Impacted Mandibular Third Molar Surgery Research Articles

In vitro studies support clinical trials showing platelet-rich fibrin-mediated local delivery of antibiotics improves outcomes in impacted mandibular third molar surgery.

Our previous clinical observations showed that platelet rich fibrin (PRF) can be used to deliver antibiotics to attenuate postoperative complications after unilaterally impacted mandibular third molar surgery (IMTMS). In order to begin understanding the mechanism involved in the beneficial in vivo effects of PRF-mediated delivery of antibiotics, in vitro studies were performed, which showed that PRF preparations containing amoxicillin/clavulanic acid or clindamycin significantly inhibited the growth of S. aureus bacteria. In our previous study, comparisons were made between control and treated groups. However, since variations among individual patients could possibly affect the results, the current study included patients with bilaterally symmetric impacted mandibular third molars, allowing us to compare control and antibiotic treatment within each patient. The effects of PRF preparations containing amoxicillin/clavulanic acid or clindamycin on IMTMS was tested in 60 clinical cases. Antibiotic-injected PRF treatment after bilaterally IMTMS resulted in significantly reduced pain, less use of analgesics, and reduced swelling and trismus compared to the control group (PRF without antibiotics) confirming our previous results after unilaterally IMTMS. The in vitro results support the hypothesis that in vivo delivery of antibiotics using PRF produces therapeutic effects after IMTMS by attenuating bacterial infection and inflammation.

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes.

To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90mg, dexamethasone 4mg, or no premedication (control group) 1h before surgery. Paracetamol 500mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24h, 48h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Analgesic and Anti-Inflammatory Effects of Articaine and Perineural Dexamethasone for Mandibular Third Molar Surgery: A Randomized, Double-Blind Study

We aimed to investigate the effectiveness of articaine and perineural dexamethasone (DX) in reducing postoperative sequelae such as swelling and maximum mouth opening that are harming the quality of life of patients after impacted mandibular third molar (IMTM) surgery. We implemented a randomized clinical trial composed of patients undergoing IMTM extraction.The predictor variable was the treatment group. The patients were randomly assigned to 1 of 3 groups: Group A was administered 3.6mL of articaine mixed with 2mL of saline solution; group B, 3.6mL of articaine and 1mL of DX (4-mg/mL solution) with 1mL of saline solution; and group C, 3.6mL of articaine with 2mL of DX (8-mg/mL solution). The primary outcome variables were swelling (determined by anatomic facial landmarks), pain, and maximum mouth opening. Other variables comprised the duration of surgery, number of analgesics taken in the postoperative period, hygiene, and petechiae. The sample was composed of 60 patients (20 per treatment group), with a mean age of 25.18±5.22years; 53.3% were women. Postoperative swelling was significantly reduced in groups B and C (P<.05). Maximum mouth opening was significantly increased in groups B and C (P<.05). The results of this study suggest that combining DX with articaine improves the management of discomfort after IMTM surgery. The use of articaine via a mandibular block was not associated with neural damage in our study.

Curcumin probably does not reduce pain importantly after impacted mandibular third-molar surgery compared with mefenamic acid

Maulina T, Diana H, Cahyanto A, Amaliya. The efficacy of curcumin in managing acute inflammation pain on the post-surgical removal of impacted third molars patients: a randomized controlled trial [published online ahead of print June 16, 2018]. J Oral Rehabil. https://doi.org/10.1111/joor.12679.

Efficacy of NSAID (Lornoxicam) After Impacted Third-Molar Surgery With/Without Conscious Sedation: A Double-Blind Randomized Clinical Study

Aim: Pain and swelling following surgery for impacted third molars can be controlled by various methods. This study compared the analgesic and anti-inflammatory efficacy and tolerability of lornoxicam, aspirin and a placebo with and without conscious sedation in impacted mandibular third-molar surgery. Materials and Methods: 60 patients undergoing third-molar surgery were divided into 2 groups of conscious sedation and routine local anesthesia (n=30). Both groups were divided into three subgroups (n=10) that received either Lornoxicam, aspirin, or a placebo postoperatively. Results: In both the conscious sedation and local anesthesia groups, swelling reduction was significantly greater with Lornoxicam compared to aspirin and placebo (pConclusion: Conscious sedation resulted less pain and swelling. Moreover, Lornoxicam was found to be an effective analgesic and anti-inflammatory agent for use in conjunction with oral surgery.

IMPACTED MANDIBULAR THIRD MOLAR SURGERY;

Objective: The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. Materials &amp; Methods: It was a prospective randomized control study carried in Department of Oral &amp; Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars (right or left) were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets (2mg) dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours (1st day), after 48 hours (2nd day), after 72 hours (3rd day) and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. Results: The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Conclusions: Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual.

Azithromycin as prophylaxis for the prevention of postoperative infection in impacted mandibular third-molar surgery

Rotational use of antimicrobials is one of the strategies that have been suggested to reduce the development of drug-resistant bacteria. Cycling of homogeneous antimicrobial exposure is, however, unlikely to control the emergence of antimicrobial resistance. Penicillins and cephalosporins have been extensively used for therapeutic and prophylactic management of oral infection. The aim of the study was to investigate the clinical effects of azithromycin as prophylaxis on the prevention of postoperative infection in impacted mandibular third-molar surgery. The study design was a retrospective, single-center review. One (2.2%) of all 45 patients exhibited dry socket infection. In several categories, there was significant effectiveness of azithromycin in comparison with other antimicrobials, although there was no significant difference in the occurrence rate of dry socket infection. Azithromycin might be of value for prophylactic use in impacted mandibular third-molar surgery in which penicillins and cephalosporins were mainly used. Therefore, it might be available for one of the rotational agents.

The effect of locally applied gauze drain impregnated with chlortetracycline ointment in mandibular third-molar surgery

A prospective randomized crossover, within-patient, controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline (Aureomycin 3%®, Lederle) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted mandibular third molars. The teeth were removed on two separate occasions; on one side drain was inserted in the socket, and on the other side no drain treatment was used for control. The influence on postoperative pain, swelling, and mouth opening ability was investigated. The results indicated a statistically significant reduction (P = 0.02) in the incidence of postoperative inflammatory complications, defined as postoperative alveolitis, from 35% in the no-drain group to 4% in the drain group. No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction. There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method. It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain, swelling, and mouth opening reduction after impacted mandibular third-molar surgery.