Extraction Of Mandibular Third Molars Research Articles

Anatomical Risk Factors of Nerve Injuries Following Surgical Removal of Mandibular Third Molar

Introduction: Surgical removal of the mandibular third molar has its own set of complications. The mandibular impacted teeth are in proximity to the Inferior Alveolar Nerve (IAN), Buccal Nerve, and Lingual Nerve (LN). Therefore, each of these nerves is always at risk of injury during extraction. Objectives: This study was to evaluate the anatomical risk factors of nerve injury after the surgical extraction of mandibular third molars in patients visiting the department of oral and maxillofacial surgery of People’s Dental College and Hospital. Methods: This prospective study was conducted with 315 participants who presented with a mandibular third molar impaction and underwent Intraoral Periapical Radiograph (IOPAr), panoramic radiograph, as well as Cone Beam, Computed Tomography (CBCT). CBCT was done in those patients in which the mandibular third molar was in close contact with the mandibular canal. Results: Collected data from 315 patients showed that the incidence of Inferior alveolar nerve (IAN) and lingual nerve(LN)injury was 0.31%. Of which one had mesioangular class B, level II type of impaction in 17year male and the other had horizontal class C, level II type of impaction in 47year female respectively. In both cases, the tooth was lingually placed in relation to IAN. Conclusions: Various factors are responsible for nerve injury after the removal of the mandibular third molar. In our study, the incidence of nerve injury to IAN and LN was comparatively low and the most common risk factor was angulation and anatomical position of the impacted mandibular third molar.

Anatomic feasibility of a modified 3-distal site anesthesia injection method for impacted mandibular third molar extraction using cone-beam computed tomography.

BackgroundVarious injection methods have been used to improve the success rate of inferior alveolar nerve (IAN) block and reduce the pain and complications. But these methods also have their advantages and disadvantages. A modified 3-distal site anesthesia injection method proposed in 2015 was used clinically with satisfactory results at some dental clinics in China. This study aimed to determine the feasibility of this modified 3-distal site anesthesia injection method for extraction of an impacted mandibular third molar from an anatomical point of view.MethodsThree-dimensional (3D) reconstruction and analysis of the mandibles was performed using cone-beam computed tomography (CBCT) scanning to measure the simulated needle insertion depth, infiltration distance, and other important parameters. These parameters were compared with an actual depth of 20 mm and a theoretic infiltration distance of 10 mm. The main parameters were compared between males and females.ResultsSixty-three CBCT datasets were imported into Simplant OMS software for 3D reconstruction. The left simulated insertion depth did not differ from 20 mm, while right insertion depth was >20 mm (P<0.05). The bilateral infiltration distances were <10 mm (P<0.05) and articaine blocked the IAN. The widths of the mandibular rami were greater than the syringe length (21 mm), thus it was not possible for the syringe to reach the distal edge of the mandible. There was no difference in the simulated needle insertion depth and infiltration distance between the left and right (P>0.05). The bilateral simulated insertion depths, infiltration distances, widths of the mandibular rami, and height of the left mandibular foramen in females were less than in males (P<0.05), while there was no difference in the height of the right mandibular foramen and bilateral insertion angles (P>0.05).ConclusionsThe modified 3-distal site anesthesia injection method was shown to block the IAN based on anatomic evidence derived from 3D analysis on the measurements by CBCT.

Efficacy of Preoperative Piroxicam, Diclofenac, Paracetamol With Tramadol and Placebo Tablets for Relief of Postoperative Pain After the Removal of Impacted Mandibular Third Molars: A Randomised Controlled Trial.

AimWe aimed to analyze the influence of preoperative piroxicam, diclofenac, paracetamol, tramadol, and placebo tablets as measured in the time required for rescue analgesia for postoperative pain relief after the extraction of impacted mandibular third molar.Materials & methodsForty-four patients who needed extraction of impacted mandibular third molar were arbitrarily categorized into four groups namely, piroxicam, diclofenac, paracetamol with tramadol, and placebo. The test medicine was given one hour preoperatively before the surgical removal. The pain was assessed using visual analog scale (VAS) and verbal rating scale (VRS) scores preoperatively and at the third and 24th hours. The time required for escape analgesia was measured. ResultsThe mean VAS and VRS scores showed significant differences across the groups after 24 hours. The mean score was lowest for the patients taking piroxicam (1.30+1.95) and highest for patients taking tramadol + paracetamol (4.50+2.59). As far as escape analgesia is concerned piroxicam group was by far superior.ConclusionThe pain scores and the rescue analgesic requirement suggested that piroxicam analgesic significantly reduced pain; moreover, it is a safe as well as an efficacious substitute to the conventional non-steroidal anti-inflammatory drugs (NSAIDs) for mandibular third molar impactions.

Photobiomodulation for Managing “Dry Socket”: A Randomised Controlled Trial

There are no studies that have evaluated the effect of Alveogyl with and without adjunct photobiomodulation therapy (PBMT) in reducing self-rated post-operative pain (SPP) in patients with alveolar osteitis (AO; dry socket). The aim of the present randomised controlled trial was to assess the effectiveness of Alveogyl with and without PBMT for the management of SPP in patients with AO. Adult nonsmokers with diagnosed AO were included. Patients were randomly divided into 4 groups. In Group 1, patients underwent mechanical curettage (MC) with copious normal saline irrigation. In Group 2, patients underwent MC+Alveogyl dressings in extraction sites which were changed every 48 hours until cessation of pain. In Group 3, patients underwent MC+Alveogyl followed by PBMT using a 660-nm indium-gallium-aluminum-phosphide diode laser. In Group 4, patients were treated solely with PBMT. The visual analogue scale was used up to 3 postoperative days to assess SPP up to 3 days at 6- (T0) and 12-hour (T1) intervals. Statistical analyses were performed using the analysis of variance and Bonferroni post hoc adjustment tests. Correlation between SPP scores and age, sex, and eruption status of teeth was assessed using logistic regression models. P values <.01 were nominated as being statistically significant. In all, 14, 13, 14, and 14 individuals with AO were included in groups 1, 2, 3 and 4, respectively. All patients had undergone extraction of mandibular third molars. At baseline and on day 1, there was no difference in SPP in all groups. On days 2 and 3, mean visual analogue scale (VAS) scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 2 compared with Group 3. On days 2 and 3, mean VAS scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 4 compared with Group 3. There was no difference in SPP in groups 3 and 4 on day 3 at T0 and T1 intervals. PBMT following MC and Alveogyl dressing is more efficient in reducing SPP compared with MC with or without Alveogyl dressing in patients with AO.

Effects of platelet-rich fibrin in the surgical extraction of mandibular third molar

Background: Platelet-rich fibrin (PRF) has a wide variety of applications in the field of oral surgery due to its biological potential to accelerate the wound-healing process and tissue regeneration. Aim: The objective of this review was to find out whether the role of PRF had been reported to be efficient in the surgical extraction of mandibular third molar (M3). Methods: An electronic search of the English-language literature in the PubMed (Medline) database was performed for the period from January 2015 to September 2021. Only randomized controlled trials (RCTs) comparing the impact of PRF application were included in this review. According to the Cochrane Collaboration's standards, the reviewer assessed the risk of bias. Review Manager (version 5.4) Windows software was used for the meta-analysis. Results: A total of 39 papers were found in the computerized search, with 13 RCTs meeting the qualitative analysis requirements and 10 trials included in the meta-analysis. The results of a meta-analysis for M3 surgery showed that PRF reduces the incidence of alveolar osteitis (AO) (P = 0.005) and pain on the first (P = 0.05), third (P = 0.002), fourth (P = 0.01), and seventh (P = 0.0003) postoperative days. The meta-analysis also revealed that there was no substantial improvement (P = 0.44) in soft tissue healing with the application of PRF following M3 surgery. Conclusions: The application of PRF after M3 extraction decreased the incidence of AO and postextraction pain.

Listening to music before tooth extraction attenuates sympathetic nervous system activity: A randomized control trial

AbstractAimThe effect of listening to music before tooth extraction on the autonomic nervous system and psychological state remains unclear. This prospective study explored the hypothesis that playing music before the extraction of an impacted mandibular third molar would stabilize patients' autonomic nervous system activity and circulatory dynamics.MethodsThirty‐six patients were randomized into two groups: control and music. Patients in the music group listened to music before tooth extraction. Heart rate variability and circulatory dynamics were recorded during the procedure. The Modified Dental Anxiety Scale and State Trait Anxiety Inventory scale scores were recorded before the procedure, and the latter was used to assess postoperative anxiety scores.ResultsSympathetic nervous activity significantly increased in the control group during the administration of local anesthesia, bone removal, and extraction (p &lt; 0.01), although this increase was lower in the music group during the administration of local anesthesia and extraction (p &lt; 0.05). In the music group, the postoperative anxiety score was significantly lower than the preoperative score (p &lt; 0.05).ConclusionPlaying music preoperatively may help reduce sympathetic nerve activity during the administration of local anesthesia and tooth extraction.

Assessment of effect of anti-platelet therapy on minor surgical procedures

Background: Antiplatelet therapy is to treat thromboembolic disorders, but it causes hemorrhages. Aspirin is the drug in regular practice. The present study was conducted to assess the effect of anti- platelet therapy on minor surgical procedures. Materials &amp; Methods: 80 patients selected for mandibular third molar extraction of both genders were randomly divided into 2 groups of 40 each. In Group I, patients on antiplatelets drugs (75 mg of aspirin/ 75 mg clopidogrel) were enrolled and in group II, patients who discontinued the drug before 5 days of extraction of mandibular third molar were enrolled. Bleeding was observed after 1 and 24 hours. Results: Group I had 24 males and 16 females and group II had 14 males and 26 females. The mean bleeding time in group I was 75.21 seconds and in group II was 75.14 seconds. The mean duration of surgery in group I was 54.2 months and in group II was 52.1 months. After 1 hour, no bleeding was seen in 38 in group I and 39 in group II and ooze in 2 in group I and 1 in group II.

Clinical application of autogenous tooth as bone graft material in extraction socket- A prospective study

IntroductionAmong the different graft materials used in dental clinics, autogenous bone is the most ideal. However, its biggest short coming is that the amount invested is limited, resorption is unavoidable and a secondary defect is generated at the donor site. Extracted tooth has been discarded as infective medical dust. So, the present study was aimed to evaluate the efficacy of autogenous tooth as graft material in the extraction socket of third molar region. Materials and methodA split mouth study design was undertaken. 20 patients requiring extraction of bilateral mandibular third molars were included in the study. This study was carried out in third molar region. Group A: PRF membrane was placed in the third molar extraction socket. Group B: Autogenous tooth processed into bone graft was used in the third molar extraction socket, over which PRF membrane was placed. Postoperative pain and bone healing were assessed in the post-operative follow-up visits. ResultsWe observed that Group B showed significantly faster bone healing as compared to Group A, in terms of overall density and trabecular pattern of bone at the end of 3 months and 6 months following extraction. ConclusionThis study clearly indicates that autogenous tooth used as bone graft material showed improved bone healing at the third molar extraction sockets. This study emphasis on use of human dentin as graft material as it was simple, cost effective, required no special armamentarium and infrastructure for preparation and even did not require additional donor site.

A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars.

Background: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients’ quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. Methods: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. Results: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. Conclusions: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.

Correlation of Pericoronal Radiolucency Around Impacted Mandibular Third Molars Using CBCT with Histopathological Diagnosis: A Prospective Study

Purpose: This study aimed to correlate the pericoronal width surrounding impacted mandibular third molars with their histopathological findings. Materials and Methods: The present study included patients who were advised for extraction of impacted mandibular third molars with the pericoronal radiolucency radiographically. The CBCT scans were compared with histopathologic findings of the follicles. Results: Out of 70 patients evaluated histopathologically, 24 patients showed mild inflammatory changes, whereas 34 patients revealed cystic changes suggestive of a dentigerous cyst, followed by 12 patients showing evidence of calcifications in the pericoronal follicles. The dentigerous cyst was more likely to occur if the bucco-lingual width of the pericoronal radiolucency was 14.00-16.00mm, and calcifications were found to be most likely present if the buccolingual width was 12.00-14.00mm, both of which were statistically significant. Conclusion: CBCT can be a reliable tool in the evaluation of pericoronal follicular space, and the values in different dimensions can be an accurate predictor radiologically for the diagnosis of pathologies when compared to 2D imaging.

Breakage and displacement of the high-speed hand-piece bur during impacted mandibular third molar extraction: three cases

BackgroundThe high-speed hand-piece bur is one of the methods to perform tooth sectioning during the minimally traumatic extraction of impacted mandibular third molars. During tooth sectioning, the breakage of the bur might take place when it is improperly used. Three cases of the breakage and displacement of a high-speed hand-piece bur during extraction are reported, aiming to remind dental surgeons of this complication.Case presentationThe bur fragment in case 1 was embedded in the mandibular bone under the previously removed crown of tooth 48 and distal to tooth 47. The bur fragment in case 2 was embedded in the lingual edge of the socket and partly beneath the mucosa on the lingual side. The position of the bur fragment in case 3 was similar to that of case 1 but was completely embedded in the spongious bone. The three cases were performed by first-year residents, and all of the bur fragments were successfully removed by attending doctors after accurately locating them by radiological examination.ConclusionsIn order to avoid breakage of the high-speed hand-piece bur, the number of uses of the bur should be monitored and the integrity and state of the bur should be carefully checked. Moreover, light pressure with little lateral force should be used during tooth sectioning. If bur breakage and displacement occur, the retrieval protocol should be determined based on the imaging findings and conducted as soon as possible to avoid serious consequences.

Comparison of triangle flap and comma-shaped flap of clinical results after third molar surgery

Background: The extraction of the mandibular third molar is a common oral surgical procedure. Postoperative complications after third molar surgery such as swelling, pain, and trismus have a considerable influence on the quality of life in patients. Methods to alleviate these complications have been the focus of a lot of studies. Aim: To evaluate the surgical wound and postoperative complications after third molar surgery by comparing two different flaps: triangle flap and comma-shaped flap. Materials and Methods: a clinical trial with a split-mouth design. Thirty healthy patients were subjected to surgical extraction of both impacted mandibular third molars, located in a similar clinical and radiographic position. Two different flaps are used: triangle flap and comma-shaped flap. Result: The parameters of pain, swelling, and trismus in the comma-shaped flap group were greater than in the triangle flap group on postoperative days 1 and 2, with a statistically significant difference (p&lt;0.05). On day 7, no significant interference was found between the 2 groups for all parameters of pain, swelling, and trismus (p&gt;0.05). Conclusion: The comma-shaped flap is better than the triangle flap concerning postoperative pain, swelling, and trismus. Key words: Lower third molar surgery, split-mouth design, comma-shaped flap, triangle flap

Efficacy of Ibuprofen Gargle for Postoperative Pain After Mandibular Third Molar Extraction: Protocol for a Phase II, Placebo-Controlled, Double-Blind, Randomized Crossover Trial.

BackgroundExtraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral NSAIDs are associated with adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical analgesics have been proposed as alternatives to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars when compared with a placebo gargle.ObjectiveThis will be the first clinical study to compare the efficacy of an ibuprofen gargle with that of a placebo for relieving postoperative pain in addition to loxoprofen after mandibular third molar extraction.MethodsThis study will be performed at Kobe University Hospital. Participants (N=40) will be randomized equally to 1 of 2 groups. The ibuprofen-placebo group will receive an ibuprofen gargle on postoperative day (POD) 1 and a placebo gargle on POD 2. The placebo-ibuprofen group will receive a placebo gargle on POD 1 and an ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargles on PODs 3-5 at least once daily. The primary objective is to estimate the within-subject difference on a visual analog scale (VAS) before and 5 minutes after using the ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject differences in ΔVAS before and 15 minutes after using the ibuprofen or placebo gargle on PODs 1 and 2, ΔVAS before and 5 or 15 minutes after using the ibuprofen gargle on PODs 3-5, overall efficacy (self-completion, 5 scales) on PODs 1-5, daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1-7, and the occurrence of adverse events.ResultsThe Certified Review Board of Kobe University approved the study. The intervention was implemented in May 2021. For the primary analysis, we will calculate the mean and SD of ΔVAS5 on PODs 1 and 2 and the within-study difference in ΔVAS5. The treatment effect will be estimated by dividing the mean ΔVAS5 in the within-subject difference by 2 and calculating the P value using an unpaired t test. For the secondary analysis, we will calculate the mean and SD of ΔVAS15 on PODs 1 and 2 and the within-study difference in ΔVAS15. The treatment effect will be estimated as in the primary analysis.ConclusionsThis trial will provide exploratory evidence of the efficacy and safety of an ibuprofen gargle for pain reduction after mandibular third molar extraction.Trial RegistrationJapan Registry of Clinical Trials jRCTs051210022; https://tinyurl.com/39ej23zuInternational Registered Report Identifier (IRRID)DERR1-10.2196/35533

Analgesia and Side Effects of Codeine Phosphate Associated with Paracetamol Versus Oxycodone After the Extraction of Mandibular Third Molars: A Randomized Double-Blind Clinical Trial Using the Split-Mouth Model.

To assess the analgesia and side effects of 10mg oxycodone as compared to 30mg of codeine phosphate associated with 500mg of paracetamol after bilateral lower third molar extraction. This is a prospective, randomized, double-blind study applied to a sample of 16 patients. They were evaluated for seven days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Wilcoxon distribution. The side effects of these medications were assessed by the Q Cochran test. A p value of < .05 was considered statistically significant. The mean score of the VAS of pain was higher in the oxycodone side, where few patients reported the use of rescue analgesic. There was no report of rescue medication in codeine phosphate associated with paracetamol side. The most common side effects reported in both groups, predominantly in patients using the oxycodone, were drowsiness, dizziness, and headache. The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice than oxycodone for controlling postoperative pain. RBR-8ntwmyq 07/07/2021.

Effect of dexamethasone on postoperative swelling in patients undergoing impacted molar surgery

Background: The present study was undertaken for comparing the therapeutic effects of Dexamethasone administered intramuscularly pre-operatively vs. post operatively after the surgical extraction of impacted mandibular third molars. Materials and methods: A total of 40 participants were enrolled. Complete demographic and clinical details of all the patients were obtained. Clinical examination was carried out of all the subjects. Only those patients were enrolled which were scheduled to undergo impacted third molar extraction. All the subjects were randomly divided into two study groups with 20 participants in each group as follows: Group A: Administration of intramuscular Dexamethasone pre-operatively. Group B: Administration of intramuscular Dexamethasone post-operatively. All the surgical procedures were carried under the hands of skilled and experienced oral surgeons. Routine post-operative home care instruction was given to all the patients along with antibiotic coverage. Patients were recalled on the 7th day and sutures were removed. Clinical examination was done. Data was analyzed by using SPSS software. Results: Mean swelling among patients of group A at immediate postoperative period, postoperative 1st day, postoperative 3rd day and postoperative 7th day was 13.1 cm, 12.5 cm, 12.9 cm and 11.5 cm respectively. Mean swelling among patients of group B at immediate postoperative period, postoperative 1st day, postoperative 3rd day and postoperative 7th day was 13.5 cm, 14.8 cm, 15.1 cm and 11.3 cm respectively. Statistically significant difference was obtained while comparing the mean postoperative swelling among patients of group A and group B. Conclusion: Better post-operative therapeutic effects are achieved by pre-operative administration of intramuscular injection of dexamethasone as compared to post-surgical administration in impacted third molar surgeries.

Role of topical gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on the wound healing after surgical extraction of impacted mandibular third molar

Odontostomologic procedures like extractions especially surgical removal of impacted 3rd molars, implants, biopsies etc are often associated with post-operative pain and inflammation. Traditionally chlorhexidine was used in this regard. Recently, topical gel, Bexident Post (ISDIN, SPAIN) has been in use to control post-operative discomfort. The aim of this study is to clinically evaluate the efficacy of Bexident Post (ISDIN, SPAIN) that contains chitosan, dexpenthanol, allantoin and 0.2% chlorhexidine on wound healing after surgical extraction of mandibular impacted 3rd molars. A study sample of 10 patients with similar type of bilateral impacted mandibular 3rd molar was included in the study. Total of 10 extractions were assingned in one of the two groups. Only difference between the two sides in terms of surgical protocol will be the Experimental side applied 10 mL thrice daily for 10 days while Control side did not. All patients were aware of the purpose of present study and written consent was taken requiring their participation. Results showed that facial swelling, mouth opening and pain were all significant between the two groups. The groups were homogenous only in terms of infection as neither of the groups showed post-operative signs of infection.

RADIOLOGICAL PREDICTION OF INFERIOR ALVEOLAR NERVE INJURY FOLLOWING SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR- A COMPARATIVE STUDY BETWEEN PANORAMIC RADIOGRAPH AND CONE BEAM COMPUTED TOMOGRAPH

The chances of neurological complications following surgical removal of impacted mandibular third molar increase when there is close contact between the inferior alveolar nerve and the tooth root. Thus, it is important to evaluate the topographic relationship between them preoperatively. AIMS AND OBJECTIVES- To assess the possible nerve injury following extraction of impacted mandibular third molar by comparing the relevant panoramic features with cone beam computed tomography (CBCT) ndings and evaluate the diagnostic accuracy of OPG. MATERIAL AND METHODS –A total number of 30 patients requiring surgical removal of impacted mandibular third molar under local anesthesia and having a close relationship between impacted mandibular third molar and inferior alveolar canal in panoramic radiograph were included in the study and were advised for CBCT evaluation. Statistically signicant association w RESULTS - as found between darkening of the root in OPG and absence of narrowing of the canal in CBCT with P value 0.008 (P&lt;0.05) while distribution of darkening of the root (OPG) according to presence or absence of corticalisation (CBCT) was not statistically signicant . The panorami CONCLUSION - c radiographs may be useful to assess the close relationship between mandibular canal and third molar root tip but it cannot appraise the type of intimate relationship present between them for which CBCT is the reliable tool.

Comparison between Modified Triangular Flap and Envelop Flap Techniques for Surgical Removal of Impacted Mandibular Third Molar

Objective: To compare postoperative outcomes in surgical extraction of mandibular third molar with envelop flap versus modified triangular flap.&#x0D; Setting &amp; Duration: Oral &amp; Maxillofacial Surgery Unit at Faculty of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Study period was from January 2021 to December 2021.&#x0D; Subject and Methods: A set of 60 individuals were sequentially assigned 30 to the Group A envelop flap and 30 to the Group B modified triangular flap for surgical removal of the mandibular third molar tooth. The demographic and clinical parameters was identified and recorded in proforma. The discomfort, swelling, and restricted mouth opening linked with an impacted mandibular third tooth are all assessed prior to surgery. The flap pattern employed for the extraction of the impacted lower third molar tooth, pain, and mouth opening was all reported on the proforma at the end of the procedure. On the seventh postoperative day, each patient was evaluated again.&#x0D; Results: - The average age of patients in group A was 29.77±7.17 years and 28.20±6.28 years in group B. Mean pain score was significantly low in group A as compare to group B [0.87±0.86 vs. 2.93±0.87 p=0.0005]. Mean mouth opening was significantly high in group A than group B [12.86±3.59 vs. 6.12±1.67; p=0.0005].&#x0D; Conclusion: In comparison to the envelope flap, the modified triangular flap was more effective when considering the postoperative periodontal state of the surrounding third molar and the dehiscence after wound recovery.

Piezosurgery Versus Conventional Osteotomy: A Comparison of Techniques in the Extraction of Unerupted Mandibular Third Molars in Children

Piezoelectric bone surgery is a precise and effective osteotomy technique used in maxillofacial surgery. The purpose of this study was to compare postoperative sequelae and efficacy of extractions of unerupted mandibular third molars in children by piezosurgery and conventional osteotomy. Healthy subjects, aged 10 to 14years, needing removal of their bilateral lower third molars were included in this study. The right or left unerupted mandibular third molars were randomly extracted by either piezosurgery or conventional osteotomy. Pain (qualified by the visual analog scale), facial swelling, trismus, and operation duration were evaluated. All 32 study patients (40.6% males and 59.4% females with an average age of 11.91±1.40years) completed the entire trial. Swelling and trismus experienced by the conventional osteotomy were more severe than the piezosurgery group on the third (10.34±2.36mm vs 4.9±1.95mm and 6.09±2.08mm vs 2.34±1.79mm, respectively) and seventh (2.03±1.26mm vs 0.25±0.57mm and 0.91±1.00mm vs 0.09±0.30mm, respectively) days postoperatively (P<.01). Visual analog scale showed that pain levels of children in the piezosurgery group were significantly less than the conventional osteotomy group on third day postoperatively (2.06±1.41 vs 4.81±1.94; P<.01). The operation duration of the piezosurgery group was significantly longer than the conventional osteotomy group (27.16±5.75minutes vs 16.69±3.22minutes; P<.01). Compared with conventional osteotomy, piezosurgery can effectively reduce the severity of postoperative sequelae for the extraction of unerupted lower third molars in children.

Comparative Study of two Flap Designs on Postoperative Sequelae after Removal of Impacted Mandibular Third Molar

Objective: The purpose of current study was to have comparison between the postoperative outcomes of triangular (wards) flap versus an envelope flap after surgical extraction of impacted mandibular third molar. Methods: Current study was a double-blinded randomized controlled trial conducted at the Department of Oral &amp; Maxillofacial surgery, Fatima Memorial Hospital, Lahore. Sixty patients were randomly recruited in two groups with random number table. Both groups consisted of 30 patients each. Among the patients of Group A, envelope flap was used for surgical access whereas patients of Group B received triangular flap for surgical access. Both Groups were followed on 2nd and 7th day postoperatively for pain status and trismus. Results: Mean±SD of pain score at postoperative day 7th for group A was 23.47±6.75 and for group B it was 24.03±10.5 which was statistically insignificant (p&gt;0.05). The difficulty index was found to have statistically significant (P&lt;0.05) on 7th postoperative day pain. On the 7th postoperative day group A (envelope flap) had a mouth opening mean of 41.03mm and group B (triangular flap) which had a mean of 40.47mm which was statistically insignificant (p&gt;0.05). The difficulty index was found to have statistically significant effect (P&lt;0.05) on 7th postoperative day Conclusion: The study concluded that there was no statistically significant difference between the two flap designs on postoperative pain and trismus while the difficulty of impaction was found to have statistically significant effect on postoperative pain and trismus Keywords: envelope flap, triangular flap, trismus