Mandibular 3rd Molars Research Articles

Acute Pain Management Following Mandibular Third Molar Exodontia: A Bibliometric Analysis of Randomized Controlled Trials

Introduction and aimsTo reveal the evolution of pain management strategies following mandibular third molar (M3M) exodontia, examine the geographic contribution of research, and explore future developments through a bibliometric analysis. MethodsA comprehensive search was conducted in various leading databases. Data on bibliometrics, participant demographics, and agent regimens were extracted for eligible studies. Descriptive bibliometrics, citation analysis, and keyword bursts were performed to assess the research outputs, distribution, and emerging hotspots. ResultsA total of 173 randomized control trials from 2004 to 2024 were included. The number of publications showed a consistent upward trend since 2007. Brazil exhibited the most publications and citations. Germany presented the highest mean citations per publication. Brazil, Spain, and Italy showed the closest collaboration. Appropriately 14,391participants with 14,710 extracted M3M were enrolled. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most extensively studied analgesics, followed by glucocorticoids, opioids, and paracetamol. NSAIDs and paracetamol were predominantly administered orally, whereas glucocorticoids and opioids were primarily applied topically (P < .001). Studies on opioids significantly predated the studies using other agents. Adverse events were found in 50.87% of the included studies, where nausea and vomiting were the most frequently reported. Tramadol and piroxicam have drawn increasing interest in recent years. ConclusionsThis study revealed information on the research outputs, distribution, and future developments of analgesic agents following M3M exodontia. Brazil exhibited the highest level of productivity and recorded the most citations. NSAIDs generated the largest amount of research and are emerging as a benchmark for comparative studies. Oral administration is the most frequently used approach for agent delivery. Nausea and vomiting are the most commonly reported adverse effects. Clinical relevanceThe bibliometric analysis offers insights into the field of pain management following mandibular 3rd molar exodontia and how it has evolved. Tramadol and piroxicam have become research hotspots in recent years.

Incidence and Pattern of Mandibular Impacted 3rd Molars and Their Relationship with the Mandibular Canal in Population of Jizan Province of Saudi Arabia: A Retrospective Radiographic Study

ABSTRACT Introduction: Impacted mandibular third molars pose challenges in dental practice, often requiring surgical intervention. This retrospective study aims to analyze the demographics, impaction patterns, and anatomical relationships of impacted mandibular third molars among Saudi patients. Methodology: Data from 722 patients visiting the Department of Maxillofacial Surgery and Diagnostic Sciences at Jizan University were retrospectively analyzed. Parameters including gender distribution, impaction types, relationship with the mandibular canal, and age demographics were evaluated based on panoramic radiographs. Results: Bilateral impaction predominated (57.59%), with mesioangular impaction being the most common (46.51%). Gender differences were noted in impaction types and relationships with the mandibular canal. Interruption of white lines of the canal was more frequent in males (70.00%). Early adulthood (20-25 years) exhibited the highest prevalence of impaction. Conclusion: The study provides insights into the demographics and characteristics of impacted mandibular third molars among Saudi patients. Gender-specific variations and age distribution underscore the importance of tailored treatment approaches and early intervention.

Evaluation of Recombinant Human Platelet Derived Growth Factor (rhPDGF-BB) Along with Tricalcium Phosphate (β-TCP) in Impacted Mandibular 3rd Molar Sockets

Aim: The aim of this study was to evaluate efficacy of Recombinant Human Platelet derived Growth Factor (rhPDGF-BB) mixed with Tricalcium Phosphate (β-TCP) particles in mandibular 3rd molar extraction socket for bone regeneration. Setting And Design: A comparative clinical trial consisting of 10 patients who wanted to undergo the surgical extraction of mandibular 3rd molar bilaterally, were undertaken in the institutional settings, where in each patient one side of lower third molar extraction site was kept as control and in the other side graft material was used, after the approval from the institutional ethical committee. Materials And Methods: In this study 10 patients were included with mean age of 28.3 years (Ranging from (20-35 years). These were 4 male and 6 female patients. In each patient one side of lower third molar extraction site was kept as control site and in the other side graft material was used kept as study site. Hence 10 control sites were compared with 10 study sites. Selection of site for placement of graft was done randomly. In 6 patients study site was on right side and in 4 patients study site was on left side. Clinical parameters like pain, facial swelling, total number of analgesic tablets required evaluated at 48hrs and at 7th day. While, radiographically bone density was evaluated after 1st and 3rd month postoperatively. Other parameters like infection, sinus discharge, wound dehiscence, dry socket or graft leakage were also observed. Results: rh PDGF with β – TCP when used in mandibular third molar extraction socket results in rapid bone regeneration seen via increased bone density. It also results in less post-operative discomfort to the patient like pain and swelling. Complications like infection, sinus discharge, wound dehiscence, dry socket or graft leakage were not encountered and the tissue showed good acceptance with no graft rejection. Conclusions: The rh PDGF/β – TCP combination is a novel bone grafting material with excellent results and should be included in the armamentarium when bone defect is encountered.

Story of a Displaced Tooth – A Case Report

Various iatrogenic complication may be seen during extraction of mandibular 3rd molar. Displacement of mandibular 3rd molar into pterygomandibular space is usual but displacement into an unusual space like submandibular space or sublingual space is very rare. This can cause significant physical and psychological problems for the patient. The treatment for this kind of complications may vary from a conservative treatment to surgical procedure, what will depend on clinical features, symptoms, the location of the tooth, and its relation to adjacent structures. The present case report illustrates a rare complication of extraction of impacted mandibular third molar that was displaced into the sublingual region. Upon locating the tooth, successful removal of tooth was performed. Healing was uneventful after a 3 month of follow up.

A geospatial analysis of factors influencing clinical decision-making of rural and urban dental practitioners in Tiruppur district

Objectives: The core of dental practice is clinical decision-making. Geographic information system was used in our study to evaluate the clinical decision-making of dental practitioners in urban and rural Tiruppur district, Tamil Nadu. Materials and Methods: This cross-sectional study included 50 certified dental practitioners from both urban and rural areas. The research was conducted in June 2022. The tem-item and self-administered questionnaire was designed to collect data on practitioner, patient, and provider characteristics. The questionnaire was distributed to participants through an online Google form forum, and the results, clinical decision-making, were quantified using a series of hypothetical case situations. The association between rural and urban dental practitioners was assessed using the “Chi-square test.” Results: Twenty-six (14 [56%] urban and 12 [48%] rural practitioners) chosen the most conservative treatment approach of coronoplasty for asymptomatic impacted mandibular 3rd molar. Thirty (17 [68%] urban and 13 [52%]) rural practitioners preferred the conservative treatment plan of removal of caries followed by GIC Restoration for class I dental caries in a 7-year-old child. For the case scenario relation to class I malocclusion with spacing, 16 (64%) of urban dental practitioners preferred aligner-based treatment rather than fixed orthodontic appliance. This treatment choice differs statistically between urban and rural practitioners. Conclusion: The current research revealed an association between non-clinical features and dental professionals’ self-reported treatment preferences. It provides a foundation for future research into the elements hypothesized to impact dentists’ treatment decisions.

Epidemiological Analysis and Management of Patients with Facial Space Infections of Odontogenic Origin: A Retrospective Evaluation of Two Years

Objective: Odontogenic infections are one of the most common pathologies in the oral and maxillofacial regions. The spread of odontogenic infections after unsuccessful or late treatment can lead to serious complications. The aim of this study is to examine the epidemiological features and treatment management of patients with odontogenic facial abscesses.&#x0D; Methods: This retrospective study included 88 patients with odontogenic facial area abscesses treated at Afyonkarahisar health sciences university, faculty of dentistry’s maxillofacial surgery clinic between 2019-2021. The socio-demographic, socio-economic characteristics and clinical examination findings of the patients and treatment methods for odontogenic abscess were analyzed comprehensively. Data were&#x0D; evaluated using SPSS-20 and the level of significance was set at p &lt; .05.&#x0D; Results: In the two-year period between 2019 and 2021, 88 patients (44 male and 44 female, mean age was 39.72±16.42) were treated for diffuse facial infections of odontogenic origin. The most commonly involved area was the submandibular area (38.6%), the most affected tooth was mandibular 1st molar and mandibular 3rd molars (18.2%), and the most common cause was dental caries (65.90%). Incision and drainage were performed in half of the patients (36.4% intraoral, 13.6% extraoral). The most commonly used drugs were clindamycin (36.4%), amoxicillin-clavulanate, and ornidazole combination (27.3%).&#x0D; Conclusion: The results of this study confirm that odontogenic abscesses can heal without complications with timely and effective basic interventions such as incision and drainage. In this study, successful results were obtained with the parenteral clindamycin, and a combination of oral amoxicillin-clavulanate and ornidazole in the treatment of odontogenic abscesses.

Prevalence and pattern of third molars impaction: A retrospective radiographic study.

Third molar impaction is considered a prevalent issue. The research aimed to study the pervasiveness and pattern of impaction in Karbala/Iraqi population. Orthopantomograms were studied regarding its angulation, impaction depth, and correlation with ramus. The outcomes manifested that the prevalence of 3rd impacted molars was 34.71%, with the proportion of male to female as 0.83:1. Impacted mandibular 3rd molars were significantly encountered. The prevalence of vertical angulation, mesioangular, horizontal, and inverted were significantly associated with the impacted mandibular 3rd molars (P < 0.05). However, the prevalence of distoangular and bucco/lingual was significantly associated (P < 0.05) with the upper impacted 3rd molars. Level C of impaction was significantly (P < 0.05) the most typical level in the maxilla impacted the 3rd molar, and level A and level B of impaction were significantly (P < 0.05) the most prevalent level correlated with the mandibular 3rd molar impaction. Class II was significantly (P < 0.05) the frequently occurring condition subsequent to Classes III and I. In conclusion, the impaction of 3rd molars was significantly predominant in females and lower jaw. The vertical angulation, level C of impaction associated with maxillary 3rd molars and levels A and B of impaction related with mandibular 3rd molars, and Class II are the most encountered conditions.

Clinical and radiographic evaluation of ozone therapy in odontectomy of impacted mandibular third molar

Introduction: Ozone can interact with blood components to have a positive impact on tissue microcirculation, oxygen metabolism, cell energy, immunomodulatory properties, and antioxidant defense systems. In dental surgery, ozone may be useful to promote hemostasis, enhance local oxygen supply, and inhibit bacterial growth. Ozone has been suggested for usage in dentistry due to its healing, antibacterial, and disinfecting qualities. Aim: To assess the influence of topical ozone administration on patient comfort after third molar surgery. Material and Methods: Two equal groups of the forty patients with lower impacted third molars who required surgical extraction were chosen at random. Patients in Group (I) had odontectomy for an impacted mandibular 3rd molar. Patients in Group (II) underwent odontectomy of the impacted mandibular 3rd molar, then ozone gel was injected into the socket. The follow-up visits were performed where the intensity of pain, the symptoms of trismus, swelling and radiographic bone density were evaluated. Results: Group II showed statistical significant difference of pain compared to group I while both groups showed no statistical significant difference with regard to swelling and trismus and radiographic bone density. Conclusion: After odontectomy of the mandibular third molar, ozone gel application therapy proved helpful for reducing postoperative discomfort and improving quality of life. Yet, in addition to bone density, it had no impact on either post-operative edema or trismus.

Efficacy of Post-Extraction Suturing on the Incidence of Dry Socket Occurrence in Erupted and Semi-Erupted Mandibular Third Molar: A Case-Control Study

Objectives: The main aim of this study is to evaluate the incidence of dry sockets in patients in relation to their clinical parameters such as pain, the disintegration of the clot, and halitosis regardless of their oral hygiene status. Also, to find sex and age-related to the reported parameters during surgical technique (time and complication).Methods: A prospective cross-sectional study was done on 60 patients (30 study group and 30 control group) aged 21 -50 years with semi-erupted and full-erupted lower 3rd molars, which were indicated for extraction. The mandibular 3rd molar was extracted without any suturing in the control group, while extraction of the 3rd molar for the study group using a figure-eight suture. All the patients were evaluated for pain, presence of clot and condition of the alveolar bone to diagnose dry socket.Results: The incidence of dry sockets was only 3 cases (5%) (one in study group and another two in control group) who were male heavy smokers. Regarding the clinical signs after 3, 5, and 7 days of tooth extraction, pain was severe/very severe in 3.3% at extraction sites in the study group and 6.7% in the control group on the 3rd day. While, the pain was moderate in 3.3% and 6.7% at extraction sites in the study and control groups, respectively, on the 5th day. In both groups, the blood clot was found in 100% of extraction sites on the 5th and 7th days but it was not found in 3.3% and 6.7% of extraction sites in study and control groups on the 3rd postoperative day, respectively. Also, halitosis was found in only 1% of the control group on the 3rd day but it was absent in 100% of the study group on the 3rd, 5th, and 7th postoperative days and the control group on the 5th and 7th days.Conclusions: We realized that the incidence of dry sockets was less without significant difference in patients with a figure-eight suturing of extraction site that might be the cause for reducing pain in a study group as well as the amount of blood clot on 3rd postoperative day.

COMPARATIVE EVALUATION OF MICROLEAKAGE IN DIFFERENT RESTORATIVE MATERIALS AN INVITRO STUDY

Introduction: Microleakage is one of the most frequent cause behind a restoration failure. Numerous advancements in restorative materials and placement techniques have been made to overcome this problem. Aim And Objectives: The purpose of this study is to evaluate the microleakage of three different restorative materials with different chemical structure and to determine which among the three has more sealing ability. Materials And Methods: Thirtyextracted mandibular 3rd molars were stored in distilled water and standardized class 1 cavity preparation was done. All the 30 samples were divided into 3 experimental groups GROUP I (GIC), GROUP II (ORMOCER), GROUP III (CENTION N) 10 sample in each group. Teeth were buccolingually sectioned in two halves and immersed in 2% basic fuschin dye and micro leakage was assessed under stereomicroscope. Results: IN our invitro study the highest microleakage was observed in GIC (1.5±0.849) followed by Cention n (0.7± 0.6749) and Ormocer (0.3± 0.483) respectively.Significant difference was observed in group I and group II with p value of 0.0005. Conclusion: Better sealing ability were observed in Ormocer&gt;Cention-n&gt;GIC.

A COMPARATIVE SPLIT MOUTH STUDY TO EVALUATE THE ANALGESIC EFFICACY OF “DICLOFENAC TRANSDERMAL PATCH” AND “DICLOFENAC INTRAMUSCULAR INJECTION” IN THE IMMEDIATE POST OPERATIVE PERIOD IN PATIENTS UNDERGOING IMPACTED MANDIBULAR THIRD MOLAR REMOVAL

Introduction: Successful surgical treatment is based on correct surgical techniques and the prevention and management of postoperative pain and complications. For postoperative analgesia, multimodal combinations are prescribed nowadays. Aim: The present study aims to evaluate the analgesic efficacy of diclofenac trans-dermal patch and diclofenac intramuscular injection in immediate post-operative patients after extraction of impacted mandibular 3rd molar and the objective is to evaluate the side effects associated with both the modalities and to compare the analgesic efficacy of two modalities. Material and Methods: In this study, eighty bilaterally impacted third molars were selected. The study drugs (trans-dermal Diclofenac patch and Diclofenac intramuscular injection) were divided into two groups Group A (40 cases) and Group B (40 cases). Post-operative self-evaluation by the patient for pain was done. It was recorded at intervals of 2 hours, 8 hours, 16 hours, 24 hours, 2nd day and3rd day using the Visual Analogue Scale.Results and Discussion: Statistically significant higher pain score observed among group B at 8 hours (Mean rank = 28.20; p= 0.001), 16 hours (Mean rank= 30.25; p= 0.001), 24 hours (Mean rank=30.50; p= 0.001), 2 days (Mean rank= 27.05; p= 0.001) and 3rd day (Mean rank= 26.50; p= 0.001) respectively after extraction when compared with group A.Conclusion: Transdermal diclofenac patch is an effective, non-invasive, and cost-effective way of managing post-operative pain and can be used as a modality to control pain in an immediate post-operative period.

Clinical Approach to Coronectomy in Horizontally Impacted Mandibular Wisdom Teeth

Objective: This study is focused on the identification of comprehensible radiographical and clinical features for the risk assessment of coronectomies in horizontally impacted mandibular third molars which require surgical treatment. A classification, based on a literature review and well-defined risk assessment algorithm, has been developed to streamline the decision-making process. Methods: A PubMed, OVID Medline and Google Scholar search for articles related to keywords such as “Coronectomy, Horizontal Impacted Third Molar, Coronectomy vs Extraction” has been performed. Results: Only horizontally impacted mandibular 3rd molars which required surgical intervention were included. The relationship of the apical portion of the roots with the IAN, evaluated on the CBCT, was used to classify the tooth as low, medium or high risk for extraction. If a tooth was classified as medium or high risk for total removal, it was further assessed and classified for coronectomy. According to a literature review and to our clinical judgement, 4 indicators can beidentified as relevant in the individual risk assessment related to coronectomy. Based on a cumulative point score, the indication for a coronectomy has been appraised as ‘low risk', ‘moderate risk' or 'high risk’. Conclusion: Horizontal impactions of lower third molars are not necessarily to be considered a contraindication for coronectomy. Our classification offers a guideline in the decision-making process on whether a coronectomy represents a viable treatment option for mandibular horizontally impacted third molars.

Clinical Approach to Coronectomy in Horizontally Impacted Mandibular Wisdom Teeth

Objective: This study is focused on the identification of comprehensible radiographical and clinical features for the risk assessment of coronectomies in horizontally impacted mandibular third molars which require surgical treatment. A classification, based on a literature review and well-defined risk assessment algorithm, has been developed to streamline the decision-making process. Methods: A PubMed, OVID Medline and Google Scholar search for articles related to keywords such as “Coronectomy, Horizontal Impacted Third Molar, Coronectomy vs Extraction” has been performed. Results: Only horizontally impacted mandibular 3rd molars which required surgical intervention were included. The relationship of the apical portion of the roots with the IAN, evaluated on the CBCT, was used to classify the tooth as low, medium or high risk for extraction. If a tooth was classified as medium or high risk for total removal, it was further assessed and classified for coronectomy. According to a literature review and to our clinical judgement, 4 indicators can beidentified as relevant in the individual risk assessment related to coronectomy. Based on a cumulative point score, the indication for a coronectomy has been appraised as ‘low risk', ‘moderate risk' or 'high risk’. Conclusion: Horizontal impactions of lower third molars are not necessarily to be considered a contraindication for coronectomy. Our classification offers a guideline in the decision-making process on whether a coronectomy represents a viable treatment option for mandibular horizontally impacted third molars.

Surgical Management of Impacted Bilateral Mandibular Molars Adjacent to Inferior Alveolar Nerve to Avoid Paresthesia of Lower Lip

The extraction of impacted 3rd molar is most frequently performed surgery now-a-days as it can lead to infections, cysts, tumors, neuralgiform pain, and disturbances of occlusion, masticatory dysfunctions and myoarthropathies. Damage to inferior alveolar nerve leads to impairment of sensation in the lower lip, which is most unpleasant postoperative complication. For surgical removal of impacted mandibular molars, relative position of inferior alveolar nerve with mandibular 3rd molar is of utmost importance. There are number of positions in which inferior alveolar nerve is located in relation to impacted 3rd molar which, either in a direct contact with the 3rd molar or has no contact at all. While performing surgical procedures in the vicinity of 3rd molar, Inferior Alveolar Nerve can be damaged but with high expertise and precision the operator can spare the nerve without any injury. In this case report, we discuss about the surgical management of a case with bilateral impacted 38, 47, near the Inferior alveolar nerve to avoid paraesthesis of lip.

Age estimation by determination of the stages of third molar development using Kullman's method

Determination of dental age in a living person is also equally important to know his /her age where there is no birth record available for legal purposes.The present study involves the radiographic examination of mandibular 3rd molar on digital Panoramic X-Ray. The radiograph of each subject was then interpreted following the guidelines suggested by Kullman et al (1992) for age estimation based on their developmental stage and root length of mandibular third molar. This study concluded that the developmental stages of root of mandibular third molar gives fairly accurate results and can be considered for the age estimation with the methodology suggested by Kullman et al.

Comparison of Two Suturing Techniques in Removal of Mandibular 3rd Molar Surgery

Objective: This study was planned to evaluate the techniques of primary wound closure as well as secondary wound closure after removal of mandibular 3rd molar and the difference of both techniques was assessed in term of swelling, pain, and trismus. Methodology: This randomized clinical trial was conducted in the surgery department a tertiary care hospital of Sargodha, Pakistan. Sample size was 60 patients. Both genders were included and the patients’ age was between 19 to 30years, who presented with the complaint of pain and later on, referred for surgical removal of 3rd molar of mandible were the subject of interest of current study. Using lottery method, patients were divided into two groups. Primary closure technique was used on patients of group 1 and secondary closure technique was used for patients of group 2. The collected data was entered in SPSS version 25.0 and analyzed. Independent sample t test was used to explore the difference between two groups. Results: Facial swelling and trismus was found significantly different in both groups on 3rd and 7th day after surgery (p=.001, P=.001). Conclusion: In Conclusion, secondary wound closure technique is better in terms of pain, facial swelling and trismus than primary wound closure technique in surgical removal of impacted 3rd molar of mandible. Keywords: Trismus, Facial Swelling, Primary wound closure, Secondary wound closure

Comparative analysis of effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner

Background: Postoperative oedema is a consequence of tissue injury during surgery and the raising of muscular attachments, and appears as a result of direct trauma to blood and lymph vessels. Postoperative pain is a common phenomenon after surgery, due to surgical trauma and the release of pain mediators. After surgical extraction of impacted lower third molars, the pain is most intense 3-5 hours following extraction, just after the cessation of local anesthesia. Several methods of controlling the immediate inflammatory response associated with the third molar surgery abound in the literature. Aim of the study: To compare the effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner. Materials and methods: 45 Subjects for the present study were selected and divided into 3 groups of 15 patients each (group I- submucosal dexamethasone, group II sub-mucosal methylprednisolone, group III – submucosal placebo, normal saline) from amongst the patients who reported to OPD, at random basis irrespective of side, age, caste, creed, gender and socioeconomic status. Study was carried out in those patients who required surgical removal of impacted mandibular 3rd molars.

Mystery revealed on efficacy of intravenous dexamethasone vs methylprednisolone on post-operative sequelae after 3rd molar surgery

Background: Owing to its potent mode of action and lengthy half-life, dexamethasone has been used in oral surgery for many years. Several dexamethasone delivery methods for third molar surgery have been proposed. Dexamethasone administration has been a source of debate, with studies being unable to agree on the best effective method for reducing post-extraction complications. Aim: To carry out comparative evaluation of effect of intravenous 8 mg Dexamethasone and 40 mg Methylprednisolone on pain, swelling and trismus post-operatively after mandibular impacted 3rd molar surgery. Methods and Materials: The study used a split mouth technique, in which the impacted mandibular 3rd molars were extracted one at a time, separated by at least 21 days. Following surgical removal of an impacted mandibular third molar, the patient was given 8mg Dexamethasone intravenously at the first appointment. The surgical removal of the mandibular third molar on the contralateral side was performed on the same patient at the second session after 21 days, and 40 mg Methylprednisolone was administered intravenously post-operatively. Results: For the 2nd, 5th, and 7th day postoperative evaluations, patients showed decreased swelling with the Dexamethasone protocol compared to the Methylprednisolone protocol. There was a statistically significant difference between the two groups.

Effect of Submucosal Injection of Tramadol on Postoperative Complications after Third Molar Surgery

Objective: To determine the effectiveness of submucosal application of tramadol for acute postoperative pain, swelling and trismus. Material and Methods: A total of 84 patients having age between 18 to 35 years with irrespective of gender and require impacted mandibular 3rd molar extractions were included in study whereas patients with pericoronitis, periapical infection or lesions with respect to impacted 3rd molars, opposing traumatic occlusion or impinging upper 3rd molars or pregnant and lactating women were excluded in study. Subjects were distributed in two groups by port (chit) method i.e., Group A (Tramadol Group) with 42 patients and group B (sterile normal saline group) with 42 patients. Postoperative pain, swelling and trismus were recorded on Day 1, 2, 3 and 7 Results: Male patients were 25 (59.5%) and 25 (59.5%) and female patients were17 (40.5%) and 17 (40.5%) with mean age of25.7±4.7 (18-35) years and 26.5±4.9 (18-35) years in group A (Tramadol Group) and group B (Sterile Normal Saline Group) respectively. Post-operative findings in both groups were significantly different, group A (Tramadol Group) is better from group B (Sterile Normal Saline Group) in terms of post-operative pain, swelling and trismus. Conclusion: Submucosal Tramadol is more effective, safe and reliable than sterile normal saline in patients after third molar surgery. Keywords: Effectiveness, Submucosal, Tramadol, Facial pain, Third Molar

Role of topical gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on the wound healing after surgical extraction of impacted mandibular third molar

Odontostomologic procedures like extractions especially surgical removal of impacted 3rd molars, implants, biopsies etc are often associated with post-operative pain and inflammation. Traditionally chlorhexidine was used in this regard. Recently, topical gel, Bexident Post (ISDIN, SPAIN) has been in use to control post-operative discomfort. The aim of this study is to clinically evaluate the efficacy of Bexident Post (ISDIN, SPAIN) that contains chitosan, dexpenthanol, allantoin and 0.2% chlorhexidine on wound healing after surgical extraction of mandibular impacted 3rd molars. A study sample of 10 patients with similar type of bilateral impacted mandibular 3rd molar was included in the study. Total of 10 extractions were assingned in one of the two groups. Only difference between the two sides in terms of surgical protocol will be the Experimental side applied 10 mL thrice daily for 10 days while Control side did not. All patients were aware of the purpose of present study and written consent was taken requiring their participation. Results showed that facial swelling, mouth opening and pain were all significant between the two groups. The groups were homogenous only in terms of infection as neither of the groups showed post-operative signs of infection.