Extraction Of Mandibular Third Molars Research Articles

Effectiveness of low-level diode laser in the management of complications after third-molar surgical extraction: Systematic review and meta-analysis.

The aim of this study was to evaluate the effects of low-level laser therapy (LLLT) in reducing postoperative pain, swelling, and trismus after extraction of third molars. The authors conducted a literature search without restriction on dates or language in the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials database, Web of Science, and Scopus. They selected only split-mouth randomized clinical trials investigating the use of LLLT and comparing the effectiveness with a placebo group. The authors identified 803 references and evaluated 131 articles in full text. After this analysis, the authors included 18 articles in this study. The results of the meta-analysis suggest potential efficacyofLLLT in the reduction of postoperative pain (standardized mean difference [SMD],-1.11; 95% CI,-1.63 to-0.58; P < .001) and swelling (SMD,-0.50; 95% CI,-0.88 to-0.11; P= .01) at 48hours and trismus (SMD, 0.35; 95% CI, 0.16 to 0.53; P= .002) at 7 days after surgery. Evidence shows low certainty to indicate the use of LLLT after mandibular third-molar extraction. Future studies with improved methodology are needed to establish its efficacy in reducing pain, swelling, and trismus.

Geostatics in impacted mandibular third molar surgury

Exploring the application of minimally invasive techniques in the extraction of impacted mandibular third molar (IMTM), to achieve the treatment goal of "less trauma, short time, fast recovery", remains the focus of dentists. For now, the IMTM are mostly extracted in pieces after removing the crown and root resistance by bone removal and tooth segmentation, using 45°reverse-angle high speed turbine, piezosurgery, chisel or other dynamic system. However, There is a lack of principle-level parsing in different provinces and primary hospitals, while experience is still the main factor in avoiding excessive bone removal in complex IMTM extraction, as well as optimizing the specific position and angle of the parting teeth, finding the fulcrum and designing the best dislocation path when there is root resistance. In this review, the principle of geostatics was introduced into the extraction of IMTM. According to this principle, we analyzed how to design a clever tooth cutting line cleverly to enhance the efficiency of tooth segmentation, and how to optimize the mechanical design of root dislocation and the root dislocation path. Meanwhile, we will also focus on how to minimize trauma to alveolar bone during tooth extraction, so as to reduce the risk of intraoperative and postoperative complications, and provide interpretation and reference for dentists in surgical design and techniques of minimally invasive tooth extraction.

Clinical characteristics and removal of broken burs retained in the lower jaw

BackgroundA broken bur retained in the lower jaw is an uncommon complication that occurs during the extraction of the impacted mandibular third molar. The purpose of this retrospective study was to investigate the clinical characteristics of the broken burs and review our experience with the removal of the broken burs in these cases.MethodsAll patients, who suffered the broken bur remained in the lower jaw due to the extraction of the impacted mandibular third molar and presented to our hospital from July 2019 to July 2024, were included in this retrospective study. Demographic information of these cases was analyzed by descriptive statistics and the treatment methods were summarized.ResultsBased on the location of the broken burs, these cases can be classified into three types: (1) in the mandible; (2) between the lingual alveolar bone and periosteum; and (3) in the soft tissue of the mouth floor. In the cases of type 1, the removal of the broken burs was assisted by a tooth-supported digital guiding plate that precisely located the broken bur. The localization of the broken burs in types 2 and 3 was based on the preoperative radiographs, and the removal of the broken burs in the two types was mainly dependent on the surgeons’ experience. All the broken burs were successfully removed, and all patients displayed uneventful healing.ConclusionsThe broken burs remained in the lower jaw due to the extraction of the impacted mandibular third molar assumes many forms. The key point for the successful removal of the broken burs is to choose the corresponding methods based on the location of the broken burs.

Does Peripheral Nerve Stimulator-Guided Extraoral Mandibular Nerve Block Provide Effective Anaesthesia for Third Molar Surgery: A Prospective Interventional Study.

Mandibular nerve block provides good quality and long-lasting analgesia. In situations necessitating extraoral nerve-blocking procedures, clinicians may find it technically challenging to administer this block due to its uncertain surface landmarks or distorted anatomy. Peripheral nerve stimulator is a device used to electrically stimulate the peripheral and terminal branches of the nerve. This prospective interventional clinical study was carried out in the Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College And Hospital in patients requiring surgical extraction of mandibular third molar. Patients were divided into two groups: control group and test group based on computer-generated randomization. Control group patients underwent impaction procedure after conventional extraoral mandibular nerve block, while test group patients underwent impaction procedure after PNS-guided extraoral mandibular nerve block. Statistical analysis was done and the mean length of anaesthesia between the two groups was compared using a paired t test, and the mean pain levels up to six hours were compared using a Wilcoxon signed-rank test. Out of 42 patients, 25 were male and 17 were female. The mean age was 28.36years. The age range was 19-52years. In both control and test groups, no patients had failure of anaesthesia, and no one complained of pain during the procedure; hence, no supplemental injections were given. Visual analogue scale score remained (score ≤ 2) up to 6h for patients in test group. Thus, using a peripheral nerve stimulator guarantees the success of the block. For patients undergoing third molar surgery, it is a reliable, secure, and safer option for administering extraoral mandibular nerve block. In the future, the use of this technique could extend to pain control during major procedures such as cleft lip and palate, orthognathic, tumour removal, and facial injuries too.

Screening Female Patients With Autonomic Nervous System Imbalance Using the Toho Medical Index Before Tooth Extraction.

Imbalanced autonomic nervous system (ANS) activity raises concerns about the development of systemic complications during dental treatment. The purpose of this study was to determine whether a psychological test (Toho Medical Index (TMI)) prior to the impacted mandibular third molar extraction can identify patients with potentially imbalanced autonomic function. In this prospective study, 34 healthy adult patients with no history of systemic disease were assigned to either the autonomic imbalance group (type II, III, IV) or the control group (type I) based on the results of the TMI. We evaluated sympathetic nervous system activity (low/high frequency (LF/HF)), parasympathetic nervous activity, heart rate (HR), and systolic blood pressure (SBP) values before extraction of the impacted mandibular third molar. LF/HF and SBP in the autonomic imbalance group were significantly higher preoperatively than those in the control group. In addition, preoperative HF values were significantly lower in the autonomic imbalance group compared to those in controls (Mann-Whitney U test, p < 0.05); no significant group differences in HR were found (Mann-Whitney U test, p < 0.05). ANS activity before extraction of the impacted mandibular third molar was assessed subjectively using the TMI and objectively using HR variability analysis. Our findings suggest that some patients do not have symptoms specific to dysautonomia but have an imbalance of autonomic function before extraction of the impacted mandibular third molar, and TMI can identify such patients.

Coronectomy Versus Surgical Extraction for Mandibular Third Molars—A Pilot Study Assessing Patient Reported Outcome Measures for Post‐Operative Recovery

ABSTRACTIntroductionSurgical extraction of impacted Mandibular Third Molars (M3M) is one of the most common oral surgery procedures. Coronectomy procedures provide an alternative technique in cases of high‐risk inferior alveolar nerve damage. Recovery from both treatments can impact quality of life and may influence patient decisions.AimTo improve information provision on recovery and post‐operative effects of surgery during patient decision‐making for coronectomies and surgical extractions of M3M.MethodTwenty patients receiving coronectomies and 20 patients receiving surgical extractions were surveyed on postoperative days 1, 3, 7 and 14. The following parameters were assessed: pain, swelling, disturbed sleep, feeling unwell, difficulty carrying out day‐to‐day tasks, difficulty eating, difficulty brushing/cleaning the back of the mouth, difficulty opening the mouth, and return to work/social activities. A two‐way repeated measures ANOVA test was carried out.ResultsDays 1 and 3 exhibited the most severe symptoms across all parameters for both cohorts. Statistical analysis revealed no significant differences in scores among the parameters and across all days for both treatments. Social limitations were similar for both groups, with 30% of patients returning to work/social activities on day 1 and 100% on day 14. Type of impaction did not appear to influence the severity scores in either group.ConclusionWhile the subjective nature of the results should be considered, the immediate and short‐term postoperative recovery is comparable for coronectomies and surgical extractions of M3M.

Flapless extraction of impacted mandibular third molars: A contemporary surgical approach

The aim of this review is to evaluate the clinical outcomes of flapless extraction of impacted mandibular third molars compared to traditional flap-based techniques, with a focus on patient satisfaction, complication rates, and overall surgical efficiency. The extraction of impacted mandibular third molars (wisdom teeth) is a common procedure in oral and maxillofacial surgery, traditionally performed using a flap-based technique. While this method provides clear access to the impacted tooth, it is often associated with significant postoperative morbidity, such as pain, swelling, and extended recovery time. Recent innovations have introduced flapless extraction as a minimally invasive alternative, aiming to minimize tissue trauma and preserve periosteal integrity. This technique, however, presents its own set of challenges, including limited visibility and technical demands.This review analyzes the current literature on flapless extraction techniques, drawing from retrospective studies, randomized controlled trials, and clinical case reports. The data include comparisons of postoperative outcomes between flapless and traditional methods, emphasizing factors such as operative time, postoperative discomfort, and the frequency of complications. Findings indicate that flapless extraction generally results in reduced postoperative pain, swelling, and faster recovery times compared to traditional flap-based techniques. Patients who undergo flapless extraction report higher satisfaction due to less postoperative discomfort and a quicker return to normal function. However, the technique poses challenges in cases of deeply impacted teeth, where the lack of a flap may hinder complete access and increase the risk of complications. Flapless extraction represents a promising evolution in the surgical removal of impacted mandibular third molars, offering several advantages over traditional methods, particularly in reducing postoperative morbidity. However, the technique requires precise surgical skill and is not suitable for all cases. Careful case selection is crucial, and continued research is needed to further validate its efficacy and safety in complex scenarios.

Clinical and Molecular Impact of Advanced Platelet-Rich Fibrin on Pain, Swelling, and Distal Periodontal Status of Mandibular Second Molars After Mandibular Third-Molar Extraction.

Background and Objectives: This study aimed to evaluate the role of A-PRF (advanced platelet-rich fibrin) in the enhancement of wound healing and protecting the periodontal health of mandibular second molars after the extraction of mandibular third molars. Additionally, the study assessed the levels of pro-inflammatory cytokines in the gingival crevicular fluid (GCF) of mandibular second molars as markers of inflammation. Materials and Methods: Twenty-five systemically healthy adult patients with bilateral removal of impacted mandibular third molars were included. Each patient received A-PRF in one extraction site, while the contralateral site served as a control. Periodontal parameters of the adjacent second molar, including probing depth (PD) and clinical attachment level (CAL), were measured in distal-vestibular (DV) and distal-lingual (DL) sites. Pain, swelling, and overall healing were subjectively evaluated. Levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) in the GCF were analyzed. Evaluations occurred at baseline and three months post-surgery. Results: A-PRF significantly improved PD (from 4.69 ± 0.61 mm to 3.85 ± 0.34 mm in DV, and from 4.71 ± 0.65 mm to 3.79 ± 0.27 mm in DL, respectively) and CAL (from 2.41 ± 0.25 mm to 1.82 ± 0.21 mm in DV, and from 2.40 ± 0.36 mm to 1.75 ± 0.19 mm in DL, respectively) of the adjacent second molar, compared to control sites, three months post-surgery. Pain and swelling scores were notably lower on the 7th postoperative day in the A-PRF group. A-PRF also reduced pro-inflammatory cytokines in GCF, significantly more than in control sites, at three months post-surgery. Conclusions: A-PRF enhances the periodontal and inflammatory status of adjacent teeth and wound healing after the extraction of mandibular third molars.

Digital design combined with endoscopic minimally invasive extraction of impacted mandibular third molars with roots in contact with the mandibular canal

Objective: To study the clinical efficacy of digital design combined with three-dimensional (3D) printing model minimally invasive extraction of complex impacted mandibular third molars. Methods: Eight patients who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from April 2023 to March 2024 were included, including 3 males and 5 females, aged from 27 to 57 years old. The impacted mandibular third molars of all patients were closely related to the mandibular canal, and part of the dental tissue entered the mandibular canal. Preoperative digital design was used to simulate the intraoperative tooth segmentation and bone removal operation of the power system and the segmented tooth dislocation path, and analyze the tooth extraction resistance. The mandibular teeth, mandibular canal and mandibular model were three-dimensionally printed using light-curing resin inkjet. During the operation, an endoscope was used combined with the 3D printed model to minimally invasively extract the impacted mandibular third molar. Quantitative sensory testing of the patient's lower lip skin on the operated side was performed before surgery, 2 days after surgery, and 7 days after surgery. Clinical data such as operation time were collected. A paired sample t test was performed on the 2 and 7 days postoperative data and the preoperative data to compare the data differences. Results: All 8 patients successfully completed preoperative design, model printing and minimally invasive surgery. The number of teeth segmented in the preoperative design was (4.4±1.3), and the number of teeth segmented in the actual operation was (4.0±1.1). The operation time was (33.3±13.0) min. None of the patients had postoperative numbness of the lower lip or other postoperative complication. It was observed endoscopically that the inferior alveolar neurovascular bundle was exposed in the extraction socket during the operation. The patient's pressure pain threshold 2 days after surgery (0.601±1.170) was significantly lower than before surgery (1.251±1.109) (t=2.83, P=0.025). Conclusions: For complicated impacted mandibular third molars, digital design combined with 3D printing model can be used to perform minimally invasive extraction with the assistance of an endoscope.

Does the use of intra-alveolar honey after lower third molar extraction reduce postoperative inflammatory complications? A systematic review and meta-analysis.

Protocols are currently being studied in preventing postoperative complications after exodontia. This systematic review and meta-analysis aims to evaluate whether the application of intra-alveolar honey reduces inflammatory complications after the extraction of mandibular third molars (CRD 42.023.467.041). Searches were carried out in six electronic databases. Clinical trials comparing intra-alveolar honey administration with non-intervention or placebo after mandibular third molar extraction were selected to assess their impact on postoperative inflammatory parameters. The Cochrane ROB 2 tool was used to assess the bias risk in included studies, Stata software to conduct a meta-analysis for quantitative synthesis, and the GRADE system to evaluate the certainty of the evidence. This systematic review included 5 studies with 330 participants, and two studies were included in the meta-analysis. The results of the meta-analysis demonstrated that postoperative pain on the second day [MD: - 1.05; 95% CI - 2 to - 0.1] and fifth day [MD: - 0.97; 95% CI - 1.97 to - 0.03] was lower in the honey group compared to the control group. Total analgesic consumption [MD: - 4.77; 95% CI - 6.73 to - 2.81] was also lower in patients in the intervention group. The descriptive results indicated that honey appears to be beneficial in controlling edema, reducing trismus, and improving healing after extraction of third molars. Alveolar osteitis showed inconclusive results. The use of intra-alveolar honey after extraction of mandibular third molars seem to be associated with pain reduction. For the other outcomes, the results remain uncertain.

Radiological and Surgical Assessment of Proximity of Roots of Mandibular Third Molar to the Inferior Alveolar Canal in Impacted Teeth

ABSTRACT Background and Objective: A mandibular canal around the lower third molar roots house the inferior alveolar nerve (IAN). There is a risk of nerve injury during surgical tooth extraction. Methods: The College of Dental Sciences at Davangere’s Department of Oral and Maxillofacial Surgery served as the outpatient setting for this investigation. The study comprised one hundred participants who were going to have their mandibular third molars surgically extracted. The risk of IAN injury was evaluated by comparing the radiographic findings from preoperative orthopantomography and intraoral periapical radiographs with intraoperative observations. Results: The study revealed that the patient’s age did not have a significant correlation with the risk of nerve injury. However, cases involving bony impactions were found to have a higher risk of IAN damage. Additionally, mesioangular impactions and radiographic indicators, such as root deflection, were associated with an elevated risk of nerve injury. Conclusion: To reduce the risk of IAN injury during the extraction of mandibular third molars, it is essential to have a detailed understanding of the relevant anatomical features and to plan the surgical procedure meticulously.

Analgesic effects of ultrasound-guided inferior alveolar nerve block for extraction of impacted mandibular third molar: a retrospective cohort study

Analgesic effects of ultrasound-guided inferior alveolar nerve block for extraction of impacted mandibular third molar: a retrospective cohort study

Automatic detection and proximity quantification of inferior alveolar nerve and mandibular third molar on cone-beam computed tomography.

During mandibular third molar (MTM) extraction surgery, preoperative analysis to quantify the proximity of the MTM to the surrounding inferior alveolar nerve (IAN) is essential to minimize the risk of IAN injury. This study aims to propose an automated tool to quantitatively measure the proximity of IAN and MTM in cone-beam computed tomography (CBCT) images. Using the dataset including 302 CBCT scans with 546 MTMs, a deep-learning-based network was developed to support the automatic detection of the IAN, MTM, and intersection region IR. To ensure accurate proximity detection, a distance detection algorithm and a volume measurement algorithm were also developed. The deep learning-based model showed encouraging segmentation accuracy of the target structures (Dice similarity coefficient: 0.9531 ± 0.0145, IAN; 0.9832 ± 0.0055, MTM; 0.8336 ± 0.0746, IR). In addition, with the application of the developed algorithms, the distance between the IAN and MTM and the volume of the IR could be equivalently detected (90% confidence interval (CI): - 0.0345-0.0014mm, distance; - 0.0155-0.0759 mm3, volume). The total time for the IAN, MTM, and IR segmentation was 2.96 ± 0.11s, while the accurate manual segmentation required 39.01 ± 5.89min. This study presented a novel, fast, and accurate model for the detection and proximity quantification of the IAN and MTM on CBCT. This model illustrates that a deep learning network may assist surgeons in evaluating the risk of MTM extraction surgery by detecting the proximity of the IAN and MTM at a quantitative level that was previously unparalleled.

Comparative study on the short-term clinical effects of distal incision flap technique in the extractions of mesially/horizontally impacted mandibular third molar with high or medium position

ObjectiveThe extraction of impacted mandibular third molars (M3Ms) often lead to postoperative complications such as pain, swelling, and trismus. Flap design during surgery plays a critical role in determining the severity of these complications. This study aimed to compare the impact of three surgical flap types—modified triangular flap (MTF), modified envelope flap (MEF), and distal incision flap (DIF)—on surgery duration and postoperative complications. Study DesignPatients aged 18–30 years with mesially/horizontally impacted M3Ms in Class I, II and Position A, B from June 2023 to June 2024 were included. The primary predictor variable was the surgical flap type (MTF, MEF, or DIF), and the primary outcome variables were surgery duration and postoperative complications, including pain, swelling, and trismus. Covariates included patient demographics and M3M positions. Descriptive statistics, one-way ANOVA, and Pearson correlation analyses were used, with significance set at P < .05. ResultsA total of 135 patients were included. The DIF technique resulted in the shortest surgery duration and the lowest postoperative pain, swelling, and trismus on the 3rd and 7th days. ConclusionWhile limited in its applicability, the DIF is a safe and effective technique, reducing surgery duration and postoperative complications. Long-term studies are needed to confirm these findings.

Does Pederson Difficulty Index Accurately Predict the Difficulty of Mandibular Third Molar Extraction?

Abstract Context: To determine the relationship between the Pederson difficulty index and the modified Parant scale and to assess the effectiveness of the Pederson difficulty index in predicting the difficulty of mandibular third molar extractions. Settings and Design: This cross-sectional study recruited participants with indications for third molar extractions. Pederson’s difficulty index was used to evaluate the anticipated difficulty of preoperative mandibular third molar extraction. Surgical extraction of impacted third molars was done under local anesthesia and patients were then assessed postoperatively with the Modified Parant Scale. Methods: In this study, 85 participants indicated for surgical extraction of mandibular third molars under local anesthesia were enrolled between February 2018 and July 2018. The relationship between Pederson’s difficulty index modified Parant scale and duration of extraction was evaluated. Statistical Analysis Used: Sociodemographic variables of study participants were summarized with descriptive statistics. Student’s T-test was utilized for mean differences between groups and correlations were computed between Pederson and modified Parant scale. Results: This study comprised 85 participants with a mean age of 25.8 years ± 4.6, showing no significant difference across genders (P = 0.87). Pederson difficulty index demonstrated a sensitivity of 46.4% and a specificity of 89.5% and a moderate correlation (0.35, P &lt; 0.001) was observed between Pederson difficulty index and surgery duration, ditto, between Pederson and modified Parant scores (0.36, P &lt; 0.001). Conclusion: In conclusion, our study underscores the importance of pre-operative assessment for mandibular third molar extraction, highlighting the Pederson Difficulty Index’s moderate predictive value but emphasizing concerns about its sensitivity.

EVALUATION OF POSTOPERATİVE MORBİDİTY FOLLOWİNG OPERATIONS OF IMPACTED MANDIBULAR THIRD MOLARS WITH BONE RETENTION

This study is aimed to see how gender and whether tooth is placed on the right or left affected the length of the operation, edema, trismus, and discomfort after surgical extraction of an impacted mandibular third molar. This prospective study was conducted in the Inonu University. The study included 104 mandibular wisdom tooth with bone retention. There were 55 females and 49 males among the 104 patients, with 53 left and 51 right impacted mandibular third molar. The operations were performed by the same surgeon in the same operating room. The time between the incision and the suture was determined and recorded as the operation time for each procedure. Before surgery, on the 2nd postoperative day, and on the 7th postoperative day, the patients were compared in terms of facial swelling impacted mandibular third molar, discomfort, and trismus. IBM SPSS V23 was used to evaluate the data. The left impacted mandibular third molar extraction takes longer than the right impacted mandibular third molar extraction. Tooth 38, which have a longer operation time, are more prone to swelling, discomfort, and trismus. When tooths are extracted, right-handed surgeons cause less postoperative morbidity 48. We recommend that both right-handed, left-handed surgeons operate in clinics that conduct impacted tooth extractions.

A prospective randomized study on the efficacy of real-time dynamic navigation in deep horizontal mandibular third molar extractions

PurposeThis study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures.MethodsA prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p < 0.05.ResultsIn the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant (p = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury.ConclusionThe precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery.Graphical

A 3D-Planned Inward Fragmentation Technique for the Removal of Impacted Mandibular Third Molars: A Case Series.

Background/Objectives: The extraction of impacted mandibular third molars (M3Ms) carries significant risks, especially regarding the inferior alveolar nerve (IAN). This study aimed to evaluate the effectiveness of a 3D-planned inward fragmentation technique (3Dp-IFT) to improve surgical outcomes, reduce complications, and preserve bone structure in cases involving complex M3M impactions. Methods: Twenty-three patients aged between 18 and 36 years requiring M3M removal were included. Preoperative planning involved the use of cone-beam computed tomography (CBCT) for precise localization of the furcation area, followed by the creation of a 3D navigation template using PlastyCAD software version 1.7. The surgical procedure was performed under local anesthesia, with meticulous endoscopic assistance to ensure accurate access and minimize trauma. Postoperative outcomes, such as bone loss, pain, swelling, and mouth opening range, were carefully measured. The data were systematically organized and analyzed descriptively using Microsoft Excel. Results: No disturbances to the IAN or lingual nerve were observed. The mean buccal bone loss was 2.2 mm, with a standard deviation of 1.2 mm. Postoperative pain and swelling were generally low, with significant reductions within the first week. The use of the 3D navigation template significantly improved surgical access, enhancing safety and minimizing complications. Conclusions: The 3Dp-IFT technique represents a significant advancement in the minimally invasive removal of M3M by allowing precise access to critical anatomical areas while minimizing bone loss and postoperative complications. This approach is particularly beneficial for complex cases involving M3M near the IAN, thereby improving surgical safety and patient outcomes.

Effect of Hyaluronic Acid on Socket Healing After Lower Impacted Third Molar Tooth Extraction in 40 Dental Patients.

BACKGROUND Surgical extraction of impacted mandibular third molars is the most commonly performed procedure in oral surgery; its associated complications include sensory nerve damage, swelling, and trismus. This study aimed to evaluate the effects of hyaluronic acid (HA) on healing of the socket following extraction of the lower impacted third molar tooth in 40 dental patients. MATERIAL AND METHODS This prospective, double-blind, randomized, controlled study was carried out on 40 adult healthy patients indicated for surgical removal of bilateral impacted mandibular third molars with equal surgical difficulty (moderate surgical difficulty according to the Koerner index. Patients with right mandibular third molars were included into the study (HA) group and those with left mandibular third molars were included into the control group. Surgical removal of impacted teeth was performed at different times for each patient for proper measurement of postoperative clinical variables, including pain, swelling, and mouth opening. RESULTS Postoperative pain evaluation results using the visual analog scale (VAS) showed reduced pain levels at all observation periods. Postoperative swelling peaked in intensity within 12-48 hours, resolving between the 5th and 7th days, and there was no significant difference in pre- and postoperative measurements of interincisal opening between both groups (P>0.05). CONCLUSIONS We found that intra-socket application of hyaluronic acid after surgical extraction of impacted mandibular third molars promoted normal wound healing, and there was a clinical benefit of reduced postoperative pain and swelling.

Comparative Evaluation of Postoperative Edema Following Mandibular Third Molar Extraction Using Zirconia versus Carbide Burs

Aim: The use of zirconia burs with low thermal conductivity in the extraction of impacted mandibular third molars may improve postoperative patient outcomes. The aim of this study was to evaluate the effect of using zirconia burs on postoperative edema, trismus, and pain in impacted mandibular third molars. Materials and Method: This prospective randomized controlled study was conducted between January and July 2023 with participants who underwent impacted mandibular third molar extraction surgery at the Marmara University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery. The primary outcome measures were facial volume and surface area change measured by a mobile 3D scanning device. Postoperative maximum interincisal opening (MIO) and pain (measured by the VAS) were secondary outcome measures for this study. Age, sex, classification and position of the mandibular third molar were the demographic variables. Facial volume changes, MIO, and pain were compared within and between groups using a general linear model. Results: A total of 40 patients aged between 18 and 45 years were included in the final analysis. Postoperative facial volume, surface area, MIO, and pain did not significantly differ between the zirconia group and the carbide bur group on days 3 and 7 (P &lt; 0.05). Conclusion: The use of zirconia burs for bone removal in mandibular wisdom tooth extraction did not result in a statistically significant difference with regard to postoperative facial edema, MIOs or pain.