Molar Extraction Surgery Research Articles

The Impact of Muscle Energy Techniques on the Temporomandibular Motions Following Extraction Surgery of the Third Molar Tooth: A Randomised Clinical Trial.

Trismus and subsequent restricted range of motion in the temporomandibular joint may impede vital activities of daily living. The primary purpose of the current study was to explore the impact of muscle energy techniques on the range of temporomandibular motions in individuals with trismus and restricted range of the temporomandibular motions after third molar extraction surgery. Eligible volunteers were randomly assigned to either the intervention or control group. Participants in the intervention group received muscle energy techniques over seven consecutive postoperative days, while those in the control group did not receive any intervention. Both groups adhered to the recommended postoperative healthcare protocol provided by a single dentist. The range of cardinal and linear intra-articular motions of the temporomandibular joint was assessed on the first, second and seventh postoperative days in each group using a vernier calliper and an ultrasound machine, respectively. The range of linear intra-articular motion (p-value < 0.001) and cardinal motion (p-value < 0.032) of the TMJ significantly increased within groups after the first postoperative week. The range of temporomandibular motions, except for the forward displacement of the mandibular condyle (p-value = 0.193), and the range of mandibular retrusion (p-value = 0.339) exhibited a significant difference between groups (p-value < 0.017) after the first postoperative week. The current study revealed, for the first time, that muscle energy techniques increase the range of cardinal and linear intra-articular motions in individuals with trismus and restricted range of the temporomandibular motions following third molar extraction surgery. Clinical Trials: IRCT20211016052783N1.

Different Uses of Conscious Sedation for Managing Dental Anxiety During Third-Molar Extraction: Clinical Evidence and State of the Art.

Dental anxiety, linked to avoiding dental treatment and heightened medical and surgical risks, prompted this systematic review. The objective is to synthesize existing evidence on conscious sedation techniques employed for managing dental anxiety in patients scheduled for third molar extraction surgery, aiming to identify optimal approaches and address knowledge gaps. This systematic review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" checklist and the population, investigation, comparation, outcome framework. The protocol still needs to be registered. A thorough search was conducted, incorporating MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews until February 2024. Only randomized controlled trials were considered, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The risk of bias was evaluated following the Cochrane Handbook for Systematic Reviews of Interventions. Eighteen randomized controlled trials involving 2081 patients were included. Certain factors limited the feasibility of a meaningful meta-analysis, leading to a narrative synthesis. Conscious sedation with virtual reality showed an association with improved dental anxiety in 4 studies. One study reported reduced cortisol levels with midazolam compared with a placebo, whereas another noted significant variations in perioperative renin levels with remifentanil versus placebo. This review reveals inconclusive and conflicting findings regarding the role of conscious sedation in managing dental anxiety during third molar extraction surgery. Persistent uncertainties arise due to a need for consistent, standardized outcome measures. Addressing these limitations in study design is crucial for future research.

Efficacy of using 810-nm diode laser after impacted lower third molar extraction surgery at Hue University of Medicine and Pharmacy Hospital

Efficacy of using 810-nm diode laser after impacted lower third molar extraction surgery at Hue University of Medicine and Pharmacy Hospital

Assessment of Electromyographic Changes in Masseter and Temporalis Muscles for Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, themasseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved. Conclusion Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.

A mouse model of chronic primary pain that integrates clinically relevant genetic vulnerability, stress, and minor injury.

Chronic primary pain conditions (CPPCs) affect over 100 million Americans, predominantly women. They remain ineffectively treated, in large part because of a lack of valid animal models with translational relevance. Here, we characterized a CPPC mouse model that integrated clinically relevant genetic (catechol-O-methyltransferase; COMT knockdown) and environmental (stress and injury) factors. Compared with wild-type mice, Comt+/- mice undergoing repeated swim stress and molar extraction surgery intervention exhibited pronounced multisite body pain and depressive-like behavior lasting >3 months. Comt+/- mice undergoing the intervention also exhibited enhanced activity of primary afferent nociceptors innervating hindpaw and low back sites and increased plasma concentrations of norepinephrine and pro-inflammatory cytokines interleukin-6 (IL-6) and IL-17A. The pain and depressive-like behavior were of greater magnitude and longer duration (≥12 months) in females versus males. Furthermore, increases in anxiety-like behavior and IL-6 were female-specific. The effect of COMT genotype × stress interactions on pain, IL-6, and IL-17A was validated in a cohort of 549 patients with CPPCs, demonstrating clinical relevance. Last, we assessed the predictive validity of the model for analgesic screening and found that it successfully predicted the lack of efficacy of minocycline and the CB2 agonist GW842166X, which were effective in spared nerve injury and complete Freund's adjuvant models, respectively, but failed in clinical trials. Yet, pain in the CPPC model was alleviated by the beta-3 adrenergic antagonist SR59230A. Thus, the CPPC mouse model reliably recapitulates clinically and biologically relevant features of CPPCs and may be implemented to test underlying mechanisms and find new therapeutics.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review.

The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention. The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase. The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2). This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration. L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial

ObjectiveTo compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). MethodsTwenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). ResultsA progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. ConclusionThe different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.

Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A split-mouth, randomized, controlled trial.

The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90s vs. 144.5 ± 68.85s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).

Comparative efficacy of pre-operative and post-operative administration of amoxicillin in third molar extraction surgery - A systematic review and meta-analysis.

To compare the effectiveness of pre-operative and post-operative administration of amoxicillin in patients undergoing third molar extraction surgery. A systematic search was executed according to PRISMA guidelines for studies published till December 2021. Studies were included based on the pre-eligibility criteria. The risk of bias was assessed using the Cochrane risk of bias tool. The heterogeneity was evaluated, and a random effect model was used for meta-analysis. A total of five studies were included from an initial search of 96 studies. The included studies were randomized controlled trials and comparative studies assessing pre-operative and post-operative administration of antibiotics among patients undergoing third molar extraction surgery. For comparison between pre-operative and post-operative groups, interincisal distance, complications, pain, and swelling were systematically reviewed and meta-analysis was done for interincisal distance and complications. The mean change in interincisal distance ranged from 5.5 to 47.9 and from 4.56 to 46.1 in the pre-operative and post-operative amoxicillin groups, respectively. Complications reported were infections, alveolar osteitis, nausea, diarrhea, gastric pain, rash, and headache with a pooled incidence of 4.3-33% in the pre-operative amoxicillin group and 0-22.7% in the post-operative amoxicillin group. Quantitative synthesis of data carried out from meta-analysis shows a significant difference in the pre-operative and post-operative amoxicillin groups in improving the interincisal distance and incidence of complications post surgery. The qualitative synthesis of data derived from systematic review for pain provides favoring results for post-operative amoxicillin administration. In case of swelling, a non-conclusive result was obtained.

POSSIBLE COMPLICATIONS RESULTING FROM THIRD MOLAR EXTRACTION

Third molar extraction surgery presents a considerable potential risk of triggering complications. In view of this, it is imperative that there is careful planning, aiming to prevent accidents during the procedure and minimize possible complications in the intra- and postoperative period. Intraoperative complications may include hemorrhage, fracture of the maxillary tuberosity and oroantral communication, and postoperative complications may include alveolitis, edema, and paresthesia of the inferior alveolar nerve. 17 studies indexed in the BVS, LILACS, Scielo and Pubmed databases were selected. The selection of articles occurred in accordance with the inclusion and exclusion criteria. Therefore, the importance of having in-depth knowledge and solid skills on the subject is highlighted, both for a preventive approach and for dealing effectively with the situation in question.

Pain management following dental trauma and surgical procedures.

Surgical procedures and post-traumatic management of dental patients require effective pain management during treatment, but being considerably more invasive than conservative treatments, pain management is required into the postoperative period. Clinical trials on pain intensity following dental surgical procedures (e.g., 3rd molar extraction, implant placement, periodontal, and endodontic surgery) have shown that pain is most intense approximately 5-6 h after completion of the procedure, reaching its peak levels during the first postoperative day. Greatest consumption of analgesics occurs during the first 48-72 h after 3rd molar extraction. For the management of perioperative pain associated with either conservative or surgical dental treatment, the local anesthetics articaine, lidocaine, mepivacaine, and prilocaine are preferred. These drugs, with a vasoconstrictor, provide a rapid onset and a duration of pulpal anesthesia adequate to complete most dental and surgical procedures painlessly. For management of post-traumatic and postsurgical pain, bupivacaine-administered by an appropriate nerve block-near the conclusion of a surgical procedure, can provide the patient with a pain-free period of up to 12 h. Nonsteroidal anti-inflammatory drugs represent the most effective drugs for the management of dental postsurgical pain. NSAIDs, as a group in therapeutic doses, have numbers needed to treat (NNTs) ranging from 2 to 3, while opioid analgesics do not approach those for NSAIDs. A protocol for management of pain following surgical procedures and traumatic injuries is discussed in this paper and includes preemptive NSAID; perioperative pain management; postoperative pain management-local anesthesia; postoperative pain management-analgesics; postoperative telephone call.

Eficácia da profilaxia antibiótica na extração de terceiros molares

Abstract Introduction Third molar extraction surgery is a common dental procedure, often challenging with increased post-operative complications. The need for antibiotic prophylaxis in these cases remains debated. Objective The aim of this study was to evaluate the effect of antibiotic prophylaxis on the postoperative clinical course of third molar extraction surgeries. Material and method Sixty-three patients were randomly allocated into two groups after extraction of the four third molars. ATB group (N = 33) the patients received 1g of amoxicillin one hour before the surgical procedure, CTR group (N = 30) the patients did not receive antibiotic prophylaxis. Clinical analyses were performed at 3, 7, 14, and 30 days after the surgical procedure. These analyses consisted of assessing oedema, variation in mouth opening, and soft tissue healing. Furthermore, patient-centered analyses were also carried out through the application of the visual analogue scale (VAS) to assess pain, inflammation, bleeding, difficulty opening the mouth, and chewing. Result No influence of antibiotic prophylaxis was observed on the evolution of clinical parameters of healing, oedema, and mouth opening. Patients did not notice differences regarding their comfort during the postoperative period. Conclusion The incidence of complications observed in the present study was low and was not related to infectious processes. The use of prophylactic antibiotic therapy has no beneficial effects on the postoperative clinical course in third molar extraction.

Low-level laser and management of common complications after the mandibular third molar surgery: A double-blind randomized clinical trial

There are controversies on the analgesic and anti-inflammatory effects of low-level laser therapy on pain, edema, and trismus after mandibular third molar extraction surgery. This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) on discomforts occurring after the mandibular wisdom tooth removal. This double-blind, split-mouth design, randomized clinical trial study was performed on 36 healthy controls with bilateral symmetrical mandibular third molar referred to the Department of Oral and Maxillofacial Surgery of Dental Faculty from January to November 2019. After surgical extraction, the laser group underwent laser (Ga-Al-As diode laser, 808 nm, 200 mW) intraorally and extraorally just after surgery and 24 h after surgery. For the placebo group, the handpiece was inserted without laser irradiation. The pain level was assessed by Baker Wong scale at 2, 4, 6, 12, 24, 36, 48, and 60 h postoperatively, and the edema and the extent of mouth opening were examined before surgery, at the 1st and 7th days after surgery. The data were collected and analyzed by SPSS at the significant level of 0.05. The statistical analysis of 32 participants' data (laser group: n = 32, placebo group: n = 32) indicated that the mean score of pain in 3 days after surgery in the interventional group was significantly lower than the score of the placebo group (P < 0.001). Furthermore, the swelling and the extent of the mouth opening differed significantly between the two groups at 1st and 7th days after the procedure (P < 0.001). Our findings showed that the LLLT had beneficial effects on the management of pain, edema, and trismus following after 3rd molar extraction surgery.

Contribuição ao estudo da profilaxia antimicrobiana em cirurgias de extração dos terceiros molares

ABSTRACT The use of antibiotic prophylaxis in the extraction of third molars is extremely controversial, raising several discussions about the most appropriate clinical protocol to avoid postoperative complications. To review the literature on the subject, describing the evidence for and against antibiotic prophylaxis to prevent surgical site infections in third molar extractions, besides establishing a prophylactic protocol and dosage regimen. A literature review was carried out analyzing scientific evidence from articles on the PubMed and Scielo platforms by searching for the descriptors “antibiotic therapy and infection in third molar extraction surgery”, “antimicrobial prophylaxis and infective endocarditis”, “antibiotic prophylaxis and adverse effects”, “antibiotic therapy in dentistry”, “surgical time and incidence of infections in extractions”, including original articles and double or triple blind randomized clinical trials, in Portuguese and English, published between 1980 and 2021, separated in chronological order. There is no consensus in the literature on the indication of antimicrobial prophylaxis, but factors as surgeon’s skill, time elapsed during the procedure and the patient’s general health status directly affect the incidence and severity of infections. Among all the literature analyzed for this study, it is possible to infer that the topic is still extremely questionable and, therefore, it is essential to conduct new experimental studies to obtain more conclusive data on the subject.

Evaluation of pain after third molar extraction surgery using hyaluronic acid versus ozone gel as socket preservatives

Evaluation of pain after third molar extraction surgery using hyaluronic acid versus ozone gel as socket preservatives

The clinical utility of steroids in facial trauma: A retrospective study of 638 patients

AbstractGlucocorticosteroids reduce post‐operative swelling, trismus and pain after third molar extraction, maxillofacial trauma and orthognathic surgery. Steroids may affect immune system and retard wound healing. However, the use of steroids may or may not lead to infection. Patients were divided into two groups based on steroid therapy. The minimum follow‐up was for 6 months. Independent t‐test and chi‐square statistics were used for quantitative and categorical data respectively. A p &lt; 0.05 was considered significant at 95% confidence interval. A total of 638 patient records were divided into two groups; group A (steroid group) and group B (non‐steroid group). After 6 months 45% of group A patients and 2% of group B patients had infection (p value‐0.077). The mean duration of analgesic requirement in group A was 3.9 ± 1.5 days compared to 4.4 ± 2.1 days in group B (p = 0.01). Oedema was present in 9% of patients in group A compared to 12.5% in group B after 1 week (p &lt; 0.0001). The mean VAS score at 1 week was 0.03 ± 0.18 in group B compared to 0 in group A (p &lt; 0.001). Use of steroids does not increase the risk of infection. It significantly reduces the duration of analgesic requirement with the reduction in oedema and pain.

Displacement of impacted third molar

The displacement of the tooth into the fascial spaces is an unusual complication in the procedure of third molar extraction surgery. The present article reported three cases regarding the displaced teeth in the third molar extraction, including two mandible cases and one maxillary case. The reason and treatment of the displaced tooth were reviewed.

Efficacy of Low Level Laser Therapy in Reducing Pain, Swelling and Trismus Following Impacted Third Molar Extraction Surgery: A Split-mouth Randomised Controlled Trial

Introduction: The use of local or systemic corticosteroids and non steroidal anti-inflammatory drugs are often recommended after surgical extraction of impacted lower third molars to abolish postoperative pain, but some of them may manifest adverse effects such as gastrointestinal irritation, systemic bleeding tendency, and allergic reactions. Aim: To evaluate the efficacy of low level laser therapy in reducing pain, swelling, and trismus following impacted third molar extraction surgery. Materials and Methods: The present split-mouth randomized controlled clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore, Karnataka, India. The study sample consisted of nine clinically and radiologically confirmed cases of bilateral symmetrical impacted mandibular third molars indicated for extraction. After extraction surgery, low level laser therapy was administered intraorally and extraorally (Low Level Laser Group). On the contralateral side (Non laser Group), extraction was carried out 15 days prior in the same manner except that patient was not subjected to laser therapy. Trismus, pain, swelling and healing were evaluated on 2nd, 3rd, 4th and 7th day; and were subjected to statistical analysis using Independent-t-Test and Mann-Whitney Test. Results: The study consisted of nine patients, among which six were males and three were females with mean age of 25.89±6.79 years. Pain intensity was lower in the laser group than in the non laser group at all-time points assessed and was non significant (p-value &gt;0.05). Swelling when assessed was less for laser group than non laser group at all-time points and were statistically significant (p-value &lt;0.05) except on the 7th day. The extent of mouth opening was greater in the laser group than in the non laser group at all-time points which was statistically significant only on 2nd day (p-value=0.048). Both laser and non laser group had no statistically significant difference in healing (p-value &gt;0.05). Conclusion: The use of therapeutic laser in the postoperative management of patients undergoing surgical removal of impacted third molars decreases postoperative pain, swelling, and trismus.

Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Extraction Surgery

Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Extraction Surgery

Editorial: Neuroimaging: How Can Clues from the Brain Help Pain Management?

Editorial: Neuroimaging: How Can Clues from the Brain Help Pain Management?