Extraction Of Mandibular Third Molars Research Articles

ASSESSMENT OF SWELLING IN PATIENTS AFTER EXTRACTION OF IMPACTED THIRD MOLARS.

Aims: To assess swelling after surgical extraction of impacted mandibular third molar using two different techniques i.e. comma incision and standard Wards incision. Study Design: Cross sectional study. Setting: Dental OPD of Isra Dental College, Isra University. Period: February to August 2017. Materials and Methods: A sample of 70 patients with impacted third molar was selected by non-probability purposive sampling. Patients were distributed in either conventional technique or by coma shaped incision groups. All procedure was carried out at the Department of Oral surgery, Isra Dental College Hospital. Post-operative measurement of swelling was measured on 1st, 3rd and 7th day respectively. Results: Mean ± SD was noted as 28.70 ± 3.89 years respectively. Age distribution was from 20 – 35 years. Gender distribution in group A was 11 (31.4%) males and 24 (68.6%) females while in group B was 17 (48.5%) males and 18 (51.5%) females respectively with X2 = 2.14 and p= 0.22. Swelling was measured after surgical extraction at day 1, day 3 and day 7. Conclusion: The results of this study showed that the swelling was to some extent reduced in the Coma incision in comparison to the standard Ward`s incision. Further research with newer flap designs like the comma design, which might lessen the post-operative problems, ought to be measured in the extraction of impacted third molar surgery.

Effect of concentrated growth factor (CGF) on short-term clinical outcomes after partially impacted mandibular third molar surgery: A split-mouth randomized clinical study

PurposeThe aim of this study was to evaluate the effectiveness of concentrated growth factor(CGF) on soft tissue healing and postoperative side effects following third molar surgery. MethodsThis study was designed on 60 patients as a randomized single-blind clinical trial. The predictor variable was the implementation of CGF fibrin matrix, which was categorized as CGF and non-CGF. The primary outcome variable of the study was the healing of soft tissue around the extraction socket. The secondary outcome variables were pain, swelling and trismus. Data were analyzed using the non-parametric Brunner and Langer model. Statistical significance was set at P<.001. ResultsSixty patients (39 female, 21 male; mean age 25.82) with impacted mandibular third molars participated in the study. Statistical analysis revealed that there were significant differences between the control and test groups with regard to soft tissue healing, postoperative pain, swelling, and trismus (P<0.001). ConclusionThe application of CGF accelerates soft tissue healing and is beneficial in minimising postoperative side effects, particularly pain, swelling and trismus, after extraction of mandibular third molars. Clinical trials numberNCT03913884.

Pattern of Angulations and Common Indications for Extraction of Impacted Mandibular Third Molar at KMU-Institute of Dental Sciences, Kohat

Background: The extraction of an impacted mandibular third molar (MTM), with associated pathologies or clinical manifestations is an important and one of the most frequent decisions in dentistry. The angle formed by the longitudinal axis of second and third molar is used to determine angulation of impacted MTM. The aim of this study was to identify the pattern of angulations of impacted mandibular third molar and common indications for extraction associated with these angulations.Material and Methods: This descriptive cross-sectional study was carried out at Department of Oral &amp; Maxillofacial Surgery, Khyber Medical University Institute of Dental Sciences, Kohat, Khyber Pakhtunkhwa (KP) from November 2017 to July 2018. A total of 349 patients presenting with impacted mandibular third molars were included in this study. Name, age, gender, address, the angulation of the impacted tooth and the indication for extraction of the impacted tooth were recorded. Data comprising of qualitative and quantitative variables were analyzed using SPSS version 17.Results: Out of 349 patients, 206 were male and 143 females, with the male to female ratio of 1.4:1. The age range of the patients was from 18 years to 60 years with a mean age of 26 ± 6 years. The most common age group with impacted third molar was ≤ 25 years followed by 26 to 30 years’ age group. The most common angulation was mesioangular followed by vertical, horizontal and distoangular impacted mandibular third molar. Pericoronitis was the most common indication for extraction in all angulations except horizontal impaction where root resorption of the second molar was more common.Conclusion: Mesioangular is the most common angulation in impacted mandibular third molars. Pericoronitis is the main indication for all angulations of impacted mandibular third molars except horizontal angulation, occurring mostly in the third decade of life.

Effects of Lactobacillus reuteri-containing lozenges on healing after surgical removal of mandibular third molars: a randomised controlled trial.

We investigated the effect of probiotic supplements on oral wound healing, swelling, pain and discomfort after surgical removal of mandibular third molars. A second aim was to evaluate if the intervention could influence the concentrations of oxytocin in saliva. Sixty-four consecutive volunteers (18-34 years) were enrolled to a double-blind randomised placebo-controlled trial with two parallel arms. Following surgery, the patients were asked to take three lozenges per day containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo for two weeks. The clinical healing and extra-oral swelling were scored two weeks post-operatively. Samples of wound exudate were cultivated for the presence of Staphylococcus aureus and β-haemolytic streptococci. Salivary oxytocin concentrations were analysed from pre- and post-surgery samples using ELISA technique. Compliance and the subjective perception of swelling, pain and discomfort were reported daily through visual analogue scales in a logbook. All patients except three completed the protocol and the postoperative course was uneventful in most cases. Minor extra-oral swellings were noted in five patients, but none required antibiotic treatment. At the 2-week follow-up, there were no significant differences in clinical wound healing index, extra-oral swelling, bacterial growth or salivary oxytocin levels between the groups. The self-reported data unveiled, however, a significantly reduced sense of swelling, in particular during the second week after surgery in the probiotic test group (P<0.05). Likewise, significantly fewer nights with disturbed sleep and fewer days with sick-leave from work were reported among the participants in the test group (P<0.05). No differences were found in the post-operative use of analgesics. In conclusion, we found no significant influence of probiotic supplements on objective wound healing after surgical extraction of impacted mandibular third molars. However, since the patients' perceived significant post-operative ameliorations, further studies are needed to explore the patient's value of the intervention.

Comparison of Post-Operative Symptom Severity (PoSSe) Scores in patients undergoing Mandibular Third Molar surgery in Ile-Ife, Nigeria

Background: The Post-Operative Symptom Severity (Posse) score is useful in the assessment of patients after third molar surgery. Objective: To evaluate patients' perceptions of quality of life after surgical extraction of an impacted mandibular third molar by comparing their Post-operative Symptom Severity (PoSSe) scores at Post-operative Weeks (POW) 1 and 4. Methods: Seventy patients (age 18 to 35 years) at the Out-Patient Department were enrolled in a prospective study prior to surgical removal of third molars. Each patient was given a PoSSe questionnaire to be completed at POW 1 and POW 4. The scale assessed recovery in seven key domains on patients’ subjective feeling about pain, eating, speech, sensation, appearance, sickness and interference with daily activities. Results: All but one patient returned completely filled questionnaires. The mean age of the study population was 25.7 ± 4.5 years. The mean PoSSe score at POW 1 and POW 4 were 35.0 ± 7.2 and 33.2 ± 6.9 respectively with statistically significant difference (p = 0.010). The PoSSe score was higher among males compared to females at POW 1 (37.2 ± 7.6 vs 33.5 ± 6.6) and also higher among males at POW 4 (33.8 ± 9.4 vs 32.7 ± 4.6). Conclusion: The severity of symptoms was perceived to be worse at POW 1 when compared to POW4 but the symptoms were still severe at POW4. There is a need for surgeons need to pay more attention to management of symptoms in the post-operative intermediate period.

Assessment of Valeriana officinalis l. (Valerian) for Conscious Sedation of Patients During the Extraction of Impacted Mandibular Third Molars: A Randomized, Split-Mouth, Double-Blind, Crossover Study

The objective of the present study was to evaluate the effectiveness of an herbal drug (valerian) to control anxiety during mandibular third molar extraction compared with a reference benzodiazepine drug commonly used in dental procedures (midazolam). Twenty anxious patients with an indication for bilateral extraction of mandibular third molars were selected. The patients received capsules containing valerian 100mg or midazolam 15mg orally 60minutes before the procedures in a randomized, split-mouth, crossover design. Changes in the physiological parameters (eg, oxygen saturation, heart rate, blood pressure, respiratory rate) were assessed at specific times during surgery, and the patients completed a questionnaire postoperatively. The data were analyzed using the Wilcoxon and paired t tests, with a significance level of 5%. No statistically significant differences in oxygen saturation were observed, regardless of the drug used. However, the other physiological parameters were significantly lower when the patients had taken midazolam compared with valerian. Somnolence was the most common side effect reported with both drugs. Although midazolam was more effective in reducing the physiological parameters studied, valerian seemed to provide the comfort and relaxation required, with no sedation and less somnolence than midazolam, during third molar extraction. Further studies are necessary before valerian can be clinically recommended.

Early Postoperative Masticatory Efficiency After Surgical Extraction of a Partially Impacted Mandibular Third Molar

Abstract The extraction of mandibular third molars is a traumatic procedure accompanied by marked clinical symptoms in the postoperative period. The aim of the present study was to determine the effects of the removal of a partially impacted mandibular third molar on the masticatory efficiency in patients in the early postoperative period. Material and methods. A total of 47 participants, divided into two groups, took part in this pilot study. The first group included 33 patients with a mean age of 18.3 years (SD = 0.9 years), defined as the Control group; the second group involved patients with a mean age of 33.3 years (SD = 1.86), referred to as the Clinical group. The masticatory efficiency of the Clinical group patients was objectively double-checked using a Protab® test bite: once during the preliminary examination (prior to extraction of the wisdom tooth) and again 7 days after the surgical removal of the wisdom tooth. A sieve analysis was applied to determine the artificial test bite particle size and size distribution following mastication. Feedback on the Clinical group patients’ assessment of any subjective complaints was obtained through a questionnaire containing two questions considered relevant to patients’ masticatory efficiency. The data from the sieve analysis of each fraction were analyzed using the Statistics Software Package for Epidemiological and Clinical Research (IBM SPSS V.20.00). Results. The data processing of all parameters tested prior to and after extraction of the wisdom tooth revealed statistically significant differences. Only the duration of chewing after the third molar extraction matched the chewing duration in the healthy control subjects (p = 0.198). The analysis of the feedback on the self-assessment of patients from the Clinical group demonstrated that prior to extraction all subjects (100%) experienced pain to a varying degree, whereas in half of the patients (50%) the pain disappeared following extraction. The Spearman’s test for correlation between mean particle sizes as well as the questionnaire feedback indicated a strong positive relationship with food trapping. Accordingly, the larger mean particle size was linked to the self-assessment of food trapping around the wisdom tooth prior to extraction (Spear-man’s Rho = 0.57, p = 0.032). There was also a correlation between the chewing time and the sensation of pain in the teeth adjacent to the extraction wound. The results suggested that the shorter duration of chewing was associated with a greater sensation of pain (Spear-man’s Rho = -0.61, p = 0.026). Conclusion. The eruption of mandibular third molars causes difficulties in the masticatory process. A positive trend was observed towards normalizing of the chewing duration following extraction (t = -1.356, p = 0.198).

The effect of platelet rich fibrin on surgical outcome of mandibular third molar surgery

Background: Surgical extraction of impacted mandibular third molar is often associated with post-operative inflammatory sequelae such as pain, swelling, trismus and in some instances healing complications such as alveolar osteitis, acutely inflamed alveolus and acutely infected alveolus. These complications are a source of discomfort to patients.

Assessment of pain and swelling following surgical extraction of impacted mandibular third molar using complete and partial wound closure techniques in a tertiary institution

Assessment of pain and swelling following surgical extraction of impacted mandibular third molar using complete and partial wound closure techniques in a tertiary institution

Effect of Submucosal Injection of Tramadol on Postoperative Pain After Third Molar Surgery

This study aimed to evaluate the effectiveness of submucosal injection of tramadol in treating postoperative pain after surgical extraction of impacted mandibular third molars. We implemented a randomized controlled trial. The sample was divided into 30 cases (receiving tramadol injection) and 30 controls (receiving saline solution injection). Patients were asked to complete a visual analog pain scale (VAPS) at 0.5, 1, 2, 4, 6, 12, 24, and 48hours.Patients also were asked to note the time at which rescue analgesics were taken, as well as the total number of analgesics taken. The VAPS data were analyzed using the unpaired Student t test. Other variables were analyzed using analysis of variance with the Bonferroni t test and Pearson χ2 test. P<.05 was considered significant. A total of 60 patients, 32 men and 28 women (mean age, 27.78years; age range, 19 to 45years), took part in this study. Postoperative pain scores, as recorded on the VAPS, were significantly lower in the tramadol group, with the differences being statistically significant at 0.5, 1, 2, 4, and 6hours (P < 0.001, P=.006, P < 0.001, P < 0.001, and P < 0.001, respectively). The mean time at which the first tablet was taken and the total number of tablets taken by the tramadol group also were statistically significant (P=.001 for both). The results suggest that submucosal injection of tramadol has a significant effect on postoperative pain control after surgical extraction of impacted third molars.

MANDIBULAR IMPACTED THIRD MOLAR;

Objectives: To compare the difference in mean trismus by giving two doses of Dexamethasone after surgical extraction of impacted mandibular third molar. Study Design: Randomized controlled clinical trial. Period: 1st Jan 2016 to 30thJune 2017. Setting: Out Patient Department of Oral &amp; maxillofacial Surgery, Nishtar Institute of Dentistry Multan. Methodology: Data was entered on SPSS version 23 and mean ± SD were calculated for quantitative variables like age and mouth opening in mm. Similarly frequency and percentage of qualitative variables were calculated and presented like gender and incidence of trismus. P value ≤ 0.05 was considered as significant. Results: There were 60 patients in total. Males were 31 (51.7%) while females were 29 (48.3%) (Graph-1). Mean age of the patients was 37.25 + 9.04 years ranging from a minimum of 20 to a maximum of 50 years. When students t-test was applied to compare the means of two groups, in group A the mean trismus was found to be 25.77 + 3.58 mm while in group B the mean trismus was found to be 35.53 + 5.11 mm. The t-value was found to be 8.56 and df 58. The p-value was found to be &lt; 0.0001 which was clinically significant. Conclusion: The dosage of 8 mg of dexamethasone was statistically more significant in the reduction of trismus as compare to 4mg (p-value =0.000). So it is recommended that Dexamethasone with dosage of 8mg should be used to control postoperative trismus after surgical extraction of mandibular impacted third molar.

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial

The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5days after surgery: placebo (n=32), ibuprofen (n=33), or celecoxib (n=33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6h (P<0.001), 12h (P=0.011), and 24h (P=0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.

Analysis of the Effectiveness of Lornoxicam and Flurbiprofen on Management of Pain and Sequelae Following Third Molar Surgery: A Randomized, Controlled, Clinical Trial

The aim of this study was to analyze the effectiveness of Lornoxicam and Flurbiprofen in reducing perioperative sequelae after impacted mandibular third molar surgery. Ninety-one patients who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 29), Flurbiprofen (n = 31), or Lornoxicam (n = 31). The primary outcome was postoperative pain, evaluated using the visual analogue scale (VAS) score at 30 min, 2, 6, 12, 24, 48 h, 7 and 10 days following surgery. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with Flurbiprofen and Lornoxicam was characterised by an improvement in the primary outcome. Moreover, the treatment with Lornoxicam presented significantly lower median pain scores at 2 h (p < 0.001) and at 6 h (p = 0.016) compared to Flurbiprofen and at 2 h (p < 0.001), 6 h (p = 0.01), and at 24 h (p = 0.018) after surgery compared with placebo. Swelling and maximum mouth opening values were not significantly different between the groups at each follow-up session. This trial demonstrated that treatment with Lornoxicam showed a decrease in the incidence and severity of pain in the first postoperative phase following third molar surgery compared to Flurbiprofen and placebo.

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above.

The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice. To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar. This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar. Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001). This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments.

The Effects of Music Listening During Extraction of the Impacted Mandibular Third Molar on the Autonomic Nervous System and Psychological State

Pain, anxiety, and nervousness related to dental procedures can cause acute changes in the autonomic nervous system. Music is widely accepted as a relaxation method during dental treatment; however, its effects during dental treatment are unclear. The authors explored the effects of listening to music during extraction of the impacted mandibular third molar on the autonomic nervous system and the psychological state and hypothesized that listening to music would suppress sympathetic nervous activity and decrease anxiety. In this prospective study, 40 patients scheduled for extraction of an impacted mandibular third molar were randomized into 2 groups: extraction without music (control group) and extraction while listening to music (music group). Heart rate variability was recorded during the experiment, and Modified Dental Anxiety Scale and State-Trait Anxiety Inventory (STAI) scores were recorded before and after the procedure. Descriptive and bivariate statistics were computed and the P value was set at .05. An increased low-to-high frequency ratio was observed in the control group during incision and flap reflection, bone removal, and separation of the tooth crown; the ratio was significantly decreased in the music group during these time points (P<.05). Compared with the control group, the music group had a significantly greater decrease in postoperative STAI State Anxiety scores from preoperative levels (P<.05). This study suggested that listening to music while undergoing extraction of the impacted mandibular third molar suppresses activity of the sympathetic nerves during incision, flap reflection, bone removal, and separation of the tooth crown and relieves anxiety after treatment. Future studies will focus on the mechanisms involved and methods to prevent the onset of systemic incidents.

Does chlorhexidine work as a preventive treatment for dry socket?

The literature shows dry socket to occur in approximately 25% of casesfollowing the extraction of mandibular third molars. The most frequentlyused preventive medication, both in the literature and in practice, ischlorhexidine. This medication is used orally by the patient for a few daysfollowing extraction, as a rinse for a few minutes each day, or as a gel once.Two systematic reviews of the literature and meta-analyses of dozens ofrandomised clinical studies show that with chlorhexidine, the risk of drysocket following extraction of a mandibular third molar is reduced by half.

Mandibular Third Molars and Lower Anterior Crowding: Comparison of Opinions of Oral-Maxillofacial Surgeons and Orthodontists

Objective: To compare the opinion of orthodontists and oral-maxillofacial surgeons on relation between erupting mandibular third molars and lower incisal crowding.Patients and Methods: This descriptive study involved 100 Pakistani clinicians (50 orthodontists, 50 oral-maxillofacial surgeons) to answer online questionnaire regarding their opinions on link between erupting Mandibular Third Molars along with their extraction opinion with reference to development and prevention of lower incisal crowding. Data was analyzed using SPSS version 21.0. Pearson's chi-square test was applied and statistical significance was defined at &lt;=0.05.Results: Statistically insignificant differences were found between oral-maxillofacial surgeons and orthodontists regarding question of erupting mandibular third molars in causing lower incisal crowding. Similarly, statistically insignificant differences between oral-maxillofacial surgeons and orthodontists were found regarding question of recommending preventive extraction of mandibular third molars for developing lower incisal crowding.Conclusion: No opinion differences were observed between Pakistani oral surgeons and orthodontists, regarding the link of lower third molar as a cause of lower incisal crowding.

Effect of Audio-Visual Treatment Information on Hemodynamic Parameters during the Transalveolar Extraction of Mandibular Third Molars: A Randomized Clinical Trial.

Objectives:Anxiety regarding dental procedures is a universal challenge for every patient and the treating dental surgeon. Measurement of heart rate, blood pressure, and oxygen saturation is now commonly accepted by the scientific community as an accurate and objective measurement of the patient's anxiety compared to other subjective assessments. The aim of this study was to assess the influence of educational videos demonstrating transalveolar extraction of mandibular third molars on hemodynamic parameters.Materials and Methods:The study was designed as a prospective clinical trial. The modified dental anxiety scale was used to assess the preoperative anxiety of the patient. Participating patients were divided randomly into two groups (verbal and video group). Each patient's hemodynamic parameters such as heart rate, blood pressure, and oxygen saturation were measured in the waiting area, sitting on the dental chair, incision, bone drilling, tooth elevation, suturing, and in the postoperative area. All the analysis was done using the SPSS version 18 software.Results:Overall, there were no significant differences between the two groups with respect to hemodynamic parameters. The mean heart rate and blood pressure of patients between both groups were comparatively consistent and did not very much from the onset of procedure to the end. On the other hand, oxygen saturation levels were statistically significantly higher in the video group at the onset of incision and drilling.Conclusions:Videos can be interpreted in different ways by patients. Overall, hemodynamic parameters are overall not influenced with videos.

Efficacy of Autologous Leucocyte-Platelet-rich Fibrin (L-PRF) versus Hydroxyapatite as a Graft Material for Socket Healing after Surgical Extraction of Impacted Mandibular Third Molars: A Comparative Clinical and Radiographic study

OBJECTIVE: The purpose of this study was to compare the efficacy of Leucocyte -platelet‑rich fibrin (L-PRF), and hydroxyapatite (HA) for reduction of pain and swelling, the incidence of dry socket, soft tissue healing, and bone regeneration after surgical removal of impacted mandibular third molar in human patients.Patients and Methods: Thirty-six patients (20 males and 16 females) requiring extraction of mandibular third molars were randomly grouped as L-PRF, HA, and Control‑treated. All the procedures were done on an outpatient basis without any complication such as lip numbness. The patients were assessed for postoperative pain, swelling and maximal inter-incisal distance on the 1st, 3rd and 7th postoperative days. Exposed bony socket wall (dry socket), as well as soft tissue healing (healthy granulation tissue Formation), were also assessed at 1st, 3rd, 7th and 14th day of postoperative periods depending on the standard methods. Assessment of daily and total analgesics consumption was done and Radiological assessment of the extraction site was done at 2 and 6 months interval. Results: Pain, swelling, interincisal distance, and soft tissue healing had statistically significant more improvement for L-PRF group compared to HA and control groups. Radiographic assessment showed comparatively lesser bone density values in PRF and control sites at 2 and 6 months than HA site. Conclusion: Our study showed that L-PRF is better graft materials than HA regarding pain, swelling, dry socket, and soft tissue healing post‑L-PRF placement in the extraction socket. Bone regeneration is induced quickly by HA as compared to PRF. However, study with a wide scale of clinical cases is very much essential to be more decisive regarding the efficacy of the graft materials.

Postoperative Pain Attack after Mandibular Third-Molar Extractions under Intravenous Sedation in a Patient with Fibromyalgia Syndrome : A Case Report

Postoperative Pain Attack after Mandibular Third-Molar Extractions under Intravenous Sedation in a Patient with Fibromyalgia Syndrome : A Case Report