Extraction Of Mandibular Third Molars Research Articles

Surgical Extraction of Mandibular Third Molars: Risk Assessment and Predictable Complexity

Objective. The study aims to develop and validate new practical and simple but robust index to determine the complexity level of surgical extraction of mandibular third molars (MTM). Methods. A cross-sectional study with sample of 100 patients referred for management of MTM. Complexity index scores recorded twice at 6 weeks intervals preoperatively by oral and maxillofacial specialist. Prediction of the surgical difficulty and the degree of agreement of different variable indexes were calculated. Results. Out of 100, 78 patients with 139 impacted MTM, 26 were males and 52 were female, with a mean age of 26.40±6.39 years (range, 18-45 years). The prediction of operative difficulty was significant as measured by impaction angulation, distance to ramus, and impaction depth. Most cases were classified as complexity level II (63 [80%]). Although only 3 out of 100 cases (4%) were classified as complexity level III. There was no significant difference in age based on the gender (male: 27.54±7.35 years, female: 25.83±5.86 years; P=0.268). Conclusion. Using MTM complexity index as a preoperative tool to evaluate the surgical difficulty, including different patient-specific variables could facilitate treatment planning, help prevent complications and assess the possibility of referral.

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

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

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

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

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study.

Background and objective This study aims to explore the concept of preemptive analgesia, which is the technique of administration of analgesic agents before the painful stimulus. This bridges the time gap between the onset of action of the analgesic agentsand the wear-off of local anesthesia. Existing literature also brings up the concept of central sensitization, which is the hyper-activity of the nervous system in response to a noxious stimulus. Administration of preemptive analgesia prevents central sensitization and hence provides prolonged analgesia to the patient. For the benefit of this study, tab. Etoricoxib 90 mg was used as the analgesic agent. In addition, this study aims to investigate the effects of the administration of tab. Etoricoxib 90 mg 30 minutes before extraction of a single mandibular third molar on the effects of pain experienced by the patient after tooth extraction as compared to a placebo. Methodology This was a double-blinded, prospective, observational study. The pain experienced by 50 participants in each group was measured at 1 hour, 6 hours, 12 hours, and 24 hours postoperatively using a visual analog scale (VAS). The independent samples t-test was then conducted to evaluate the results and draw out conclusions. Results The average difference in pain experienced was maximum in the first hour after the procedure. The mean VAS score reported by patients was 3.14 in the study group but was 6.40 in the control group within the first hour. This difference was reduced in the first six hours after the procedure, with the average score being 3.82 in the study and 7.16 in the control group. The difference was the least after 12 hours, with the study group experiencing a VAS score of 4.64 and controls experiencing a VAS score of 6.14. After the first 24 hours, the mean VAS score was 3.80 in the study group and 5.60 in the control group. Conclusions Preemptive administration of tab. Etoricoxib 90 mg can reduce postextraction pain in healthy adult patients as compared to placebo tablets, with a maximum difference in pain reduction seen at the end of the first six hours (P= 0.012) and the minimum at the end of 12 hours (P= 0.0197).

Impact of Single-Session Intraoral and Extraoral Photobiomodulation on Pain Control after Extraction of Impacted Mandibular Third Molar: A Pilot Study

This study aims to evaluate the impact of a single session of intraoral and extraoral photobiomodulation (PBM) on controlling pain and improving a patient’s daily activities following surgical extraction of the impacted mandibular third molar, using combined three wavelengths: “445 nm, 660 nm, and 970 nm”. A pilot study was conducted on 22 patients undergoing extraction of an impacted mandibular third molar. The patients were randomly divided into two groups: (1) The Test Group consisted of patients subjected to immediate postoperative PBM. The extraoral PBM parameters were power = 550 mW and spot area = 5 cm2, while the intraoral parameters were power = 200 mW and spot area = 2 cm2. (2) The Control Group consisted of the patients not subjected to PBM. For all the patients, the pain was evaluated via a Numeric Rating Scale (NRS) on day 0, day 1, day 3, and day 7 after surgical intervention. The patient’s daily activities were evaluated on day 7 via a custom-made questionnaire. A statistically significant difference was observed between groups in the pain NRS scores on day 0 (p = 0.022), day 1 (p = 0.047), and day 7 (p = 0.028). No significant difference was found on day 3 (p = 0.153). A marginal statistical significance was observed with the number of painkillers taken (p = 0.054). No significant difference was observed with the questionnaire score (p = 0.206). This pilot study showed a significant reduction in postoperative pain on days 0, 1, and 7 with a single session of intraoral and extraoral PBM. However, the number of painkillers taken and the scores of the daily activities questionnaire did not show statistical significance despite the observed better results in patients subjected to PBM.

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

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

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

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

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

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

Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial.

Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions.The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3:normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft® Corp., Redmond, USA) worksheets and analyzed using Stata17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.

Effectiveness of Advanced Platelet-Rich Fibrin on Postoperative Sequelae for Impacted Mandibular Third Molar Surgery: A Prospective Study.

Introduction Impacted third molar extraction is frequently removed surgically by maxillofacial surgeons, which is mostly associated with postoperative sequelae like pain and swelling. It is essential to minimize the complications and enhance wound healing in the extracted socket of the third molar. Hence, this study aimed to assess the efficiency of advanced platelet-rich fibrin (A-PRF) in wound healing and reducing pain after surgical extraction of the impacted mandibular third molar (IMTM). Materials and methods Thirtyhealthy patients who have been diagnosed with Pell and Gregory class II IMTM were included in this study. In the study group, which comprises 15 patients, extraction sockets were filled with A-PRF extract. In the control group, no material was placed in the extraction sockets. The pain was assessed preoperative and on the third and seventh postoperative days using a visual analog scale (VAS). Wound healing was assessed on the third and seventh postoperative days using a modified laundry scale. SPSS for Windows was used for data analysis. Categorical data was compared between the groups using the Chi-square test. P-value less than 0.05 was considered as statistically significant. Results The study population's mean age was 25.67 ± 2.4 years. Nineteen patients were male, and 11 patients were female. Differences in mean pain scores between the groups were not statistically significant both on the third postoperative day (p=0.59)and the seventh postoperative day (p=0.33). During the seventh day postoperative day, the study group exhibited better wound healing compared to the control group and the results were statistically significant (p=0.01). Conclusion A-PRF is a simple and effective method of reducing postoperative sequela by promoting wound healing after surgical extraction of IMTM. Ithas the advantage of less chance of allergic and anaphylactic reactions, unlike their predecessor platelet concentrates.

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

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

Is ChatGPT a reliable source of scientific information regarding third-molar surgery?

BackgroundChatGPT (OpenAI) is a large language model. This model uses artificial intelligence and machine learning techniques to generate humanlike language and responses, even to complex questions. The authors aimed to assess the reliability of responses provided via ChatGPT and evaluate its trustworthiness as a means of obtaining information about third-molar surgery. MethodsThe authors assessed the 10 most frequently asked questions about mandibular third-molar extraction. A validated questionnaire (Chatbot Usability Questionnaire) was used and 2 oral and maxillofacial surgeons compared the answers provided with the literature. ResultsMost of the responses (90.63%) provided via the ChatGPT platform were considered safe and accurate and followed what was stated in the English-language literature. ConclusionsThe ChatGPT platform offers accurate and scientifically backed answers to inquiries about third-molar surgical extraction, making it a dependable and easy-to-use resource for both patients and the general public. However, the platform should provide references with the responses to validate the information. Practical ImplicationsPatients worldwide are exposed to reliable information sources. Oral surgeons and health care providers should always advise patients to be aware of the information source and that the ChatGPT platform offers a reliable solution.

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

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

Eficiencia del gel de ozono tópico como complemento de antibióticos y analgésicos en las secuelas tras la extracción del tercer molar mandibular impactado

Introduction: Extraction of the impacted mandibular third molar is a common procedure in dentistry. Many complications may arise after this operation, the most common being pain, trismus, and swelling. Systemic medications have been used in an attempt to manage these problems, but because of their side effects, the need for non-medication treatment arises to treat these complications without side effects, such as cryotherapy, ice packs, low-level laser therapy, and ozone. Ozone is one of the most effective antimicrobials used in the dentistry field, and it also has a positive effect on soft tissue healing, activates cellular metabolism, and can react with blood components; for these reasons ozone is used to manage trismus, swelling, and pain after removal of the mandibular third molar. Aim: The purpose of the study was to assess the effects of topical ozone gel on complications from the extraction of the impacted mandibular third molar. Materials and Methods: Thirty patients were enrolled in the current study and were randomly divided into two equal groups. Preoperatively clinical examination included measurement of facial swelling measurements and maximum mouth opening. The position and configuration of the impacted lower third molar, the surrounding bone, the mandibular canal, and the neighboring tooth were all assessed using a panoramic X-ray. On days 2 and 7, after surgery, the facial swelling dimensions and maximum mouth opening were again assessed. Statistics were used to analyze results. Results: Findings indicate statistical significance for pain, but not for swelling or mouth opening. Conclusions: After lower third molar surgery, topical ozone gel helps reduce postoperative pain. Keywords: Molar, third; Tooth, impacted; Ozone; Pain; Trismus; Edema.

Comparison of the Effectiveness of Four Different Irrigation Solutions on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Oral and maxillofacial surgeons frequently perform the removal of impacted mandibular third molars. The success of this surgical intervention depends on meticulous surgical technique and the use of appropriate irrigants to minimize complications in the postoperative period. Aim The aim of this study was to evaluate the efficacy of four different irrigation solutions (povidone-iodine, metronidazole, chlorhexidine gluconate (CHX), and normal saline)on postoperative sequelae like pain, trismus, swelling, and alveolar osteitisfollowing surgical extraction of the impacted mandibular third molars. Materials and methods The current research was a randomized study carried out at Saveetha Dental College and Hospital in Chennai, India, from December 2022 to March 2023.The study population consisted of 112 participants who were referred to the Oral and Maxillofacial Surgery for the surgical removal of impacted mandibular third molars. The population was divided into four groups, with 28in each group. They were categorized as A, B, C, and D based on the final irrigation solution used after surgical removal of the impacted teeth. In group A, patients received 0.5% povidone-iodine as the final irrigation solution; group B received 1% metronidazole; group C received 0.12% chlorhexidine gluconate (CHX); and group D received 0.9% normal saline.Patients were examined on the first and seventh postoperative days to assess pain, swelling, trismus, and alveolar osteitis. The results were analyzed with SPSSStatistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) software for Windows (MicrosoftCorporation, Redmond, Washington, United States). A p-value less than 0.05 was considered statistically significant. Results Group B experienced significantly less pain than groups A, C, and D on the first and seventh postoperative days (p<0.05). The facial swelling was significantly less on the first and seventh postoperative day in groupB compared to groups A, B, and D (p<0.05). There was no statistically significant variation observed in trismus (mouth opening) across the groups on both the first postoperative and seventh postoperative days. The presence of alveolar osteitis was seen in groups A, C, and D, but no instances were reported in group B. Conclusion It can be concluded that among the four irrigation solutions used in the lower third molar surgery,metronidazole irrigation solution yielded the best results in terms of less pain, swelling, and alveolar osteitis followed by chlorhexidine.There was no difference between povidone-iodine irrigation and normal saline irrigation on the postoperative sequelae. Postoperative trismus does not depend on the irrigation solutionused in the third molar surgery.

Comparative evaluation for the accuracy of mandibular third molar impaction status with respect to surrounding dentoalveolar structures using orthopantomogram as against cone beam computed tomography

Mandibular third molar impaction impose a great dental problem especially to young adults. It is the most commonly impacted tooth in the entire dentition of humans. The cause of impaction may vary and may include lack of space, malposition and physical barrier on the path of eruption. This impaction can lead to different pathologies, from infection to development of cysts. Injury to the inferior alveolar nerve during extraction of mandibular third molar is also a possibility during treatment which can lead to numbness, tingling or burning sensation of the affected side. It can also have adverse effects on the adjacent second molar. Several studies have been done to determine the angulation, depth of impaction, space available between the second molar and ramus, proximity to inferior mandibular third, status of adjacent second molar using several criteria and classification using orthopantomography (OPG) and cone beam computed tomography (CBCT). But there is very little research done on the precision of both OPG and CBCT and comparisons of their diagnostic accuracy. In this study, adults above 21 years of age who have impacted mandibular third molar (IMTM) will be taken for OPG where OPG will provide two-dimensional radiography and CBCT will deliver three-dimensional radiography. Different criteria will be used to assess the status of the impaction and see the sensitivity and specificity in both OPG and CBCT. This study is important to help determine which radiographic diagnostic tool is preferable for assessing the status of impacted third molar and its relation to its surrounding structures and estimate the difficulty index for extraction of mandibular third molar impaction. It will also further help in preventing any injury or complication which can arise to the surrounding structures both during and after extraction and which will also help in achieving best possible outcome for patients.

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

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

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

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

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

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

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

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