Impacted Mandibular 3rd Molars Research Articles

A geospatial analysis of factors influencing clinical decision-making of rural and urban dental practitioners in Tiruppur district

Objectives: The core of dental practice is clinical decision-making. Geographic information system was used in our study to evaluate the clinical decision-making of dental practitioners in urban and rural Tiruppur district, Tamil Nadu. Materials and Methods: This cross-sectional study included 50 certified dental practitioners from both urban and rural areas. The research was conducted in June 2022. The tem-item and self-administered questionnaire was designed to collect data on practitioner, patient, and provider characteristics. The questionnaire was distributed to participants through an online Google form forum, and the results, clinical decision-making, were quantified using a series of hypothetical case situations. The association between rural and urban dental practitioners was assessed using the “Chi-square test.” Results: Twenty-six (14 [56%] urban and 12 [48%] rural practitioners) chosen the most conservative treatment approach of coronoplasty for asymptomatic impacted mandibular 3rd molar. Thirty (17 [68%] urban and 13 [52%]) rural practitioners preferred the conservative treatment plan of removal of caries followed by GIC Restoration for class I dental caries in a 7-year-old child. For the case scenario relation to class I malocclusion with spacing, 16 (64%) of urban dental practitioners preferred aligner-based treatment rather than fixed orthodontic appliance. This treatment choice differs statistically between urban and rural practitioners. Conclusion: The current research revealed an association between non-clinical features and dental professionals’ self-reported treatment preferences. It provides a foundation for future research into the elements hypothesized to impact dentists’ treatment decisions.

Prevalence and pattern of third molars impaction: A retrospective radiographic study.

Third molar impaction is considered a prevalent issue. The research aimed to study the pervasiveness and pattern of impaction in Karbala/Iraqi population. Orthopantomograms were studied regarding its angulation, impaction depth, and correlation with ramus. The outcomes manifested that the prevalence of 3rd impacted molars was 34.71%, with the proportion of male to female as 0.83:1. Impacted mandibular 3rd molars were significantly encountered. The prevalence of vertical angulation, mesioangular, horizontal, and inverted were significantly associated with the impacted mandibular 3rd molars (P < 0.05). However, the prevalence of distoangular and bucco/lingual was significantly associated (P < 0.05) with the upper impacted 3rd molars. Level C of impaction was significantly (P < 0.05) the most typical level in the maxilla impacted the 3rd molar, and level A and level B of impaction were significantly (P < 0.05) the most prevalent level correlated with the mandibular 3rd molar impaction. Class II was significantly (P < 0.05) the frequently occurring condition subsequent to Classes III and I. In conclusion, the impaction of 3rd molars was significantly predominant in females and lower jaw. The vertical angulation, level C of impaction associated with maxillary 3rd molars and levels A and B of impaction related with mandibular 3rd molars, and Class II are the most encountered conditions.

Clinical and radiographic evaluation of ozone therapy in odontectomy of impacted mandibular third molar

Introduction: Ozone can interact with blood components to have a positive impact on tissue microcirculation, oxygen metabolism, cell energy, immunomodulatory properties, and antioxidant defense systems. In dental surgery, ozone may be useful to promote hemostasis, enhance local oxygen supply, and inhibit bacterial growth. Ozone has been suggested for usage in dentistry due to its healing, antibacterial, and disinfecting qualities. Aim: To assess the influence of topical ozone administration on patient comfort after third molar surgery. Material and Methods: Two equal groups of the forty patients with lower impacted third molars who required surgical extraction were chosen at random. Patients in Group (I) had odontectomy for an impacted mandibular 3rd molar. Patients in Group (II) underwent odontectomy of the impacted mandibular 3rd molar, then ozone gel was injected into the socket. The follow-up visits were performed where the intensity of pain, the symptoms of trismus, swelling and radiographic bone density were evaluated. Results: Group II showed statistical significant difference of pain compared to group I while both groups showed no statistical significant difference with regard to swelling and trismus and radiographic bone density. Conclusion: After odontectomy of the mandibular third molar, ozone gel application therapy proved helpful for reducing postoperative discomfort and improving quality of life. Yet, in addition to bone density, it had no impact on either post-operative edema or trismus.

A COMPARATIVE SPLIT MOUTH STUDY TO EVALUATE THE ANALGESIC EFFICACY OF “DICLOFENAC TRANSDERMAL PATCH” AND “DICLOFENAC INTRAMUSCULAR INJECTION” IN THE IMMEDIATE POST OPERATIVE PERIOD IN PATIENTS UNDERGOING IMPACTED MANDIBULAR THIRD MOLAR REMOVAL

Introduction: Successful surgical treatment is based on correct surgical techniques and the prevention and management of postoperative pain and complications. For postoperative analgesia, multimodal combinations are prescribed nowadays. Aim: The present study aims to evaluate the analgesic efficacy of diclofenac trans-dermal patch and diclofenac intramuscular injection in immediate post-operative patients after extraction of impacted mandibular 3rd molar and the objective is to evaluate the side effects associated with both the modalities and to compare the analgesic efficacy of two modalities. Material and Methods: In this study, eighty bilaterally impacted third molars were selected. The study drugs (trans-dermal Diclofenac patch and Diclofenac intramuscular injection) were divided into two groups Group A (40 cases) and Group B (40 cases). Post-operative self-evaluation by the patient for pain was done. It was recorded at intervals of 2 hours, 8 hours, 16 hours, 24 hours, 2nd day and3rd day using the Visual Analogue Scale.Results and Discussion: Statistically significant higher pain score observed among group B at 8 hours (Mean rank = 28.20; p= 0.001), 16 hours (Mean rank= 30.25; p= 0.001), 24 hours (Mean rank=30.50; p= 0.001), 2 days (Mean rank= 27.05; p= 0.001) and 3rd day (Mean rank= 26.50; p= 0.001) respectively after extraction when compared with group A.Conclusion: Transdermal diclofenac patch is an effective, non-invasive, and cost-effective way of managing post-operative pain and can be used as a modality to control pain in an immediate post-operative period.

Comparative analysis of effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner

Background: Postoperative oedema is a consequence of tissue injury during surgery and the raising of muscular attachments, and appears as a result of direct trauma to blood and lymph vessels. Postoperative pain is a common phenomenon after surgery, due to surgical trauma and the release of pain mediators. After surgical extraction of impacted lower third molars, the pain is most intense 3-5 hours following extraction, just after the cessation of local anesthesia. Several methods of controlling the immediate inflammatory response associated with the third molar surgery abound in the literature. Aim of the study: To compare the effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner. Materials and methods: 45 Subjects for the present study were selected and divided into 3 groups of 15 patients each (group I- submucosal dexamethasone, group II sub-mucosal methylprednisolone, group III – submucosal placebo, normal saline) from amongst the patients who reported to OPD, at random basis irrespective of side, age, caste, creed, gender and socioeconomic status. Study was carried out in those patients who required surgical removal of impacted mandibular 3rd molars.

Mystery revealed on efficacy of intravenous dexamethasone vs methylprednisolone on post-operative sequelae after 3rd molar surgery

Background: Owing to its potent mode of action and lengthy half-life, dexamethasone has been used in oral surgery for many years. Several dexamethasone delivery methods for third molar surgery have been proposed. Dexamethasone administration has been a source of debate, with studies being unable to agree on the best effective method for reducing post-extraction complications. Aim: To carry out comparative evaluation of effect of intravenous 8 mg Dexamethasone and 40 mg Methylprednisolone on pain, swelling and trismus post-operatively after mandibular impacted 3rd molar surgery. Methods and Materials: The study used a split mouth technique, in which the impacted mandibular 3rd molars were extracted one at a time, separated by at least 21 days. Following surgical removal of an impacted mandibular third molar, the patient was given 8mg Dexamethasone intravenously at the first appointment. The surgical removal of the mandibular third molar on the contralateral side was performed on the same patient at the second session after 21 days, and 40 mg Methylprednisolone was administered intravenously post-operatively. Results: For the 2nd, 5th, and 7th day postoperative evaluations, patients showed decreased swelling with the Dexamethasone protocol compared to the Methylprednisolone protocol. There was a statistically significant difference between the two groups.

Effect of Submucosal Injection of Tramadol on Postoperative Complications after Third Molar Surgery

Objective: To determine the effectiveness of submucosal application of tramadol for acute postoperative pain, swelling and trismus. Material and Methods: A total of 84 patients having age between 18 to 35 years with irrespective of gender and require impacted mandibular 3rd molar extractions were included in study whereas patients with pericoronitis, periapical infection or lesions with respect to impacted 3rd molars, opposing traumatic occlusion or impinging upper 3rd molars or pregnant and lactating women were excluded in study. Subjects were distributed in two groups by port (chit) method i.e., Group A (Tramadol Group) with 42 patients and group B (sterile normal saline group) with 42 patients. Postoperative pain, swelling and trismus were recorded on Day 1, 2, 3 and 7 Results: Male patients were 25 (59.5%) and 25 (59.5%) and female patients were17 (40.5%) and 17 (40.5%) with mean age of25.7±4.7 (18-35) years and 26.5±4.9 (18-35) years in group A (Tramadol Group) and group B (Sterile Normal Saline Group) respectively. Post-operative findings in both groups were significantly different, group A (Tramadol Group) is better from group B (Sterile Normal Saline Group) in terms of post-operative pain, swelling and trismus. Conclusion: Submucosal Tramadol is more effective, safe and reliable than sterile normal saline in patients after third molar surgery. Keywords: Effectiveness, Submucosal, Tramadol, Facial pain, Third Molar

Role of topical gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on the wound healing after surgical extraction of impacted mandibular third molar

Odontostomologic procedures like extractions especially surgical removal of impacted 3rd molars, implants, biopsies etc are often associated with post-operative pain and inflammation. Traditionally chlorhexidine was used in this regard. Recently, topical gel, Bexident Post (ISDIN, SPAIN) has been in use to control post-operative discomfort. The aim of this study is to clinically evaluate the efficacy of Bexident Post (ISDIN, SPAIN) that contains chitosan, dexpenthanol, allantoin and 0.2% chlorhexidine on wound healing after surgical extraction of mandibular impacted 3rd molars. A study sample of 10 patients with similar type of bilateral impacted mandibular 3rd molar was included in the study. Total of 10 extractions were assingned in one of the two groups. Only difference between the two sides in terms of surgical protocol will be the Experimental side applied 10 mL thrice daily for 10 days while Control side did not. All patients were aware of the purpose of present study and written consent was taken requiring their participation. Results showed that facial swelling, mouth opening and pain were all significant between the two groups. The groups were homogenous only in terms of infection as neither of the groups showed post-operative signs of infection.

EVALUATION OF PATTERNS OF IMPACTED THIRD MOLARS AND THEIR ASSOCIATION WITH VITAL STRUCTURES BY RADIOGRAPHIC EXAMINATION

Objective: To assess the patterns of impacted 3rd molars and their proximity with adjacent vital structures.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Oral &amp; maxillofacial department of Rawalpindi Dental Hospital, from Oct 2016 toFeb 2018.&#x0D; Methodology: Patient sample size was 956. Orthopantomograms (OPGs) were assessed to determine the presence, patterns of impacted third molars and their relation to maxillary sinus and inferior alveolar canal (IAC) in maxilla and mandible respectively.&#x0D; Results: Out of 956 Orthopantomograms with 3499 3rd molars examined, 808 (23.09%) were impacted. Frequency of impaction was much higher in mandible than maxilla. Out of 527 impacted mandibular 3rd molars 238 (45.16%) were mesio-angular, 370 (70.21%) had class 1 relation to mandibular ramus &amp; 266 (50.47%) had level B depth, while among 281 impacted maxillary third molars 134 (47.69%) had vertical angulation and 162 (57.65%) had level B depth. Two hundred and eighty four (53.89%) impacted mandibular 3rd molars showed relationship with the inferior alveolar canal, out of which 187 (35.48%) impacted mandibular 3rd molars showed interruption of white line as the most common radiographic finding.&#x0D; Conclusion: Frequency of impacted third molars was more common in mandible and among females whereasthere is significant difference in patterns of impaction among mandible and maxilla. While most impacted teethhave approximation with IAC and maxillary sinus.

English

BACKGROUND Most commonly occurring impacted teeth encountered in dental surgery are mandibular 3rd molars. Reasons of impactions may be due to evolution and modern dietary habits, lack of space, decreased skeletal growth, and disproportionate crown size. Impacted tooth may cause various complications, if left untreated distal caries is commonly seen in mandibular 2nd molars. The aim of the current study was to determine the prevalence of distal caries of mandibular 2nd molars due to impacted mandibular 3rd molars. Symptoms like distal caries of 2rd molars is one of the major factors affecting the oral health next to periodontal disease and periodontal abscess. METHODS The study included 103 patients, reported to the dental department of Tripura Medical College and BRAM &amp;Teaching Hospital, Agartala. The study was done from July 2019 – December 2019, age ranged from 18 to 50 years. Panoramic radiographic examinations were carried out in each patient. Angulations of impaction and incidence of caries of the adjacent mandibular 2nd molars were recorded. All data were collected and analysed using percentage analysis. RESULTS 103 patients panoramic radiographs were studied, out of 103, 63 (61 %) were male, 40 (39 %) were female. 31 patients (30.1 %) out of 103 patients were found to have distal caries of mandibular 2nd molars adjacent to mandibular 3nd molars. 85 % of caries was associated with mesioangular impaction. CONCLUSIONS Careful monitoring to detect the caries lesions in early stage is necessary, as the distal caries on the mandibular 2nd molars was found to be high. Subsequently proper measures should be taken for restoration of mandibular 2nd molars and removal of impacted mandibular 3rd molars, if necessary. KEYWORDS Distal Surface Caries, Mandibular 2nd Molars, Impacted Mandibular 3rd Molars, Angulation

A Comparative Study of Platelet-Rich Fibrin and Platelet-Rich Fibrin with Hydroxyapatite to Promote Healing of Impacted Mandibular Third Molar Socket.

The purpose of this study was to compare the efficacy of platelet-rich fibrin (PRF) and platelet-rich fibrin (PRF) with hydroxyapatite (HA) on postoperative pain, swelling, soft tissue healing and osseous regeneration in mandibular third molar extraction socket in human patient. This prospective study included total 40 patients who reported to the Department of Oral and Maxillofacial Surgery (OMFS), Teerthanker Mahaveer Dental College and Research Centre (TMDC&RC), Moradabad (U.P.). Twenty patients each in both the groups of PRF and PRF with HA were included for the management of impacted mandibular 3rd molar extraction sockets and were evaluated for effectiveness. Evaluation was done on the basis of following parameters pain and swelling at time interval of 1st, 3rd, 7th day, soft tissue healing at time interval of 3rd, 7th, 14th day and osseous regeneration at time intervals of 1st, 3rd, 6th month postoperatively. Pain and swelling were less in the PRF with HA group when compared to PRF group. Soft tissue healing was better in the PRF with HA group compared to the PRF group. The result of the study shows rapid bone regeneration in the extraction socket treated with the PRF with HA group when compared with the PRF group. Also there was less postoperative discomfort in the PRF with HA-treated group. PRF a mitogenic promoter together with a bone graft forms a scaffolding, promotes early healing thus being creating beneficial for the patient and is also economic.

Correlation of Panoramic Radiological and Intra-Operative Findings of Impacted Mandibular 3rd Molar in Relation to Inferior Alveolar Canal: A Prospective Study.

The objective of this study was to correlate the preoperative radiological findings and intraoperative surgical findings during removal of impacted mandibular 3rd molar with respect to the inferior alveolar canal. The prospective study design included 100 patients between the age group of 20years and 50years who visited the Department of Oral and Maxillofacial Surgery at Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bengaluru. A preoperative panoramic radiograph was taken and the parameters were assessed and a normal surgical protocol was followed to extract the impacted mandibular 3rd molar with intra-operative assessment as well. Out of the 100 patients with definitive radiological signs showing close relation of the third molar to the mandibular canal who underwent surgical removal, only 12 patients presented with definitive clinical findings of the association. A true close relationship between the third molars and mandibular canal increases the risk of inferior alveolar nerve injury, and accurate evaluation of the relationship is essential to avoid the risk of surgery. The accuracy of the plain radiographs to diagnose an intimate relationship between the neurovascular bundle and the third molar root has its limitations, since only 12 of the 100 patients with positive radiological signs showed clinical evidence of involvement. Surgeons should be aware of the limitations of the radiographic markers of panoramic radiography and should consider more detailed imaging in more specific cases in which one or more radiographic marker is present.

Clinical application of flap or flapless buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact: A comparative study

PurposeTo investigate and compare the clinical application of flap or flapless buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact in terms of the average surgery duration, number of root fracture, postoperative pain degree and duration, postoperative swelling degree and duration, degree of limitation of mouth opening. Materials and methodsThe present study was conducted of 28 patients who were examined and underwent bilateral extraction of impacted mandibular 3rd molar. One molar was randomly extracted with flap buccal surgery (Control Group, CG) and the other one with flapless buccal surgery (Experimental Group, EG) in the same patient. ResultsGender distribution, average age, average surgery duration and number of root fracture between the two groups were not statistically significant (P>0.05). The postoperative pain degree, swelling degree and degree of limitation of mouth opening were all significantly greater in CG than EG. Moreover, the duration of postoperative pain and swelling were all were all significantly longer in CG than EG (0.01<P<0.05). ConclusionCompared with the flap buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact, the clinical use of the flapless buccal surgery is a safe and effective method with less swelling, pain and degree of limitation of mouth opening. However, we need further study based on the broader indications, a much larger number of patients included and a follow-up in the longer term to confirm our point.

Systemic Use of Arnica Montana for the Reduction of Postsurgical Sequels following Extraction of Impacted Mandibular 3rd Molars: A Pilot Study.

Background Postsurgical sequels (PSS) are a group of complications commonly encountered following invasive dental surgical procedures such as bone grafting procedures, external sinus grafting, and 3rd molar extractions. These include pain, intraoral and extraoral bruising, and edema. The aim of this study is to evaluate the clinical efficacy of arnica montana (AM) in the management of PSS following extraction of impacted mandibular 3rd molars. The investigators null hypothesis includes no significant role of AM in reducing PSS following dental extraction. Materials and Methods The investigators implemented a case-control pilot study enrolling twenty-three patients with impacted mandibular 3rd molars. These patients were allocated to AM or control group. Baseline clinical measurements were collected and included: (1) length of the surgical procedure, (2) pain score, (3) maximum mouth opening, and (4) facial measurements to evaluate edema levels. Subjects in active group received systemic AM tablets following the manufacturer instructions. All study subjects were followed up on Days 2, 4, and 7. Data was analyzed for statistical significance. Results A total of 30 impacted mandibular 3rd molars were extracted, in which 22 completed with AM. There were 16 females, and the average age was 26 years. On Day 2, subjects in the AM group reported significantly lower VAS compared to control group (3.09 ± 2.22 versus 4.75 ± 1.28). In addition, bleeding, extraoral bruising, edema, and decrease in maximum mouth opening were significantly less reported in the AM group. Conclusions This study describes the potential benefit of AM in reducing PSS following dental extractions.

Frequency of Lingual Nerve Injury after the Removal of Impacted Mandibular Third Molar

Objective: to determine the frequency of lingual nerve injury after the removal of impacted mandibular 3rd molar. Study Design: Cross sectional study Place and duration: outdoor patient department of Oral and Maxillofacial Surgery Hitec Dental College, Foundation College of Dentistry Peace Gernal Hospital, Nishtar Institute of Dentistry,Multan from January 2018 to January 2019 in one year duration. Results: Study included 335 patients with mean age of 20.86 + 1.95 yrs. Males were 190(56.7%) and females were 145(43.3%).lingual nerve injury was found in 28 patients(8.4%)while it was absent in 307 patients(91.6%).There was no significant effect was found on the frequency of lingual nerve injury for age or gender of the patient population. Conclusion: Lingual nerve injury is a commonly encountered complication among those undergoing extraction of impacted third molar. It should be carefully sought in all the patients undergoing the surgical procedure and improvement in surgical skills and techniques needs to be emphasized to further reduce the incidence and risk of this complication. Keywords: Impacted third molar, Lingual nerve, OPG (orthopantomogram), Dentistry, Mandible. DOI : 10.7176/JMPB/57-01 Publication date : July 31 st 2019

BILATERAL ORTHOKERATINIZED ODONTOGENIC CYSTS OF THE MANDIBLE. CASE REPORT AND REVIEW OF THE LITERATURE

Introduction First described by Wright in 1981, orthokeratinized odontogenic cyst (OOC) represents a developmental condition derived from epithelial dental lamina rests. Radiographically, OOC appears as a unilocular radiolucency associated with an impacted mandibular third molar. Occasional examples of bilateral/multicentric OOCs have been reported in the literature. Here, we present the clinical, radiographic and microscopic features of a patient with bilateral mandibular OOCs. Case report A healthy 19-year-old male presented with asymptomatic unilocular radiolucencies associated with left and right impacted mandibular 3rd molars. Both molars were extracted and the associated lesions enucleated. Microscopic examination of both specimens showed identical microscopic features consisting of cystic cavities lined by orthokeratinized stratified squamous epithelium with hypergranulosis. A diagnosis of bilateral OOCs was rendered. No recurrence was evident after 4-months. Discussion Six cases (including ours) of bilateral/multicentric OOCs have been documented in the English and Spanish literature. An analysis of the published demographics of this condition showed that most bilateral/multicentric OOCs have a striking predilection for young adult males (age range: 19-41 years; mean age: 27.3 years) with only one case presenting in a female. Bilateral OOCs are almost exclusively associated with impacted mandibular third molars. However, one report documented OOCs in all quadrants. The follow-up period for these cases ranged from 4 months-13 years with no recurrence stated. Conclusion Bilateral OOCs are uncommon and appear to have an excellent prognosis with no recurrence expected. However, more reports with long-term follow-up are needed to draw meaningful conclusions about their biological behavior.

Comparison of different grafting materials for treatment of bone defect distal to the molar in canine.

The extraction of impacted mandibular 3rd molar is highly related to bone defect distal to the adjacent 2nd molar. The aim of this study was to evaluate the effect of different grafting materials for the treatment of bone defect distal to the mandibular molar in canine model. In 12 beagle dogs, bilateral mandibular 2nd and 3rd molars were extracted and entire mesial bone of the 2nd molar extracted socket was surgically removed. Twenty-four bone defects (4 mm width and 8 mm depth) were randomly assigned to 4 groups, and grafted using 1 of the following protocols: (1) group C: no graft; (2) group Ta: autogenous bone (AB); (3) group Tb: deproteinized bovine bone mineral (DBBM) with a collagen membrane (CM); and (4) group Tab: an equal mixture of AB/DBBM + CM. Quantitative imageology analyses using micro-CT and fluorescence microscopy, as well as qualitative analyses using histological and histomorphometric evaluations, were characterized at postoperative 12 weeks. Significant differences of all variables were tested by multivariate analysis (P < .05). The defect depth was significantly lower in groups Ta, Tb, and Tab (1.70, 1.97, and 1.61 mm, respectively; mean) than in the group C (3.66 mm, P < .01, all). Compared to the sites received DBBM/CM, sites grafted with AB or AB/DBBM exhibited significant greater and faster new bone formation (P < .01). The percentage of DBBM remnants area (%) was significantly higher in group Tb than in group Tab (10.43% and 1.13%, P < .01; mean). Our data suggested grafting AB alone, DBBM/CM, or AB/DBBM/CM resulted in similar periodontal parameters in canine. Furthermore, the AB could accelerate new bone regeneration and mineralization, and promote the biodegradation of DBBM.

Local use of antifibrinolytic agent in prevention of alveolar osteitis (A clinical study)

The study was done to evaluate the effect of local use of antifibrinolytic agent in the prevention of alveolar osteitis after extraction of impacted mandibular 3rd molar. The study took place on 90 consecutive patients (45 patients in each group). After surgical extraction the sockets were irrigated immediately with 10ml of solution (tranexamic acid or placebo) for 2 min. 4 times / day (every 6 hours) for 2 days. Patients returned in five to seven days for suture removal complaining of postoperative pain were examined to verify the severity of the localized osteitis which graded as mild, moderate, or severe according to the patient’s stated degree of pain which scored according to visual analogue scale .The incidence of dry sockets in the group treated with 10% tranexamic acid was 6.6% compared with 28.8% in the sockets treated with placebo. In addition, the untreated group presented with dry sockets judged to be more severe.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study.

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

Importance of Clinical and Radiological Parameters in Assessment of Surgical Difficulty in Removal of Impacted Mandibular 3rd Molars: A New Index.

The aim of the study is to assess the clinical and radiological factors that increase the surgical difficulty in removal of mandibular impacted 3rd molar and design a new difficulty predictive index. The data was collected from 100 patients with impacted mandibular 3rd molar who presented to Department of Oral and Maxillofacial Surgery, K.L.E's Institute of Dental Sciences. Clinical and radiological parameters included in the New Index were noted. The tooth was then removed under local anesthesia and time taken for the removal was noted. The Pederson Index, New Index and time taken were co-related using kappa statistical analysis. The kappa agreement between Pederson Index and time taken was 66.50% (0.2231) whereas between New Index and time was 89% (0.7177) indicating that New Index is a better predictor of the difficulty. The New Index is a reliable tool in predicting the difficulty in the removal of mandibular impacted third molar.