Removal Of Impacted Third Molars Research Articles

Full life cycle changes of low impacted mandibular third molar associated cystic lesions and adjacent tooth root resorption: a retrospective study

ObjectiveLow impacted third molars are usually asymptomatic and are often found by X-ray examination. The removal of asymptomatic low impacted third molars is one of the most controversial clinical issues in oral and maxillofacial surgery.MethodsIn this study, 806 patients with low impacted mandibular third molars (LIMTMs) (full bony impaction) were analyzed to determine the prevalence and risk factors for cystic lesions and adjacent tooth root resorption throughout the patients’ entire life cycle.ResultsThe results showed that the prevalence of adjacent tooth root resorption and cystic lesions was age-related, exhibiting a trend of first increasing and then decreasing; prevalence peaked at the age of 41 to 45 years old, the prevalence rates were 12.50% and 11.11% respectively. And the lowest prevalence rate was 2.86% and 2.44% in ≥ 61 group and 56- to 60-year age group respectively. Age was an independent risk factor for adjacent tooth root resorption of LIMTMs, whereas age and impaction type (especially inverted impaction) were independent risk factors for cystic lesions.ConclusionsThe full life cycle management strategy for LIMTMs may need to be individualized. Surgical removal is recommended for LIMTMs in patients younger than 41 to 45 years, especially for inverted, mesioangular, and horizontally impacted LIMTMs. LIMTMs in patients older than 41 to 45 years may be treated conservatively with regular follow-up, but surgical removal of inverted impacted LIMTMs is still recommended to avoid cyst formation.

Postoperative outcome after coronectomy versus surgical removal of impacted mandibular third molars - clinical and oral health-related quality of life follow-up

Postoperative outcome after coronectomy versus surgical removal of impacted mandibular third molars - clinical and oral health-related quality of life follow-up

EFFICACY OF SUBLINGUAL VERSUS ORAL PIROXICAM IN MANAGEMENT OF POST-SURGICAL PAIN, SWELLING AND TRISMUS AFTER LOWER 3RD MOLAR SURGERY- A RANDOMIZED CONTROL CLINICAL TRIAL

Background of the study: Third molar surgical removal is a common procedure in oral and maxillofacial surgery, causing moderate to severe pain, swelling, and trismus. Postoperative pain control improves patient recovery and oral function, with commonly used analgesics including Ibuprofen, Aceclofenac, Ketorolac, Tramadol, Paracetamol, Nalbuphine, Nimusulide, and Buprenorphine. Aim and Objective: The study compares oral and sub-lingual Piroxicam for managing post-surgical pain after extraction of impacted third molars, focusing on analgesia onset, pain intensity, swelling, and trismus degree. Materials and method: A randomized control trial was conducted on 30 patients who underwent surgical removal of mandibular impacted third molars. The patients were divided into two groups: Group I (Study) and Group II (Control). All patients underwent the procedure by a single surgeon. Post-operative medications were prescribed according to the study design, with Piroxicam 20mg administered sub-lingually (Group I) and 20mg orally (Group II). The parameters were assessed and measured for both groups, and the results and statistical analysis were compared. Result: The results revealed that the inter-group difference for the post-operative symptoms evaluated using a t-test for Equality of means by comparing the pre-op, POD 2, POD 7 values was statistically significant. Mean onset time taken and pain perception by Group I (Sub-lingual) in the first dose was 32.3 minutes and for Group II was 51.21 minutes which was established to be significantly (P<0.05) low for the sub-lingual group by statistical analysis. Conclusion: The study found that the sublingual route of administering Piroxicam had a faster onset of action and better analgesia postoperatively compared to the oral route. This is crucial for patients and surgeons to improve compliance and comfort post-operatively after impaction surgery, as potent analgesics are essential for effective pain management.

Risk factor analysis for perioperative complications in impacted third molar surgery - a single center experience.

The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting ​​upper third molars and hypesthesia of the inferior alveolar nerve (IAN) ​​when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies. The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data. Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN. Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.

Effect of local application of leukocyte and platelet-rich fibrin (L-PRF) on postoperative swelling and salivary IL-6 levels after surgical removal of impacted mandibular third molars.

Effect of local application of leukocyte and platelet-rich fibrin (L-PRF) on postoperative swelling and salivary IL-6 levels after surgical removal of impacted mandibular third molars.

Comparison of the efficacy of aescin and diclofenac sodium in the management of postoperative sequelae and their effect on salivary Prostaglandin E2 and serum C–reactive protein levels after surgical removal of impacted mandibular third molar: a randomized, double-blind, controlled clinical trial.

Introduction Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars. This study aimed to correlate salivary PGE2 levels and serum C-reactive protein levels with subjective and objective symptoms after surgical extraction of the mandibular third molar and their relationship with drug therapy. Methods The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar. Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C–reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). Conclusion The proposed study is expected to show a favorable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery. The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C–reactive protein, which are reliable inflammatory markers. The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.

Distribution and impaction patterns of third molars in a sample of German population: Retrospective analysis in a high turnover maxillofacial department

BackgroundThe surgical removal of impacted third molars is considered a routine procedure for oral and maxillofacial surgeons. However, the distribution of impacted molars varies among different populations. A study into impaction patterns in the German population is currently not described. The aim of this retrospective study is to determine patterns of impacted third molars in a sample of German population, to identify gender and age specific differences as well as further risk factors for impacted molar extraction and to compare these results with other studies. Materials and methodsThe clinical findings and digital panoramic radiographs of 84 patients with a total of 243 impacted third molars that had been subjected for tooth extraction, from January to September 2023, were collected and analyzed. All third molars were analyzed according to Winter´s angulation, Pell and Gregory Score of depth and relationship to ramus. Furthermore, inferior alveolar nerve and maxillary sinus proximity were identified through a newly developed risk score and an analysis of patient´s gender and age regarding impaction patterns was performed. ResultsNo significant gender specific differences were found regarding the impaction patterns. Third molar angulations significantly differed regarding patient´s age (cut-off 26 years). In comparison, third molar depth, bone coverage, nerve approximity and angulation patterns differed from the results of other populations. ConclusionThe results of this study can serve as a baseline for further studies of third molar impactions in the German population to minimize perioperative complications in impacted third molar surgery.

Transcriptome Sequencing of Gingival Tissues from Impacted Third Molars Patients Reveals the Alterations of Gene Expression.

The removal of impacted third molars by surgery may occur with a series of complications, whereas limited information about the postoperative pathogenesis is available. The objective of this study is to identify changes in gene expression after flap surgical removal of impacted third molars and provide potential information to reduce postoperative complications. The gingival tissues of twenty patients with flap surgical removal of impacted third molars and twenty healthy volunteers were collected for gene expression testing. The collected gingival tissues were used RNA sequencing technology and quantitative real-time PCR validation was performed. DEG was mapped to protein databases such as GO and KEGG for functional annotation and, based on annotation information, for mining of differential expression genes in patients with mpacted third molars. A total of 555 genes were differentially expressed. Among the top up-regulated genes, HLA-DRB4, CCL20, and CXCL8 were strongly associated with immune response and signal transduction. Among the top down-regulated genes, SPRR2B, CLDN17, LCE3D and LCE3E were related to keratinocyte differentiation, IFITM5, and BGLAP were related to bone mineralization, UGT2B17 is associated with susceptibility to osteoporosis. KEGG results showed that the DEGs were related to multiple disease-related pathways. This first transcriptome analysis of gingival tissues from patients with surgical removal of impacted third molars provides new insights into postoperative genetic changes. The results may establish a basis for future research on minimizing the incidence of complications after flap-treated third molars.

Can Hyaluronic acid gel enhance wound healing faster than Advanced Platelets Rich Fibrin following surgical removal of impacted mandibular third molars? A Randomized Controlled Trial

Can Hyaluronic acid gel enhance wound healing faster than Advanced Platelets Rich Fibrin following surgical removal of impacted mandibular third molars? A Randomized Controlled Trial

Comparison of the Effectiveness of Four Different Irrigation Solutions on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Oral and maxillofacial surgeons frequently perform the removal of impacted mandibular third molars. The success of this surgical intervention depends on meticulous surgical technique and the use of appropriate irrigants to minimize complications in the postoperative period. Aim The aim of this study was to evaluate the efficacy of four different irrigation solutions (povidone-iodine, metronidazole, chlorhexidine gluconate (CHX), and normal saline)on postoperative sequelae like pain, trismus, swelling, and alveolar osteitisfollowing surgical extraction of the impacted mandibular third molars. Materials and methods The current research was a randomized study carried out at Saveetha Dental College and Hospital in Chennai, India, from December 2022 to March 2023.The study population consisted of 112 participants who were referred to the Oral and Maxillofacial Surgery for the surgical removal of impacted mandibular third molars. The population was divided into four groups, with 28in each group. They were categorized as A, B, C, and D based on the final irrigation solution used after surgical removal of the impacted teeth. In group A, patients received 0.5% povidone-iodine as the final irrigation solution; group B received 1% metronidazole; group C received 0.12% chlorhexidine gluconate (CHX); and group D received 0.9% normal saline.Patients were examined on the first and seventh postoperative days to assess pain, swelling, trismus, and alveolar osteitis. The results were analyzed with SPSSStatistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) software for Windows (MicrosoftCorporation, Redmond, Washington, United States). A p-value less than 0.05 was considered statistically significant. Results Group B experienced significantly less pain than groups A, C, and D on the first and seventh postoperative days (p<0.05). The facial swelling was significantly less on the first and seventh postoperative day in groupB compared to groups A, B, and D (p<0.05). There was no statistically significant variation observed in trismus (mouth opening) across the groups on both the first postoperative and seventh postoperative days. The presence of alveolar osteitis was seen in groups A, C, and D, but no instances were reported in group B. Conclusion It can be concluded that among the four irrigation solutions used in the lower third molar surgery,metronidazole irrigation solution yielded the best results in terms of less pain, swelling, and alveolar osteitis followed by chlorhexidine.There was no difference between povidone-iodine irrigation and normal saline irrigation on the postoperative sequelae. Postoperative trismus does not depend on the irrigation solutionused in the third molar surgery.

Comparative Study of the Surgical Excision of Impacted Mandibular Third Molars Using Surgical Burs and an Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser.

Background The use of lasers has increased in the field of dentistry in recent years. However, in the field of oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissue, and less focus is placed on the use of lasers for hard tissues. Aim The present study aimed to comparatively evaluate the efficacy of a erbium-doped yttrium aluminum garnet (Er:YAG) laser for cutting the bone while removing the impacted mandibular third molar with the use of a surgical bur. Methods The study assessed 80 subjects undergoing removal of impacted mandibular third molars. The subjects were recruited from the Department of Oral and Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India. They were randomly divided into two groups, each consisting of 40 subjects. Group I used an Er:YAGlaser to remove the bone, while Group II used a surgical bur. Assessments and comparisons were made for complications, wound healing, trismus, edema, bleeding, and pain. Results The study examined the efficacy of the Er:YAG laserfor cutting the bone and extracting the impacted mandibular third molars using a surgical bur in two groups of 80 patients each. When the laser was used in place of a surgical bur, Group I patients experienced less edema, bleeding, and discomfort; nevertheless, the difference was not statistically significant. Time taken by laser for bone cutting was significantly higher compared to the surgical bur. In Group I (laser), trismus existed for a longer time. For mouth opening, the preoperative mouth opening was comparable in the two groups with p = 0.87. Conclusion Pain, hemorrhage, and edema were lesser, and the time required for bone cutting was substantially longer in the laser group. Apart from these, laser-assisted intra-oral bone cutting should be preferred because of its less invasive nature, simpler procedure, and simpler osteotomy when compared to traditional surgical burs and also in anxiety-prone patients.

Comparative Evaluation of Efficacy of Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) in Bone Regeneration after Surgical Removal of Impacted Bilateral Mandibular Third Molars - A Comparative Study.

Aims and Objectives: To compare the efficacy of platelet rich plasma (PRP) and platelet rich fibrin (PRF) in bone regeneration after removal of impacted bilateral third molars. Materials and Methods: The study was carried out as an open clinical trial on 20 patients chosen from the ones referred to the department of Oral & Maxillofacial Surgery for surgical removal of bilateral mandibular third molar. Patients were prepared for surgical procedure, Inferior alveolar nerve block given using 2% lignocaine hydrochloride with 1:2,00,000 adrenaline. Third molar were removed by flap reflection and bone drilling. Finally, PRF in lower left mandibular third molar region and PRP in lower right mandibular third molar region was inserted and wound closure was done. Cone bean computer tomography (CBCT) was made on 1st postoperative day and 4 months after surgery to evaluate alveolar bone height and density. Result: Alveolar bone height and bone density at post-operative 1st day and 4 months were compared between PRP and PRF group. The bone density and bone volume were analyzed, and there was no significant difference between bone density in PRP and PRF at day 1 and 4th month. Conclusion: As per our study and evaluation, in our postoperative follow up there was no statistically significant differences in bone regeneration by placement of PRP and PRF in extracted socket of third molar. Thus, with this study we can conclude that PRF, would be a good option to Oral and Maxillofacial Surgeons in the near future due to ease of extraction.

Can Topical Agents (Arnica and Mucopolysaccharide Polysulfate) Reduce Postoperative Pain, Edema and Trismus Following Mandibular Third Molar Surgery?

Postoperative supplemental maintenance following mandibular third molar surgery remains an area of interest. Topical agents can modulate inflammatory processes. The aim of the present study was to determine if topical application of arnica or mucopolysaccharide polysulfate (MPSP) reduces pain, trismus, and edema following the removal of impacted mandibular third molars. A single center randomized controlled clinical trial was conducted. The patients were randomized into three groups: the control group (standard therapy [ST]: antibiotic+nonsteroidal anti-inflammatory drugs twice a day), the arnica group (arnica+ST), and the MPSP group (MPSP+ST). The patients' pain, trismus, and edema values were measured preoperatively and on postoperative days 1, 3, 5, and 10. Sex, age, and operation time were also included. Analyses included descriptive statistics, analysis of variance, post hoc tests, and determinations of intraclass correlation coefficients. Statistical significance was set at P<.05. Sixty patients with a mean age of 26.98±10.88years were included in the study; 55% were females and 45% were males. The mean operation time was 23.8±3.27minutes. According to the visual analogue scale scores (in centimeter units), the arnica and MPSP groups felt less pain than the control group until day 5 (0.6±0.88, 3.75±1.16, 4.75±1.29, and 1.05±1.10, respectively, for the arnica group; 0.35±0.59, 3.25±1.62, 5.0±1.65, and 1.50±1.32 for the MPSP group; and 1.30±1.17, 5.75±1.37, 7.05±1.10, and 3.15±1.53 for the control group; P<.05). The trismus was lower on days 1, 3, and 5 in the arnica group (-8.05±2.82, -12.15±3.1, and -2.15±1.81, respectively) than in the control group (-12±3.82, -15.65±4.81, and -4±2.81, respectively) (P<.05). The edema was lower on days 1 and 3 in the MPSP group (0.95±2.2 and 1.75±3.7, respectively) than in the control group (2.45±0.9 and 3.6±0.8, respectively) (P<.05). Arnica and MPSP had similar pain-relieving action, but arnica was more effective at reducing trismus, while MPSP was more effective at reducing edema. Topical application of arnica or MPSP may have a beneficial effect on relieving pain 5days after surgery, but arnica was also effective at reducing trismus, while MPSP was also effective at reducing edema. Both arnica and MPSP reduced postoperative sequelae.

Single-centre retrospective study of postoperative complications after removal of mandibular third molars using a straight lowspeed handpiece

ObjectiveWe aimed to analyze the incidence of postoperative complications after the removal of impacted mandibular third molars using a dental straight, low-speed handpiece. MethodsThis single-center retrospective descriptive study was conducted from January 2018 to December 2021. Inclusion criteria for the enrolled patients were complete medical records, no history of systemic disease, and received surgical removal of impacted mandibular third molars using a straight, low-speed handpiece. ResultsA total of 1050 patients underwent mandibular third molar removal with a straight, low-speed handpiece under local anesthesia. Most complications occurred in cases involving horizontal angulation (15.4%) and those categorized as level B (13.3%) and class II (13.9%) impactions. The difficulty index indicated moderate difficulty in most cases (55.3%), with the most and least common postoperative complications being pain (5.7%) and paresthesia (1.5%), respectively. ConclusionMost complications reported in this study were minor, transient, and within the ranges reported in the literature. No major complications, such as emphysema, were reported, while paresthesia was the least frequently reported complication. Thus, third molar removal using a straight, low-speed handpiece was associated with few complications and might be used as one of the safe procedures.

Palatal approach for surgical removal of mesioangularly impacted maxillary third molar - a pilot study

ObjectiveThis study aimed to investigate the application of the palatal approach for surgical removal of IMTM, and to evaluate its success rate, surgical duration, postoperative outcomes, and incidence of complications.MethodPatients with mesioangularly IMTM (Archer Classification Class B) in the none-buccal position to the adjacent second molar, which were indicated for surgical removal, were enrolled in this study. The patients were assigned into two groups according to the surgical approach: the buccal or palatal approach. The impacted tooth positions, diagnosis, past dental and medical history, and radiographic examination were recorded pre-operatively. The duration, surgery details, and surgical complications were documented during the surgery.Result40 teeth were enrolled in our study. All teeth were removed completely. The operation time was significantly shorter in the palatal approach group compared to the buccal approach group (13.3 ± 2.8 min vs. 22.3 ± 5.5 min, P<0.001). The incidence of traumatic ulcers of the lips was significantly higher in the buccal approach group than in the palatal approach group (7/20 vs. 0/20, P = 0.008).ConclusionIt is more efficient to perform surgery with a palatal approach if a Class B mesioangularly IMTM is located in the non-buccal aspect of the adjacent second molar.Clinical trial registration numberChiCTR2000040063

Can the Position of the Impacted Third Molars Be an Early Risk Indicator of Pathological Conditions? A Retrospective Cone-Beam Computed Tomography Study.

The aim of this retrospective study was to evaluate the prevalence of pathologies associated with impacted third molars in relation to tooth position on cone-beam computed tomography images. In 348 cone-beam computed tomography images, the position of 640 impacted third molars (mesiodistal angulation, buccolingual inclination, impaction depth, and contact point localization) and the presence of pathologies (distal caries, external root resorption, marginal bone loss, and pathological follicular space) were evaluated. The data were analysed statistically with a significance level set at P < 0.05. Distal caries was mostly detected in relation to Class A (20.4%) and contact point at (12.5%) and above (10.5%) the cementoenamel junction (CEJ) (P = 0.000; P < 0.05). External root resorption and marginal bone loss were more common in mesioangular angulation (52.3% and 80.1%, respectively), Class C (53% and 73.8%, respectively), and contact point below the CEJ (53.2% and 73.3%, respectively) (P = 0.000; P < 0.05). Lingual inclination was identified as a new risk factor for associated pathologies (P < 0.05). Pathological follicular space was significantly more likely to occur in those with inverted angulation (100%) and absence of contact (31.5%) (P = 0.000 and P = 0.010, respectively; P < 0.05). Pathologies arising in second molars in relation to impacted third molars are significantly associated with the three-dimensional position of impacted third molars, and watchful monitoring or prophylactic removal of impacted third molars should be considered, taking into account the relevant risk parameters for the related pathologies.

Does the “Root Removal First” strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position? — a randomized clinical trial

ObjectiveTo evaluate the clinical outcomes of the “Root Removal First” strategy in the surgical removal of impacted mandibular third molar (IMTM) in the class C and horizontal position.Materials and methodsA total of 274 cases were finally included in the statistics. The positions of IMTM in the horizontal position were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the “Root Removal First” strategy was applied in the new method (NM) group, and the conventional “Crown Removal First” strategy was executed in the traditional method (TM) group. The clinical information and relevant data upon follow-up were recorded.ResultsThe duration of the surgical removal and the incidence rates of lower lip paresthesia in the NM group were significantly lower than those in the TM group. The degree of mobility of the adjacent mandibular second molar (M2) in the NM group was significantly lower than that in the TM group at 30 days and 3 months post-operation. The distal and buccal probing depth of the M2, as well as the exposed root length of M2 in the NM group, were significantly lower than those in the TM group 3 months post-operation.ConclusionsThe “Root Removal First” strategy can reduce the incidence rate of inferior alveolar nerve injury and periodontal complications of the M2 in the surgical removal of IMTM in class C and horizontal position with high efficiency.Trial registrationChiCTR2000040063.

Role of Prophylactic Dose of Oral Amoxicillin Trihydrate in Prevention of Bacteremia Post Surgical Removal of Impacted Mandibular Third Molar: A Clinical Study.

The current study is designed to evaluate the efficacy of pre-operative prophylactic antibiotic for prevention of bacteremia after surgical removal of impacted mandibular third molar SRIMTM. The study was carried out as an open clinical trial. Fifty patients who fulfilled the criteria were included. Twenty five randomly selected patients (study group) were administered two grams oral dose of amoxicillin trihydrate, one hour prior to the procedure. Twenty five patients (control group) were not administered any antibiotic prior to the procedure. All patients underwent surgical removal of impacted mandibular third molar through intraoral approach under local anesthesia. Blood culture for detection of aerobic and anaerobic micro-organisms was done for all 50 patients. Eleven out of the twenty five patients (44%) in the control group showed positive growth, including mixed growth (aerobic and anaerobic). Seven patients showed purely anaerobic, 2 patients purely aerobic and two mixed growth. In the study (antibiotic) group, 7 out of the 25 patients (28%) showed positive growth, including mixed growth. Three patients showed purely anaerobic, 2 patients purely aerobic and 2 mixed type of growth. The study suggests that the judicious use of antibiotic prophylaxis, in conjunction with optimal oral health care serves to minimize the adverse effects of antibiotic therapy; and at the same time reduce the significant morbidity and mortality associated with systemic infections that might occur due to bacteremia resulting from surgical procedures of the oral cavity.

Conventional Rotary Technique and Piezosurgical Technique in the Removal of Impacted Mandibular Third Molar: A Comparative Study.

To compare the operating time, postoperative pain, edema, trismus, and patient acceptance following surgical removal of impacted third molar using piezosurgery and conventional rotary technique. About 42 patients with impacted mesioangular mandibular third molars were included in this study. Subjects are divided into two groups: group I (treated with conventional rotary technique) and group II (treated with piezosurgery). Duration of surgery, pain, trismus, and swelling were assessed. The patients were evaluated on the 1st, 3rd, and 7th postoperative days. Postoperative pain, trismus, and edema were reduced with piezosurgery compared with conventional technique. Even though the duration of time was longer with piezosurgery, patient comfort was found to be better. Piezosurgery is a meticulous and innovative ultrasonic technique with selective bone cutting and better postoperative outcomes. However, it is expensive, and the operating time is prolonged. Piezosurgery is an alternative in the surgical removal of third molars as it ensures precise and selective cutting, with no injury to the surrounding soft tissues. Postoperative outcome and patient acceptance are improved with piezosurgery.

Comparative Evaluation Of The Effectiveness Of Dexamethasone And Adrenaline With 2% Lignocaine For Pterygomandibular Nerve Blocks: A Randomized Controlled Clinical Study

Background and Aim: Dexamethasone, a glucocorticoid, has been used in local anesthetics as an additive for various locoregional nerve blocks. Although, its use in the dental field has not been unexplored and concealed. The current study was conducted to evaluate and compare the calibre of anesthesia, their hemodynamic response, vasoconstrictive effects, and control of pain while administering pterygomandibular nerve blocks using 2% Lignocaine hydrochloride solution with Dexamethasone(4mg/ml) with that of the standard 2% Lignocaine hydrochloride solution and Adrenaline bitartrate (1:80000). Materials and Methods: This triple-blind randomized controlled study included 80 healthy subjects, aged between 18-45 years with an indication for surgical removal of impacted mandibular third molars. With the aid of a computer-generated sequence, the subjects were arbitrarily assigned into 2 groups (40/group)- Group 1: patients administered with 2% Lignocaine hydrochloride and Dexamethasone Sodium Phosphate (4mg/ml) solution, and Group 2: patients administered with 2% Lignocaine hydrochloride with Adrenaline bitartrate (Adr) 1: 80,000 (12.5 μgm/ml) solution. The variables were assessed based on their time of onset, depth (pain) and duration of anesthesia, systolic, diastolic, and mean arterial blood pressures, heart rate, and blood loss. Results: Statistically significant difference (P&lt;0.05) was noticed for the onset (shorter onset in Group 1) and duration of action (prolonged in group 1) and number of analgesics required (less in grp 1). Statistically non-significant difference between 2 groups (P&gt;0.05) for pain, blood loss, cardiovascular variables (systolic, diastolic and mean arterial blood pressures and heart rate) at various intervals was noted. Conclusion: Dexamethasone added to Lignocaine shortens onset, prolongs duration of action and yields better control of post-operative pain as compared to Lignocaine with Adr. Vasoconstrictive properties, hemodynamic variables and intra-op pain control were comparable. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.172-178