Molar Surgical Extraction Research Articles

Postoperative Complications of Third Molar Surgical Extraction in a Malaysian Sample

The most common impacted teeth in adults are the mandibular third molars which frequently require surgical extraction. There are many factors contributing to the occurrence of postoperative complications, one of which is surgeon’s experience. Hence, this study aimed to determine the prevalence of postoperative complications of third molar extractions by different level of surgical experience. Methods: A retrospective study was conducted in Kulliyyah of Dentistry, International Islamic University Malaysia. A total of 112 cases were collected from the records of surgical extraction of lower third molars performed by dental students, dental officers and specialists, collected data was transferred into special case sheets and analyzed using IBM SPSS 23. Results: From 112 cases, 64(57.1%) had presented with postoperative complications. The highest prevalence of postoperative complications was in dental students’ group 38 out of 62 patients (61.3%), followed by specialists’ group 20 out of 39 patients (51.3%) and dental officers’ group 6 out of 11 patients (51.6%). Meanwhile, the common complications observed were pain (33.9%), swelling (20.5%), trismus (12.5%), paresthesia (6.3%) and bleeding (3.0%). Conclusions: There is no statistically significant correlation between the postoperative complications and the level of surgeons’ experience.

Effect of Third Molar Surgery on Sleep Health Parameters of Young Adults: An Observational Study.

Background and Objectives: The role of surgical extraction of the third molar in patients' sleep quality remains unclear, although it is one of the most common oral surgical procedures. The aim of this study is to assess the changes in patient-reported sleep health outcomes after third molar surgery and to investigate any associations between sleep parameters and post-extraction pain. Materials and Methods: Young adults without known comorbidities who were in need of mandibular third molar surgical extraction were included. All participants completed a sleep diary, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires, which were used to assess sleep habits, daytime sleepiness, sleep quality and insomnia severity one week before and after extraction. In addition, a visual analog scale was completed postoperatively to assess the perception of pain. Results: Out of 75 patients who completed the study protocol, 32 (42.7%) were males and 43 (57.3%) were females, with a mean age of 24.01 (±3.43) years. Postoperatively, statistically significant higher scores were observed for PSQI [4.85 (±2.32) before vs. 5.39 (±2.75) after, p = 0.041], AIS [5.56 (±3.23) before vs. 6.91 (±4.06) after, p < 0.001] and average weekly number of nocturnal awakenings [2.01 (±3.72) before vs. 4.19 (±5.20) after, p < 0.001] but not for ESS, average weekly sleep duration and average weekly sleep onset latency. Pain perception was increased in patients who slept worse on almost all seven postoperative days, although this did not reach statistical significance. Conclusions: Third molar surgery impacts sleep quality and insomnia severity in the first week after extraction, while there is no effect on daytime sleepiness. The worsening of subjective sleep symptoms after extraction may be associated with an increased perception of pain.

Evaluation of anxiety and hemodynamic changes in surgical removal of lower third molar under local anesthesia.

Objective: To determine the anxiety and hemodynamic changes in surgical removal of lower third molar under local anesthesia. Study Design: Comparative Cross-sectional study. Setting: Department of Oral and Maxillofacial Surgery, Institute of Dentistry of Liaquat University of Medical Health Sciences, Jamshoro. Period: January 2021 to December 2021. Material &amp; Methods: Three hundred and fourteen patients were selected by non-probability convenience sampling technique. Patient having age between 18 to 50 years with either gender presented with third molar surgical extraction, first experience of tooth extraction and partial bony impaction were included in study. The demographic and clinical parameters like age, gender, level of anxiety and hemodynamic changes were identified. Hemodynamic parameters were recorded on before starting the surgical procedure (T1), after 5 minutes of injecting local anesthesia (T2) and after completion of surgery (T3). Results: Out of 314 patients, male patients were 156 (49.7%) and female patients were 158 (50.3%) with mean age of 31.0 ± 9.2 (18-50). In third molar extraction significant difference was observed for hemodynamic parameters at T1, T2 and T3 intervals. Conclusion: Surgical removal of lower third molar under local anesthesia significantly increases the anxiety, blood pressure and heart rate after injecting local anesthesia.

Role of intravascular methylprednisolone in surgical impaction

Introduction: Mandibular impacted third molar surgical extraction may cause pain, trismus and swelling. Hence in this study we aim to evaluate the effect of methylprednisolone injection into the muscles on pain edema and trismus post third molar impaction. Material and Methods: We injected methylprednisolone acetate into the masseter muscle via the intrabuccal approach, one hour before the surgery and immediately after suturing of the surgical wound, among the 100 subjects divided to two groups as case and controls, we evaluated postoperative pain, trismus and swelling. The numeric pain scale (NPS) was used for pain assessment. Results: we observed that superior results in preoperative group for mouth opening, pain and all the facial swelling parameters, they were also statistically significant differences than when the postoperatively administered methylprednisolone acetate. Conclusions: Preoperative administration of the methylprednisolone is more effective in reducing pain, trismus and swelling, when compared to that administered postoperatively.

Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient's Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study.

Mandibular third molar surgical extraction, either partially erupted or fully impacted, is the most common surgical procedure in oral and maxillofacial surgery (OMFS). However, this procedure can be associated with many postoperative complications including persistent pain, swelling, trismus, and paresthesia due to nerve injury. This study aimed to identify the correlation of postoperative complications with patient's age, sex, and surgical difficulty level. This study was a cross-sectional retrospective and single-center research conducted on patients with a history of mandibular third molar surgical extraction in the period between 2017 and 2019 at Dental and Oral Hospital Universitas Airlangga, Surabaya, Indonesia. The researchers assessed the factors of age, sex, and surgical difficulty level regarding postoperative complications on the first day of the surgery and after one week on the 7th day of it. Among 916 respondents, the majority of the sample was females (59%) and the dominant age group (60.9%) was the age group of 21–30 years while the dominant surgical difficulty level was shown by the advanced cases group (77%). The statistical analysis showed that there was a significant correlation between surgical difficulty level and postoperative complications including pain, trismus, and paresthesia on the first-day assessment. On the other hand, age was significantly related to complications like pain, swelling, and trismus on the first-week assessment. Age and surgical difficulty level were the most common risk factors of the mandibular third molar extraction postoperative complications. Dentists should take into consideration that older patients (≥51 years) and patients with complex surgical level are more vulnerable to severe postoperative complications.

Effectiveness of Different Routes of Corticosteroid Administration on Postoperative Complications Associated With Impacted Mandibular Third Molar Surgical Extraction (A Randomized Controlled Clinical Trial)

Effectiveness of Different Routes of Corticosteroid Administration on Postoperative Complications Associated With Impacted Mandibular Third Molar Surgical Extraction (A Randomized Controlled Clinical Trial)

Oral Health-related Quality of Life (OHRQoL) Following Surgical Extraction of Impacted Mandibular Third Molars: Preliminary Observations in a Saudi Arabian Subpopulation.

Introduction:OHQoL is crucial for the best preoperative assessment and development of suitable indications for mandibular third molar surgical extraction. The current study hopes to report QoL after surgical extraction of impacted mandibular third molars. Materials and Methods:This was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, between January 2020 and April 2020. After consenting to partake in the study, patients’ baseline demographics, indication for seeking third molar removal and laterality of impaction were recorded. All the surgical extractions were performed by the same surgeon. Pain was assessed pre and postoperatively with the numerical pain rating scale while QoL was assessed pre and postoperatively using the validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHQoL).Results:A total of 92 patients were recruited. There are 41 (44.6%) males and 51 (55.4%) females with M:F of 1:1.2. Age range was between 18 and 48 years with a mean of (31.2 ± 6.6) years. Age group 20–29 years constitutes the highest number of patients. Subscales: eating, appearance, sleep, mood and work revealed more percentage complaints (42.9%, 23.4%, 24.7%, 28.6%, and 16.9%, respectively). Regarding mean domain and overall QoL scores, it was observed that there was gradual improvement in mean scores from the Pre-op values and the review periods with best mean QoL reported at POD 14Conclusion:Improvement in overall mean QoL scores during the review periods as compared with the preoperative score was observed. Eating, appearance, sleep, mood and work subscales revealed more percentage complaints.

Effectiveness of pre-operative oral corticosteroids in reducing pain, trismus and oedema following lower third molar extractions: a systematic review.

Aim To determine if a single pre-operative dose of oral corticosteroids would be effective in reducing pain, trismus and oedema following lower third molar surgical extraction. Secondary outcomes of interest were post-operative complications such as infections.Methods Searching was conducted using Embase, Medline, DOSS, CINAHL and CENTRAL for randomised controlled trials. Four studies which compared pre-operative oral corticosteroids to placebo before lower third molar surgical extractions were eligible for inclusion.Results All studies were judged to be at unclear risk of bias. All studies tested the efficacy of 8 mg dexamethasone 60-90 minutes before surgical extractions. While three studies showed improvement in pain visual analogue scale (VAS) scores in the dexamethasone groups, two were not statistically significant. One study found no improvement in pain scores on VAS. One study found no difference in either trismus or oedema. One study reported one occurrence of post-operative alveolar infection in the dexamethasone group and one occurrence of alveolar osteitis in the placebo group.Conclusion While there seems to be an improvement in pain scores on VAS, these results are not clinically significant. Post-operative analgesia plays a more important role clinically.

Mandibular third molar surgery: A review of common and uncommon complications

Background: Third molar surgical extraction is one of the commonest surgical procedures in oral surgery and it is associated with postoperative complications. However, some of these complications are commoner than others and they have variable impacts on the quality of life of the patients.Objective: To review the common and uncommon complications of third molar surgery as reported in the literature.Methods: PubMed, ScienceDirect databases, AJOL, and Google scholar literature search was done to identify related articles on complications of mandibular third molar surgical extractions. Other online materials were also reviewed. The search words used were mandibular, third molar, lower jaw, surgical extraction, common, uncommon, and complicationsResults: Common complications of third molar surgery identified include; postoperative pain, swelling, trismus, infection, dry socket, inferior alveolar and lingual nerve damage, injury to the adjacent tooth, with their attendant impact on the patient’s quality of life.Conclusion: Third molar surgical extractions are associated with certain complications and some of them are unavoidable. Therefore, adequate patients’ education and psychological preparation for the procedure and its sequelae are necessary.

A surgeon’s dilemma: Evidence based selection of suturing technique to minimize post-operative complications following lower third molar surgical extraction

Background&#x0D; Lower third molar extraction is usually associated with multiple stigmae that deters the patients in most cases to postpone or not seek appropriate surgical care. It is also one of the most feared procedure amongst dentists and dental students. However, evidence has been reported suggesting that the choice of suturing technique can have a profound effect on post-operation complications and thereby can improve the overall outlook and comfort of the patient. In the past, multiple techniques like Mattress, Continuous etc have been compared with tissue glues, staples however, a comparative clinical study amongst the simplest and most commonly used suturing techniques have not been reported.&#x0D; Material and Methods&#x0D; Sixty patients with impacted mandibular third molars fulfilled the inclusion criteria and were randomly divided into three groups of 20 each. All patients underwent third molar extraction and sutures were placed using different techniques – Simple Interrupted (Group A), Continuous (Group B) and Figure of eight (Group C). Patients were evaluated pre-operatively as well post-operatively (at different time points) for five parameters - Pain, Swelling, Trismus, Periodontal health of second molar and Wound infection. Kruskal-Wallis (non-parametric ANOVA) with post-hoc and effect size was used for statistical analysis with P &lt; 0.05 as statistically significant.&#x0D; Results&#x0D; Statistically significant differences were obtained in terms of pain and trismus between Groups A and C post-operatively (P &lt; 0.05). There were also significant differences in pain between Groups B and C post-surgery (P &lt; 0.05). No significant differences were found between groups for swelling, periodontal health of second molar and wound infection.&#x0D; Conclusions&#x0D; Figure of eight suturing presents with better patient outlook and is associated with lower pain, swelling and trismus. Continuous and simple interrupted suturing can be preferred as second-in-line techniques. Final choice of technique shall be made based on wound anatomy, patient history and surgeon’s expertise.

The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

Background: Periapical and Orthopantomogram (OPG) are the most commonly used radiographs for assessment of the relationship of lower 3rd molar roots with the inferior alveolar canal. Panoramic radiographs provide inadequate information of the buccolingual relationship between the roots of the 3rd molar &amp; mandibular canal being two-dimensional (2D) in nature. To verify the relationship in three (3D) dimensions and to make a predictable treatment plan, traditional investigations may be supplemented by using CBCT. Cone-beam computerized tomography (CBCT) is an office-based radiography technique used to assess the three-dimensional relationship of lower 3rd molar roots with inferior alveolar nerve.&#x0D; Patients and methods: This comparative-cross sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital (FMH), Lahore from 1st January 2019 till 30th June 2019. A total of 124 patients requiring removal of lower wisdom tooth were enrolled and then divided into two groups (62 in each) randomly. OPG was used for diagnosis of impacted lower 3rd molars in Group A patients while CBCT for diagnosis in Group B patients. A self-designed Performa was used to collect the data and final information was collected after 3 months of follow-up. Data analysis was performed using SPSS 20. A chi-square test was used to compare the postoperative paraesthesia between the OPG group and CBCT group patients. A p-value &lt;0.05 was taken as significant.&#x0D; Results: The occurrence of postoperative paresthesia between the two groups is significantly different; being a low percentage in the CBCT group at 2nd, 7th day and after 3 months follow-up visits with a p-value of 0.019, 0.019, and 0.005 respectively. On 3 months follow up, the distribution of paraesthesia between the two groups is significantly different; 20 patients (32.25%) in OPG group A and those of 7 (11.29%) in CBCT group B experienced paresthesia with a p-value of 0.005.&#x0D; Conclusion: It is better to use CBCT to improve the postoperative paraesthesia for lower third molar surgical extraction.

Effect of Dexamathasone in Surgical Extraction of Mandibular Impacted Third Molar

&#x0D; Objective: The objective of this study was to determine the role of dexamethasone in mandibular third molar surgical extraction.&#x0D; Methodology: This cross sectional study was conducted in Oral &amp; Maxillofacial surgery department, Liaquat University of Medical &amp; Health sciences Hyderabad / Jamshoro. 50 cases were included in this study by using simple random sampling technique. All patients were divided into two groups. Patients in Group-A were given dexamethasone (DM)8 mg intramuscularly (IM) before surgery and 4 mg 24 hours after surgery and Augmentin tablet 625mg Q12 hrs. and Brufen 400 mg Q8 hrs. and patients in group-B were given Augmentin 625 mg BD and Brufen 400 mg TDS post operatively only. The facial swelling was checked before and after surgery.All information was collected and entered in a proforma.&#x0D; Results: The study sample was consisted of 62% men and 38% women. Mean age was 26.9±6.64.The mean preoperative swelling was 109.20 ± 1.190 mm in control group and 109.44 ± 1.083 in DM group. After 48 hours of surgery, post extraction swelling increased in both group with mean swelling 114.28± 1.242 mm in control group and 114.64± 1.350 in DM group, after a week of surgery more swelling was reduced in DM group as compared to control group.&#x0D; Conclusion: It is found that Dexamethasone group showed decrease in swelling as compared to control group.

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up.

Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.

Herbal medicines as anxiolytics prior to third molar surgical extraction. A randomized controlled clinical trial.

This study aimed to compare the effects of Passiflora incarnata, Erythrina mulungu, and midazolam in controlling anxiety in patients undergoing mandibular third molar extraction. The volunteers underwent extraction of their third mandibular molars in a randomized, placebo-controlled, triple-blind, and parallel clinical trial. Passiflora incarnata (500 mg), Erythrina mulungu (500 mg), or midazolam (15 mg) was orally administered 60 min before the surgery. The anxiety level of participants was evaluated using questionnaires and measurements of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). A total of 200 volunteers were included in this clinical trial. Considering each procedure independently, no significant differences (p > 0.05) in BP, HR, and SpO2 were observed among the protocols. Passiflora incarnata showed a similar effect to midazolam but differed from placebo and mulungu, which were unable to control anxiety in this situation. Therefore, the results suggest that Passiflora configures an herbal medicine with an anxiolytic effect, adequate to use in third molar extractions. The use of Passiflora incarnata may be an alternative to benzodiazepines for controlling anxiety in patients scheduled for oral surgery under local anesthesia. ClinicalTrials.gov : ANSI-388.427.

Use of chlorhexidine 0.2% gel to prevent alveolar osteitis in mandibular third molar surgical extraction.

Objectives: To evaluate the efficacy of 0.2% chlorhexidine gel placed intra alveolar in the prevention of alveolar osteitis after the surgical extraction of mandibular third molar. Study Design: Randomized Control trial. Setting: Department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro/Hyderabad. Period: January 2016 to July 2016. Material &amp; Methods: This study consisted of 40 patients in control group A and 40 patients of Chlorohexidine gel group B used after surgical extraction. A single dose of 0.2% bio-adhesive gel was introduced in group B while the control group A was left alone. Postoperative complications like pain, swelling, limited mouth opening, and dry socket were seen. Frequency and percentages were calculated. Mean +/- SD were calculated for quantitative variables. Results: On 3rd day patients reported with pain in group A were 24 and in group B were 15. Pain was seen in 4 patients (10%) on 15th day in group A while in group B no patient came with pain. 19 patients reported with dry socket on day 3 in group A and 4 patients in group B, While none of the patient encountered with Dry socket on 15th day in group in both groups. Conclusion: The data presented indicates that the bio-adhesive gel containing 0.2% chlorohexidine, applied post-extraction produced a better patient recovery.

The effects of systemic proteolytic enzyme therapy on pain and swelling in third molar surgery equal to diclofenac therapy: a prospective randomized double blinded clinical trial

The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. CTRI Registration Number CTRI/2018/03/012502.

Assessment of Effect of Submucosal Injection of Dexmedetomidine on Postoperative Symptoms

Embedded third molar surgery is the most frequent oral-maxillofacial surgical procedure performed. The purpose of this study was to assess the clinical effect of submucosal dexmedetomidine (dex) on decreasing postoperative edema, trismus, and pain after surgical molar extraction. We carried out a double-blind, randomized, prospective study including patients undergoing surgical bilateral embedded mandibular molar extraction. Patients were divided into 2 groups: those receiving saline solution and those receiving dex. The main outcome measures of pain, facial swelling, and trismus were assessed on days 2 and 7 after surgery. In addition, patients were requested to record the time rescue analgesics were taken, as well as the total number taken. The variables were analyzed using the Student t test and a repeated-measures general linear model. P<.05 was considered statistically significant. The study included 40 patients (9 women and 11 men per group; mean age, 23.40years) undergoing surgical bilateral embedded mandibular molar extraction. On day 2, a statistically significant difference in edema was found between the groups (P=.004). On days 2 and 7, statistically significant differences in the severity of trismus were found between the groups (P=.001 and P<.001, respectively). In addition, statistically significant differences were found between the groups in visual analog scale pain scores at 1, 6, 12, 24, and 48hours (P=.161, P=.038, P=.110, P=.136, and P=.007, respectively) and in the number of analgesic tablets taken (P<.001). Preoperative submucosal dex is an efficient, safe, and beneficial therapeutic strategy to decrease edema, trismus, and pain after surgical molar extraction.

Effectiveness of Low Level Laser Therapy (LLLT) and Dexamethasone Phonophoresis in Minimizing Postoperative Swelling Versus Trismus following Surgical Removal of Mandibular Impacted Third Molar: A Clinical Comparative Study

Background and review: The quality of life experienced by patients following third molar surgery is increasingly becoming a health concern; surgical removal of wisdom teeth under local anaesthesia is widely carried out in general dental practice. This procedure is usually associated with postoperative pain, swelling, and trismus as direct and immediate consequences of the surgical procedure. Many clinicians have, emphasized the necessity for better pain, swelling and trismus control in patients who undergo third molar surgery, American Academy of Craniomandibular disorders and the Minnesota Dental Association recommendations have been cited as the most commonly employed methods of physiotherapy treatment such as; short wave diathermy, ultrasound (US) and Low level laser therapy (LLLT). (1)Objective: The aim of this study is to evaluate the effectiveness of Low Level Laser Therapy (LLLT) and Dexamethasone phonophoresis on the post-operative clinical outcomes (facial swelling & trismus) following lower third molar surgical removalPatients & Methods: The study was performed on 30 patients (16 males & 14 females) aged 25-45 suffering from impacted mandibular third molar. They were divided into two equal groups; Group (A) received low level laser therapy immediately after third molar surgical extraction for (The laser has been given as output power 15mW, pulsed 80% and dose 4.3J/sq.cm for 6minutes for 7 days after surgery), Group (B) received phonophoresis of dexamethasone ampoule (in each session with half of 8mg ampule and 35 g ultrasound gel immediately after third molar surgical extraction (7 minutes session over the masseter muscle area for 7 days). Maximum inter-incisal opening MIO and facial swelling measurements were evaluated on pre-operative, 2nd day and 7th day postoperatively. Results: Results showed that there is no significant difference between administration of dexamethasone phonophoresis and (LLLT) for the reduction of postoperative edema and trismus. Also this study demonstrates that both Low level Laser Therapy and Dexamethasone Phonophoresis were significantly effective in decreasing trismus following third molar surgery as manifested by the highly increased Maximum Inter-incisal Opening MIO, but only dexamethasone phonophoresis has a significant effect on reduction of edema as manifested by significant decreasing of measurements (FM) while there was no significant difference on edema at 7th day post-operatively in laser group. Conclusion: This study demonstrates that there is no significant difference between LLLT and dexamethasone phonophoresis for reduction of edema and trismus but only dexamethasone phonophoresis has a significant effect on decreasing edema on seventh postoperative day.

Effect of intramuscular and submucosal dexamethasone injection after lower third molar surgical extraction: preliminary study

Effect of intramuscular and submucosal dexamethasone injection after lower third molar surgical extraction: preliminary study

Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars.

The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction. Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters. Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0mm) and disto-lingual (T0-5.4/T1-3.2mm) sites. The average attachment gains at T1 were 1.9 and 2mm, respectively (P<0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD≥4mm at baseline healed at 6months recall without periodontal pockets. Older age (mean 55years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7mm was more likely to be associated with PPD ≥ 4mm 6months postextraction (P<0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4mm after healing (OR=41.4; 95% CI=10.9 to 156.5, P<0.05). Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.