Maxillary Molar Extraction Research Articles

English

Third molar extraction remains one of the most common surgical procedures performed in dentistry either by intra-alveolar or trans alveolar methods; yet such a common surgical procedure sometimes results in relatively rare complications. The incidence of complications can be reduced by proper preoperative planning, knowledge of the surgical anatomy, good surgical technique and recognition of complications. Sub conjunctival haemorrhage after maxillary third molar extraction is one such complication, which till now not more than three cases of similar findings have been reported in the literature. The purpose of this article is to present a rare case of sub conjunctival haemorrhage after maxillary right third molar extraction in a 56-year-old female reported at The Department of Oral and Maxillofacial Surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India.

Cementocyte alterations associated with experimentally induced cellular cementum apposition in Hyp mice.

Cellular cementum, a mineralized tissue covering apical tooth roots, grows by apposition to maintain the tooth in its occlusal position. We hypothesized that resident cementocytes would show morphological changes in response to cementum apposition, possibly implicating a role in cementum biology. Mandibular first molars were induced to super-erupt (EIA) by extraction of maxillary molars, promoting rapid new cementum formation. Tissue and cell responses were analyzed at 6 and/or 21 days post-procedure (dpp). High-resolution micro-computed tomography (micro-CT) and confocal laser scanning microscopy showed increased cellular cementum by 21 dpp. Transmission electron microscopy (TEM) revealed that cementocytes under EIA were 50% larger than control cells, supported by larger pore sizes detected by micro-CT. Cementocytes under EIA displayed ultrastructural changes consistent with increased activity, including increased cytoplasm and nuclear size. We applied EIA to Hyp mutant mice, where cementocytes have perilacunar hypomineralization defects, to test cell and tissue responses in an altered mechanoresponsive milieu. Hyp and WT molars displayed similar super-eruption, with Hyp molars exhibiting 28% increased cellular cementum area versus 22% in WT mice at 21 dpp. Compared to control, Hyp cementocytes featured well-defined, disperse euchromatin and a thick layer of peripherally condensed heterochromatin in nuclei, indicating cellular activity. Immunohistochemistry (IHC) for cementum markers revealed intense dentin matrix protein-1 expression and abnormal osteopontin deposition in Hyp mice. Both WT and Hyp cementocytes expressed gap junction protein, connexin 43. This study provides new insights into the EIA model and cementocyte activity in association with new cementum formation.

Alendronate/dexamethasone combination therapy worsens soft and hard tissue wound healing around implants in rat maxillae.

Dental implant treatment in patients prescribed medications is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around the implants. However, there is no scientific information on how bisphosphonate and/or steroid therapies affect wound healing around implants after implant placement. The aim of this study was to histopathologically and immunopathologically investigate the effects of bisphosphonate and/or steroid therapy on the early stages of soft and hard tissue wound healing around implants in rat maxillae. Eight-week-old female Wistar rats were used. Alendronate (ALN) monotherapy, dexamethasone (DEX) monotherapy, and ALN/DEX combination therapy were started 4weeks after tooth extraction of right maxillary first molars. Saline was used as a control (n=14/group). Implant placement was carried out after grossly and manually confirming no open wounds at 16weeks post-extraction. Euthanasia was performed at 18weeks post-extraction. Microcomputed tomography, histological stains and immunostaining to detect blood vessels and macrophages were performed to quantitatively analyze wound healing around implants. ALN/DEX combination therapy significantly increased necrotic bone with more empty lacunae and polymorphonuclear cell infiltration with open wounds when compared with all other therapy groups. Necrotic bone was broadly distributed from the crestal bone to the lower area near the apex of the implants in the ALN/DEX group. Interestingly, both ALN/DEX combination therapy and DEX monotherapy significantly increased the number of CD68+NG2- macrophages, whereas only ALN/DEX combination therapy, not DEX monotherapy, significantly shifted the M1/M2 ratio to M1 by significant increases in M1 macrophages and unchanged M2 macrophages in the connective tissue around implants. Within the limitations of this study, these findings may contribute to understanding the early stages of the histopathology and immunopathology of BRONJ-like lesions around dental implants. Continuous accumulation of M1 macrophages without alteration of M2 macrophages may be associated with developing BRONJ around implants.

Efficacy of Minimal Volume of Articaine Local Anesthetic for Buccal Infiltration During Extraction of Maxillary and Mandibular First and Second Molars: A Prospective Study

Efficacy of Minimal Volume of Articaine Local Anesthetic for Buccal Infiltration During Extraction of Maxillary and Mandibular First and Second Molars: A Prospective Study

The role of IFT140 in early bone healing of tooth extraction sockets.

Primary cilium is a key organelle of regulating bone development and maintenance. The aim of this study is to investigate whether ciliary intraflagellar transporter protein 140 (IFT140) plays a positive role in extraction socket healing by promoting bone formation. A left maxillary first molar extraction model was established using 6-week-old Ift140flox/flox (Ctrl group) and Ift140flox/flox , Osx-cre (cKO group) mice. The maxillary bone samples from 1, 2, and 3weeks were postoperatively evaluated by micro-CT, molecular biology, and histomorphometry analysis. Alveolar bone marrow stromal cells (aBMSCs) from 4-week-old mice were cultured in vitro and tested for proliferation and osteogenic ability. Ciliated cells were predominantly observed in the early socket healing stage with highly expressed ciliary protein IFT140. Compared with the Ctrl group, the healing of extraction sockets in the cKO group was significantly delayed. The proliferation and osteogenic differentiation ability of aBMSCs were reduced in the cKO group. IFT140 has a facilitating role in the early osteogenesis of extraction socket healing and is involved in regulating the proliferation and osteogenic differentiation of aBMSCs.

The Assessment Of Need For Suturing Following Maxillary Third Molar Extractions

The Assessment Of Need For Suturing Following Maxillary Third Molar Extractions

Assessment of the complications encountered during and after surgical removal of maxillary third molar: An observational study

Aim: To evaluate the prevalence of different complications during and after maxillary third molar extraction. Materials and Methods: An observational study was conducted at Ruby Dental Clinic and Implant Centre, Kunnamkulam, Kerala, India from April 2018 to March 2019. Total 120 Patient who were planned for surgical extraction of maxillary third molar were included in this study. All surgical extractions of maxillary third molar were performed under local anesthesia by a qualified and experienced oral and maxillofacial surgeon. Results: A total of 120 patients of surgical extraction of maxillary third molar were carried out under local anaesthesia over a scheduled period of study. 38 patients were having intra-operative or postoperative complications. Out of 120 patients, 75 were males and 45 were female patients. Most common complications in our study were maxillary tuberosity fracture seen in 13 patients (34.2%). The second most commonly found complication was delayed wound healing 6 (15.8%), postoperative pain 5 (13.2%) and post-operative infection 4 (10.5%). Conclusion: The risk of complications in third molar surgery will always exist and increases in proportion to the surgical difficulty.

Effect of Mirogabalin on Peripheral Neuropathic Pain after Maxillary Molar Extraction : A Case Report

Effect of Mirogabalin on Peripheral Neuropathic Pain after Maxillary Molar Extraction : A Case Report

The assessment of need for suturing following maxillary third molar extractions

Maxillary third molar extractions (MTME) are one of the most common procedures done in maxillofacial surgery. Nevertheless, there are general complications that arise with every surgery. In our study, we have aimed to understand why suturing had been done following MTME and to observe a predilection in age and gender. By attempting to do so, we may establish when suturing is required and if age and gender have a role to play. A retrospective cross-sectional study was conducted after reviewing and analysing the data from 86,000 patient records between June 2019 and March 2020. Patients with an established record of MTME were selected from the age group of (20-60) years. The females of the study population had a larger frequency for having undergone MTME (52.7%) compared to the males (47.3%) and lastly transgenders (0.1%). The highest incidence of MTME was found in the age group of (31-40) years with 30.6% followed by (20-30) and (41-50) years with 26.9% each. (51-60) years had the least MTME done (15.6%). There was a higher incidence of extracted 28’s than 18’s (52.1% > 47.9%). Sutures were placed only in 1.6% of the total cases due to tuberosity fractures that had occurred as a complication of MTME. The placement of a suture following exodontia is not always mandatory, but when a complication such as a maxillary tuberosity fracture arises, suturing must be done. It is imperative to be equipped with the knowledge on how to manage possible complications, because even simple exodontias can prove to have fatal outcomes. Thus, further studies must be done to confirm our findings and to test other geographical locations and ethnicities.

The assessment of need for suturing following maxillary third molar extractions

Maxillary third molar extractions (MTME) are one of the most common procedures done in maxillofacial surgery. Nevertheless, there are general complications that arise with every surgery. In our study, we have aimed to understand why suturing had been done following MTME and to observe a predilection in age and gender. By attempting to do so, we may establish when suturing is required and if age and gender have a role to play. A retrospective cross-sectional study was conducted after reviewing and analysing the data from 86,000 patient records between June 2019 and March 2020. Patients with an established record of MTME were selected from the age group of (20-60) years. The females of the study population had a larger frequency for having undergone MTME (52.7%) compared to the males (47.3%) and lastly transgenders (0.1%). The highest incidence of MTME was found in the age group of (31-40) years with 30.6% followed by (20-30) and (41-50) years with 26.9% each. (51-60) years had the least MTME done (15.6%). There was a higher incidence of extracted 28’s than 18’s (52.1% > 47.9%). Sutures were placed only in 1.6% of the total cases due to tuberosity fractures that had occurred as a complication of MTME. The placement of a suture following exodontia is not always mandatory, but when a complication such as a maxillary tuberosity fracture arises, suturing must be done. It is imperative to be equipped with the knowledge on how to manage possible complications, because even simple exodontias can prove to have fatal outcomes. Thus, further studies must be done to confirm our findings and to test other geographical locations and ethnicities.

Age and gender related distribution of patients undergoing maxillary third molar extractions

Age and gender related distribution of patients undergoing maxillary third molar extractions

Comparative analysis of dimensional alterations following extraction of maxillary molars using three-dimensional images' superimposition: a CBCT study.

The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23mm2) and 65.10% (8.33 ± 4.51mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.

Effect of Pain Relief After Extraction of Maxillary 3rd Molars in Patients Clinically Diagnosed with Temporomandibular Disorders

Effect of Pain Relief After Extraction of Maxillary 3rd Molars in Patients Clinically Diagnosed with Temporomandibular Disorders

Extraction of Maxillary Teeth Without a Palatal Injection: A Randomized Control Trial

ABSTRACT Purpose: The aim of this research was to assess the clinical effectiveness of buccal infiltration of 4% Articaine hydrochloride in comparison to routine buccal and palatal infiltration during the extraction of maxillary molars. Patients and Methods Current research were carried out on 200 patients where study group included 100 patients, and 100 were controls. Unilateral extractions were made to patients in the research group. All patients were injected with 1.8 ml of 4% Articaine hydrochloride with 1:100.000 epinephrine in the buccal vestibule of chosen tooth for removal without performing palatal injection. The maxillary tooth was removed after 8 minutes. One hundred participants in the control group were subject to the same procedure with palatal injection. Upon extracting, every patient completed a face pain scale (FPS) and visual analog scale (VAS). Results: According to the FPS and VAS scores, the difference in pain rates was statistically non-significant (p>0.05) when compared with permanent maxillary dental removal with or without palatal injection. Conclusion: Permanent maxillary tooth extraction is possible when 1.8 mL of 4% Articaine is deposited in the buccal vestibule of the tooth without palatal anesthesia.

Mechano-adaptive Responses of Alveolar Bone to Implant Hyper-loading in a pre-clinical in vivo model.

Oral implants transmit biting forces to peri-implant bone. In turn, those forces subject peri-implant bone to mechanical stresses and strains. Here, our objective was to understand how peri-implant bone responded to conditions of normal versus hyper-loading in a mouse model. Sixty-six mice were randomly assigned to 2 groups; both groups underwent bilateral maxillary first molar extraction followed by complete healing. Titanium alloy implants were placed in healed sites and positioned below the occlusal plane. After osseointegration, a composite crown was affixed to the implant so masticatory loading would ensue. In controls, the remaining dentition was left intact but in the hyper-loaded (test) group, the remaining molars were extracted. 3D finite element analysis (FEA) calculated peri-implant strains resulting from normal and hyper-loading. Peri-implant tissues were analyzed at multiple time points using micro-computed tomography (µCT) imaging, histology, enzymatic assays of bone remodeling, and vital dye labeling to evaluate bone accrual. Compared to controls, hyper-loaded implants experienced a 3.6-fold increase in occlusal force, producing higher peri-implant strains. Bone formation and resorption were both significantly elevated around hyper-loaded implants, eventually culminating in a significant increase in peri-implant bone volume/total volume (BV/TV). In our mouse model, masticatory hyper-loading of an osseointegrated implant was associated with increased peri-implant strain, increased peri-implant bone remodeling, and a net gain in bone deposition. Hyper-loading results in bone strain with catabolic and anabolic bone responses, leading to a net gain in bone deposition.

Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind, randomised, clinical trial

The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method. Then, teeth were extracted and the pain assessed. During the extraction of teeth, 90.63% of patients in the lidocaine-treated group and 36% of patients in the articaine-treated group experienced pain (p<0.0001). In other words, the rates of successful anaesthesia with lidocaine and articaine buccal infiltration were 9.38% and 64%, respectively. Despite the better performance of articaine, it seems that some factors such as bone thickness and anatomical variations among individuals, besides the condition of the tooth, affects articaine’s level of efficiency in each case.

Class II Division 1 malocclusion treatment with extraction of maxillary first molars: Evaluation of treatment and post-treatment changes by the PAR Index.

ObjectiveTo investigate occlusal result and post‐treatment changes after orthodontic extraction of maxillary first permanent molars in patients with a Class II division 1 malocclusion.Setting and SampleRetrospective longitudinal study in a private practice, with outcome evaluation by an independent academic hospital. Ninety‐six patients (53 males, 43 females) consecutively treated by one orthodontist with maxillary first permanent molar extraction were studied, divided into three facial types, based on pre‐treatment cephalometric values: hypodivergent (n = 18), normodivergent (n = 21) and hyperdivergent (n = 57).MethodsOcclusal outcome was scored on dental casts at T1 (pre‐treatment), T2 (post‐treatment) and T3 (mean follow‐up 2.5 ± 0.9 years) using the weighted Peer Assessment Rating (PAR) Index. The paired sample t test and one‐way ANOVA followed by Tukey's post hoc test were used for statistical analysis.ResultsPAR was reduced by 95.7% and 89.9% at T2 and T3, respectively, compared with the start of treatment. The largest post‐treatment changes were found for overjet and buccal occlusion. Linear regression analysis did not reveal a clear effect (R‐Square 0.074) of age, sex, PAR score at T1, incremental PAR score T2‐T1, overjet and overbite at T1, and facial type on the changes after treatment (incremental PAR score T3‐T2).ConclusionsThe occlusal outcome achieved after Class II division 1 treatment with maxillary first permanent molar extractions was maintained to a large extent over a mean post‐treatment follow‐up of 2.5 years. Limited changes after treatment were found, for which no risk factors could be discerned.

The effect of melatonin on prevention of bisphosphonate-related osteonecrosis of the jaw: an animal study in rats

ObjectivesMelatonin induces human stem cells, converts pre-osteoblasts to mature osteoblasts, and reduces the duration of this transition. However, melatonin itself prevents activation of osteoclasts. Here, we evaluate the role of melatonin in prevention of bisphosphonate-related osteonecrosis of the jaw.Materials and MethodsIn this experimental-interventional study, 30 rats were evaluated in 3 groups. The first and second groups received saline and zoledronic acid, respectively, for 4 weeks and the third group received 4 weeks of zoledronic acid and 3 weeks of melatonin simultaneously. First-right-maxillary-molar extraction was performed for all animals, which were sacrificed after 4 weeks of recovery. The extraction sockets were examined histologically for the presence of osteonecrosis, number of osteoclasts and fibroblasts, severity of inflammation, and vascularization. Data were analyzed by chi-square, one-way ANOVA, Tukey, Kruskal–Wallis and Fisher’s exact statistical tests (α=0.05).ResultsOsteonecrosis was observed in 20%, 90%, and 70% of the first, second and third groups, respectively (P=0.008). The lowest number of osteoclasts and fibroblasts was seen in the third group.ConclusionMelatonin may effectively prevent some undesirable side effects of bisphosphonates. However, further studies are required to confirm the results of this study.

Soft Tissue Dimensions Following Tooth Extraction in the Posterior Maxilla: A Randomized Clinical Trial Comparing Alveolar Ridge Preservation to Spontaneous Healing.

Background: To assess the soft tissue dimension following tooth extraction and alveolar ridge preservation in the posterior maxilla compared to spontaneous healing. Methods: Thirty-five patients randomly assigned to alveolar ridge preservation (ARP) and spontaneous healing (SH) after maxillary molar extraction. The crestal, buccal, and palatal gingival thickness at 6 months was measured around virtually placed implant fixtures using superimposed cone-beam computed tomography and intraoral scan taken at 6 months. Buccal mucogingival junction (MGJ) level change over 6 months was estimated using intraoral scans obtained at suture-removal and 6 months. Results: The crestal gingiva was significantly thinner in group ARP (−1.16 mm) compared to group SH (p < 0.05). The buccal and palatal gingiva was significantly thinner at the implant shoulder (IS) level in group ARP (buccal: −0.75 mm; palatal: −0.85 mm) compared to group SH (p < 0.05). The thickness at 2 mm below the IS of both sides and the buccal MGJ level change were similar in both groups (p > 0.05). Conclusions: ARP in the posterior maxilla resulted in a thinner soft tissue on top of and at the prospective level of the implant shoulder at 6 months. The buccal MGJ level changed minimal for 6 months in both groups.

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