Impacted Mandibular Third Molars Research Articles

A comparative study of a two-stage surgical approach combining coronectomy with microimplant anchorage traction for extraction of impacted mandibular third molars with different traction angles

Objective: To establish a two-stage surgical procedure of impacted mandibular third molars (IMTMs) extractions assisted by coronectomy and microimplant anchorage traction and to investigate the influencing factors of root movement and the effects of different traction angles on the clinical outcomes. Methods: Fifty-three IMTM in contact with inferior alveolar nerve (IAN) that underwent tooth extraction in the Peking University School of Stomatology from January 2022 to June 2023 were included, with coronectomy and microimplant anchorage implantation in the first stage of the surgery, root traction was achieved with orthodontic elastic and microimplant anchorages by about 600 g of force, when the IMTM root was detached from IAN, a second surgery was performed to extract the residual root. The basic information of patients and M3M, data on the microimplant anchorage implantation and traction, imaging measurements, and complications were recorded and analyzed. Results: The movement distance of the residual roots was (1.80±0.92) mm, and the duration of traction was (32.9±7.9) d. Multiple linear regression analysis showed that the residual root movement distance was significantly correlated with age, gender, number of roots, traction angle, and depth of the distal bone defect of the second molar (P<0.05). The smaller the traction angle, the more significant the movement of the residual roots (P=0.044). In one case (1.9%, 1/53), the patient experienced abnormal sensation in the lower lip 16 days after traction. Conclusions: The two-stage surgical method of combined coronectomy with rapid traction technique to extract the IMTM allows for rapid movement of the residual root and reduces the risk of IAN injury. The efficiency of root movement can be accelerated by appropriately reducing the traction angle during surgery. The traction effect can be predicted based on indicators such as age, gender, number of roots and depth of distal bone defects of second molar.

Are There Differences in the Causes and Complications of Mandibular Third Molar Extraction in Older Patients Compared to Younger Patients?

BackgroundAlthough most impacted third molars (ITM) are extracted in the teens and early 20s, some undergo extractions after their 40s. It is unclear whether the reasons for extraction, the degree of impaction, and complications differ in patients in an older age group compared with a younger age group. PurposeThe purpose of this study was to measure the association between age and 1) reason for extraction and 2) postoperative complications. Study design, setting, sampleThis was a retrospective cohort study of patients who had undergone surgical extraction of at least one mandibular ITM at a single institution. We excluded 1) age under 20 years, 2) follow-up period of less than 1 week, and 3) tooth extraction under general anesthesia. Predictor variableThe primary predictor variable was age, classified into 3 groups (20s:20-29; 30s:30-39; over 40s: 40 and greater). Outcome variableThe primary outcome variables were reason for extraction (prophylactic or symptomatic) and presence of complications. The secondary outcome variable was type of complication (post-operative infection, dry socket, neurosensory disturbance, presenting pain over 1 month, retained root requiring secondary treatment). CovariatesThe covariates were sex, laterality of ITM, and difficulty of extraction as measured by the difficulty index, a measure based on depth, orientation, and ramus relationship/space available, with a higher score indicating greater difficulty. AnalysesChi-square test was performed to analyze the association of categorical outcome variables and covariates. Level of statistical significance was set at P<0.05. ResultsOf a total of 831 eligible subjects, there were 555 (66.8%), 159 (19.1%), and 117 (14.1%) in 20s, 30s and over 40s age groups, respectively. The percentage of symptomatic extraction of ITM was significantly higher in the over 40 age group compared with the 20s group (92.3% vs. 69.4%, (p<0.001). Complication rate also significantly differed between over 40s group and the 20s group (7.7% vs. 1.8%, p<0.001). Difficulty index and indications for ITM extraction were significantly different between groups (p<0.001). ConclusionSymptoms, difficulty, and complications related to ITM increase at over 40 years of age. This should be taken into consideration during the joint clinical decision-making process with patients with ITM.

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

Surgical Extraction of Mandibular Third Molars: Risk Assessment and Predictable Complexity

Objective. The study aims to develop and validate new practical and simple but robust index to determine the complexity level of surgical extraction of mandibular third molars (MTM). Methods. A cross-sectional study with sample of 100 patients referred for management of MTM. Complexity index scores recorded twice at 6 weeks intervals preoperatively by oral and maxillofacial specialist. Prediction of the surgical difficulty and the degree of agreement of different variable indexes were calculated. Results. Out of 100, 78 patients with 139 impacted MTM, 26 were males and 52 were female, with a mean age of 26.40±6.39 years (range, 18-45 years). The prediction of operative difficulty was significant as measured by impaction angulation, distance to ramus, and impaction depth. Most cases were classified as complexity level II (63 [80%]). Although only 3 out of 100 cases (4%) were classified as complexity level III. There was no significant difference in age based on the gender (male: 27.54±7.35 years, female: 25.83±5.86 years; P=0.268). Conclusion. Using MTM complexity index as a preoperative tool to evaluate the surgical difficulty, including different patient-specific variables could facilitate treatment planning, help prevent complications and assess the possibility of referral.

Efficacy of Dexamethasone Injection at Different Sites on Postoperative Sequelae After Extracting Mandibular Impacted Third Molars: A Randomized Controlled Trial

BackgroundDexamethasone, an efficacious anti-inflammatory agent, is widely used after tooth extraction. However, its optimal injection site has yet to be investigated. PurposeWe compare the efficacy of dexamethasone injection at different sites on postoperative sequelae after extracting mandibular impacted third molars (MITMs). Study design, setting, and sampleA prospective randomized controlled trial was conducted. Healthy adults with fully MITMs scheduled for extraction were included. Exclusion criteria were 1) Patients with the systemic alteration that prevented the surgical procedure; 2) pregnancy, breastfeeding, premenstrual period; 3) hypersensitivity to the drug under test; and 4) those who did not return for postoperative follow-up at one, three, and seven days. Exposure variableThe subjects were randomized to three groups. An online randomization plan generator assigned each subject to a single treatment by randomly permuting blocks. Different sites for postoperative dexamethasone injections included the buccal side of the adjacent second molar and extraction sockets. Dexamethasone injection (4 mg) on the buccal side of the adjacent second molar (group 1), an injection on the buccal side of extraction sockets (group 2), an injection of physiological saline (0.8 mL) on the buccal side of the adjacent second molar (control). Outcome variablesThe outcome variables were postoperative facial swelling, limitation of the mouth opening, postoperative pain, and postoperative quality of life evaluation. The pain was assessed using a visual analog scale (VAS) at one, three and seven days, postoperatively. The quality of life was recorded throughout the Posse scale at seven days. CovariatesThe covariates are age, sex, length of operation, and type of impacted teeth and surgery. AnalysesThe statistical analysis was performed using ANOVA, repeated measures ANOVA, Chi-square, or Fisher’s exact tests with P-values < 0.05 considered statistically significant. ResultsOur study included 58 participants with a mean age of 19.48 ± 3.31 years; group 1 (n = 24), group 2 (n = 20), and control group (n = 14). On day three postoperative, the swelling and trismus were significantly less in group one than in the other two groups (P < 0.05), and group one had an overall postoperative quality of life compared to other groups (P < 0.05). Unaffected speech function was present in 73.7% of patients in group 1, while 50% of patients in group 2 had affected speech function three days after the operation (p < 0.05). The "unable to open mouth" of the “Eating subscale” and “felt tingling” had statistical significance (p < 0.05). ConclusionsDexamethasone injections on the buccal side of the adjacent second molar can be a viable option for treating facial swelling and limitation of mouth opening after total MITMs extraction.

Assessment of Impaction Pattern of Mandibular Third Molars in an Iranian Subpopulation: a Retrospective Cross-sectional Study

Background: Impacted teeth are teeth that cannot be indicated in their physiological position in the expected period. Impacted mandibular third molar (IMTM)is the most common tooth to be impacted. Impaction of the tooth may be accompanied by complications such as pain, swelling, caries, bone loss, and inferior alveolar canal pathology. Because of possible complications of the IMTMs,a surgical extraction may be necessary. Moreover, knowing the pattern of IMTMs can lower the possibility of complications after the surgery.This research aims to evaluate the impaction pattern of the IMTMs in the population of patients referring to the Dentistry faculty of the Guilan University of medical sciences clinic. Methods: In this retrospective analytic cross-sectional study 98 radiographs were gathered and the angulation, depth, and side of impactions, inferior alveolar canal pathology, and decay existence were evaluated. Then each factor was assessed based on age and gender. Analyzing data was done using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). Conclusion: Mesioangular pattern and level B of impaction depth were the most prevalent position of the IMTMs. Most cases had unilateral impaction and right-sided impaction was more frequent than left-sided.

The Accuracy of Bone Assessment Distal to Lower Second Molars Using Panoramic Radiography: A Systematic Review and Meta-Analysis.

Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar.

Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is to compare changes in bone level distal to the mandibular second molar (MSM) in patients with an extracted IMTM versus non-extracted IMTM using OPG. Methods: In this retrospective case–control study, 160 orthopantomograms (OPGs) of 80 patients who attended Dental Hospital of the University of Barcelona (HOUB) were randomly selected. Participants were stratified into a study group and control group. Results: Males and females experienced bone gain in the study group and bone loss in the control group. However, the difference in bone-level change was not statistically significant regarding gender in the study group. Within the study group, the age group of 29–39 years demonstrated significant (p-value = 0.042) bone gain after extraction compared to other age groups. However, the control group demonstrated bone loss in all age groups in which the difference is not statistically significant (p-value 0.794). Conclusions: Bone improvements distal to the MSM were observed after the extraction of an IMTM compared to when an IMTM was not extracted.

Effectiveness of Advanced Platelet-Rich Fibrin on Postoperative Sequelae for Impacted Mandibular Third Molar Surgery: A Prospective Study.

Introduction Impacted third molar extraction is frequently removed surgically by maxillofacial surgeons, which is mostly associated with postoperative sequelae like pain and swelling. It is essential to minimize the complications and enhance wound healing in the extracted socket of the third molar. Hence, this study aimed to assess the efficiency of advanced platelet-rich fibrin (A-PRF) in wound healing and reducing pain after surgical extraction of the impacted mandibular third molar (IMTM). Materials and methods Thirtyhealthy patients who have been diagnosed with Pell and Gregory class II IMTM were included in this study. In the study group, which comprises 15 patients, extraction sockets were filled with A-PRF extract. In the control group, no material was placed in the extraction sockets. The pain was assessed preoperative and on the third and seventh postoperative days using a visual analog scale (VAS). Wound healing was assessed on the third and seventh postoperative days using a modified laundry scale. SPSS for Windows was used for data analysis. Categorical data was compared between the groups using the Chi-square test. P-value less than 0.05 was considered as statistically significant. Results The study population's mean age was 25.67 ± 2.4 years. Nineteen patients were male, and 11 patients were female. Differences in mean pain scores between the groups were not statistically significant both on the third postoperative day (p=0.59)and the seventh postoperative day (p=0.33). During the seventh day postoperative day, the study group exhibited better wound healing compared to the control group and the results were statistically significant (p=0.01). Conclusion A-PRF is a simple and effective method of reducing postoperative sequela by promoting wound healing after surgical extraction of IMTM. Ithas the advantage of less chance of allergic and anaphylactic reactions, unlike their predecessor platelet concentrates.

Relationship between the impacted mandibular third molar and adjacent second molar' external root resorption by cone-bean computed tomography analysis.

The relationship between the impacted mandibular third molar (IMTM) and the external root resorption (ERR) of the mandibular second molar (MSM) was analysed with cone-beam computed tomography (CBCT). The risk factors affecting the ERR of the MSM were examined to provide a reference. A total of 327 patients (total: 578 teeth) admitted to the Affiliated Hospital of Yanbian University for IMTM extraction from January 2017 to December 2019 was chosen and divided according to gender and age. The correlation between the IMTM and ERR of MSM was analysed, including inclination angle, impaction direction and depth. The relationship of mandibular ascending ramus classification with ERR of MSM was also analysed. In addition, the correlation between the MTM impaction type and the severity of ERR was analysed. The incidence of ERR of MSM in male patients was higher than in females (27.9% vs.17.6%, p = 0.018). The occurrence and the site of ERR showed statistical differences in the inclination angle [(≤20°, 3.6%) vs. (21°-40°, 27.1%) vs. (41°-60°, 27.6%) vs. (61°-80°, 25.6%) vs. (>80°, 31.7%), p <0.001], impaction direction [(Vertical, 1.1%) vs. (Mesial, 32.7%) vs. (Horizontal, 25.3%), p <0.001] and depth of MTM [(Low position, 38.6%) vs. (Median position, 32.0%) vs. (High position, 13.7%), p <0.001]. Also, there was a significant difference in the mandibular ascending ramus type [(Class I, 17.4%) vs. (Class II, 32.3%) vs. (Class III, 44.9%), p <0.001]. In addition, the severity of ERR showed statistical differences in the mesial (40.9%, p<0.05), lower impaction (54.5%, p<0.05) depth of MTM and type III of mandibular ascending ramus (63.6%, p<0.05). The inclination angle, impaction direction, and depth of MTM were the influencing factors for the occurrence and site of ERR. Also, mandibular ascending ramus type was the impact fact. For MTM with mesioangular, lower impaction, and mandibular ascending ramus with type III, the ERR of the MSM was severer.

Localised 0.2% chlorhexidine irrigation delivery system versus oral antibiotics in reducing postoperative complications in the surgical extraction of impacted mandibular third molar (IMTM). - a randomised controlled trial.

The purpose of the study was to compare the efficacy of the use of 0.2% chlorhexidine irrigation and the oral antibiotics for the prevention of postoperative complication like pain, trismus, swelling and infection after the surgical extraction of IMTM. A randomised, double blinded clinical trial was planned with two equal groups. Patients were randomly divided into two groups using computer-generated codes with an allocation ratio of 1:1. Group I (Control): Standard preoperative and postoperative systemic oral antibiotics and Group II (Study): No systemic antibiotics and Chlorhexidine irrigation local delivery. The primary outcomes evaluated were postoperative pain, mouth opening, swelling and infection. The secondary outcome variables were the number of analgesics and antibiotics taken by the patient in the postoperative period, the satisfaction of the patient and adverse events, were followed up regulary for 7 days postoperatively. A total of 84 patients, divided into two equal groups participated in the study. In intergroup comparison of swelling, the difference was non-significant on postoperative day (POD) 1 and 7, except for POD 3, where it showed significantly lower results in the antibiotic group (p = 0.012). However, there was no significant difference in pain found between both groups at any of the postoperative time points, and the study group had a lesser need for rescue analgesics than the control group. A statistically significant difference in incidence of dry socket was observed (p = 0.03) and gastrointestinal adverse symptoms, but it showed insignificant results for wound dehiscence and pus discharge. Also, patient satisfaction was higher in the study group. both antibiotics and localised delivery demonstrated comparable results in terms of swelling, pain and trismus. However, with lesser adverse events, the localised chlorhexidine delivery with curved tips outperformed the antibiotic group.

Comparative evaluation for the accuracy of mandibular third molar impaction status with respect to surrounding dentoalveolar structures using orthopantomogram as against cone beam computed tomography

Mandibular third molar impaction impose a great dental problem especially to young adults. It is the most commonly impacted tooth in the entire dentition of humans. The cause of impaction may vary and may include lack of space, malposition and physical barrier on the path of eruption. This impaction can lead to different pathologies, from infection to development of cysts. Injury to the inferior alveolar nerve during extraction of mandibular third molar is also a possibility during treatment which can lead to numbness, tingling or burning sensation of the affected side. It can also have adverse effects on the adjacent second molar. Several studies have been done to determine the angulation, depth of impaction, space available between the second molar and ramus, proximity to inferior mandibular third, status of adjacent second molar using several criteria and classification using orthopantomography (OPG) and cone beam computed tomography (CBCT). But there is very little research done on the precision of both OPG and CBCT and comparisons of their diagnostic accuracy. In this study, adults above 21 years of age who have impacted mandibular third molar (IMTM) will be taken for OPG where OPG will provide two-dimensional radiography and CBCT will deliver three-dimensional radiography. Different criteria will be used to assess the status of the impaction and see the sensitivity and specificity in both OPG and CBCT. This study is important to help determine which radiographic diagnostic tool is preferable for assessing the status of impacted third molar and its relation to its surrounding structures and estimate the difficulty index for extraction of mandibular third molar impaction. It will also further help in preventing any injury or complication which can arise to the surrounding structures both during and after extraction and which will also help in achieving best possible outcome for patients.

The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study

BackgroundThe injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM).MethodsThis retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher’s exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher’s exact test.ResultsThere were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8).ConclusionsRoot orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.

Effect of chlorhexidine gel on the prevention of alveolar osteitis and post‐operative pain following transalveolar extraction of impacted mandibular third molars: A randomized study

AbstractObjectiveThis study aimed to compare the efficacy of 0.2% chlorhexidine gel with warm saline mouth rinse (WSMR) in the prevention of alveolar osteitis (AO) following transalveolar impacted mandibular third molar (IMTM) extraction after accounting for surgical operative confounding factors.Materials and MethodsWe conducted a parallel design randomized study. Participants were consenting adults randomly assigned to 0.9% WSMR and 0.2% chlorhexidine gel (administered twice daily post‐operatively) groups. All participants were followed up daily post‐operatively for one week. The primary outcome was an incidence of AO, assessed using Blum's criteria. Fischer's exact tests and regression models were used to investigate the effect of interventions on AO.ResultsOne hundred participants were enrolled in the study, with 50 participants in each group. A higher incidence of AO was observed in the WSMR group than the chlorhexidine group (16% vs. 2%, p = 0.01). However, after adjusting for duration of extraction (aOR: 0.18; 95% CI: 0.02, 1.71) and bone operating time (aOR: 0.16; 95% CI: 0.02, 1.47), the difference was not statistically significant.ConclusionsIn conclusion, the study demonstrates that the application of the 0.2% chlorhexidine gel was not significantly more effective in preventing AO compared with the use of WSMR following transalveolar IMTM extraction after controlling for operative factors.

Three-dimensional positional relationship between impacted mandibular third molars and the mandibular canal

ObjectiveTo observe the three-dimensional positional relationship between impacted mandibular third molars (IMTMs) and mandibular canal close contacts using cone beam computed tomography (CBCT).MethodsA total of 101 patients with IMTMs were selected who met the diagnostic criteria for 142 teeth (no bone wall imaging area between IMTMs and the mandibular canal, a high-density bone cortical imaging area only, or a ≦1 mm bone imaging area). The parameters of the rotating CBCT anode were set as follows: 110 kV, 40–50 mA; the focal point and exposure field were set as 0.3 mmh and a high-resolution zoom, respectively; the exposure time and image layer thickness were set as 5.4 s and 0.25 mm. Three-dimensional reconstruction was performed, and the position of the mandibular canal through the IMTM area was observed continuously from the coronal, horizontal and sagittal planes.ResultsWe found that the mandibular canal was interrupted below the third molar (TM) in 85 cases, accounting for 59.86% of all cases. The mandibular canal was located below the buccal and lingual curvatures in 33 and 19 cases, respectively, accounting for 23.23% and 19%. In addition, a small number of mandibular canals were also located on the buccal side of the mandibular molars (2.82%). We also found one case of direct insertion of the mandibular third molar (MTM) into the mandibular canal. In addition, the mandibular canal passed through the IMTM region with 125 close contacts at the roots (88.03%); 14 mandibular canals were in contact with all teeth and 3 were in contact with the crown.ConclusionThe use of CBCT can provide a dynamic and comprehensive understanding of the three-dimensional positional relationship of the mandibular alveolar nerve canal passing through the IMTM area, providing a high clinical reference value when extracting IMTMs and reducing the risk of injury to the inferior alveolar nerve.

Analgesics effect of local diclofenac in third molar surgery: a randomized, controlled trial.

This study aimed to evaluate the effect of locally diclofenac application on postoperative pain, sequalae, and adverse effects following mandibular third molar (MTM) surgery. A randomized, crossover, double-blind, controlled trial was conducted in 20 patients who required surgical removal of bilateral symmetrical impacted MTM at two separate appointments. The 40 MTMs were randomly allocated to two groups. One side was assigned 0.1% w/v diclofenac sodium as the diclofenac group. The contralateral side was assigned phosphate-buffered saline (PBS) as the control group. Postoperative pain intensity was measured by visual analogue scale (VAS), where the time when the first pain emerged, the time to first rescue medication, pain at 6 and 24h after surgery, and the total number of analgesics consumed were recorded. Postoperative swelling and trismus were assessed on postoperative days 2 and 7. The differences of continuous outcomes between two groups were analyzed by paired t-test or Wilcoxon signed-rank test. VAS scores were significantly lower when the first pain emerged and 6h after surgery in diclofenac group (p < 0.05). The onset of pain in the diclofenac group was significantly longer than in the control group (p < 0.05). Two patients reported mild nausea and dizziness in the diclofenac group. This study demonstrates the analgesic effectiveness of 0.1% local application of diclofenac within 6h postoperative with few side effects. Locally diclofenac application is an alternative of postoperative analgesic in MTM surgery which provides pain-free periods within 6h.

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

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

Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury.

Extraction of impacted mandibular third molars (IMTMs) is the most common surgery performed in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher in cases of IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. From August 2019 to June 2022, 23 patients underwent IMTM extraction by Dr. Zhao at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, and were found to have IMTMs in close proximity to the IAC. Due to high IAN injury risk, these patients underwent coronectomy-miniscrew traction to extract their IMTMs. The time between coronectomy-miniscrew insertion and complete removal of the IMTM was 32.65 ± 2.110days, which was significantly shorter than that of traditional orthodontic traction. Two-point discrimination testing revealed no IAN injury, and no injury was reported by patients during follow-up. Other complications, such as severe swelling, severe bleeding, dry socket, and limited mouth opening, were not observed. Postoperative pain levels were not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. For IMTMs that are in close proximity to the IAC and must be extracted, coronectomy-miniscrew traction is a novel approach to minimize the risk of IAN injury in a less time-consuming way with a lower possibility of complications.

Does the “Root Removal First” strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position? — a randomized clinical trial

ObjectiveTo evaluate the clinical outcomes of the “Root Removal First” strategy in the surgical removal of impacted mandibular third molar (IMTM) in the class C and horizontal position.Materials and methodsA total of 274 cases were finally included in the statistics. The positions of IMTM in the horizontal position were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the “Root Removal First” strategy was applied in the new method (NM) group, and the conventional “Crown Removal First” strategy was executed in the traditional method (TM) group. The clinical information and relevant data upon follow-up were recorded.ResultsThe duration of the surgical removal and the incidence rates of lower lip paresthesia in the NM group were significantly lower than those in the TM group. The degree of mobility of the adjacent mandibular second molar (M2) in the NM group was significantly lower than that in the TM group at 30 days and 3 months post-operation. The distal and buccal probing depth of the M2, as well as the exposed root length of M2 in the NM group, were significantly lower than those in the TM group 3 months post-operation.ConclusionsThe “Root Removal First” strategy can reduce the incidence rate of inferior alveolar nerve injury and periodontal complications of the M2 in the surgical removal of IMTM in class C and horizontal position with high efficiency.Trial registrationChiCTR2000040063.

Two Cases of Kissing Molars

Kissing molars （KMs） are an extremely rare condition in which the occlusal surfaces of impacted molars contact each other, with roots pointing in opposite directions. KMs are classified according to the type of impacted molars, the contact style of the occlusal surface, and the presence or absence of a radiolucent area around the crown. We experienced two cases of Class Ⅱ true KMs without cystic variant. In these cases, second and third molars were impacted with occlusal surfaces facing each other, without a pericoronal radiolucency around the crowns. Case 1: A panoramic X-ray and computed tomography revealed complete impaction of the right mandibular second and third molars that had occlusal surfaces contacting each other. Both teeth were extracted under general anesthesia. Case 2: A panoramic X-ray and computed tomography revealed that the occlusal surfaces of the impacted left mandibular second and third molars were facing each other directly, and the root of this impacted second molar was close to the apical radiolucent lesion of the left mandibular first molar. Under general anesthesia, tooth extraction of the left mandibular first, second and third molars and periapical cystectomy of the left mandibular first molar were performed. The postoperative courses of both cases have been good.