Removal Of Lower Third Molars Research Articles

Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials.

To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and Vazirani-Akinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction. A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes. Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P= 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB. GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB. GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia.

Клінічна оцінка ефективності застосування збагаченого тромбоцитами фібрину та композицій на його основі при атиповому видаленні нижніх третіх молярів

Клінічна оцінка ефективності застосування збагаченого тромбоцитами фібрину та композицій на його основі при атиповому видаленні нижніх третіх молярів

Alveolar repair after the use of piezosurgery in the removal of lower third molars: a prospective clinical, randomised, double-blind, split-mouth study.

The objective of this study was to evaluate the use of piezosurgery for osteotomy and odontosection in the repair of the alveoli four months after exodontia. Fifteen young patients who needed third molars extracted were included. During the extractions, one of the teeth was included in the Piezo group, in which ultrasound motor tips were used in both procedures. The other tooth was removed with a conventional rotary instrument. The values of density of the repair regions of the right and left third molars were compared using digital panoramic radiographs. There were no significant differences (p>0.05): piezo group mean (SD) 125.7 (15.4) and control group 126.7 (21.2). The bone density of the alveoli after extraction of the lower third molars with rotary instruments and surgical ultrasound was similar in both groups.

Coronectomy: a retrospective outcome study.

Inferior alveolar nerve (IAN) injury is reported as a complication following surgical removal of lower third molars. In cases where the IAN is intimately related to the roots of the tooth, coronectomy may be performed as an alternative. The objectives of this study were to record operative indications for coronectomy and assess the short- and long-term post-operative outcomes following coronectomy. This retrospective study included patients (19-95years old) that had coronectomies carried out in the Edinburgh Dental Institute and Chalmers Dental Centre within the last 10years. The patients were invited by letter to attend a review appointment. High-risk radiographic signs and short- (≤ 3months) and long-term complications (> 3months) were recorded. A total of 124 patients were invited to participate and a total 28 patients returned for review. From the rest of the patients, data was extracted from their dental records. IAN injury was reported in 5 cases (4.3%) as a short-term complication and in 2 cases (3.5%) as a long-term complication. One patient presented with eruption of roots at the review appointment 7years following surgery. In this study, 'very' long-term complications were recorded as the 28 patients that returned for a review, were seen on an average of 4.8years post-operation. Coronectomy is a relatively safe technique for preservation of the IAN. However, prospective large scale research is needed to more accurately report on the prevalence of short- and long-term complications.

Does low-level laser therapy decrease pain and swelling after surgical removal of lower third molar? a randomized crossover clinical trial

Background: Low-level laser therapy (LLLT) could be an alternative for the treatment of swelling and pain after surgical removal of lower third molar (SRLTM), but there is a paucity of data in the literature on the effects of its use.

Is juxta-apical radiolucency a reliable risk factor for injury to the inferior alveolar nerve during removal of lower third molars?

The aim of this study was to find out if juxta-apical radiolucency (JAR) is a reliable risk factor for injury to the inferior alveolar nerve (IAN) during removal of lower third molars. We designed a cohort study of patients whose dental panoramic tomograms (DPT) had shown JAR before complete removal of lower wisdom teeth. The outcome variable was postoperative permanent neurosensory disturbance of the IAN. A total of 39 patients (50 lower third molars) were identified and screened for permanent neurosensory disturbance. None reported any permanently altered sensation 18 months after the operation. Based on our group, the presence of JAR does not seem to be a reliable predictor of the risk of permanent injury to the IAN during removal of lower third molars.

Application of Piezosurgery in Surgical Extraction of Impacted Mandibular Third Molars Versus Conventional Rotatory Technique: A Randomized Controlled Trial

Objective: To compare the effectiveness of conventional rotatory and piezosurgery technique for surgical removal of lower third molars. Material and Methods: Twenty patients with impacted lower third molars (with no acute symptoms) were divided into two groups (G1 and G2) and evaluated clinically and radiographically. They were allotted alternately into rotatory (G1) and piezotome (G2). Parameters assessed were the pain, swelling, trismus, comfort, analgesics consumed, the time taken for the procedure, intraoperative soft tissue damage and any other complications. Findings were then tabulated and analyzed. Results: Findings of pain, swelling, trismus, analgesics consumed and tissue damage were favorable in the piezosurgery group. However, the time taken for the procedure was significantly more as compared to the rotatory group. Post-operative trismus, values from the piezosurgery group were found to approach normality by day seven while in the rotatory group, a significant difference was found to exist up to day 14, suggesting that patients tend to return to normal function faster in the piezo group. Conclusion: Piezosurgery was found to be a good alternative to the conventional rotatory handpiece in select cases where extraction of the tooth could be carried out with minimal bone removal.

Dexamethasone Injection Into Pterygomandibular Space Versus Sublingual Space on Post-Operative Sequalae of Lower Third Molar Intervention

BackgroundThe surgical removal of lower third molar is still the most common surgical procedure that is done in oral and maxillofacial surgery field and creates the predictable post-operative sequelae such as pain, swelling, stiffness and difficulty in mouth opening. The purpose of this study is to compare pre-operative dexamethasone injection into pterygomandibular space (PGS) and sublingual space (SLS) in lower third molar intervention of post-operative pain, swelling, and limited mouth opening.MethodsThis study is the split-mouth, randomized crossover clinical trial in 30 healthy patients (mean age 21 years). These patients had similar bilateral lower third molar impactions. The patients were randomly divided into two groups receiving either 8-mg dexamethasone injection into SLS or PGS with the 4-week washout period intervention. Clinical assessment of facial swelling and maximum mouth opening was performed before operation and on day 2 and day 7 after operation. The post-operative pain was also measured by patients’ response on pain visual analogue scale (VAS) on the first, second and third day after intervention.ResultsThere is no significant difference between PGS group and SLS group in pain and swelling on the second and seventh day after operation. However, PGS group showed a greater degree of limited mouth opening than SLS group on the second day after operation.ConclusionsThis study showed that 8-mg dexamethasone injection into PGS or SLS was not different in reduction of pain, swelling, and limited mouth opening. This result suggests that dexamethasone injection into PGS or SLS is similarly effective.

Wisdom Tooth Surgery Complications—Local Anaesthesia versus General Anaesthesia

Purpose: To compare the complication rates arising from surgical removal of lower third molars (L3M) under general anaesthesia (GA) versus local anaesthesia (LA) in the Oral and Maxillofacial Surgery (OMFS) Department, Hospital Sultanah Nora Ismail (HSNI), Batu Pahat, Johor, Malaysia. Materials and methods: This is a retrospective clinical audit of patients who underwent L3M removal under LA or GA from 1/1/2013 to 31/3/2018, with recorded complications such as surgical site infection (SSI), wound breakdown, severe pain, trismus, retained tooth structure, nerve injury and dry socket evaluated at different time intervals. Results: A total of 313 patients with 375 L3M were included in this study (male: 160, 51.1%; female: 153, 48.9%) with an age range of 18 to 40 years (mean = 27.43 years). 79 L3M were removed under GA (34.2% were classified as mild; 65.8% were moderate), whereas 296 L3M were removed under LA, (31.4% were mild impaction, 63.9% moderate and 4.7% severe. Preoperative antibiotics were given before all L3M removal under GA, while only 23 out of 296 L3M removal under LA had antibiotics. 15.2% of L3M removal under GA and 16.6% of those done under LA were associated with complications. Generally, patient with GA had lesser complications; however only SSI outcome was significant (p = 0.034). Conclusion: L3M removal under LA may have a higher risk of SSI when compared to GA. This raises the possibility that a single prophylactic antibiotic dose may prevent SSI in LA procedures.

Effect of the Surgeon's Dominant Hand on Postoperative Periodontal Status of Adjacent Molars After Removal of Lower Third Molars

The purpose was to investigate the effect of the surgeon's dominant hand and the side (right orleft) of surgical removal of third molars in the mandible on the probing pocket depth and probing attachment level on the adjacent secondmolars. This study included 73 patients (46 female and 27 male patients; average age, 15.9±1.9years) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars surgically removed by a right-handed surgeon. The probing pocket depth and probing attachment level (outcome variables), as well as the gingiva and plaque indexes (other variables), were documented preoperatively and 6months after surgical removal. Descriptive and bivariate statistics were computed, and the P value was set at .05. The mean probing pocket depth decreased by 0.69mm on the lower left second molar and by 0.64mm on the lower right second molar over the follow-up of 6months.The mean attachment gain was 0.45mm for the lower left second molar and 0.40mm for the lower right second molar. The side differences between these changes in probing pocket depth (P=.620) and probing attachment level (P=.545) were not significant. The gingival index (P=.029) and plaque index (P=.007) deteriorated significantly for the lower right compared with the lower left second molar. For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent secondmolars.

A Comparison between primary and secondary wound closure after surgical removal of lower third molars according to pain and swelling

The aim of this study was to compare between Primary and secondary closure techniques after removal of impacted third molars. This comparison was carried out according to the pain and swelling parameter. One hundred patients with impacted third molars were randomly divided into two groups (50 patients in each group). Periapical radiographs were taken for each patient to determine the degree of eruption and angulations of third molars. After surgical extraction in Group I, the socket was closed by hermetical suturing of the flap while in Group II; a 5–6 mm wedge of mucosa adjacent to the second molar was removed to obtain secondary healing. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. The statistical analysis (analysis of variance for repeated measures, P &lt; 0.05) showed that pain was greater in GI, although it decreased over time similarly in the two groups (P=0.003, F=2.6613). Swelling was significantly worse in Group I (P &lt; 0.0001, F=38.395). In Group I, dehiscence of the mucosa was present in 15% of patients at day 7, and 1% showed signs of re-infection with suppurative alveolitis at 30 days. Pain and swelling were less severe with secondary healing than with primary healing.

Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia.

Aim:The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure.Materials and Methods:Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant.Results:SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased.Conclusion:The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.

Role of juxta apical radiolucency (JAR), the ‘new’ radiological sign in assessment of risk of inferior alveolar nerve injury with lower third molar removal

Introduction: Surgical removal of lower third molars is one of the most common surgical procedures performed in the NHS. Iatrogenic injury to inferior alveolar nerve (IAN) is a rare but potentially debilitating complication of this procedure.

Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified?

BackgroundThe objective of this study was to evaluate the association between the presence of mandibular third molars and the occurrence of carious lesions in the distal aspect of the mandibular second molar.Material and MethodsA retrospective cohort study comprising 327 lower third molars extracted in the Oral Surgery and Implantology Master’s Degree program of the School of Dentistry of the University of Barcelona (Barcelona, Spain) was carried out. A descriptive and bivariate analysis was made. The diagnosis of caries in the second molar and the position of the mandibular third molar were evaluated through panoramic radiographies.ResultsThe sample included 203 patients, 94 males (46.3%) and 109 females (53.7%), with a mean age of 26,8 years and 327 lower third molars. The prevalence of second molar distal caries was 25.4% (95% CI= 20.6% to 30.2%). This pathology was significantly more frequent when the third molar was in a horizontal position (27.7%), when the contact point was at (45,8%) or below (47.0%) the cementoenamel junction (CEJ), and when the distal CEJ of the mandibular second molar and the mesial CEJ of the third molar was 7 to 12 mm apart.ConclusionsHorizontal lower third molars with contact points at or below the CEJ are more likely to produce distal caries in the mandibular second molars. Due to the high prevalence of this pathology (20.6% to 30.2%), a prophylactic removal of lower third molars with the above-mentioned features might be advisable. Key words:Second molar, caries, third molar, prophylactic removal.

Application of Dexamethasone in the Masseter Muscle During the Surgical Removal of Lower Third Molars.

The aim of the present study was to analyze the effect of the application of dexamethasone in the masseter muscle during third molar surgery. This randomized, clinical trial used dependent samples and the split-mouth method. A sample of 30 patients, with impacted or semi-impacted third molars, as well as vertical and mesioangular positions of a similar surgical difficulty (on both sides), was subjected to 2 operations: an experimental operation and a control procedure, with a 30-day wash-out. The choice of which group would be experimental or control was random. The experimental group received 8 mg of dexamethasone, which was applied directly to the masseter muscle immediately after surgery. The control group did not receive corticosteroids. Seven and 15 days after the surgery, the patients were assessed in relation to their levels of pain, trismus, and edema. Concerning edema and trismus, there was a significant difference (P <0.05) between the control and experimental groups. As for the pain scale, no significant differences were found between the presence or absence of corticoids. The present study concluded that the application of dexamethasone in the masseter muscle effectively reduces edema and trismus, but does not affect pain.

The effect of modified surgical flap design for removal of lower third molars on lingual nerve injury.

The objective of this study was to evaluate a modified flap design for removal of lower third molars with avoidance of lingual flap elevation and its effect on postsurgical lingual nerve sensory impairment. The patients included in this prospective study were those referred for removal of symptomatic lower third molars at two Oral and Maxillofacial Surgery clinics. Different patterns of impaction were included regarding the angulation and depth of the lower third molar. Patients were reviewed 1day after surgery, then after 1week. Each patient was examined at each recall visit for any sensory alterations of the lingual nerve. The data collected was correlated to several variables including the age, gender, side of operation, state of eruption, angulation, depth of impaction, and tooth division. A number of 53 patients (23 males and 30 females), at ages ranging from 16 to 43years, underwent surgical removal of 66 fully or partially impacted lower third molars under local anesthesia using a modified flap design. The modified flap design provided adequate exposure for removal of the lower third molar for all patterns of impactions included, regarding the state of eruption, angulation, and depth of the tooth. This study showed that the investigated flap design can be safely used to remove lower third molars for different patterns of impaction without jeopardizing the lingual tissues thus providing optimum protection for the lingual nerve since it provided adequate exposure to remove the tooth without the reflection of a lingual flap.

Дослідження стану жувальних м’язів після атипового видалення нижніх зубів мудрості

The article analyzes the effectiveness of treatment of inflammatory complications of atypical removal of lower third molars by ultrasonografy of masseter. The study was carried out before surgery, the first, third and seventh postoperative day. It was found that local hypothermia and dexamethasone have a significant impact on the development of atypical inflammation after removal of the lower third molars, which causes less postoperative swelling of soft tissue areas, including masseter.

Дослідження мікрофлори лунки після атипового видалення нижніх третіх молярів при застосуванні остеопластичного матеріалу «Колапол КП-3 ЛМ»

&lt;span lang="EN-GB"&gt;Results of the study of influence osteoplastic material «Kolapol KP-3 LM» on the microbial landscape of fluid from wells after the removal of lower third molars have given in this article. The results show the most pronounced effect on flora, that potentially can be the causative agent of purulent inflammation.&lt;/span&gt;

Preoperative removal of lower third molars and bilateral sagittal split osteotomy in the UK

To find out what consultants in Oral and Maxillofacial Surgery (OMFS) in the UK think about complications of bilateral sagittal split osteotomy (BSSO) in relation to lower third molars we organised a national postal questionnaire during 2012-13. Of 378 consultants, 192 practised orthognathic surgery of whom 132 replied (a 69% response rate). Eighty-one respondents routinely removed lower third molars before BSSO; 51 did not. Eighty-nine respondents thought that there was an increased risk of complications if third molars were present at the time of BSSO, mainly an increased risk of unfavourable fractures. Forty-three respondents did not think there was an increased risk of complications of BSSO when third molars were present. Of the 81 who routinely removed the lower third molars, 13 removed them within the six-month period before BSSO, 56 removed them 6-12 months before, and 11 removed them more than 12 months before. There seemed to be no difference in self-reported unfavourable fracture rates between those surgeons who routinely removed lower third molars and those who did not. The results of the questionnaire showed that there was considerable variation in surgical practice across the UK in the management of lower third molars before BSSO, both in terms of whether or not to remove these teeth at all, and if so, when to remove them.

Telephone review after minor oral surgery

An audit of outpatient clinic attendances at Cardiff Dental Hospital (between September 2009 and March 2010) showed that 30% of patients failed to attend review appointments after minor operations. To reduce rates of non-attendance we set up a system of telephone review in March 2010. Patients were given a telephone appointment two weeks after their minor operation (mainly removal of lower third molars), instead of an appointment at the outpatient clinic. A trained nurse contacted each patient to complete a structured questionnaire that included questions about numbness, pain, and swelling. During the first year of the project, 1020 patients were booked for telephone review and of these 90% were discharged. 674 (66%) were discharged after telephone review, and 245 (24%) were not contactable. A total of 101 patients (10%) were brought in for clinic review because they reported complications. Estimated staff costs per patient for telephone review and clinic review were £3.05 and £23.55 respectively. Telephone review resulted in a significant reduction in the number of patients who failed to attend the clinic (OR=0.88, 95% CI 0.81 to 0.96) and facilitated audit of complications. The use of telephone review in conjunction with clinical follow-up for those with postoperative problems allows for cost-effective care with reduced rates of non-attendance.