M3 Extraction Research Articles

Examination of the duration of vitamin B12 administration for hypoesthesia caused by inferior alveolar nerve injury after horizontally impacted mandibular third molar: A retrospective study

ObjectiveThis study aimed to assess the time to cure of hypoesthesia caused by inferior alveolar nerve (IAN) injury after horizontally impacted mandibular third molar (M3) extraction under continuous administration of mecobalamin, a vitamin B12 preparation, and factors that influence the time to cure. MethodsThis was a single-center retrospective study including 33 patients who experienced hypoesthesia after horizontally impacted M3 extraction and were treated with continuous oral administration of mecobalamin alone. The patients were divided into cured (n = 28) and uncured groups (n = 5). Demographic and clinical data were collected and analyzed. ResultsOf the 33 patients, 5 (15 %) reported uncured hypoesthesia. The median time to cure of hypoesthesia with mecobalamin administration was 33 (range, 6–202) days, and no cure beyond 7 months was reported. Age (≥30 years), Pell and Gregory classification (Position), and presence of Rood and Shehab signs ("interruption of white line of canal" and "diversion of canal") were significantly associated with prolonged time to cure. ConclusionsIt may be necessary to evaluate the efficacy of mecobalamin for IAN injury after horizontally impacted M3 extraction approximately 30 days after the initiation of administration and consider treatment modification or additional treatment within approximately 7 months.

Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction

BackgroundThird molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PurposeThe study purpose was to measure and compare differences in pain, swelling, trismus, wound healing and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. Study design, setting and sampleThis study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. Predictor variableThe predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiologic saline) side. Primary outcome variableThe primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening (MIO), were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. CovariatesThe covariates included age, sex and operation time. AnalysesThe Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P <0.05. ResultsThe study included 60 patients (mean age: 25.81 ± 4.91;23 (38%) males, 37(62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < 0.001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < 0.001), MIO (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P<0.001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P <0.001) and swelling (6.86 ± 0.70 mm, 7.15±0.80 mm, day 3, P=0.006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ±2.14, day 3, P<0.001). ConclusionThe application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative quality of life.

Radiological findings associated with postoperative wound infection after extraction of impacted mandibular third molar: A retrospective study

IntroductionStudies directly relating radiological findings to the risk of postoperative wound infection (PWI) in impacted mandibular third molars (M3) are limited and poorly understood. This study aimed to clarify the radiological risk of PWI. Materials and methodsTwenty-six patients who developed PWI after M3 extraction were retrospectively analyzed using orthopantomography (OPG) and computed tomography (CT) before M3 extraction to determine the association between M3 impaction status and PWI. These were compared with an equal number of non-infected groups. Moreover, the possibility of assessing the same risk in OPG as in CT imaging was examined. ResultsMultivariate analysis identified class III and position B of the Pell and Gregory classification system as independent risk factors for PWI. On CT, an axial overlap distance (AOD) >3.5 mm was significantly associated with PWI. Furthermore, the sagittal overlap distance (SOD) and AOD of the OPG were significantly greater in group III-B. A strong positive correlation was observed between SOD and AOD. ConclusionThese results indicate that class III, position B, and an AOD >3.5 mm may be novel risk factors for M3 PWI. The strong correlation between SOD and AOD suggests that the risk assessment for PWI can be performed by evaluating OPG alone.

A survey of dental professionals' opinions around the use of antibiotics in molar 3 extractions and dental implant placement.

This survey was conducted to determine the type and frequency of antibiotics (AB) use for the prevention of infections in dental third molar (M3) extraction and implantation procedures (DIP) among UK dentists and the opinions underpinning their practice. Systematic reviews of the evidence were undertaken alongside this survey of practicing dentists in the United Kingdom to identify the opinions and practices of those undertaking the procedures.With ethical approval, a survey was designed for online delivery and was sent to every dental practitioner in the UK with a publicly available email address or social media contact. The opening page provided the project information sheet and proceeding to complete and submit the questionnaire was considered consent to participate. The online survey was circulated to 900 identified addresses and a total of 145 responses were received. Responses were collated in Microsoft® Excel™ and analyzed using IBM® SPSS™ plus thematic analysis of free text responses. There were 42% of participants (n=61) who discouraged AB prophylactic use in M3 extractions in people with no systemic conditions and who also preferred postoperative AB use when required. Where, 57.9% of respondents (n=84) supported the short-term use of ABs (5-7 days) for M3 extraction and 53% (n=77) in DIP placement in patients with no relevant medical history. As an ad hoc finding, dentists reported on the negative impact of heavy smoking and oral parafunctional behavior on DIP success. The use of antibiotics and broad spectrum antibiotics remains higher than current guidelines would recommend. Further research is required to clarify the specific risks arising from underlying medical conditions to further clarify where prophylaxis is required.

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6months after operation (P > 0.05 for all). Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.

Assessment of Difficulty in Mandibular Third Molar Surgery by Lambade-Dawane-Mali's Index

The evaluation of mandibular third molar (M3) difficulty is extremely important. This study aims to measure the association between preoperative Lambade-Dawane-Mali's (LDM) M3 difficulty index and postoperative assessment of difficulty score. This prospective cohort study included patients with impacted M3 reported to the Department of OMFS, RRK Dental College, Akola, from 2017 to 2022. The preoperative surgical difficulty was estimated using the predictor, LDM index with scores, easy (15-25), moderate (25-30), and difficult (>30). The postoperative surgical difficulty was analyzed with the primary outcome variable, total time intervention measured from the beginning of incision to the final suturing, wherein extraction was classified as easy if time (<15minutes), moderate (15-30minutes), and difficult (>30minutes). The secondary outcome variable, Modified Parant's Scale (MPS), defines four levels of difficulty required for extraction of M3: Easy I (forceps extraction), Easy II (requiring osteotomy), Difficult III (coronal sectioning), and Difficult IV (complex extraction). Data were analyzed using agreement between LDM difficulty with three established criteria (time, MPS, Pederson index) and were assessed with Cohen's Kappa statistics. McNemar's test for paired data was used to assess concordance between two criteria of evaluation with a P-value <.05 was considered statistically significant. The study sample included 1000 patients with a mean age of 26.7±7.6years and 456 (45.6%) females. Those assessed preoperatively with LDM to be difficult and easy outcomes were found upon postoperative assessment with MPS to be 99% and 99% correct, respectively. Inter-criteria agreement and Kappa statistics suggested a positive Kappa value (κ) and statistically significant agreement between the LDM index with perioperative time (κ=0.8930), MPS (κ=0.6488), and Pederson index (κ=0.4920) at P-value 0.0001. Pair-wise comparisons of LDM criteria with perioperative time, MPS, and Pederson scale were assessed by McNemar's test, which evaluated concordance between the two criteria. Postoperative evaluation of surgical difficulty in M3 extraction was strongly correlated with preoperative variables in the LDM difficulty-scoring index. Preoperative evaluation helps in anticipating the difficulty, planning surgical management, and scheduling time more optimally.

The Role of Antibiotic Use in Third Molar Tooth Extractions: A Systematic Review and Meta-Analysis.

Background and Objectives: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. This review aims to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures. Material and methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed, reviewed, and entered on the PROSPERO© website prior to commencement. Ethics approval was gained from the University of Wolverhampton Committee. Searches were performed using PubMed©, Science Direct™, and the Cochrane Database, plus the bibliographies of studies identified. They investigated studies examining the efficacy and safety of any antibiotic regimen tested, independent of regimen used, versus a placebo, control, or no therapy, on outcomes in post third molar extraction. Results: The primary outcome of interest was postoperative infection and secondary outcomes were other post-surgical related complications of infectious nature and antibiotic adverse events. Sixteen RCTs were identified that met the selection criteria. Antibiotic use was reported to be safe, causing few adverse events. Meta-analysis of infection events showed antibiotics reduced the risk of an infection by 69%, but routine use for prophylaxis in uncomplicated procedures was not supported, and their role in patients with comorbidities or impaired immunity remains controversial. The effect on the incidence of dry socket showed no difference based upon regimen used. No significant benefit was found with respect to reduction of intraoral inflammation, wound dehiscence, haematoma, and lymphadenopathy. Conclusion: The effect on postoperative pain reduction was inconclusive. Routine use of antibiotics around M3 extraction procedures is not supported, but their use in the presence of co-morbidities and or immunosuppression remains controversial to be confirmed by future studies.

Droplets Adhesion to Surgical Masks during Standard Oral Surgery.

The most common routes of transmission of coronavirus disease 2019 are droplet and contact infections. During dental treatment, several instruments and procedures used generate droplets of saliva and blood, such as during the extraction of an impacted third molar (M3). Surgical masks are often used during tooth extraction. However, the surface structures of surgical masks against droplets are not fully understood. Therefore, we analyzed the droplets that adhered to the surgical masks during impacted M3 extraction using electron microscopy. The surgical mask was divided into three layers and observed using electron microscopy. The outer and inner layers had a similar mesh-like structure, whereas the middle layer had a denser three-dimensional structure. Droplets ranging from 20-100 µm in size, generated during the extraction, adhered to the fibers of the outer layer of the mask. Fewer droplets adhered to the middle layer than to the outer layer. Droplets did not reach the inner layer. In conclusion, we suggest that a surgical mask can prevent droplet infection when performing impacted M3 extraction. This study is expected to contribute to the study of infection control strategies during dental treatments in the future.

Effects of Flap Design on the Periodontal Health of Second Lower Molars after Impacted Third Molar Extraction.

The purpose of this study was to compare the envelope flap and triangular flap for impacted lower third molar (M3) extraction and their effects on the periodontal health of adjacent second molars (M2). A population of 60 patients undergoing M3 extraction with the envelope flap (Group A) or triangular flap (Group B) was analyzed, comparing probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) recorded at six sites (disto-lingual, mid-lingual, mesio-lingual, disto-vestibular, mid-vestibular, and mesio-vestibular) before (T0) and 6 months after extraction (T1). There was a statistically significant mean difference in PPD and CAL at two sites, disto-vestibular (dv) and disto-lingual (dl), between values recorded before and 6 months after surgery for either Group A or Group B. Furthermore, for the same periodontal records, at 6 months after surgery, a statistically significant difference was recorded between younger and older patients, implying that the healing process was more beneficial for younger patients. No significant differences were found between the two groups (A and B) in PPDdl, PPDdv, CALdl, and CALdv, confirming that the mucoperiosteal flap design does not influence the periodontal healing process of second molars.

Effects of Impacted Third Molars Extraction on Periodontal Status of Second Molar and Oral Health-Related Quality of Life

Objective: The study investigated the impacts of third molar (M3) extraction on periodontal status of adjacent second molar (M2) and oral health-related Quality of life (QoL). Methods: 272 cases with M3 were randomly divided into treatment group and control group, each of 136 cases. Questionnaire survey evaluated demographic features of the subjects. Gingival index (GI), plaque index (PLI) and conscious symptoms of adjacent teeth of the M3 were detected in both groups at baseline (T0), 1 week (T1), 1 month (T2) and 6 months (T3) after treatment. The impacts of QoL were evaluated using OHIP-14 to measure total scores and various items of OHIP-14 at different observation point. Results: The percentage of swelling and toothache in the treatment group was significantly lower than that in the control group at T1, T2 and T3. Significant differences could be seen in GI and PLI between the treatment and control groups at T2 and T3. The total score of OHIP-14 in T2 and T3 was significantly lower than that in T0 and T1 in the treatment group. The 14 items scores and the percentage of positive reaction in the treatment group were significantly lower than those in the control group at T2 and T3. Conclusion: M3 extraction had significant impacts on the periodontal status of the second molar and quality of life. This study would provide an important basis for the prophylactic removal of M3 in clinical work.

Relationship Between Types of Information, Dental Anxiety, and Postoperative Pain Following Third Molar Surgery: A Randomized Study

Third molar (M3) extraction is an anxiety-provoking procedure. Information mode delivery may affect patients' anxiety level and postoperative sequelae. This study determined the relationship between information types, dental anxiety, and postoperative pain following mandibular M3 extraction. Patients (aged 18 to 35years) requiring M3 extraction under local anesthesia were recruited into this prospective randomized study conducted in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Patients were randomized to two groups; verbal or audiovisual depending on M3 extraction information received. Primary outcome variable (difference in anxiety between groups) was assessed with State-Trait Anxiety Inventory (STAI-S) and Modified Dental Anxiety Scale(MDAS). Pain recorded on postoperative days (PODs) 1, 3, and 7 using the Visual Analog Scale was the secondary outcome. Other covariables include biodata, impaction types, and difficulty indices. Data analysis was descriptive and bivariate using IBM/SPSS for Windows, version 23 (SPSS, Chicago, IL USA) with significance set at P<.05. Ninety patients referred for M3 extraction met the inclusion criteria, 45 patients in each group. The audiovisual group had significant increase in anxiety preoperatively measured by STAI-S (P=.002) and MDAS (P=.009) when compared with the verbal group. No significant differences in the STAI-S (P=.16) and MDAS (P=.216) scores were recorded at POD7. The progressive reduction in pain in both groups was not significant at POD7 (P=.746). Preoperative verbal information allayed anxiety compared to real life audiovisual information in M3 patients. These findings will provide a baseline reference data for subsequent research in our environment.

The use of autogenous tooth bone graft powder in the treatment of osseous defects after impacted mandibular third molar extraction: a prospective split-mouth clinical pilot study

BackgroundImpaction of mandibular third molars (M3) is one of the most common diseases. Extraction of M3 usually exacerbates osseous defects at the distal aspect of the adjacent second molar (M2). BonMaker® ATB has been cited as a novel autogenous bone grafting material. The aim of this pilot study was to introduce a novel method for repairing the distal osseous defects of M2 after the surgical removal of M3 with autogenous tooth graft powder (ATGP).MethodA total of five patients were enrolled in this prospective split-mouth clinical pilot study. Four impacted wisdom teeth were extracted bilaterally from each patient with proximal alveolar bone loss ≥ 5 mm of M3. The ATGP was prepared chairside from two extracted one side third molars and randomly implanted in one of the M3 extraction sockets, and the other side was treated with a blank and considered the control site. Patients were followed up at 6 months.ResultsThe five patients included three males and two females. Their ages ranged from 25 to 30 years, with a median of 27 years. Primary wound healing without complications was achieved in all the patients. There was a greater tendency for swelling of the cheeks and trismus to occur at the experimental site on the third postoperative day. Compared with the control site, the experimental site exhibited progressive bone filling and ossification in the sixth postoperative month. Moreover, the probing pocket depth of the experimental site was lower than that of the control site.ConclusionThe results of this study demonstrate that ATGP effectively and economically repairs distal osseous defects of M2. Further study is required to validate the effectiveness with a larger study population.

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.

Effects of platelet-rich fibrin in the surgical extraction of mandibular third molar

Background: Platelet-rich fibrin (PRF) has a wide variety of applications in the field of oral surgery due to its biological potential to accelerate the wound-healing process and tissue regeneration. Aim: The objective of this review was to find out whether the role of PRF had been reported to be efficient in the surgical extraction of mandibular third molar (M3). Methods: An electronic search of the English-language literature in the PubMed (Medline) database was performed for the period from January 2015 to September 2021. Only randomized controlled trials (RCTs) comparing the impact of PRF application were included in this review. According to the Cochrane Collaboration's standards, the reviewer assessed the risk of bias. Review Manager (version 5.4) Windows software was used for the meta-analysis. Results: A total of 39 papers were found in the computerized search, with 13 RCTs meeting the qualitative analysis requirements and 10 trials included in the meta-analysis. The results of a meta-analysis for M3 surgery showed that PRF reduces the incidence of alveolar osteitis (AO) (P = 0.005) and pain on the first (P = 0.05), third (P = 0.002), fourth (P = 0.01), and seventh (P = 0.0003) postoperative days. The meta-analysis also revealed that there was no substantial improvement (P = 0.44) in soft tissue healing with the application of PRF following M3 surgery. Conclusions: The application of PRF after M3 extraction decreased the incidence of AO and postextraction pain.

Effects of Low-Level Laser Therapy on Osseous Defects Distal to Mandibular Second Molar after Extraction of Impacted Third Molar.

Objective To evaluate the efficiency of low-level laser therapy on the distal osseous defects of the mandibular second molar (M2) after the adjacent impacted third molar (M3) extraction. Methods A total of 59 clinic cases were screened out, whose M3 were impacted and the distal alveolar bone of M2 had been destroyed horizontally. They were randomly divided into 2 groups based on whether they would have laser irradiation or not after M3 extraction. Then, postoperative complications of the 2 groups were compared. The alveolar bone level distal to M2 was established before and 3 to 6 months after M3 extraction by radiographic evaluation, which was compared between two groups. Results The incidence of severe pain and mouth-opening limitation was significantly lower in the LLLT group than that in the control group. The amount of bone formation in the LLLT group was higher than that in the control group 3 months after the operation, and the difference was statistically significant. But the difference was not statistically significant 6 months after surgery. Conclusion LLLT may alleviate postoperative complications and improve early osteogenesis. It is a viable option for use in the treatment of osseous defects distal to mandibular second molars following extraction of impacted third molars.

Autologous Dentin Graft after Impacted Mandibular Third Molar Extraction to Prevent Periodontal Pocket Formation-A Split-Mouth Pilot Study.

This preliminary study aims to evaluate the efficacy of an autologous dentin graft in preventing periodontal defects after impacted or semi-impacted lower third molars’ (M3) surgical extraction. For this purpose, radiographic and periodontal evaluation of post-extractive sockets were performed. Ten patients were enrolled in the study: twenty M3 extraction sockets were treated with a split-mouth modality. After tooth extraction, the experimental sites were filled with autologous dentin graft obtained by the extracted M3, while the control sites were filled with blood clot alone. Flaps were closed by first intention to ensure the stability of the wounds. Post-extractive sites were monitored at days 15, 90 and 180. The healing was not affected by any complications associated with the use of the autologous dentine graft in all cases. The measurements recorded at six months showed a reduction of the probing pocket depth distal to the second lower molar (M2) at both surgical sites, with a greater reduction observed at the experimental sites. Radiographic evaluation also showed a greater amount of bone gain at the grafted sites compared to the control sites. The results of this preliminary study suggest that autologous dentin grafts can be useful in preventing the formation of periodontal defects distal to M2 after M3 surgical extraction.

PREDICTION OF EXTRACTION DIFFICULTY FOR INFERIOR THIRD MOLAR

Inferior third molar impaction remains an actual topic of discussion in modern dentistry due to the frequent complications and treatment contraindications. According to Rock and Elsey inferior third mandibular molar impaction occurs in 73% of young people. Many theories of impaction of inferior 3rd molar have been proposed, but the most popular is the insufficient development of retromolar space. Some authors claim that M3 extraction should only be performed when complications may occur, others say that M3 should be extracted if there are no contraindications, but Martin Kunkel is the advocate of the prophylactic extraction of the inferior third molar. In order to achieve the proposed goal, the frequency of impaction of mandibular third molar and their relationship with neighboring anatomical structures was evaluated. There were statistically processed data of medical records and radiographic examination. This study was made based on 320 patients treated in the University Dental Clinic nr.2, SUMPh ,,Nicolae Testemițanu”. Of these, 147 patients were selected: 58 patients with impacted inferior 3rd molar and 89 patients with inferior 3rd molar apparently erupted in the correct position. The most common complication caused by M3 was pericoronitis, followed by second molar caries.

Removal of nonimpacted third molars alters the periodontal condition of their neighbors clinically, immunologically, and microbiologically

Considering the adverse effects of nonimpacted third molars (N-M3s) on the periodontal health of adjacent second molars (M2s), the removal of N-M3s may be beneficial to the periodontal health of their neighbors. This study aimed to investigate the clinical, immunological, and microbiological changes of the periodontal condition around M2s following removal of neighboring N-M3s across a 6-month period. Subjects with at least one quadrant containing an intact first molar (M1), M2, and N-M3 were screened and those who met the inclusion criteria and decided to receive N-M3 extraction were recruited in the following investigation. M2 periodontal condition was interrogated before M3 extraction (baseline) and at 3 and 6 months postoperatively. Improvements in clinical periodontal indexes of M2s in response to their adjacent N-M3 removal, along with changes in inflammatory biomarkers among gingival crevicular fluid (GCF) and the composition of subgingival plaque collected from the distal sites of the M2s of the targeted quadrant were parallelly analyzed. Complete data of 26 tooth extraction patients across the follow-up period were successfully obtained and subsequently applied for statistical analysis. Compared to the baseline, the periodontal condition of M2s was significantly changed 6 months after N-M3 removal; specifically, the probing depth of M2s significantly reduced (P < 0.001), the matrix metalloproteinase (MMP)-8 concentration involved in GCF significantly decreased (P = 0.025), and the abundance of the pathogenic genera unidentified Prevotellaceae and Streptococcus significantly decreased (P < 0.001 and P = 0.009, respectively). We concluded that N-M3 removal was associated with superior clinical indexes, decreased GCF inflammatory biomarkers, and reduced pathogenic microbiome distribution within the subgingival plaque. Although the retention or removal of N-M3s continues to be controversial, our findings provide additional evidence that medical decisions should be made as early as possible or at least before the neighboring teeth are irretrievably damaged.

Collaboration with an infection control team promoted appropriate antibiotic use for third molar extraction at a Japanese hospital

Oral antibiotic therapy is routinely administered when a third molar (M3) is extracted to prevent infectious complications after surgery. Oral third-generation cephalosporins are frequently used after M3 extraction in Japan but at the expense of an increased risk of antimicrobial resistance. Therefore, the infection control team (ICT) at our institution recommended a reduction in use of these agents after M3 extraction. In this study, we compared the types of antibiotic agents prescribed for patients undergoing M3 extraction before and after this recommendation. We investigated the relationship between type of antibiotic used and the likelihood of infectious complications as well as cost savings in patients who underwent M3 extraction in the 6 months before and after the ICT recommendation in July 2018. There was a marked reduction in use of oral third-generation cephalosporins after M3 extraction (P < 0.0001) and increased use of oral penicillins and first-generation cephalosporins after the ICT recommendation. Moreover, surgical site infection (SSIs) were significantly less common after the ICT recommendation (P = 0.0099); however, the SSI rate was higher in patients who received a third-generation cephalosporin than in those who received penicillin (8.8% vs 0.5%). There was also a significant saving in per-patient antibiotic costs after the ICT recommendation (269.5 ± 282.0 JPY vs 454.7 ± 376.6 JPY; P < 0.0001). These findings suggest that collaboration with an ICT promotes appropriate antibiotic use, decreases the risk of an SSI, and improves the cost-benefit ratio in patients undergoing M3 extraction.

Detecting direct inferior alveolar nerve – Third molar contact and canal decorticalization by cone-beam computed tomography to predict postoperative sensory impairment

BackgroundInjury to the inferior alveolar nerve (IAN) is a severe complication of third molar (M3) surgeries that may interfere with speech, chewing, and social interactions, all of which affect quality of life. Factors such as direct IAN-M3 contact and interruption of the mandibular canal border (decorticalization) diagnosed from cone-beam computed tomography (CBCT) images have been reported as risk factors, although their relation to postoperative sensory impairment is controversial. The purpose of this study was to assess the association between postoperative nerve injury and direct contact between IAN and M3 or canal decorticalization defined with CBCT. Materials and methodsSeventy-five patients with at least one M3 tooth (total of 126 teeth) in direct contact with the IAN were included in the study. All associations were confirmed with CBCT. Nerve injuries after surgery were confirmed and follow-ups were made with information given by patients, light touch, and pinprick tests. The relationship between sensory impairment and direct contact between IAN and M3 or canal decorticalization on CBCT images was statistically assessed. ResultsOne M3 extraction (0.8%) presented with postoperative permanent sensory impairment. No correlation between nerve injury and direct contact with the IAN or canal decorticalization on CBCT could be established. ConclusionThere is no association between nerve injury and direct IAN-M3 contact or canal decorticalization. Although orthopantomography is commonly used to plan M3 surgeries, consideration of CBCT as a viable alternative is warranted.