. The aim of this study was to evaluate the effectiveness of intra-alveolar gel chlorhexidine in preventing dry socket after the surgical removal of third molars.Material and MethodsThe sample involved the treatment of 40 patients who required extraction of third molars impacted, which were randomly assigned to research groups: experimental group (chlorhexidine gel 0.12%) and control group (placebo gel). Performed the extraction was administered 1 mL of chlorhexidine gel or 1 mL of placebo gel within the socket. The removal of suture was on the fifth postoperative day in which the presence or absence of dry socket was evaluated.ResultsNo relationship between the appearance of dry socket after application of chlorhexidine gel or placebo gel (X2 test, p = 0.311) was found. However, significant differences (U Mann-Whitney test, p = 0.036) in the pain presented on the fifth postoperative day were evident (VAS).ConclusionsThe administration of intra-alveolar chlorhexidine gel 0.12% could generate a better response to postoperative pain after the removal of third molars. Key words:Third molar surgery, dry socket, chorhexidine gel.

A Systematic Review on Effect of Single-Dose Preoperative Antibiotics at Surgical Osteotomy Extraction of Lower Third Molars

We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of a single dose of preoperative antibiotic administered perorally, intravenously, intramuscularly, or topically for preventing infection and alveolar osteitis in lower third molar surgical extraction applying osteotomy. The Medline, Cochrane Library, and Embase databases were searched for RCTs until August 2015. The primary outcome measure was postoperative inflammatory reactions, with a subgroup analysis of surgical site infection (SSI) and alveolar osteitis. A risk-of-bias assessment of the included trials was done according to the Cochrane guidelines. A total of 53 RCTs were identified; however, only 10 could be included in the present review. A meta-analysis of the 10 trials showed a statistically significant reduction in SSI and alveolar osteitis when antibiotics had been used (odds ratio [OR] = 0.30; 95% confidence interval [CI], 0.19 to 0.47; P ≤ .00001). A subgroup meta-analysis of 6 trials showed that preoperative administration of antibiotics perorally or intravenously significantly reduced the incidence of SSI (OR = 0.19; 95% CI, 0.08 to 0.45; P = .0002). A meta-analysis of 5 trials showed that 2 g of preoperative oral amoxicillin was able to reduce the incidence of SSI and the difference was statistically significant (OR = 0.22; 95% CI, 0.08 to 0.59; P = .002). Seven trials reported on alveolar osteitis, 6 studies on oral use, 2 studies on amoxicillin, 2 on metronidazole, 2 on penicillin V, and 1 on the intravenous use of penicillin. The pooled results showed that preoperative antibiotics significantly reduced the prevalence of alveolar osteitis (OR = 0.35; 95% CI, 0.13 to 0.96; P = .04). The subgroup analysis showed that penicillin V was effective in reducing the incidence of alveolar osteitis (OR = 0.1; 95% CI, 0.03 to 0.30; P ≤ .0001). A single oral dose of 2 g of amoxicillin before lower third molar osteotomy surgical extraction significantly decreased the incidence of SSI. A single dose of 0.8 g of penicillin V before lower third molar osteotomy surgical extraction significantly decreased the incidence of alveolar osteitis.

Cross-tongue procedure: a new treatment for long-standing numbness of the tongue

The lingual nerve may be injured during oral procedures, usually during extraction of lower third molars. Patients often complain of numbness of the hemitongue postoperatively. If this persists for 3 months or more, microsurgical exploration and reconstruction of the lingual nerve is required, and better outcomes are achieved after early repair. After 18-24 months the production of axoplasmic fluid through the axons of the proximal stump is reduced, and neurorrhaphy between the proximal and distal stumps is not recommended. In such cases we suggest that a portion of the opposite lingual nerve should be used as an additional nerve source.