Extraction Of Impacted Mandibular Third Molars Research Articles

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.

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study

BackgroundThe injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM).MethodsThis retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher’s exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher’s exact test.ResultsThere were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8).ConclusionsRoot orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.

The Effect of the COVID-19 Pandemic on the Decision-making Process of Mandibular Impacted Third Molar Extraction

Objectives: In this study, we investigated the impact of the COVID-19 pandemic on the decision-making process for impacted mandibular third molar removal and related clinical teaching. Methods: From April 21 to April 28, 2020, we distributed a self-constructed survey via the Wenjuanxing software platform to oral clinicians engaged in the extraction of mandibular third molars. Results: We received 321 valid responses. Overall, 22.4% of clinicians were temporarily not performing tooth extractions in outpatient clinics and 50.2% of clinicians were temporarily not performing impacted tooth extractions. The main reason cited was that aerosol-generating high-speed handpieces were not recommended for use during the pandemic, opting instead for the surgical handpiece with copious saline irrigation as the main method for bone removal; the hammer-and-chisel method was considered to be too traumatic and posed too high of a risk for iatrogenic injury. Conclusions: The implementation of disease control measures during the COVID-19 pandemic significantly affected clinical decision-making regarding impacted mandibular third molar extractions; the main reason cited was the contraindication of using aerosol-generating high-speed handpieces. The hammer-and-chisel method may represent a valuable surgical application under the requirements for epidemic prevention and control. We provide a new idea for the extraction of interrupted permanent molars in the context of epidemic prevention and control is provided.

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.

Evidence-based clinical decision making for the management of patients with periodontal osseous defect after impacted third molar extraction: A systematic review and meta-analysis

Background/purposeExtraction of impacted mandibular third molar (MTM) is one of the most common procedures in clinical dental treatment; building a decision tree to perform MTM extraction can be prudent in alleviating periodontal diseases. This study is to review the latest research on the management of periodontal osseous defect (POD) after MTM extraction and rebuild a new clinical decision tree. Materials and methodsCurrent study was conducted according to PRISMA statement. Medline, Embase, Scopus, and Google Scholar were searched concerning treatment of MTM extraction up to Oct.2019. Three focused questions revolving around asymptomatic versus disease site, age, and necessity of ridge preservation after >6 months follow up will be answered. ResultsA total of 7 studies were included for meta-analysis. Evidences were inadequate in regards to asymptomatic vs disease site of MTM extraction in the long-term follow-up. For patients with age <25 years, postoperative probing depth (PD) always remained at < 4 mm. However, for patients with age >25 years with initial PD > 7 mm, residual pockets still remained at 5 mm. For ridge preservation, significant positive effect in reduction of second molar distal site PD was observed, regardless of different biomaterials being placed (z = 4.69, p < 0.00001). ConclusionAge is of utmost importance in preoperative evaluation during impacted MTM extraction. The timing for ridge preservation is essential determinant for achieving optimal treatment outcome. The clinical decision tree as proposed could serve as guidance when dealing with POD after impacted MTM extraction.

Sublingual dexamethasone may result in a small decrease in pain after impacted mandibular third-molar surgical extraction

Gozali P, Boonsiriseth K, Kiattavornchareon S, Khanijou M, Wongsirichat N. Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery. J Dent Anesth Pain Med. 2017;17(1):47-53. .

Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: A systematic review update and meta-analysis

BackgroundThe authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of impacted mandibular third molars. Types of Studies ReviewedThe authors searched for randomized clinical trials in which the investigators evaluated the efficacy of LLLT compared with that of placebo or no treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The authors used random effects model meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. ResultsThe authors included 21 studies. There was low-certainty evidence that LLLT results in less pain at 2 days after surgery (mean difference [MD], −1.42 on a 10 point scale; 95% confidence interval [CI], −2.18 to −0.67) and moderate certainty that it results in negligibly less pain at 7 days (MD, −0.59; 95% CI, −0.96 to −0.22); moderate-certainty evidence that LLLT has a negligible benefit on reducing trismus at 2 days (MD, −3.42 millimeters; 95% CI, −5.34 to −1.50) and at 7 days after surgery (MD, −2.30 mm; 95% CI, −3.96 to −0.64); lastly, there was moderate-certainty evidence that LLLT results in less postoperative swelling at 2 days (standardized MD, −0.82; 95% CI, −1.28 to −0.35) and low-certainty evidence that LLLT results in negligibly less postoperative swelling at 7 days after surgery (standardized MD, −0.17; 95% CI, −0.4 to 0.07). Low-quality evidence suggests that LLLT will not cause adverse effects. Conclusions and Practical ImplicationsLLLT probably has negligible benefits but may not result in adverse events. Evidence does not support the use of LLLT in clinical practice to reduce complications after impacted mandibular third-molar surgical extractions.

A higher incidence of dry socket may be related to the use of oral contraceptives after impacted mandibular third-molar extraction

Systematic review conclusionOral contraceptive use may increase the incidence of dry socket in women after impacted mandibular third-molar extraction.Critical summary assessmentThe results of this systematic review summarizing the evidence from 12 articles reporting on 16 studies suggest that female patients using oral contraceptives have a higher risk of developing dry socket as a postoperative complication consecutive to the extraction of their impacted mandibular third molars compared with female patients not using this contraceptive method.Evidence quality ratingLimited evidence. Oral contraceptive use may increase the incidence of dry socket in women after impacted mandibular third-molar extraction.

Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

Pilot clinical study of the dental cone beam CT examination before the impacted mandibular third molar extraction

To evaluate the diagnostic accuracy of the cone beam computed tomography (CBCT) in judging the relationship between the impacted mandibular third molar (IMTM) and the inferior alveolar canal (IAC). Sixty IMTM superimposing on the canal partially or touching the canal in line on panoramic radiograms were examined by CBCT. All CBCT images of these cases were observed by two dentists respectively. Then, all these IMTM were extracted by minimally invasive surgery, and the conditions of the IMTM sockets were observed. Two dentists observed the CBCT images independently and reached a consensus. Diagnosis test was performed in this study. Eight IMTM sockets were bleeding during the extracted operation, and whether the IAC wall was broken could not be judged. The other 52 IMTM sockets were clear and the walls of IAC were broken in 29 IMTM extractions. The sensitivity, specificity, Youden index, positive predictive value and negative predictive value of CBCT were 82.8%, 87.0%, 88.9% and 80.0% respectively. The diagnostic accuracy judged by the two dentists and Kappa coefficient were calculated as 84.6% and 0.800. The CBCT examination had good authenticity and reliability, and it was very helpful in predicting the actual relationship between the IMTM and IAC.

The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: A preliminary study

Swelling, pain and trismus are undesirable consequences of impacted mandibular third-molar extraction. The authors conducted a study to evaluate the effectiveness of cryotherapy, the therapeutic use of cold, in reducing undesirable consequences after surgery. Fourteen patients aged 20 to 28 years comprised the sample. The authors extracted two impacted mandibular third molars at different times from each patient. Immediately after surgery, the patient underwent cryotherapy on one side for 30 minutes every one and one-half hours for 48 hours when he or she was awake. The patient did not receive cryotherapy on the other side. The authors performed clinical examinations to measure trismus and swelling before surgery, immediately after surgery and 24 and 48 hours after surgery. The authors compared both sides for differences in swelling, pain and trismus in each patient. The results showed significant statistical differences in two of the five points that were used to measure the swelling (Wilcoxon nonparametric signed rank test of linear distances between the angle of the mandible to the pogonion and to the tragus). They found statistical differences between the two sides in relation to the pain; however, they found no significant differences in relation to trismus. Cryotherapy was effective in reducing swelling and pain in this sample. Despite playing no role in the reduction of trismus, cryotherapy was effective in reducing swelling and pain in this sample, and the authors still recommend it be used. Cryotherapy is helpful after third-molar extraction. Further studies need to be conducted that use larger samples of patients and other types of therapy, such as low-level laser therapy.