Impacted Molar Surgery Research Articles

Efficacy of Ketorolac Tromethamine Diluted Saline Irrigant on Postoperative Sequelae in Patients Undergoing Lower Third Molar Impaction Surgery: A Prospective Clinical Study.

Background Lower third molar surgery is very commonly performed for minor oral surgery by an oral and maxillofacial surgeon. One of the main chief complaints that patients report back to the clinic after getting their lower third molar impaction surgery is immediate postoperative pain. In our study, we have compared the efficacy of ketorolac tromethaminediluted saline solution over plain saline solution used as an irrigant in reducing postoperative swelling and pain. Aim The aim of the current study is to analysetheefficiencyof ketorolac tromethamine diluted saline solution over normal saline without any drug dilution in reducing postoperative sequelae likepain and swellingafter surgical removal of the lower third molar. Materials and methods This study was carried out at the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, from April 2023 to July 2023. The study included 50 individuals who wanted to prophylactically get the lower third molar removed surgically. These participants were divided into two groups. One group received ketorolac diluted saline irrigant while the other group received plain saline (0.9% NaCl) as irrigant. Postoperatively, pain and swelling were evaluated in both groups. Both pain and swelling were measured preoperatively, postoperatively after 48 hours, and postoperatively after seven days. The swelling was measured using a 4-point measuring scale, and pain measurement was done using a 10-point visual analogue scale. Statistical analysis was done using StatisticalPackage for the Social Sciences (IBM SPSS StatisticsforWindows,IBMCorp., Version 23.0, Armonk,NY). For the comparison of continuous variables between the two groups, an unpaired t-test was used. The normality of the results obtained was checked using the Shapiro-Wilk test. The results were considered statistically significant if the P-value was less than 0.05. Results Based on the results obtained it was found that participants who were included in the ketorolac saline group had comparatively lower postoperative pain scoresthan participants in the plain saline group and this was statistically significant (P=0.001). Postoperative swelling was also comparatively lower in the ketorolac tromethamine saline group but the results were not statistically significant at the end of day 7 (P=0.09). Conclusion Upon observing the cumulative results obtained, weconclude that ketorolac saline (10mg/100mL) was more efficaciousin terms of pain reduction than the regular saline solution in impacted lower third molar surgery.

Evaluation of the effect of dental anxiety on vital signs in the order of third molar extraction

BackgroundDental anxiety is a prevalent concern affecting patients undergoing various dental procedures, particularly surgical interventions. Understanding the impact of patients’ anxiety levels on their physiological responses during dental surgeries, such as third molar impaction surgery, is crucial for optimizing patient care and outcomes. Therefore, this study aimed to investigate the effect of patients’ anxiety levels on vital signs during third molar teeth impaction surgery.MethodsA cross-sectional study was conducted, including 45 randomly selected, healthy patients. Demographic information was recorded after obtaining consent from the patients prior to surgical intervention. Preoperative anxiety levels were determined using the Modified Dental Anxiety Scale (MDAS). Pupil measurements were taken from the patients before surgery, at 10 min after the surgery began, and at 10 min after the surgery ended. Systolic (SBP) and diastolic (DBP) blood pressure, pulse rate, temperature, and haemoglobin oxygen saturation (SpO2) values were recorded.ResultsThe MDAS test results were statistically significantly higher in women compared to men (p < 0.001). Positive correlations were observed between MDAS score and both preoperative pulse rate (r = 0.344, p = 0.021) and SpO2 level during the operation (r = 0.462, p = 0.001). However, no significant correlations were found between MDAS and DBP (p = 0.575), SBP (p = 0.176), fever (p = 0.238), or pupil diameter (p = 0.338).ConclusionsThird molar impaction surgery induces anxiety in adult patients 20 years and older. Vital sign monitoring provides information about the patient’s emotional state, both before and during the procedure. Since anxiety causes changes in vital signs during dental procedures, it is important to follow these findings to have an idea about the general condition of the patients.

The Role of Cyanoacrylate after Mandibular Third Molar Surgery: A Single Center Study.

The management of the surgical wound of partially impacted mandibular third molar surgery has a great impact on recovery as well as on food impact retention. The present study used clinical parameters and health-related quality of life (HRQL) to compare outcomes of cyanoacrylate application versus traditional suture of third molar impaction surgery. This was a retrospective observational study of subjects scheduled for outpatient third molar surgery. Each participant signed an informed consent agreement. Inclusion criteria were as follows: presence of at least one partially impacted mandibular third molar, confirmed with a preoperative panoramic radiograph. Exclusion criteria were the following: smoking, diagnosed diabetes mellitus. Between June 2020 and September 2023, a total of 78 patients of mean age 31.14 years old (range 21-40 years, standard deviation 9.14), were included in this study-38 patients were male, 40 patients were female. A group of patients received traditional silk suture (G1 = 41 patients), while the second group (G2 = 37 patients) received hemostasis performed with fibrin sponge and, after complete soaking of the sponge, the application of cyanoacrylate gel on the blood clot and suture with one 2/0 stitch in order for recovery for secondary closure. The following parameters were measured: HRQL, average pain (AP), maximum pain (MP), complication score (CS), facial swelling (FS), and erythema. For HRQL parameters, oral disability was found to be significantly higher in G1 while AP was significantly higher in G2 (p < 0.05). AP was higher in G2 (p = 0.0098), as well as MP (p = 0.001). No differences were found with regards to CS (p = 0.0759). FS and erythema were higher in G1 (p < 0.0001 for facial swelling, and p = 0.0001 for erythema). on the basis of this study, the use of cyanoacrylate after mandibular third molar surgery appears to be useful in order to reduce postoperative oral disability, facial swelling, and erythema after tooth extraction, with increased average and medium pain: clinicians may consider its use in selected cases.

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.

Efficacy of Dexamethasone Diluted Saline Irrigant on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Clinical Study.

Background Third molar impaction surgery is one of the most commonyet challenging procedures done as a part of minor oral surgery. Years of research and improvisation of techniques have been done, yet there are still a lot of postoperative sequelae after surgical removal of the impacted tooth. In our study, we have compared the efficacy of dexamethasone diluted saline solution over plain saline solutionused as an irrigant in the reduction of postoperative sequelae for lower third molar surgery. Aim The aim of the study was to evaluate the efficacy of dexamethasone dilutedsaline solution over plain saline solutionin the reduction of postoperative sequelae for lower third molar surgery. Materials and methods The research was conducted atSaveetha Dental College and Hospitalin the Department of Oral and Maxillofacial Surgery. The study consisted of 48 individuals, 24 of whom haddexamethasone saline as an irrigant (8 mg of dexamethasone was diluted in 100 ml of plain saline) (Group 1), and 24 inwhom plain saline was used as an irrigant (Group 2) in the lower third molar surgery. Patients were evaluated postoperatively for pain and swelling. The postoperative swelling was measured on postoperative day two and day seven.Postoperative pain was measured onday two, day four, and day seven after surgery using a visual analog scale. Data were analyzed using SPSS (IBM Corp., Armonk, NY) with P-values less than 0.05 considered statisticallysignificant. The statistical test used to compare the outcomes between the two groups was the independent samples t-test. Results It was found that study participants in the dexamethasone saline irrigation group reported statistically significantly lesser pain than participants receiving plain saline irrigation on day two (P = 0.001), day four (P = 0.001), and day seven (P = 0.001), respectively. Also, there was a reduction in swelling among participants in the dexamethasone saline irrigation group when compared to the normal saline irrigation group, which was statistically significant (P = 0.001) on day two, while the postoperative swelling was not statistically significant onday seven (P = 0.08) between the two study groups. Conclusion Based on the results obtained, it can be concluded thatdexamethasone saline solution (8 mg/100 mL) was more effective as an irrigantin reducing the postoperative sequelaethan regular saline solution in the lower third molar surgery.

Does Submucosal Placentrex® Injection Hasten the Soft Tissue Healing in Mandibular Third Molar Impaction Surgery? A Prospective Randomized Split-Mouth Study

Background: This study focused to evaluate the potency of injection Placentrex® by assessing the rate of soft tissue healing with bilateral symmetrical third molar impaction by using early wound healing score. Materials and Methods: The split mouth study included 23 patients with bilaterally symmetrical third molar impaction. Randomly one side was selected as study group and other side as control group. 2 ml of Placentrex® injection was administered submucosally before surgical removal on the buccal and retromolar region in study group while control group was allowed to heal naturally. Parameters like soft tissue healing, pain, trismus and swelling were assessed on 1st,3rd and 7th post operative days. Early healing score was used to assess the soft tissue healing after surgical removal. Results: The mean re-epithelialization based on CSR on 3rd post operative day showed characteristic significance with mean score of 4.56 (p&lt;0.05) when compared to the control group which showed a mean score of 2.73. The inflammation based on CSI on 3rd postoperative day for the study group revealed a mean value of 1.73 (p&lt;0.05) whereas for the control group a mean of 1.04 was recorded proving significance. It was found that there was no significant statistical difference in the case and control group in relevance to post operative pain, swelling and mouth opening. Conclusion: Placentrex® exhibited characteristic significance in early soft tissue healing with signs of less inflammation and early reepithelialisation.

Evaluation of Adjunctive Low Level Laser Therapy in Postoperative Management of Pain, Swelling, Trismus Following Surgical Removal of Impacted Mandibular Third Molars

Our aim is to evaluate the effectiveness of Low Level Laser Therapy (LLLT) in the control of postoperative pain, swelling, and trismus associated with the surgical removal of impacted mandibular third molars. This study was carried out as a single centre, prospective study with a sample size of 30 patients to evaluate the effectiveness of LLLT following surgical removal of impacted third molars. Patients were randomly divided into two groups of 15 each. Group 1(Study /LLLT group) consisted of patients undergoing LLLT and with the use of postoperative analgesics and antibiotics. Group 2 (Control) included patients who were administered postoperative analgesics and antibiotics without the concurrent use of LLLT. The predictor variable was the LLLT application following mandibular third molar impaction surgery. The outcome variables namely pain, swelling, and trismus were evaluated on the day of surgery and 1st, 3rd, and 7th postoperative days (POD).Results:The pain was highest on POD 1 and gradually reduced by POD 7 in the study group when compared to the control group. Swelling showed a steep increase on POD 1 and thereafter a gradual reduction was observed on POD 7, when compared to the control group, the study group showed a significant decrease in swelling. Mouth opening was the lowest on POD1 and gradually increased by POD 7 in the study group than in the control group. Conclusion: The results of the study suggest that the application of LLLT to impacted mandibular third molar sockets helps eliminate/or reduce postoperative pain, swelling, and trismus.

Prospective Comparative Evaluation of the Efficacy of Single Dose Preoperative, Intraoperative and Postoperative Administration of Antibiotics in Mandibular Third Molar Impaction Surgery: Pilot Study

Prospective Comparative Evaluation of the Efficacy of Single Dose Preoperative, Intraoperative and Postoperative Administration of Antibiotics in Mandibular Third Molar Impaction Surgery: Pilot Study

A Comparison between the Outcomes of Wound Closure by Primary and Secondary Healing after Mandibular 3rd Molar Impaction Surgery

Background: The one of the most frequently performed procedure by the surgeon in the oral and maxillofacial surgeries is removal of mandibular third molar. Objective: The study aimed to compare the process of primary and secondary wound closure outcomes after the surgical removal of impacted mandibular third molar. Study design: It is a comparative study conducted at Armed Forces Institute of Dentistry, Rawalpindi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The 65 patients visited the oral and maxillofacial surgery department of hospital were included in the study. According to the inclusion criteria, these patients had impacted their third molar and they were medically fit and ready to come for follow ups after the operation as well. The patients were divided into two groups. The group A had 33 patients, the average age of these patients was 30 years and proportion of male and female among these 33 patients was 40% male (13) and 60% female (20). Group B had 32 patients and among those 32 patients there were 46% male (14) and 53% female (18) and the average age of the participants was 27. Results: The percentage incidence of swelling and pain was higher in the group A. The values was statistically significant. The mouth opening was highly observed in the group B patients. The post-operative pain was measured at first day, third day and 7th day by making use of the visual analog scale. The comparison was made. The mean pain score on third day was 4.9 and 3.5 and on the seventh day the mean pain score was 3.2 and 1.5 respectively for group A and B. the overall variation in pain scores were significantly high. Conclusion: In this study, the conclusion is made that the secondary closure was a suitable option then the primary closure for the post-operative pain and swelling. There was no variation found in case of periodontal healing irrespective of the closure procedure used, but the risk of infection and food impaction is more in case of secondary closure. Therefore, if patients have poor hygiene conditions secondary closure is not suitable for them. Keywords: wound closure, healing type and mandibular third molar.

Comparative Evaluation of Preoperative Local and Systemic Intramuscular Administration of Dexamethasone Injection in Mandibular Third Molar Impaction Surgery

Statement of the problemThe study aimed to evaluate the effect of systemic and local intramuscular administration of dexamethasone on pain and mouth opening and postoperative swelling following mandibular third molar impaction surgery and to verify its effect on functional outcome. Materials and methodsThe study comprised of 36 cases graded as moderately difficult according to the Pederson difficulty index, further subdivided equally into 2 groups. In Group I, 2ml of 8mg dexamethasone was injected intramuscularly in the masseter muscle 2 hours prior to surgery. In Group 2, a 2ml injection of 8mg dexamethasone was injected in the deltoid muscle 2 hours prior to surgery (Figure 1). All the patients were evaluated for pain, mouth opening, and postoperative swelling at first, third, and seventh postoperative day, and intergroup comparisons were made for both groups. Methods of data analysisStatistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data were presented as mean and appropriate. Statistical tests were applied. ResultsBoth groups showed improvement in mouth opening with the resolution of pain and postoperative swelling in the last follow-up. However, Group I showed a considerable reduction in swelling and pain with less trismus when compared with Group II at all intervals (Table 1). Outcomes dataFor Group I, the mean changes in mouth opening were noted to be 26.94±1.06 mm, 31.05±1.03mm, 36.87±0.72, respectively at first, third, and seventh postoperative day from the initial mean mouth opening of 37.67±1.89mm (Figure 2). Mean changes in mouth opening for patients in Group II were noted to be 23.06±0.99mm, 27.88±0.99, and 35.05±0.63, respectively at first, third, and seventh postoperative day (Figure 4). The highest pain score was seen at first postoperative day after surgery (7.15±1.08 in Group I; 8.5±1.44 in Group II). The mean score for pain obtained was 5.11±1.01; 1.01±0.82, and 5.38±1.37; 2.069±1.12 for Group I and Group II at the end of postoperative third and seventh day, respectively. The average postoperative swelling for Group I was 5.83±1.18mm, 4.73±0.83mm, and 4.47±0.58mm, respectively, at first, third, and seventh postoperative day. Similarly, the average postoperative swelling was 6.93±1.72mm, 6.05±0.94mm, and 4.64±0.81mm at first, third, and seventh postoperative day in Group II. ConclusionLocal intramuscular injection of dexamethasone through intra-buccal approach can be a simple, useful adjunct in the surgical treatment of impacted third molars for minimizing swelling, trismus, and pain following surgical extraction.

Risk factors for postoperative nausea and vomiting after the removal of impacted third molars: a cross-sectional study

BackgroundA better understanding of the risk factors for postoperative nausea and vomiting (PONV) could improve patient outcomes. This study aimed to analyze the risk factors for PONV and its onset after third molar impaction surgery, and to demonstrate the importance of controlling anesthesia-related factors regardless of patient-specific factors.MethodsWe included patients who reported nausea and vomiting within 12 h of extubation. Patients with incomplete data, those who could not communicate, and those with gastrointestinal disorders were excluded. We evaluated patient-specific risk factors, and the use of volatile anesthetics and intraoperative fentanyl anesthetic-related factors. Multiple logistic regression analysis was performed taking patient background factors into account.ResultsIn total, 182 patients who underwent disimpaction of the third molar under general anesthesia between January 2017 and December 2018 at Nagoya Ekisaikai Hospital, were included. Approximately 12.6% (n = 23) patients experienced PONV, with no significant difference in terms of sex, smoking status, age, and body mass index compared to patients without PONV. Multiple logistic regression analysis revealed no interaction between fentanyl and volatile anesthetics. The major risk factor for PONV was the use of volatile anesthetics. Patients in whom anesthesia was maintained by volatile anesthetics were 13.35 times more likely to have PONV than those in whom total intravenous anesthesia was induced (P < 0.001).ConclusionMaintenance of anesthesia with volatile anesthetics is a risk factor for PONV.

Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery?

BackgroundReduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments.MethodsTo address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient’s satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar’s tests.ResultsThe pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient’s satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant.ConclusionDue to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.

Efficacy of Platelet Rich Plasma in Third Molar Impaction Surgery, PRP in Third Molar Surgery

The use of autologous platelet concentrates mainly platelet rich plasma has been of relevance recently in the field of Oral and Maxillofacial surgery. These concentrates had the ability to improve the hard and soft tissue healing. This ability of the platelet concentrates had been studied in the healing after mandibular third molar impaction surgery. The various parameters like bone density, soft tissue healing, postoperative pain, swelling, and alveolar osteitis were taken into account. The patients were evaluated on 1 st , 2 nd , 7 th day, 1 st month, and 2 nd month postoperatively. The values for each parameter were found out and tabulated. Materials and Methods: Twelve patients, seven males and five females with bilaterally impacted mandibular third molars were included in the study. Autologous platelets were concentrated. This was applied on one of the sockets, which was randomly taken as the test side. The other socket was treated as the control. Results: Statistical analysis was done using Mann-Whitney U test for pain and soft tissue healing, which revealed the values for pain being statistically significant for the test side and no statistical difference was noted for soft tissue healing. Bone density and swelling were analyzed with t -test. Bone density values were statistically significant for the test side, while swelling did not show much statistical significance. None of the patients presented with alveolar osteitis in any side. Summary and Conclusion: Platelet rich plasma is a surgical additive that can be used to improve bone and soft tissue healing. It contains a wide array of growth factors that are responsible for their healing potential.

Preemptive analgesia in third molar impaction surgery

Introduction:We have evaluated efficacy of diclofenac sodium as pre-emptive analgesia agent in a prospective triple blind placebo controlled randomized clinical trial in a patients undergoing third molar impaction surgery.Materials and Methods:Randomization of groups was done by randomization software and two groups were constituted one group receiving placebo pre operatively and then the drug for next five days while the other group was given diclofenac sodium pre operatively and then for five days.Results:Results were achieved with help of measurement of outcome variables like postoperative tenderness, swelling and trismus on a visual analogous scale (VAS) and other personalized scale. Collected data shows that there is a significant reduction in the score of postop tenderness in experimental group (P = 0.00), while there is a minimal difference between score of postoperative swelling and tenderness (P > 0.04).Conclusion:So, we can conclude that use of diclofenac sodium as a preemptive analgesic agent is beneficial for better pain control in third molar impaction surgery.

Anxiety Measurements among Dental Students undergoing Third Molar Removal

Abstract Background and objective This study was conducted to quantify the anxiety associated with third molar extraction in dental students. And to compare the anxiety levels between males and females, among impacted and non-impacted groups. Methods The study included 100 dental students who reported to Department of Oral and Maxillofacial Surgery, College of Dental Sciences, requiring mandibular third molar removal. Only those patients who met the inclusion and exclusion criteria were selected. The anxiety levels were evaluated based on the scores of the Corah's Dental Anxiety Scale. Results Results showed scores among female patients was higher than males; however the difference between male and female patients was statistically not significant. Among impacted and non-impacted groups score was higher among the impacted group, but the difference between impacted and non-impacted groups was statistically not significant too. Conclusion To conclude, maxillofacial surgeons should consider patients who visit dental offices for third molar impaction surgery as most prone to anxiety which could either result from conditioning or learned responses from their peers. Noteworthy, prior awareness of the patient's psychologic makeup and susceptibility to anxiety may be of value, thus enabling appropriate therapy and improved recovery postoperatively.

Intranasal Ketorolac for Pain Secondary to Third Molar Impaction Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of intranasal (IN) ketorolac in patients who had third molar extraction surgery with bony impactions. After surgery, patients were randomly assigned to receive IN ketorolac 31.5 mg (n = 40) or IN placebo (n = 40). Safety was assessed from spontaneously reported adverse events and measurement of vital signs. Efficacy assessments included pain intensity, which was measured on a 0- to 100-mm visual analog scale, total pain relief, and global pain evaluation up to 8 hours after dosing or until patients required rescue analgesia. The primary efficacy variable was the summed pain intensity difference score over the first 8 hours after dosing. Summed pain intensity difference values +/- SE were significantly higher (indicating better analgesia) in the ketorolac group compared with placebo (136.7 +/- 33.0 vs -105.2 +/- 29.1, P < .001). Total pain relief scores were significantly higher (P < .001) in the ketorolac group compared with placebo at all times. A larger proportion of subjects in the ketorolac group reported good, very good, or excellent pain control compared with the control group (60% vs 13%). Times to perceptible (21.5 minutes) and meaningful (66.0 minutes) pain relief were significantly shorter and the time to rescue analgesic use was significantly longer in the ketorolac group (P < .001). Eight patients in the placebo group and 3 in the ketorolac group had adverse events, none of which was serious. The 3 events in the ketorolac group were reports of mild headache. A single IN ketorolac 31.5 mg dose was well tolerated and provided rapid and effective pain relief in oral surgery patients for a period up to 8 hours.

Fibroblast Proliferation due to Exposure to a Platelet Concentrate: An in vitro Study

ABSTRACT Introduction The major cellular events in the tissue repair are mitogenesis, migration and metabolism. The proteins responsible for coordination of these events are called “growth factors”. The activated platelets at the wound margins release several growth factors, such as PDGF, TGF-β and EGF, etc., and plasma exudates also provide an important source of TGF-β factors. Materials and methods Periodontal ligament fibroblast obtained from third molar impaction surgery, periodontal ligaments were cultured under standard conditions and spread on 96 well tissue culture plates. Platelet concentrate was obtained after centrifugation of 350-400 ml of blood at 1000 and 5000 rpm. 15 μl of platelet concentrate was added to each well. The proliferation rate of test and control group was determined by Redox indicator (Alamar blue® assay). The number of cells were counted by neu bar counting chamber after 24, 48 and 72 hours. Results The proliferation activity of cells was considerably higher in the platelet concentrate group (test group) than the control group. The difference was highly significant upto 72 hours after addition of platelet concentrates (Mann-Whitney U test p &lt; 0.001). Conclusion A cellular effect of the platelet concentrate is clearly discernible. It was concluded that the use of platelet concentrate is an effective modality of regeneration.

Influence of lower third molar position on the incidence of preoperative complications

The present study sought to relate the clinical outcome of mandibular third molar impaction surgery to the orthopanoramic radiographically determined position of the affected teeth based on the classifications of Pell and Gregory, and Winter. A retrospective study was made of 165 patients undergoing the surgical extraction of lower third molars at School of Dentistry of the University of Barcelona, Barcelona, Spain. The positions of the 259 extracted third molars were documented according to the classifications of Pell and Gregory, and Winter, together with the type of mucosal and bony coverage involved. These tooth position parameters were radiologically assessed using Radio Memory software and were retrospectively correlated to the observed infectious, noninfectious, and neurological postsurgical outcomes. A statistically significant relationship (P < .05) was recorded between the appearance of infectious complications and the position parameters "Pell and Gregory classification," "mucosal coverage," and "bony coverage." A statistically significant relationship (P < .05) was observed between the appearance of noninfectious problems and the parameter "Winter classification." Finally, a significant association (P < .05) was recorded between the position variables and the existence of unwanted neurological changes. The mandibular position of the impacted third molar may be able to be correlated to the development of complications resulting from impaction removal. Vertical third molars in positions IIA and IIB of the Pell and Gregory classification, with partial mucosal and bony coverage, are the most susceptible to undesired outcomes.

Minimal incision third molar impaction surgery

Minimal incision third molar impaction surgery

The influence of surgical stress, anxiety and benzodiazepine intravenous sedation on recall of oral surgery

Abstract This study, part of a larger investigation of the efficacy and safety of intravenous sedation in dentistry, reports the prevalance of failure to recall information during third molar impaction surgery and attempts to differentate the effects of stress and benzodiazepines on recall. Both recognition of neutral pictures and the recall of surgical procedures were assessed. Recall failure in the drug groups ranged from zero for recall of stressful procedures, completed before drug titration, to 92 percent of subjects for recognition of the neutral picture presented at 5 minutes after the surgical procedure began. Placebo condition subjects had almost no recall loss. Recall failure was demonstrated to be primarily a function of the volume of midazolam employed. However, operative stress and trait and state anxiety explained some of the findings.