Extraction Of Mandibular Third Molars Research Articles

Comparative Study of the Efficacy of Low-Level Laser Therapy and Dexamethasone in Reducing the Severity of Post-Operative Inflammatory Response Following Surgical Extraction of Mandibular Third Molars.

To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Trismus (4.61 ± 0.26cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Automated Prediction of Extraction Difficulty and Inferior Alveolar Nerve Injury for Mandibular Third Molar Using a Deep Neural Network

Extraction of mandibular third molars is a common procedure in oral and maxillofacial surgery. There are studies that simultaneously predict the extraction difficulty of mandibular third molar and the complications that may occur. Thus, we propose a method of automatically detecting mandibular third molars in the panoramic radiographic images and predicting the extraction difficulty and likelihood of inferior alveolar nerve (IAN) injury. Our dataset consists of 4903 panoramic radiographic images acquired from various dental hospitals. Seven dentists annotated detection and classification labels. The detection model determines the mandibular third molar in the panoramic radiographic image. The region of interest (ROI) includes the detected mandibular third molar, adjacent teeth, and IAN, which is cropped in the panoramic radiographic image. The classification models use ROI as input to predict the extraction difficulty and likelihood of IAN injury. The achieved detection performance was 99.0% mAP over the intersection of union (IOU) 0.5. In addition, we achieved an 83.5% accuracy for the prediction of extraction difficulty and an 81.1% accuracy for the prediction of the likelihood of IAN injury. We demonstrated that a deep learning method can support the diagnosis for extracting the mandibular third molar.

Prevention of inflammatory complications after surgical extraction of mandibular third molars

Inflammatory complications are the most prevalent problems after surgical extraction of mandibular third molars. The main options for prevention are prophylactic antibiotics usage before surgery or in the postoperative period; a method of postoperative management of a tooth socket, implying healing by primary or secondary closure. Each of the postoperative management types has advantages and disadvantages. The aim of the study was to compare complete suturing versus iodoform gauze packing of tooth socket for prevention of inflammatory complications after mandibular third molar removal. A retrospective cohort study was performed. The medical records of 273 patients who underwent mandibular third molar extraction for orthodontic indications were analyzed. Data of 100 patients were included, in 50 cases the postoperative management was carried out using iodoform packing, in other 50 cases complete suturing was performed. Depending on the type of data and distribution, we used the chi-squared test, Fisher's exact test, Student's t-test, Mann-Whitney U test. A p<0.05 was needed to achieve statistical significance. Alveolitis developed in 8 % cases of iodoform gauze packing and 34% cases of suturing. The differences are statistically significant (p=0.003). The total rehabilitation period (days) in patients with no alveolitis using iodoform gauze packing was 8 (7; 31) (Me (Q1; Q3)), using complete socket suturing was 7 (7; 8) (Me (Q1; Q3)), the differences are statistically significant (p=0.003). The best option for the prophylaxis of alveolitis after surgical extraction of mandibular third molar is secondary closure using iodoform gauze packing. However, in the cases with no alveolitis when complete suturing was performed, healing occurred much faster, which justifies the development of an alternative method for third molar socket healing.

APPLICATION OF PIEZOSURGERY IN EXTRACTION OF IMPACTED THIRD MOLARS

Removal of impacted permanent third molars is considered to be one of the most common and routine oral surgical procedures. This intervention is usually performed in the classical way with the use of rotatory &nbsp;instruments and burs. As an alternative to this classical approach, piezosurgery can be used, which is an osteotomy technique based on ultrasonic vibrations. The crucial advantage of piezosurgery is that it is inert to soft tissues. The aim of this study was to compare piezosurgery with the rotatory osteotomy technique, with particular reference to the time required to perform the intervention and the intensity of postoperative sequelae: pain, swelling, and trismus. This paper summarizes published experiences and knowledge of piezosurgery, with special regard to the extraction of mandibular third molars. For the purposes of this research, an automatic detailed search was performed on the electronic database PubMed for the period 2012-2022. Keywords used in the search were: piezosurgery, impacted third molars. The initial filtration resulted in 47 scientific papers, 17 of which met the selection criteria. Of particular interest were papers such as Meta-analyzes and systematic reviews. A review of the literature indicates that although patients undergoing piezosurgery required longer operating times, they had less postoperative pain, swelling, and trismus. Keywords: impacted molar, piezosurgery. &nbsp

Pre-emptive analgesia efficacy of piroxicam versus tramadol in oral surgery.

This double-blind randomized controlled trial (RCT) was conducted to evaluate the pre-emptive analgesia and anti-inflammatory efficacy of piroxicam compared with tramadol in patients undergoing oral surgery. Seventy-eight patients who required extraction of impacted mandibular third molars were randomized into three treatment groups of 26 patients each: group I received 100 mg of tramadol, group II received 20 mg of piroxicam, and group III received a placebo. Drugs were administered intramuscularly 30 min prior to the extraction procedure. Pain intensity, time to first analgesic administration, total analgesic consumption, facial edema, and trismus were the outcomes of interest. The group receiving 20 mg of piroxicam showed significantly lower pain intensity, increased time to first analgesic, and reduced edema from preoperative to postoperative day seven than those in the tramadol and placebo groups. The findings of this study showed that piroxicam had significant pain relief efficacy after third molar surgery compared with that in tramadol.

Comparative efficacy of bromelain and aceclofenac in limiting post-operative inflammatory sequelae in surgical removal of lower impacted third molar: a randomized controlled, triple blind clinical trial.

BackgroundPain, edema, and trismus are predictable sequelae for surgical extraction of impacted mandibular third molars (M3M). The present study aimed to compare the anti-phlogistic potential of bromelain and aceclofenac in the reduction of post-surgical sequalae in the extraction of impacted M3M.MethodA randomized controlled, triple-blinded clinical study included 72 patients scheduled for surgical removal of impacted M3M under local anesthesia. Randomization was performed and subjects were equally allocated to groups A (control) and B (study), who intended to receive aceclofenac and bromelain, respectively. The primary outcome variables were pain, edema, and trismus evaluated on postoperative days 2 and 7 and compared with baseline values. The secondary variables evaluated were the quantity of rescue analgesics required and the frequency of adverse effects in both groups for 7 postoperative (PO) days. Data were analyzed with a level of significance of P < 0.05.ResultsGroup B demonstrated a significant decrease in the severity of edema and trismus compared to group A on both PO days 2 and 7 (P < 0.001). Bromelain demonstrated similar analgesic efficacy with an insignificant difference compared to aceclofenac (P > 0.05).ConclusionThe present study showed that the efficacy of bromelain was comparable to that of aceclofenac in reducing inflammatory complications following surgical removal of impacted M3M. Bromelain can be considered a safe and potent alternative to routinely used aceclofenac when addressing inflammatory outcomes after surgery.

Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications. Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively. Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value &gt;0.05) difference between the two doses. Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus. Keywords: Dexamethasone; impacted third molars; swelling; trismus.

Do two- and three-dimensional imaging show the same risk of nerve injury during extraction of mandibular third molars depending on their angulations and distances to the inferior alveolar canal? – A retrospective clinical study over 8 years

ObjectivesInjury of the inferior alveolar canal (IAC) is a common complication during mandibular third molar (MTM) surgery. The aim of this study was to compare the MTM risk assessment using orthopantomography (OPG) and cone beam computed tomography (CBCT) images showing different MTM angulations and distances to the IAC. Materials and methodsThis retrospective study investigated 388 lower third molars of 259 patients radiologically over eight years using OPG and CBCT. Measurement and categorisation of MTM position showed four different types of angulations: vertical (type 1), mesioangular (type 2), horizontal (type 3) and distoangular (type 4). The shortest distance from the MTM and the IAC was measured and categorized after a risk classification (class 1–3) for injury of the IAC. ResultsHigh risk (class 1) was detected in 38.4%, moderate risk (class 2) in 21.9%, and low risk (class 3) in 36.1% using OPG data. In CBCT, high risk (class 1) was found in 11.6%, moderate risk (class 2) in 5.7%, and low risk (class 3) was fount in 78.6%. The same risk classification for OPG and CBCT was present in 25.1% of cases. The most common angulation was type 1 in 49.7%, followed by type 2 in 40.5%, 5.2% in type 3, and 4.4% in type 4. ConclusionPreoperative CBCTs are essential for risk evaluation and treatment planning in MTM surgery due to differences in OPG and CBCT data regarding nerve injury risk.

Comparative Assessment of Post-Operative Sequelae Following Surgical Removal of Mandibular Third Molar with and Without Extra-Oral Application of Kinesiologic Tape

Background: The transalveolar extraction of impacted mandibular third molars creates a huge level of injury to the delicate tissues of the oral cavity, which can initiate significant inflammatory reaction. Amongst some postoperative sequelae of third molar surgeries- pain, trismus and facial oedema are the most common. Treating with taping therapy has shown acceptable outcomes in reducing pain and in managing post-operative muscle spasm.&#x0D; Objectives: The motive behind this research is to compare post-operative pain, swelling and trismus following third molar surgery in both test and control groups.&#x0D; Methodology: The research will be a prospective randomized control split-mouth non-blinded clinical study model to assess the impact of the Kinesiology Tape (KT) on post-operative sequalae following removal of mandibular third molar surgically. With the cumulative 15 patients to be allocated for operating bilaterally involved impacted mandibular third molar. The study will be done under two groups, Group A – Test group (KT) one side of patient’s face, subjected to beige tape application. Group B – Control group (No KT) other side of patient’s face, will be the controlled group without application of KT. Each patient will undergo 2 operative surgeries at 2 week-interval conducted by the same surgeon. Immediately after extraction extra-oral application of KT will be done for test group.&#x0D; Expected Results: The use of kinesiologic tape will be effective in improvement of post-operative discomfort of the patient in the conditions of reduction of swelling, pain and trismus.&#x0D; Conclusion: As kinesiologic taping originates from sports medicine, currently there are very limited evidence- based scientific studies for KT application for treatment of post-operative edema in head and neck surgeries. This study will help to evaluate the use of KT enabling patients to have a restful time after operation leading them to get a better quality of life.

Prevalence of Distal Cervical Caries in Mandibular Second Molar caused by impacted third molar

Aim: To analyse early recognition of the distal cervical caries of mandibular second molar caused by impacted mandibular third molar, to correlate oral health and caries status and to find out the average age groups and gender affected by impacted third molar Methods: A cross-sectional survey of 300 participants was conducted over a 15-month period at Rehmat Memorial Hospital, Abbottabad. 300 participants having impacted third molar having distal cervical caries in mandibular second molar were analyzed clinically and radiographically. Data was analyzed using SPSS version 23.0 Results: the demographic data of 300 patients with impacted mandibular third molars were analyzed. 64% were male and 36% female that have extractions due to impaction. Caries caused in more than half of participants by mesioangular impaction, which was 52%, 3% due to distoangular, 26% due to distal, and 18% due to horizontal impaction. In 63.25% of cases, teeth were lost due to caries, periodontitis caused 20.25% of tooth loss, pericoronitis 7.75%, orthodontics 3.75%, prosthodontics 1.2%, trauma 1%, and other factors were 2.5%. study reveals that 30.5 % of the extractions were done from 21 and 30 years and 23 %of extractions were performed. 40% of those who took part in the study did not brush their teeth. Socioeconomic status also has a great impact on tooth extractions. Conclusion: After conducting this study, it was concluded that there was a relationship between the prevalence of distal cervical caries in mandibular second molars and the placement of neighbouring impacted mandibular third molars. As a result, the extraction of mandibular third molars should be done to avoid cavities and premature tooth loss in the neighboring molar. Key words: Third molar impaction, distoangular, distal cervical caries, extraction, 2nd molar caries

Prevalência das posições e grau de dificuldade cirúrgica de terceiros molares inferiores: um estudo radiográfico retrospectivo

Aim: The objectives of this study were to evaluate the prevalence of the mandibular third molars position in according to the Winter and Pell &amp; Gregory classification, and to determine the levels of difficulty for exodontia through the Pederson index. Materials and Methods: Radiographic, cross-sectional and retrospective study evaluated 100 panoramic radiographs of patients between 15 and 61 years old, from dental records seen at the Oral Surgery department in the period from 2015 to 2017. The panoramic radiographs were evaluated using ImageJ software regarding the positioning of the lower third molars by the Winter and Pell &amp; Gregory classification, while the level of difficulty was evaluated by the Pederson index. The results obtained were submitted to descriptive statistical analysis. Results: The highest prevalence of included third molars was observed in women, with an age average of 26 years. Regarding the position of the included teeth, the vertical position (44.0%), level A (74.7%), and class III (69.9%) were the most prevalent. In the Pederson scale, the “very difficult” surgical difficulty was the most found. Discussion: results suggest establishing better surgical planning and prognosis for patients, minimizing the possibility of complications during and after extractions of mandibular third molars. Conclusion: Both classifications help the dental surgeon to establish better planning and prognosis for patients. The applicability of panoramic radiographs, associated with clinical evaluation, justifies a fewer possibility of complications in the lower third molar post-extraction.

Comparison and correlation of the factors affecting prevalence, intensity and nature of bacteremia during pre-operative, intra-operative and posto-operative period of trans-alveolar extraction of impacted mandibular third molar - An original research

Background: This study is done to compare and correlate the factors that would affect the prevalence, intensity, nature of bacteremia during pre-operative, intra-operative and aftermath trans-alveolar extraction of impacted mandibular third molar. Aim: The aim of this study is to study the prevalence, nature, and intensity of bacteremia among the patients with no antibiotics administered prior to trans-alveolar extraction, with and with-out periapical and periodontal infections. Materials and methods: A prospective clinical study and microbiological assessment on blood culture was conducted at Department of oral and maxillo-facial surgery in 50 patients who underwent surgical removal of im- pacted mandibular third molar teeth. Immunocompro- mised patients, patients having temperature greater than 1000 F, bleeding disorders, patients on recent antibiotic medications were excluded from the study. Results: On comparison of the pre-operative, intra- operative and post-operative intensity values, the intensity of bacteremia was significantly greater at the intra operative and post-extraction time than at the pre-extraction time. Conclusion: We conclude that the incidence, prevalence and the intensity of bacteremia during trans-alveolar ex- traction is more common in older patients and periodon- titis is more prevalent in patients with poor oral hygiene which in turn contributes to the intensity of bacteremia associated with trans-alveolar extraction of third molar. From this study, it is found that, the occurrence of bacteremia is increased with duration of the surgery, as in- cidence of bacteremia was high when the surgery lasted more than 35 minutes in general.

Comparison between Simvastatin and Allantoin in Bone Formation after Surgical Extraction of Mandibular Third Molars

Comparison between Simvastatin and Allantoin in Bone Formation after Surgical Extraction of Mandibular Third Molars

Influence of Lidocaine including Buprenorphine for Postoperative Analgesia after the Extraction of Mandibular Third Molars: A Randomized Controlled, Double-Blind, Split-Mouth Study.

Background The presence of opioid receptors around the peripheral nerves offers the possibility of providing postoperative analgesia, thereby encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the efficacy of peripherally administered opioids in achieving adequate analgesia in regions with inflammation. Applying the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in managing postoperative pain. The split-mouth study was carried out to evaluate the efficacy of buprenorphine added to lidocaine 2% in providing postoperative analgesia after the surgical extraction of the impacted mandibular third molar. Materials and Methods We conducted a randomized, double-blinded, split-mouth trial among 21 patients with impacted mandibular third molars bilaterally. In all patients, bilateral impacted mandibular third molars were extracted at different periods. The primary outcomes assessed were postoperative analgesia by the VAS score and the number of rescue analgesics consumed by patients at 24, 48, and 72 hours of interval via a questionnaire. Results There was a statistical significant difference in postoperative analgesia duration at 24 (P = 0.012) and 48 hours (P = 0.024), respectively, between the test and control group. Even though the mean number of rescue analgesics consumed by the test group was less than that of the control group, no significant difference was seen. Conclusion Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.

Evaluation of the Outcomes of Coronectomy Procedure versus Surgical Extraction of Lower Third Molars Which Have a High Risk for Inferior Alveolar Nerve Injury: A Systematic Review.

Results No study reported permanent inferior alveolar nerve injury (p-IANI) regarding coronectomy; however, transient inferior alveolar nerve injury (t-IANI) was reported in 0–2.20% of successful coronectomy and 0–8% of failed coronectomy. Postextraction t-IANI ranged from 0% to 16.66% while p-IANI from 0% to 3.63%. In 5 studies, root migration occurred in 2% to 85.3% of cases and the distance rate was 2.33–3.43 mm at 6 months postoperatively; then the migration gradually decreased and stopped at 12 months. Conclusion This systematic review revealed that coronectomy is an efficient alternative for the management of impacted 3rd M with a high risk of IANI. Patients who got antibiotics postcoronectomy procedures had lower infection rates than those who did not receive antibiotic therapy. We recommend further research on coronectomy with longer follow-up periods to assess the retained roots' long-term outcomes and to assess the effect of antibiotics administration on postcoronectomy infection rate. This systematic review is registered under number CRD42020198394.

Effect of light-emitting diode phototherapy on pain and trismus following surgical extraction of impacted mandibular third molars

Purpose: This study aimed to assess the effect of light-emitting diode (LED) phototherapy on pain and trismus following surgical extraction of impacted mandibular third molars. Materials and Methods: This double-blind randomized controlled clinical trial evaluated 50 patients between 20 to 35 years requiring extraction of their impacted mandibular third molars. The patients were randomized into two groups of LED phototherapy and control by flipping a coin. Patients in the LED group underwent LED phototherapy immediately after surgery with red light at 618nm wavelength, 20 mW/cm2 power density and 4 J/cm2 energy density in continuous-wave mode (irradiated area: 3.15cm×1.5cm=4.725cm2). The LED device was used in off mode in the control group (as placebo). The level of postoperative pain was measured by the numerical rating scale, and trismus of patients was evaluated by measuring the maximum mouth opening (MMO). The two groups were compared by the Mann-Whitney and NPar tests. Results: The mean difference in MMO postoperatively, compared with baseline, was lower in the LED group than the placebo group but not significantly (P=0.465). The two groups were not significantly different regarding the level of pain. Conclusion: LED phototherapy with the parameters applied in this study failed to significantly decrease the level of pain and trismus following surgical extraction of impacted mandibular third molars.

Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial

Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine–epinephrine and submucosal reinforcement with 0.8 mg dexamethasone–5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine–epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients’ scores on the VAS as well as their consumption of analgesic drugs after surgery.

Compressing inferior alveolar nerve impacted mandibular third molar: a comparison of three techniques

AbstractPurposeInjury to the inferior alveolar nerve while conducting extraction of impacted mandibular third molar is highly related to the relative position of the inferior alveolar nerve and the root of third molar. The aim of this study was to compare the incidences of inferior alveolar nerve injury in orthodontic traction, coronectomy and piezosurgery for the removal of impacted mandibular third molar.MethodsAfter examining the panoramic radiography and cone‐beam computed tomography, 66 patients with impacted mandibular third molar compressing the inferior alveolar nerve were enrolled in this study. Orthodontic traction, coronectomy and piezosurgery were carried out in 20 patients, respectively. Signs of postoperative neurosensory impairment were recorded.ResultsBaseline characteristics were similar among the three groups (p &gt; 0.05). No sign of neurosensory impairment was observed in patients performed by orthodontic traction or coronectomy. One patient who underwent piezosurgery had postoperative lower lip numbness.ConclusionsNo statistical differences in these three techniques were observed in this study. Orthodontic traction, coronectomy and piezosurgery can reduce the incidence of nerve injury during the removal of impacted mandibular third molar compressing the inferior alveolar nerve.

Efficacy and Safety of Concentrated Growth Factor Fibrin on the Extraction of Mandibular Third Molars: A Prospective, Randomized, Double-Blind Controlled Clinical Study

To investigate the efficacy and safety of concentrated growth factor fibrin (CGF) for the extraction of mandibular third molars. This was a randomized, double-blind, and controlled clinical study. Patients who underwent mandibular impacted tooth extraction were randomly divided into 2 groups. In the CGF group, the tooth extraction fossa was utilized to place CGF gel. In the control group, the fossa was filled with serum. The visual analogue scale (VAS), reductions in swelling and trismus, incidence of postoperative dry socket, distal periodontal depth and bone regeneration of the second molar, and bone density (BMD) of the extraction fossa at 24 weeks were evaluated. One hundred eighteen patients were enrolled in this study. There was no significant difference in baseline clinical characteristics between the 2 groups. The pain score of the CGF group was significantly lower than that of the control group at 2, 24, and 48 hours after operation. There was no significant difference in the reduction in swelling or trismus between the 2 groups. There were no cases of dry socket in the CGF group and 3 cases of dry socket in the control group. The periodontal probing depth and bone regeneration of the second molar when the socket was implanted with CGF were better than those that healed naturally (P < .05). The bone mineral density of each group was significantly increased at 24 weeks but was significantly different between groups (P < .05). CGF can effectively reduce reactive tooth extraction pain and help avoid dry sockets. It can promote periodontal tissue and bone healing in distal and extracted sockets.

Assessment of Passiflora incarnata L for conscious sedation of patients during the extraction of mandibular third molars: a randomized, split-mouth, double-blind, crossover study.

The aim of the present study was to evaluate the efficacy of Passiflora incarnata L for the control of anxiety during third mandibular molar extraction and compare it to midazolam, the most used benzodiazepine in dentistry. The investigators implemented a prospective, randomized, double-blind, split-mouth study. The degree of anxiety of the patients was assessed before the surgical procedure. The surgeries took place in two sessions: one on each side of the hemi-mandible and, on each of them, the patient received one of the drugs, crosswise. Anxiety control was measured through physical parameters, at the following periods during the surgery: (1) immediately administration of anxiolytic medication, (2) 30 minutes after anxiolytic medication, (3) after extraoral antisepsis, (4) after local anesthesia, (5) during incision, (6) during osteotomy, (7) between osteotomy and odontosection, (8) during odontosection, (9) during surgical store curettage, (10) during suture, and (11) immediately after postoperative care guidelines. Lastly, the volunteers received a self-assessment form in order to report their experience. Statistical analysis was performed using the Wilcoxon test. The final sample was composed of 20 patients, with a mean age of 22.5 years. The results of the physical parameters showed statistically significant differences (P < .05) for certain times and physical parameters, especially heart rate (P = .036), which showed the highest control for Passiflora at time point (3). The undesirable effects reported by patients such as drowsiness, muscle relaxation, and dizziness were greater with benzodiazepine. The results of this study suggest that Passiflora may be considered as an alternative to midazolam in controlling anxiety in dentistry. Future studies will focus on other benzodiazepines and herbal medicines.