Lower Third Molar Surgery Research Articles

Single-channel electroencephalography and its associations with anxiety and pain during oral surgery: a preliminary report

BackgroundThis study aimed to assess the course of anxiety and pain during lower third molar (LTMo) surgery and explore the role of mobile and single-channel electroencephalography under clinical and surgical conditions.MethodsThe State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), and Interval Scale of Anxiety Response (ISAR) were used. The patient self-rated anxiety (PSA), the pain felt during and after surgery, EEG, heart rate (HR), and blood pressure (BP) were assessed.ResultsThe Attention (ATT) and Meditation (MED) algorithms and indicators evaluated in this study showed several associations. ATT showed interactions and an association with STAI-S, pain during surgery, PSA level, HR, and surgical duration. MED showed an interaction and association with DAS, STAI-S, and pain due to anesthesia. Preclinical anxiety parameters may influence clinical perceptions and biological parameters during LTMo surgeries. High STAI-Trait and PSA scores were associated with postoperative pain, whereas high STAI-State scores were associated with more pain during anesthesia and surgery, as well as DAS, which was also associated with patient interference during surgery due to anxiety.ConclusionsThe findings suggest that single-channel EEG is promising for evaluating brain responses associated with systemic reactions related to anxiety, surgical stress, and pain during oral surgery.

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis.

To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars. Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The "JBI Critical Appraisal Tools for Systematic Reviews" was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence. The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = - 1.44; - 2.72 to - 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = - 1.36; - 2.13 to - 0.59). The certainty of evidence varied between very low to moderate. 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars. The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

Effect of One-Suture and Sutureless Techniques on Postoperative Healing After Third Molar Surgery

The wound closure technique for lower third molar surgery (LTMS) is an operative factor that influences wound healing and the occurrence of early postoperative complications. The present study investigated 2 closure techniques (partial closure using 1 suture and the suture-less technique) after use of a modified buccal envelope flap for LTMS. We performed a prospective, randomized, double-blind, split-mouth, controlled trial. Partial closure using 1 suture was compared with closure using the sutureless technique. The surgical sites were divided into 2 groups, group A (1 suture) and group B (sutureless). Each patient received both treatments at the same surgery. During the first postoperative week, all patients were asked to daily assess pain, facial swelling, and bleeding using self-assessment scales. All patients attended the follow-up appointment at 1week to objectively assess facial swelling and wound healing and at 1month to assess wound healing. An analysis of data was performed using the statistical package SPSS Statistics, version 24 (IBM Corp, Armonk, NY). A P value≤.05 was accepted as statistically significant. A total of 37 patients with bilateral impacted third molars of similar surgical difficulty were recruited. Of the 37 patients, 34 successfully completed the study. The results showed a statistically significant difference between the 2 techniques in postoperative pain at days 5 (P=.046) and 6 (P=.034); socket healing at 1week (P=.002) and 1month (P=.014), and soft tissue healing at 1week (P=.016). We found the 1-suture technique for LTMS to be superior to the sutureless technique in the reduction of postoperative pain and improving wound healing during the early postoperative period. We found no difference between the 2 techniques in the reduction of postoperative swelling.

Single-Dose of Submucosal Injection of Dexamethasone Affects the Post Operative Quality of Life After Third Molar Surgery.

Third molar surgery (TMS) became a routine, safe office procedure with generally predictable outcomes and relative low cost. It affects quality of life (QOL) of patients by causing considerable pain, swelling and trismus; by changing what people eat, their speech in the first few days after surgery. The purpose of the present study was to improve QOL of patient after lower TMS by injecting single dose 8mg submucosal dexamethasone. Forty healthy adult subjects of either gender underwent surgical removal of the lower impacted third molar under local anaesthesia and after being randomly assigned to receive either 8mg dexamethasone submucosal injection or normal saline injection in proximity to surgical site. Chi-square test, Mann-Whitney U test (Z), t student and unpaired t test, and Fisher extract test were used for calculation of data. Facial swelling, trismus showed significant reduction immediate postoperative day in dexamethasone groups. Patient perception postoperative pain on VAS score was not significant. PoSSe statistics, only three out of seven subscales showed a statistically significant difference between groups viz., Eating subscale, Appearance subscale, Sickness subscale but over all improvement in QOL was observed. Submucosal dexamethasone effectively reduces postoperative sequelae and improves postoperative QOL after TMS.

Effect of antibiotics on postoperative inflammatory complications in lower impacted third molar surgery

下颌第三磨牙阻生发生率很高,常引起冠周炎、邻牙远中龋、牙间骨吸收,少数可引起颌骨周围软组织间隙感染、颌骨骨髓炎、颌骨囊肿等并发症[1].下颌阻生第三磨牙拔除术后如何规范应用抗菌药物具有重要临床意义,但围手术期抗菌药物的选择和剂量并无明确的应用指南,国内外文献报道不一.不合理应用抗菌药物可能导致感染病菌的高度耐药而难以控制感染;另一方面加大了患者就医和整个社会的经济负担.现对下颌阻生第三磨牙拔除术围手术期应用抗菌药物能否预防术后炎性并发症的相关文献综述,以期对临床应用提供参考。

Factors associated with facial swelling severity following impacted lower third molar surgery: A prospective study

The ultimate purpose of this prospective study is to estimate and measure swelling associated with surgical extraction of impacted mandibular third molars in different four post-operative times and to identify the risk factors associated with determination of their risk degree. Material and Methods: In this prospective cohort study 159 consecutive cases in which removal of impacted lower third molars in 107outpatients were evaluated. Five groups of variables have been studied which are regarded as a potential factor for swelling after mandibular third removal which will enable the surgeon to predict and counsel high risk patients in order to offer a preventive strategy. Results: Facial measurements were carried out on 1 st, 2nd days, 1st and 2nd week postoperatively to measure the swelling area in each time respectively The peak level of swelling was noted on the second post-operative day and subside by seven days but in some cases the swelling was still in minor degree while in most patients it was zero by day 14. Conclusions: The degree of difficulty of the surgical extraction was the main indicators of risk factors for the swelling in all post-operative days because it involves all the other risk factors together.

Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery

The aim of this study was to compare the effect of intramuscular (IM) injection and consumption of 8mg dexamethasone in patients after lower third molar (LTM) surgery. 20 healthy Thai patients, average age 20 years, with bilateral LTM removal were recruited for this study, a double blinded, paired sample clinical trial. The washout period was 1 month after the first operation. Clinical assessment of facial swelling, pain and maximum mouth opening were measured before and after operation for 7 days. No significant difference was found in facial swelling between IM injection and consumption of 8mg dexamethasone after LTM surgery (paired t test P>0.05). The visual analogue scale scores for pain assessment showed no significant difference between IM injection and consumption of dexamethasone (paired t test P>0.05). The results conclude that IM injection or consumption of dexamethasone after LTM surgery can be used to control facial swelling, pain and trismus.

A comparative study of the effect of different third molar impactions on postoperative morbidity following lower third molar surgery

Background : The surgical removal of impacted lower third molar is one of the most frequently performed procedures in oral and maxillofacial surgery and represents a standard operation. Patients' complaints of pain, swelling and limitation in mouth opening associated with inflammatory response following lower third molar surgical extraction is an important factor affecting their daily life. The type of molar impaction has been associated with the increased postoperative morbidity following surgical removal. Objectives : The aim of this study is to compare the effect of different molar impactions according to George Winter on postoperative pain, swelling and trismus, which occur after lower third molar surgery. Patients and Methods : A comparative study of the effect of different lower third molar impactions on postoperative pain, swelling and trismus was carried out among 100 patients of both gender attending the oral and maxillofacial surgery unit of University of Nigeria Teaching Hospital, Enugu between January 2004 and February 2005. The molar impactions were mesioangular; 35, vertical; 26, horizontal; 23 and distoangular; 16. There were 40 (40%) males and 60 (60%) females all between the ages of 18-40 years. Pain, swelling and trismus were evaluated at 24 hours, 72 hours and 5 days postoperatively. The measurements obtained were recorded and converted to relative values, which provided numerical data for the comparative analysis. Results : The result of the study showed that mesioangular impaction had the highest reduction in all the postoperative variables followed by the horizontal impaction at all the evaluation periods while distoangular impaction had the least. Conclusion : The type of impaction according to Winter is associated with postoperative morbidity after lower third molar surgery. Distoangular impaction tends to have high rate of postoperative morbidity than others. This calls for adoption of extra measures in minimizing these postoperative variables by oral surgeons carrying out third molar surgery especially during distoangular disimpaction. Keywords : third molar surgery; different impactions; morbidity. Journal of College of Medicine Vol. 11 (2) 2006: 82-87