Extraction Of Molar Teeth Research Articles

Iatrogenic Pneumomediastinum and Subcutaneous Emphysema after Mandibular Left First Molar Tooth Extraction

Pneumomediastinum and subcutaneous emphysema occur due to the presence of free air in the mediastinum and subcutaneous tissue. Early diagnosis and therapy are crucial as the passage of huge amounts of air into the mediastinum may lead to lethal com- plications. We report a rare case of cervical subcutaneous emphysema and pneumomediastinum occurring after extraction of the mandibular left first molar using an air-turbine drill. A 54-year-old woman presented to the emergency service with the complaints of left cheek and neck swelling and dysphagia. Her symptoms began following a dental surgery—the extraction of the mandibular left first molar. Computed tomography showed subcutaneous emphysema, which extended bilaterally from the left cervico-facial region to the anterior and posterior mediastinum. She was admitted to our service for follow-up and antibiotic treatment with a diagnosis of subcutaneous emphysema and pneumomediastinum due to dental extraction. Five days later, she was discharged with normal physical and radiographic examinations. Dentists and oral surgeons should realize that using air injection equipment can cause life-threatening complications. They should give detailed information to patients about these possible complications and closely follow-up the patients.

Anesthetic Efficacy of 4% Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques.

The study was designed to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94%, whereas by using IANB with the same anesthetic it was 92%. No statistical differences were detected in the success rates between the two anesthetic techniques (P=0.15). Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

Ludwig's angina complicated by fatal cervicofascial and mediastinal necrotizing fasciitis

A 54-year-old man, with a history of poorly controlled diabetes mellitus, presented to the emergency room with a three-day history of severe, progressive swelling of his neck associated with odynophagia. Oral cavity examination was remarkable for trismus with mouth opening limited to two fingers, edematous floor of the mouth, drooling and a carious second lower molar tooth. Physical exam was consistent with bilateral swelling of the neck, severe tenderness and symmetric induration in the submandibular area consistent with Ludwig's angina. On admission, leukocyte count was 7300/μL increasing to 26,000. Neck CT displayed gas in the fascial planes and musculature consistent with necrotizing fasciitis descending into the mediastinum and anterior chest (Fig. 1, Fig. 2). Blood cultures were negative and wound cultures were positive for an alpha-hemolytic streptococcus not further speciated and Actinomyces meyeri. Fig. 1 CT showing presence of gas in the anterior cervical space. Fig. 2 CT showing air dissecting into the anterior mediastinum. Broad-spectrum antimicrobials with Vancomycin and Imipenem/cilastatin were initiated; emergent surgical debridement and tracheostomy were performed (Fig. 3). During the hospital course he required multiple debridements and extraction of an infected second lower molar tooth. The clinical course was complicated by septic shock, acute respiratory distress syndrome and acute renal failure. Despite aggressive medical and surgical intervention, the patient expired from multisystem organ failure on day thirteen. Fig. 3 Extensive debridement with exposed sternomastoids and tracheostomy in situ. Ludwig's angina is an aggressive, potentially fulminant, deep neck infection often caused by dental infection/abscess from polymicrobial organisms [1]. It presents with fever, chills, mouth pain, drooling and dysphagia. Cervicofascial necrotizing fasciitis is rarely seen in patients with Ludwig's angina [2]. Clinical course and prognosis of patients with both conditions is determined by their immune status. Ludwig's angina superimposed by cervicofascial necrotizing fasciitis is a surgical emergency with a mortality rate of approximately >50%. The cornerstone of the treatment is securing the airway, providing efficient drainage, appropriate antimicrobials, and improving immunologic status [3]. Clinical presentation of Ludwig's angina can be subtle even in immunocompromised individuals with extensive underlying tissue destruction as seen in our case. It is important to maintain a high index of suspicion for necrotizing fasciitis in the setting of Ludwig's angina. Delay in the diagnosis and treatment is associated with a high mortality and morbidity [4].

Knocking out maxillary third molar with a hockey stick elevator

Extraction of maxillary third molar always comes as a challenge for any dental practitioner owing to its limited accessibility and minimal space for instrument placement. Moreover, the complications related to faulty extraction technique can never be ignored. We have here described a simple and easy method of extraction of the maxillary third molar tooth using hockey stick elevators which can solve most of the problems that are faced by dental surgeons in the extraction of maxillary third molars. This technique has proved its efficacy and has been time tested for removal of a maxillary third molar providing a good alternative for routine extraction techniques of maxillary third molars.

Effect of submucosal application of tramadol on postoperative pain after third molar surgery.

The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p < 0.05). This study demonstrated that post-operative submucosal application of tramadol is an effective method for reducing acute post-operative facial pain after impacted third molar surgery.

Consent for third molar tooth extractions in Australia and New Zealand: a review of current practice

Consent for third molar tooth extractions in Australia and New Zealand: a review of current practice

Piezosurgery and classical surgical techniques in surgical extraction of third molar teeth

Piezosurgery and classical surgical techniques in surgical extraction of third molar teeth

Coronectomy Sequale: A 5-Year Follow-up Study

The extraction of symptomatic mandibular third molar (M3M) teeth that exhibit radiographic signs of involvement with the inferior alveolar canal (IAN) carries significant risk of morbidity that can be avoided with coronectomy. This treatment modality allows the surgeon to limit or eliminate the risk of temporary and permanent damage to the IAN. Few studies have investigated the long-term sequelae of the coronected root. This retrospective observational cohort study was carried out to assess and report on the status of the coronected root following a coronectomy procedure.

The relationship between occlusal support and maxillary development: An animal study.

Objective:To test the hypothesis that maxillary development may be affected by occlusal support.Materials and Methods:The sample was composed by Wistar rats (5 weeks old) divided into three groups: Control (n = 10), extraction of mandibular molar teeth – left side (n = 10), extraction mandibular molar teeth – left and right sides (n = 10). The rats were sacrificed 8 weeks postextraction. Cone beam computed tomography scan images were taken for posterior measurement of maxillary length and width. Data were analyzed by one-way analysis of variance (Tukey test as post-hoc test).Results:Maxillary length was significantly shorter (P < 0.005) in both groups after tooth extraction. No difference was observed regarding maxillary width and body weight.Conclusion:Reduced occlusal support may impair the development of the maxilla in rats.

Effect of Alendronate on Bone Formation during Tooth Extraction Wound Healing

Alendronate (ALN) is an antiresorptive agent widely used for the treatment of osteoporosis. Its suppressive effect on osteoclasts has been extensively studied. However, the effect of ALN on bone formation is not as clear as its effect on resorption. The objective was to determine the effect of short-term ALN on bone formation and tooth extraction wound healing. Molar tooth extractions were performed in mice. ALN, parathyroid hormone (PTH), or saline (vehicle control) was administered. PTH was used as the bone anabolic control. Mice were euthanized at 3, 5, 7, 10, and 21 d after extractions. Hard tissue healing was determined histomorphometrically. Neutrophils and lymphatic and blood vessels were quantified to evaluate soft tissue healing. Gene expression in the wounds was assessed at the RNA level. Furthermore, the vossicle bone transplant system was used to verify findings from extraction wound analysis. Alkaline phosphatase (ALP) was visualized in the vossicles to assess osteoblast activity. ALN exhibited no negative effect on bone formation. In intact tibiae, ALN increased bone mass significantly more than PTH did. Consistently, significantly elevated osteoblast numbers were noted. In the extraction sockets, bone fill in the ALN-treated mice was equivalent to the control. Genes associated with bone morphogenetic protein signaling, such as bmp2, nog, and dlx5, were activated in the extraction wounds of the ALN-treated animals. Bone formation in vossicles was significantly enhanced in the ALN versus PTH group. In agreement with this, ALN upregulated ALP activity considerably in vossicles. Neutrophil aggregation and suppressed lymphangiogenesis were evident in the soft tissue at 21 d after extraction, although gross healing of extraction wounds was uneventful. Bone formation was not impeded by short-term ALN treatment. Rather, short-term ALN treatment enhanced bone formation. ALN did not alter bone fill in extraction sockets.

Frequency and causes of premature extractions of deciduous molar teeth – a retrospective study

Summary Introduction. Premature loss of deciduous molar teeth is a common cause of dysfunction of the masticatory system. Analysis of the causes of premature extractions of these teeth will allow the appropriate targeting of preventive and therapeutic interventions. Aim. To determine the frequency and causes of premature extraction of deciduous molar teeth. Material and methods. Analysis of randomly selected 1880 medical records of the patients of the Department of Pediatric Dentistry (Medical University of Warsaw) concerned the necessity and causes of premature extractions of deciduous molar teeth in children under the age of 6 and the course of previous dental treatment. Data was analyzed statistically using the Mann-Whitney U-test, Spearman's rank correlation and a chi-square test; significance level - p ≤ 0.05. Results. 228 deciduous molar teeth were extracted in 139 children, most commonly due to inflammation of the pulp and its complications (abscesses, fistulas) - 84.7%, and carious destruction - 7.9%. The incidence of acute purulent inflammation decreased with age, whereas the occurrence of chronic pulpitis increased. 87.3% of the extracted teeth had not been previously treated, 7.5% had fillings and 5.2% had been pulpotomized. 54.7% of the patients had a single tooth removed and the rest - more than one. Maxillary first molars were most frequently extracted. There was no statistically significant difference in terms of gender. No relationship between age and the number of the removed tooth was found. There was a positive correlation between chronic inflammation of the pulp and age; negative correlation was found between age and acute inflammatory process of the pulp or periapical tissue as causes of extraction (Spearman's rank correlation, p < 0.05). A statistically significant difference in the average amount of premature extractions performed per one patient was found - more than one tooth was more often extracted in boys (Mann-Whitney U-test, P = 0.034).

Alveolar Ridge Conservation by Early Bone Formation After Tooth Extraction in Rabbits. A Histomorphological Study.

Alveolar ridge volume loss is an irreversible process. To prevent this physiological event, which typically result in significant local anatomical changes in both the horizontal and the vertical dimension, some strategies are indicated to minimize the loss of ridge volume that typically follows tooth extraction. The purpose of this study was to evaluate if three different bone grafts could promote new bone formation in the alveolar socket following tooth extraction for the alveolar ridge conservation. First mandibular molars of male adults rabbits were extracted and the extraction sockets were randomly treated with three different bone grafts, one xenograft and two alloplastic grafts, and a group that received no treatment (blood clot). The extraction sockets of selected rabbits from each group were evaluated at 4, 6, or 8-week post-extraction. The results indicated that the extraction sockets treated with alloplastic graft (biphasic calcium phosphate) exhibited lamellar bone formation (6.5%) as early as four weeks after the extraction was performed. Moreover, the degree of new bone formation was significantly higher (P<0.05) in the extraction sockets treated with biphasic calcium phosphate at 8-week post-extraction than that in the other study groups. In this study, we demonstrated that the proposed animal model is useful to evaluate the bone formation after tooth extraction and the alveolar ridge conservation is feasible. The new bone formation and alveolar ridge preservation with bone graft after extraction of molar teeth, could result in the maintenance of sufficient bone volume to place an implant in an ideal restorative position without the need for ancillary implant site development procedures.

Evaluation of bleeding following dental extraction in patients on long-term antiplatelet therapy: A clinical trial.

The aim of this trial was to evaluate the bleeding after dental extractions among patients on uninterrupted antiplatelet therapy. A total of 190 patients under oral antiplatelet drugs requiring extraction of a single molar tooth were randomly assigned to two groups. Group A consisted of 95 patients on uninterrupted antiplatelet therapy and Group B consisted of 95 patients who have discontinued antiplatelet medication 5 days prior to extraction. The bleeding time of all patients was checked prior to extraction. The surgical procedure involved simple extraction of a single molar tooth under local anesthesia. The extraction socket was sutured with 3-0 silk. Pressure pack with gauze was given for 1 h. Bleeding after 1 h, 24 h, 48 h, and 5 days were compared between two groups. Chi-square test was used to compare the variables. P < 0.05 was taken as significant. None of the patients in either group had any significant uncontrollable bleeding after extraction. Hence, we recommend routine single tooth extractions in patients on long-term antiplatelet medication, without interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.

Neuropraxia following Nonsurgical Removal of Impacted Third Molar

Extraction of mandibular third molar teeth are frequently associated with complications. The nature of the complication depends on the age of patient, extent of surger y, expertise of the surgeon and the anatomy of the neurovascular bundle surrounding the tooth. Paresthesia is an one such unpleasant complication which is not only related to functional sensory loss in the region innervated by the nerve but also having a psychosocial impact on the patient. This case repor t tends to highlight a neuropraxic injury following nonsurgical extraction of a mandibular third molar and return of sensory response following neuropraxic injury Neuropraxia following Nonsurgical Removal of Impacted Third Molar (PDF Download Available). Available from: https://www.researchgate.net/publication/282051978_Neuropraxia_following_Nonsurgical_Removal_of_Impacted_Third_Molar [accessed Nov 13 2017].

Comparative Effects of Clonidine and Adrenaline with Lignocaine during Maxillary Infiltration Anaesthesia for Dental Extraction.

Lignocaine is a commonly used local anaesthetic in dental practice. Many practitioners use adrenaline (epinephrine) as additive with lignocaine, and some have used clonidine, instead of adrenaline. Both having benefits and limitations. Hence a study was undertaken in our department to evaluate the advantages and disadvantages of using (plain lidocaine local anaesthetic) versus (lidocaine with adrenaline as additive) versus (lidocaine with clonidine as additive). Randomised, prospective, double blind study. Seventy five patients requiring extraction of maxillary molar teeth who fall under ASA I category were included and randomly divided into group - I (n=25) (Lignocaine), group - II (n=25) (Lignocaine ± Adrenaline) and group - III (n=25) (Lignocaine ± Clonidine). The observations recorded were, time of onset of anaesthesia, hemodynamic parameters, blood loss during procedure and duration of post operative analgesia. The statistical analysis was carried out using SPSS 16 software. A statistically significant difference was seen in blood loss, being higher in group I and duration of anaesthesia, being shortest in group I. There was no statistical difference between the three groups amongst other parameters. Adrenaline at 10 μg/ml and clonidine at 15 μg/ml can be safely used as additives with lignocaine, in maxillary infiltration anaesthesia for dental extraction; with addition of either of these two drugs, having an equal advantage over use of plain lignocaine; in terms of lower blood loss and longer duration of anaesthesia; but, with no difference in the onset of anaesthesia and with no significant hemodynamic changes.

Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review

Necrotizing fasciitis is a potentially fatal soft tissue infection characterized by generalized necrosis and gas formation in the subcutaneous tissues and fascia. It is rarely seen in the head and neck area. This report presents the case of a 62-year-old diabetic female patient with generalized cervicofacial necrotizing fasciitis extending to the front chest wall. The cause of the disease was the extraction of the infected second molar tooth. Debridement was performed on the generalized necrotic fascia, subcutaneous tissue, and the skin extending from the preauricular area to the front chest wall and nipples. A series of debridement procedures were necessary because of generalized necrosis. The patient received intensive medical supportive treatment. Following the debridement procedures, the defective area from the neck to the front chest wall was closed up with split-thickness skin graft. Abscessed tooth extraction can lead to cervicofacial necrotizing fasciitis. Necrotizing fasciitis still remains as a potentially fatal disease. Early diagnosis, early radical surgical debridement, and a multidisciplinary approach constitute the significant factors in preventing mortality in such patients.

The thermosensitive TRPV3 channel contributes to rapid wound healing in oral epithelia.

The oral cavity provides an entrance to the alimentary tract to serve as a protective barrier against harmful environmental stimuli. The oral mucosa is susceptible to injury because of its location; nonetheless, it has faster wound healing than the skin and less scar formation. However, the molecular pathways regulating this wound healing are unclear. Here, we show that transient receptor potential vanilloid 3 (TRPV3), a thermosensitive Ca(2+)-permeable channel, is more highly expressed in murine oral epithelia than in the skin by quantitative RT-PCR. We found that temperatures above 33°C activated TRPV3 and promoted oral epithelial cell proliferation. The proliferation rate in the oral epithelia of TRPV3 knockout (TRPV3KO) mice was less than that of wild-type (WT) mice. We investigated the contribution of TRPV3 to wound healing using a molar tooth extraction model and found that oral wound closure was delayed in TRPV3KO mice compared with that in WT mice. TRPV3 mRNA was up-regulated in wounded tissues, suggesting that TRPV3 may contribute to oral wound repair. We identified TRPV3 as an essential receptor in heat-induced oral epithelia proliferation and wound healing. Our findings suggest that TRPV3 activation could be a potential therapeutic target for wound healing in skin and oral mucosa.

Occurrence of the retromolar foramen in dry mandibles of South-eastern part of India: a morphological study with review of the literature.

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations.

Effect of occlusal rehabilitation on spatial memory and hippocampal neurons after long-term loss of molars in rats.

Experimental loss of occlusal support caused by the extraction or grinding of molar teeth has been reported to foment the impairment of learning and memory in laboratory animals. The purpose of this study was to examine the effect of occlusal reconstruction after long-term loss of molars on spatial memory by using 8-arm radial maze and by assessing histopathological changes of neuron density in the hippocampus. Experimental dentures were inserted into the oral cavities of molarless rats to recover the occlusal support. Age-matched groups of control, molarless and denture-wearing rats were trained to perform the maze tasks. The difference of the error incidence in the maze task was evaluated between three groups. The difference of neuron density between three groups was also evaluated at the end of the maze task. Serum corticosterone levels were also measured to estimate the chronic stress, which could be caused by extraction, insertion of the experimental denture or any experimental procedure. The error incidence in the denture-wearing group was significantly higher than that of the control group, but significantly lower than that of the molarless group. Significant differences of neuron density were observed between three groups in each of the hippocampal CA1, CA3 and DG subfields. No significant difference of the serum corticosterone levels between three groups could be observed. From the results of this study, it was suggested that the recovery of occlusal support would bring amelioration of cognitive impairment concomitant with long period loss of molars in rats.

Development and evaluation of biodegradable microspheres embedded in in situ gel for controlled delivery of hydrophilic drug for treating oral infections: In vitro and in vivo studies

Present investigation was aimed at developing biodegradable polymeric microspheres of Tetracycline hydrochloride to treat oral infections by using Poly (D, L lactic‑co‑glycolic) acid (50:50) as polymer. Microspheres were prepared using oil‑in‑oil (O/O) and water‑in‑oil‑in‑water (W/O/W) double emulsion solvent evaporation method. Microspheres prepared by W/O/W were spherical in shape compared those prepared with O/O method. Thus, the microspheres formulated by W/O/W method were further evaluated for particle size, morphology, entrapment efficiency, and percent drug release. Effects of salt addition, polymer concentration on the characteristics of microspheres and tetracycline release profile were investigated. An increase in polymer concentration decreased drug release and increased entrapment efficiency of drug. In vitro studies indicated that release of drug from microspheres could be controlled for 10-15 days depending on drug: Polymer concentration. Formulation E released 99.10% of drug from microspheres in 10 days. Addition of sodium chloride to outer aqueous phase produced spherical microspheres with smooth surface and also increased entrapment efficiency. Microspheres were further dispersed in optimized formulation of mucoadhesive in situ gel of Pluronic F127, which acts as carrier for microspheres. In vivo studies were conducted on patients who underwent molar tooth extraction to check efficacy of designed formulation. Key words: Double emulsion, in situ gel, microspheres, molar tooth extraction, poly (D, L lactic‑co‑glycolic) acid, tetracycline hydrochloride