Impacted M3 Research Articles

Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction

BackgroundThird molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PurposeThe study purpose was to measure and compare differences in pain, swelling, trismus, wound healing and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. Study design, setting and sampleThis study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. Predictor variableThe predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiologic saline) side. Primary outcome variableThe primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening (MIO), were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. CovariatesThe covariates included age, sex and operation time. AnalysesThe Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P <0.05. ResultsThe study included 60 patients (mean age: 25.81 ± 4.91;23 (38%) males, 37(62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < 0.001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < 0.001), MIO (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P<0.001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P <0.001) and swelling (6.86 ± 0.70 mm, 7.15±0.80 mm, day 3, P=0.006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ±2.14, day 3, P<0.001). ConclusionThe application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative quality of life.

Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

BackgroundSeveral measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF). PurposeThis study compared the effects of three modifications of PRF (Leukocyte-PRF, Advanced-PRF, and Advanced-PRF+) on the side effects of impacted M3 removal. Study design, setting, and sampleThis double-blinded randomized controlled trial was conducted at the Oral Surgery department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease. Independent variableThe independent variable was the PRF product grouped into four categories (control, leukocyte-PRF, advanced-PRF, and advanced-PRF+). Study subjects were randomly distributed among the four groups. Main outcome variablesThe main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 post-surgery. CovariatesAge, sex, duration of surgery, and side of surgery were the covariates. AnalysesChanges at different time points were analyzed using repeated-measures ANOVA. Pairwise comparisons were performed if significant. P-values≤.05 were considered statistically significant. ResultsThe sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P>.05). A-PRF and A-PRF+ had significantly better healing index than L-PRF on the third day (P=.02, P=.01). All the study groups significantly reduced VAS pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF+ had significantly lower VAS scores than L-PRF on the second day (P=.003, P=.02). No significant difference was found in maximum mouth opening during follow-up sessions (P=.2). Study groups had less facial swelling on days 2 and 3 than the control group (P<.05). ConclusionL-PRF, A-PRF, and A-PRF+ can improve postoperative outcomes after M3 removal, but may not impact trismus. A-PRF and A-PRF+ may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF+ have comparable results.

Effect of Advanced Platelet-Rich Fibrin (A-PRF) on Postoperative Level of Pain and Swelling Following Third Molar Surgery

BackgroundPostoperative pain and swelling following third molar (M3) removal can be debilitating, and there is interest in using advanced platelet-rich fibrin (A-PRF) to reduce their severity. PurposeThis study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal. Study design, setting, sampleThis split-mouth, single-blinded, randomized controlled trial was completed at the Oral Surgery clinic of University of Otago between November 2020 and July 2021. Patients aged between 16–40 years, with bilateral impacted mandibular M3 of similar Pederson index difficulty and deemed to be American Society of Anesthesiologists (ASA) I or II comprised the study sample. Predictor/exposure/independent variableThe exposure variable was M3 socket management. One socket received A-PRF and 1 gelatin dressing, while the other received 2 gelatin dressings. Main outcome variable(s)The outcome variables were postoperative pain and swelling over 7 days. Pain was measured using the visual analog scale, and swelling using stereophotogrammetry. CovariatesDemographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates. AnalysesThe two sides were compared using cross-tabulations and the McNemar test for categorical and paired t-tests for continuous variables. Statistical analysis used IBM SPSS Statistics for Windows (Version 28). Alpha level was at 0.05. Results76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 (65.7% female; age range 16-30 years) were included in the analysis. Mean VAS scores showed no statistically significant difference between the A-PRF and control sides, being 29.6 (95% CI 23.9, 35.3) and 29.5 (95% CI 23.5, 35.5) on day 2, and falling to 12.6 (95% CI 8.7, 16.5) and 14.2 (95% CI 10.0, 18.4) by day 7. Likewise, mean peak facial swelling on day 2 was recorded as 6.3cm3 (95% CI 4.9, 7.7) and 6.6cm3 (95% CI 5.5, 7.7), and by day 7 they were 1.1cm3 (95% CI 0.5, 1.7) and 1.0cm3 (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively. Conclusions and RelevanceA-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.

Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial

BackgroundPostoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient’s quality of life. PurposeThe study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field therapy (PEMF) following M3 removal and compare it to patients who did not receive PEMF. Study design, setting, sampleThe single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography (CT). Predictor/exposure/independent variablesThe predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. Main outcome variablesThe pain was quantified using a 100 mm visual analog scale (VAS) and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the VAS scale and the number of analgesic tablets taken. CovariatesThe study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. AnalysesA t-student test was used, placing the statistical significance for p-value values < 0.05. The primary planned analysis was a two-group, continuity-corrected, chi-square test of equality of proportions. ResultsThe study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a p-value = 0.0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a p-value = 0.0062). Conclusions and RelevanceThe study’s results attest to the effectiveness of PEMF therapy in pain control after third molar surgery.

Relationship between mandibular third molars and mandibular angle and condylar fractures.

Assess the correlation between the position of the third molar (M3) and fractures of the mandibular angle and condyle using panoramic radiographs to offer valuable data references for oral clinical research. A retrospective cross-sectional study was undertaken, involving the collection of 409 cases of mandibular fracture in the Yanbian University Hospital. The case records and panoramic radiographs of mandibular angle fracture (78 cases) and condylar fracture (106 cases) were evaluated. In the comparative analysis between the mandibular angle fracture group and the condylar fracture group, statistical significance was observed in the variables of M3 existence (P = 0.002), eruption of M3 from the alveolar cavity (P = 0.003), P&G position classification (P = 0.001), deep impactions (Classes IC, IIC, IIIB, and IIIC) (P < 0.001), and the presence of impacted M3 in both groups (P < 0.001).Regarding M3 roots, the mandibular angle fracture group exhibited the highest prevalence of multiple roots at 75.4%, surpassing the 64.6% observed in the condylar fracture group. The prevalence of proximal angles in the mandibular angle group and the condyle group was the highest, accounting for 64.6% and 61.5%, respectively. The percentage of M3 in the two groups was 80% and 43.1%, respectively, with a significant difference (P < 0.001). Impacted mandibular third molars (M3) elevate the risk of mandibular angle fractures, while their absence or normal eruption reduces this risk and protects against condylar process fractures. The fracture risk is influenced by the M3's position: P&G Class II and Class B impactions, where M3s emerge partially from the alveolar bone, are significantly associated with mandibular angle fractures. In contrast, the absence of M3 or its placement in P&G Class I and Class A positions tends to correlate with a higher incidence of condylar process fractures.

Influence of periodontal susceptibility on the periodontal healing of adjacent second molars after surgical extraction of impacted mandibular third molar

Objective: To compare bone level changes and probing depths at the adjacent mandibular second molar (M2) 6 months after impacted mandibular third molar (M3) extraction between patients with and without periodontitis. Material and Methods: Patients referred for extraction of M3 were recruited. Patients were categorized as periodontally susceptible (PSP) or healthy patients (PHP). Six months after surgical extraction of M3 (T1), periodontal probing depths (PPD) and radiographic bone level at M2 were compared between the two groups. Regression analyses were performed to identify factors associated with PPD and bone level changes. Results: Forty-two patients completed the study, and the mean follow-up duration was 6.7 months. There was no significant difference in radiographic bone gain at M2 between PSP and PHP patients (1.26mm vs 1.13 mm). Every 1% increase in full mouth bleeding score at T1 was associated with 2.64mm less bone gain at M2. The PSP group was 6.43 times more likely to have PPD ≥ 5 mm at T1. Conclusions: Second molars in patients with periodontitis were not associated with less bone level gain 6 months after extraction of impacted M3. However, second molars in patients with higher gingival inflammation were associated with less bone gain.

Association of the Vertical and Sagittal Growth Patterns of Jaws with the type of Third Molar Impactions: A Radiological Analysis

Objective: To evaluate if the jaw growth patterns are associated with third molar impactions.&#x0D; Design: Cross-sectional study.&#x0D; Study setting: Orthodontics Department, Islamic International Dental College &amp; Hospital Islamabad, Jan to Jun 2018.&#x0D; Methods: We analysed the records of 300 mandibular and maxillary third molars with specific criteria. Orthopantomogram Xrays were used to identify impactions and were classified by Pell and Gregory (P&amp;G) and Winter lines. In addition, lateral cephalograms were assessed for sagittal classes and vertical growth patterns.&#x0D; Results: Angles of impaction (Winter lines) of mandibular M3s were significantly associated with sagittal growth patterns(p=0.021), with most mesioangular impactions found in Classes I and II. High-angle subjects resulted in the highest impactions in the vertical growth patterns. High angle was followed by low angle and normal angle in mandibular M3s and normal angle and low angle in maxillary M3s. Levels of maxillary M3s (P&amp;G) and vertical patterns showed a significant association (p=0.016), with the highest M3s at level C. The maximum number of impacted M3 coexisted with P&amp;G Class- II and level B for both jaws.Conclusion: Significant associations were found between mandibular M3 angles, sagittal patterns, and levels of maxillary M3s and vertical patterns. Results conclude that facial growth patterns and M3 impactions are not completely independent and may help predict impaction status in adolescence and aid in orthodontic treatment.

Assessment of Difficulty in Mandibular Third Molar Surgery by Lambade-Dawane-Mali's Index

The evaluation of mandibular third molar (M3) difficulty is extremely important. This study aims to measure the association between preoperative Lambade-Dawane-Mali's (LDM) M3 difficulty index and postoperative assessment of difficulty score. This prospective cohort study included patients with impacted M3 reported to the Department of OMFS, RRK Dental College, Akola, from 2017 to 2022. The preoperative surgical difficulty was estimated using the predictor, LDM index with scores, easy (15-25), moderate (25-30), and difficult (>30). The postoperative surgical difficulty was analyzed with the primary outcome variable, total time intervention measured from the beginning of incision to the final suturing, wherein extraction was classified as easy if time (<15minutes), moderate (15-30minutes), and difficult (>30minutes). The secondary outcome variable, Modified Parant's Scale (MPS), defines four levels of difficulty required for extraction of M3: Easy I (forceps extraction), Easy II (requiring osteotomy), Difficult III (coronal sectioning), and Difficult IV (complex extraction). Data were analyzed using agreement between LDM difficulty with three established criteria (time, MPS, Pederson index) and were assessed with Cohen's Kappa statistics. McNemar's test for paired data was used to assess concordance between two criteria of evaluation with a P-value <.05 was considered statistically significant. The study sample included 1000 patients with a mean age of 26.7±7.6years and 456 (45.6%) females. Those assessed preoperatively with LDM to be difficult and easy outcomes were found upon postoperative assessment with MPS to be 99% and 99% correct, respectively. Inter-criteria agreement and Kappa statistics suggested a positive Kappa value (κ) and statistically significant agreement between the LDM index with perioperative time (κ=0.8930), MPS (κ=0.6488), and Pederson index (κ=0.4920) at P-value 0.0001. Pair-wise comparisons of LDM criteria with perioperative time, MPS, and Pederson scale were assessed by McNemar's test, which evaluated concordance between the two criteria. Postoperative evaluation of surgical difficulty in M3 extraction was strongly correlated with preoperative variables in the LDM difficulty-scoring index. Preoperative evaluation helps in anticipating the difficulty, planning surgical management, and scheduling time more optimally.

Droplets Adhesion to Surgical Masks during Standard Oral Surgery.

The most common routes of transmission of coronavirus disease 2019 are droplet and contact infections. During dental treatment, several instruments and procedures used generate droplets of saliva and blood, such as during the extraction of an impacted third molar (M3). Surgical masks are often used during tooth extraction. However, the surface structures of surgical masks against droplets are not fully understood. Therefore, we analyzed the droplets that adhered to the surgical masks during impacted M3 extraction using electron microscopy. The surgical mask was divided into three layers and observed using electron microscopy. The outer and inner layers had a similar mesh-like structure, whereas the middle layer had a denser three-dimensional structure. Droplets ranging from 20-100 µm in size, generated during the extraction, adhered to the fibers of the outer layer of the mask. Fewer droplets adhered to the middle layer than to the outer layer. Droplets did not reach the inner layer. In conclusion, we suggest that a surgical mask can prevent droplet infection when performing impacted M3 extraction. This study is expected to contribute to the study of infection control strategies during dental treatments in the future.

Postoperative Sequelae Following Surgical Extraction of Impacted Mandibular Third-Molar Extraction Using the Complete Closure Versus the Sutureless Techniques.

Wound closure techniques affect the severity of inflammatory complications that ensue following surgical extraction of the impacted mandibular third molar (M3). The choice of the technique remains a topic for discussion because reports regarding their associated sequelae are split. This study therefore compares the pain, swelling and trismus in the complete closure and the sutureless/non-closure techniques. This was a prospective, randomised clinical study carried out at the Dental and Maxillofacial Surgery department of a tertiary hospital. A total of 74 participants requiring impacted mandibular M3 extractions were randomised into a complete closure group and a sutureless technique group. They were subjected to the procedure under similar technique and conditions and followed up for a week to assess their experiences of pain, swelling and trismus. Variables were recorded and analysed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. The critical level of significance was set at P < 0.05. The sutureless group had statistically significantly higher postoperative pain on days 1, 3, 4 and 5 (P < 0.05) and lesser severity of trismus on day 7 (P < 0.05) than the complete closure group. There was no significant difference in swelling. Compared with the complete closure group, the sutureless group had similar severity of swelling, less trismus but had higher pain severity in the week following M3 surgery.

Periodontal status of mandibular second molar after extraction of impacted mandibular third molars- a prospective clinical trial.

Mandibular third molar (M3) extraction is the common surgical procedures carried out; however, one of the complications is development of periodontal disease in adjacent second molars (M2). Hence the purpose of this study was to evaluate the effect of extraction of M3 on the periodontal status of M2. Study included 120 sites with mandibular M2 adjacent to the impacted M3. Plaque index(PI), gingival index(GI), probing pocket depths(PD), clinical attachment levels(CAL), Gingival recession(GR) and alveolar bone height(ABH) before and 9-12 months after surgical extraction of M3 were assessed. Patients perception was assessed using dichotomous rating. Four types of impactions(IMP) were included along with surgical cofactors like degree of impaction, flap design, bone removal, tooth sectioning. At baseline mesioangular and horizontal IMP showed greater PPD and CAL. After extraction of M3 there was significant decrease in PPD & CAL. 14% cases showed significant increase gingival recession at the distobuccal of M2. Although 10.9% of patients had an alveolar bony defect(ABD) distal to the M2, there was considerable improvement in ABH from baseline. The ABDs are mostly associated with mesioangular and horizontal IMP. Extraction of impacted M3 proves to be beneficial on periodontal status of M2. However, occasionally, mesioangular and horizontal IMP are likely to develop ABD distal to M2 and hence can be followed by regenerative procedures to prevent the formation of ABD.

Contrasting organic matter composition in pristine and eutrophicated mangroves revealed by fatty acids and stable isotopes (Rio de Janeiro, Brazil)

Mangrove sediments have a high capacity of carbon storage, as the result of larger organic matter (OM) inputs from mangrove trees (litter fall and fine roots production) than OM microbial degradation and export to coastal waters. Mangrove sediments also act as traps for suspended matter and particulate OM (POM) from surrounding water masses. Fatty acids (FAs) markers, δ13C and δ15N signatures were used here to characterize the OM composition in three mangroves located in three coastal embayments of the Rio de Janeiro state (Brazil) with increasing urbanization from a pristine mangrove M1 to a moderately impacted mangrove M2 and a highly impacted mangrove M3. In these mangroves, the δ15N signature of tree leaves and sediments increases with anthropogenic influence, consistent with a large-scale eutrophication gradient along the three regions. At mangrove M1, predominant OM inputs from mangrove trees are highlighted by high proportions of long-chain fatty acids, particularly in the inland station, where high organic carbon concentrations (126 ± 108 mg g−1) indicate limited sedimentation of mineral particles and high carbon storage capacities. The sedimentary OM of M3 mangrove was more labile as confirmed by the higher proportions of algal fatty acids, enriched δ13C signature and the C/N ratio 1.6 times lower (p < 0.001) than in the pristine mangrove M1. At the M2 mangrove site, high contribution of bacterial FAs (around 20%) to sedimentary OM and high proportion of poorly biodegradable saturated fatty acids suggest that bacteria degrade algal labile OM in surface sediments but do not mineralize the most refractory fraction of OM. At the eutrophic M3 site, our findings suggest that deposition of labile POM induced an increase of fungal biomass on the sediment, apparently enhancing the microbial loop, and potentially leading to mineralization of refractory OM and carbon losses through a priming effect.

CHARACTERISTICS OF UPPER THIRD MOLAR IMPACTION IN BANDUNG CITY POPULATION

Background: The third molars (M3) are the most frequently impacted teeth because they are the last to erupt, so they often don’t get enough space to erupt. The characteristics of impacted M3 teeth can be different for each person. This study aims to provide a description of maxillary M3 impaction based on age, sex, classification, treatment, and anesthesia in Bandung City population. Method: This was a descriptive study using secondary data from medical records and panoramic radiographs at RSGM UNPAD with a purposive sampling technique. Determination of the characteristic impaction using a classification based on Archer, Shiller, Jung and Cho, and Killy and Kay, analyzed with ImageJ software by interobserver and intraobserver, and tested using Kappa statistics for reliability. Result: There were 134 impacted teeth from 102 impacted patients with 67 females (66.34%) and most cases occurred in 17-25 years old (60.4%); Class B, 82 cases (60.9%); distoangular angulation, 76 cases (56.72%); Class 3, 76 cases (52.24%); and one fused roots, 83 cases (64.93%). The most common procedure performed was odontectomy (87.25%) with local anesthesia (63.73%) Conclusion: Characteristics of upper M3 impaction in terms of position, angulation, and its relation to age and sex is needed for the diagnosis, so the management plan by the clinician is better and safer. Panoramic radiography can still be used to determine classification and diagnosis in preparing a treatment plan even though it has limitations.

CHARACTERISTICS OF FIRST DAY COMPLICATIONS AFTER ODONTECTOMY OF IMPACTED MANDIBULAR THIRD MOLAR IN GENERAL ANESTHESIA

Introduction: Odontectomy is the most common procedure performed by oral and maxillofacial surgeons. The consideration of odontectomy cases in general anesthesia with certain factors, such as patient anxiety, mental or physical disorders, degree of difficulty in impacted teeth, disoriented patients, number of teeth performed odontectomy, and duration of surgery. Some complications after odontectomy, including swelling, trismus, and paresthesia often occur from the first day after odontectomy. The purpose of this study was to determine the characteristics of the complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia at Dr. Hasan Sadikin General Hospital during January – June 2020. Methods: This study was a cross-sectional retrospective using medical record data of patients diagnosed with class I, II, and III mandibular molar impaction based on clinical and panoramic x-rays and performed odontectomy of mandibular third molar impaction in general anesthesia at Dr. Hasan Sadikin Hospital for the period January - June 2020. Results: The obtained data were 186 cases from 98 patients. Data were obtained from secondary data through medical records of mandibular third molar impaction odontectomy patients in general anesthesia who were treated at the inpatient installation of RSUP Dr. Hasan Sadikin for the period during January to June 2020 to determine the characteristics of complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia based on age, gender, and the classification of mandibular third molar impactions. The percentage of complications on the first day after odontectomy of impacted mandibular M3 in general anesthesia at Dr. Hasan Sadikin General Hospital for the period during January - June 2020 showed that the largest number was found in complications of swelling as many as 41 people (54%), followed by trismus as many as 33 people (43%) and paresthesia were 2 patient (3%). Conclusion: The most common complications were swelling and trismus, where these complications were classified as mild and normal complications from odontectomy of impacted mandibular third molars. Meanwhile, the rarest complication was paresthesia. Keywords: Complications, Post-odontectomy, Impaction of mandibular third molar

Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study.

Introduction:The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems.Aims and Objectives:This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications.Material and Methods:The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months.Results:This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal.Conclusion:Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.

A retrospective analysis of the impaction status of mandibular third molars as a risk factor for fractures of angle or condylar region of the mandible

BackgroundThe position and angulation of mandibular third molars (M3) have been found to influence the angle and condylar fractures. Due to variation in the results of relevant studies, this relationship remains not fully understood. ObjectiveTo identify the association between the depth and angulation of M3 and the risk of fracture of the mandibular angle and condyle. MethodologyA total of 527 patients were assessed from January 2012 to June 2020. Study variables included the presence, position and angulation of M3. The outcome variables were angle and condylar fractures. ResultsMean age was 28.5 years with 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted M3 (p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with M3 classified as class II (p = 0.026) and position B (p = 0.05). In contrast, class I M3 were more frequently associated with condylar fractures. With regards to the angulation, M3 between 80° – 100° were highly correlated with angle fractures (p = 0.020) whereas M3 angulations of 60° – 80° were related to condylar injuries (p = 0.025). ConclusionsFractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80ᵒ-100ᵒ) and (60ᵒ-80ᵒ) respectively.

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up.

Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.

Impaction of mandibular third molars after orthodontic treatment by the edgewise method: a retrospective study.

This study aimed to determine the incidence of mandibular third molar (M3) impaction after orthodontic treatment by edgewise appliances, and identify possible determinant factors of M3 impaction. A retrospective cohort study was conducted with 1154 patients. Complete orthodontic records were analyzed pretreatment and posttreatment, considering the following variables: type of Angle malocclusion, treatment with or without extraction of first premolars, overbite, stage of dentition, M3 prior angulation and duration of orthodontic treatment. Impaction was determined after radiographic evidence of total closure of the root apex. The chi-square test and Poisson regression (p < 0.05) were used for statistical analysis with a hierarchical approach. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Mandibular M3 impaction incidence was 17%. Overbite equal to or greater than 4 mm (RR = 1.23, 95%CI: 1.11-1.26, p < 0.001), prior mesial angulation of M3 (RR = 0.59, 95%CI: 0.52-0.68, p < 0.001), non-extraction of first premolars (RR=1.06, 95%CI: 1.01-1.12, P=0.019) and orthodontic treatment time equal to or less than three years (RR = 0.94. 95%CI: 0.90-0.99, p < 0.014) were significantly associated with impacted M3. There was no correlation between the type of Angle malocclusion and the risk of impaction. In conclusion, the incidence of mandibular M3 impaction was considered low. The main pretreatment factors directly involved in impaction were mesioangulation of M3 and overbite equal to or greater than 4 mm. Orthodontic treatment with extraction of first premolars and treatment time greater than 3 years reduce the risk of impaction.

Relationship between mandible fractures and third molars.

BackgroundThis study was conducted to determine the relationship between third molar (M3) and mandibular fracture.MethodsPatients with unilateral mandibular angle or condyle fractures between 2008 and 2018 were evaluated retrospectively. Medical records were reviewed regarding the location of fractures, and panoramic radiographs were reviewed to discern the presence and position of ipsilateral mandibular third molars (M3). We measured the bony area of the mandibular angle (area A) and the bony area occupied by the M3 (area B) to calculate the true mandibular angle bony area ratio (area A–B/area A× 100).ResultsThe study consisted of 129 patients, of which 60 (46.5%) had angle fractures and 69 (53.5%) had condyle fractures. The risk of angle fracture was higher in the presence of M3 (odds ratio [OR], 2.2; p< 0.05) and the risk of condyle fracture was lower in the presence of M3 (OR, 0.45; p< 0.05), than in the absence of M3. The risk of angle fracture was higher in the presence of an impacted M3 (OR, 0.3; p< 0.001) and the risk of condyle fracture was lower in the presence of an impacted M3 (OR, 3.32; p< 0.001), than in the presence of a fully erupted M3. True mandibular angle bony area ratio was significantly lower in the angle fractures than in the condyle fractures (p= 0.003).ConclusionAngle fractures had significantly lower true mandibular angle bony area ratios than condyle fractures. True mandibular angle bony area ratio, a simple and inexpensive method, could be an option to predict the mandibular fracture patterns.

Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: A prospective clinical study

PurposeIn this prospective, randomized, double-blind, controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on early healing of soft tissue after mandibular third molar (M3) surgery. Patients and methodsIn total, 60 patients aged 18–30 (mean 22.3), 22 male and 38 female, were included in this study. After surgical extraction of the impacted M3, L-PRF was applied to the socket in the L-PRF group (n = 20), and a combination of L-PRF and HA was applied in the L-PRF + HA group (n = 20). Nothing was applied in the control group (n = 20). The primary outcome variable was healing score for the mucosa over the extraction socket on the 7th, 14th, and 21st days. Secondary outcome variables were frequencies of postoperative complications: hemorrhagic complications, alveolar osteitis (AO), and postoperative wound infection. ResultsMean healing scores for the mucosa on the 7th, 14th, and 21st days for both the L-PRF group and the L-PRF + HA group were significantly better than those for the control group. The ratio of alveolar osteitis for the control group was 1:20 and the ratio of postoperative wound infection for the control group was 1:20. There were no cases of alveolar osteitis or postoperative wound infection in the L-PRF and L-PRF + HA groups. No hemorrhagic complications were observed in this study. ConclusionThe results of this study suggest that L-PRF alone and when combined with HA can be an effective way to improve soft tissue healing, and could be used to prevent postoperative alveolar osteitis and infection after M3 surgery. Further studies with larger study groups are necessary.