Removal Of Lower Third Molars Research Articles

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 & 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.

Comparison of Efficacy of Coumarin and Chymotrypsin/Trypsin in Patients Undergoing Surgical Removal of Lower Third Molars: A Prospective Study.

Background Third-molar surgeries are very commonly done by oral and maxillofacial surgeons. Pain and swelling that is associated with this procedure is a frequent reason for the patient's discomfort and apprehension. There is a need to look for a drug that can substantially reduce postoperative swelling amongst the patients. Pain, swelling, and trismus are common complications that are encountered after third molar surgery. These complications have a major impact on the quality of life of patients undergoing minor surgical procedures. Aim The aim of this study was to compare the effectiveness of coumarin and trypsin/chymotrypsinin the reduction of postoperative sequelae for mandibular third molar surgeries. Materials and methods The research was carried out at Saveetha Dental College and Hospital in the Department of Oral and Maxillofacial Surgery. The study consisted of 50 individuals, 25 individuals received tablets of coumarin, and 25 individuals received tablets containing a combination of trypsin/chymotrypsin postoperatively. Patients were evaluated postoperatively for pain and swelling. Postoperative pain was measured on days one, three, and seven after surgery using a visual analog scale.The postoperative swelling was measured on postoperative days three and day seven via a four-point technique.Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). P-values less than 0.05 were considered statistically significant. The independent samples t-test was used to compare the outcomes between the two groups. Results It was found that study participants in the trypsin/chymotrypsin group reported statistically significantlyless pain postoperatively than participants receiving coumarin (p=0.001). There was more reduction in swelling postoperatively in patients who were given trypsin/chymotrypsin as compared to the participants who were given coumarin, and the results were statistically significant. Conclusion Based on the data obtained, it can be inferred that the trypsin/chymotrypsin combination was more effective in reducing postoperative sequelae like pain and swelling than coumarin in the mandibular third molar surgeries.

CORONECTOMY IN LOWER THIRD MOLAR AS AN ALTERNATIVE TECHNIQUE FOR PRESERVATION OF THE INFERIOR ALVEOLAR NERVE

One of the procedures frequently performed by dentists is the removal of lower third molars. These teeth are commonly impacted and have an intimate relationship with the inferior alveolar nerve (IAN). The use of the coronectomy or intentional partial odontectomy technique is indicated in cases where the lower third molars have roots close to or associated with the IAN in order to avoid iatrogenic injuries. The technique consists of extracting the dental crown and cervical portion of the root, while the apical remainder is left in its natural place. This work aimed to describe coronectomy, including its procedural technique, advantages, indications and contraindications, as well as to understand the postoperative phenomena associated with lower third molars in close contact with the IAN. Nineteen articles from the last thirteen years were selected from the databases PubMed, Scielo, Google Scholar and CAPES journals with an emphasis on systematic reviews, published in English and Portuguese. Therefore, it is concluded that coronectomy is considered a satisfactory, safe and effective technique to be used in clinical practice, as long as the dentist knows how to indicate it appropriately, reporting its indications, contraindications and limitations.

Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials

ObjectivesTo assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.Materials and methodsThree databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.ResultsFive preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.ConclusionsHyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.Clinical relevanceHyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.

Third Molar Coronectomy vs Total Removal in Second Molar Periodontal Healing

The objective of this randomised controlled trial was to compare the periodontal healing at the distal of the adjacent second molar after coronectomy or surgical removal and the surgical morbidities of the 2 techniques. This is a pilot study of a split-mouth randomised clinical trial comparing the periodontal healing of the adjacent second molar after coronectomy or total removal of lower third molars, which was registered with the University of Hong Kong Clinical Trial Centre as HKUCTR-2948 on 21 February 2020. Cone beam computed tomography (CBCT) scans were taken preoperatively and at 6 months postoperatively. Changes in the bone level from the cemento-enamel junction, periodontal probing depth (PPD), and clinical attachment level (CAL) at the distal of the adjacent second molar were compared. Surgical morbidities in terms of pain, infection, neurologic deficit, root exposure, and need for second surgery for removal were assessed. Forty patients (22 male, 18 female) with mean age of 26.7 years were evaluated at 6 months postoperatively. Both coronectomy and total removal groups demonstrated statistically significant reduction in PPD and CAL. There was an alveolar bone gain of 1.28 ± 0.88 mm in the coronectomy group and 1.13 ± 0.73mm in the control group, which was statistically significant (P < .001 for both groups). Early findings show the periodontal healing at the adjacent second molar of coronectomy was as good as that of total removal of lower third molar. There were no differences in terms of surgical morbidities between both groups.

Mechanical Obstruction by Malposed Upper Third Molar: A Rare Cause of Trismus

Trismus is a multifactorial symptom which is most commonly presented after the removal of lower third molars. Upper third molar is a rare but true cause of trismus and must be included in the differential diagnosis. We present a rare case of trismus caused by the presence of malposed upper third molar, obstructing the forward movement of coronoid process of the mandible and restricting further mouth opening.

Systemic Enzymes and their Role in the Reduction of Post-Operative Edema After Surgical Removal of Lower Third Molars: A Randomized Controlled Double-Blind Study

Systemic Enzymes and their Role in the Reduction of Post-Operative Edema After Surgical Removal of Lower Third Molars: A Randomized Controlled Double-Blind Study

Effectiveness of the Platelet Rich Fibrin with Suture and without Suture on Postoperative Complications Following Removal of Lower Third Molars

Background: The removal of impacted 3rd molar is a traumatic surgical procedure that may lead to some postoperative sequelae such as pain, swelling, and trismus. The aim of this study was to evaluate the effects of PRF with suture, and without suture, on post-operative complications after removal of 3rd molars.Patients and Materials: This study enrolled 60 patients with partially impacted lower third molars at three centers; Postgraduate Clinic- Department of Oral and maxillofacial Surgery/College of Dentistry/ University of Sulaimani, Private Dental and Maxillofacial Clinic, and Maxillofacial Unit of Kalar General Hospital from November of 2021 till April of 2022. They were randomly allocated into 3 groups of 20 patients each. Group Ӏ was managed by PRF with suture, group ӀӀ was managed by PRF without suture and group ӀII was left without PRF and without suture. Pain, swelling, and maximum interincisal mouth opening were evaluated after the procedure at 1st, 3rd and 7th post-operative days.Results: In terms of pain (p=0.06), trismus (p=0.71), and swelling (p=0.05), there were no statistically significant differences between the study groups and the control group. In contrast to the control group, the values of the three parameters connected to the study groups were lower. In the group of PRF with suture, Visual Analogue Scale (VAS) pain scores on the 3rd and 7th days were significantly (P=0.008 and P=0.038, respectively) less than other groups. Regarding swelling and trismus, there was no significant correlation (P&gt;0.05) between groups.Conclusions: Application of PRF with and without suture had no significant effects on postoperative complications such as pain, swelling, and trismus following removal of partially impacted third molars.

Efficacy of Fentanyl Transdermal Patch in Impacted Mandibular Third Molar Surgery-A Comparative Study.

Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated. 20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 μg FTS was applied in group A while placebo patch was applied in group B. Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics. It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

Evaluation of difficulty index of impacted mandibular third molar extractions.

When compared to other teeth, third molars have a greater rate of impaction. Third molars that have been impacted are commonly encountered in dental practice, and it is the reason for complications in third molar surgery. The most commonly performed surgical procedure by dental practitioners is the third molar extraction. Despite a well-planned surgical approach, there are complications in lower third molar extractions. This study analyzes the expected difficulty during surgical removal of lower third molars that are impacted. This study analyzes the expected difficulty during the removal of impacted lower third molars by surgery. With the data from our dental institution database, the difficulty index by Pederson was used to evaluate the difficulty level of the extraction. Using SPSS, data were analyzed and results were obtained. Among impacted left mandibular third molars (38), minimal difficulty in 20.60% of the extractions, moderate difficulty in 29.58% of the extractions, and most difficulty in 2.77% of extractions were present. Among impacted right mandibular third molars (48), minimal difficulty in 18.80% of the extractions, moderate difficulty in 25.78% of the extractions, and most difficulty in 2.47% of extractions were present. According to our study, there is moderate difficulty in impacted lower third molar surgery, and it depends on factors such as systemic status and patient's age, periodontal condition, and complexity of tooth position in the dental arch.

Effect of time-dependent ibuprofen administration on the post operatory after impacted third molar extraction: a cross-over randomized controlled trial

PurposeTo evaluate time-dependent administration of ibuprofen in a lower third molar extraction model.MethodsEleven patients requiring bilateral surgical removal of lower third molars were recruited and randomized into a blinded crossover randomized controlled trial. For 3 days after surgery, the control group was prescribed ibuprofen 400 mg every 8 h. On the other hand, the experimental group received also ibuprofen 400 mg at breakfast and lunch, replacing the dinner intake with a placebo. Pain measurements (Visual Analog Scale from 0 to 10) were recorded at baseline, 24, 48, and 72 h postoperatively. Facial swelling and trismus were also measured at baseline, 24, and 72 h postoperatively.ResultsPostoperative swelling and pain perception did not show significative difference between the control and experimental groups at 24, 48, and 72 h. Trismus was significantly lower in the control group than in the experimental group at 72 h postoperatively (p = 0.008). Rescue medication consumption seemed to be comparable between groups.ConclusionEliminating night time ibuprofen might be insignificant for pain control after third molar extraction.

Tetracycline, tetracycline + gelatin sponge and placebo on postoperative pain after mandibular molar extraction

Background: Surgical removal of lower third molars is a common oral surgical procedure which causes more severe pain in comparison to the other types of oral surgery. The present study was conducted to compare tetracycline, tetracycline + gelatin sponge and placebo on postoperative pain after mandibular molar extraction. Materials &amp; Methods: 90 patients undergoing mandibular third molar extraction of both genders were randomly divided into three groups of 30 each. Group I patients were treated with intrasocket tetracycline alone, group II patients were treated with intrasocket tetracycline + gelatin sponge and group III patients were treated without any intrasocket medicaments. The postoperative pain scores were evaluated at 24 hours, 48 hours, and 7 days postoperatively. Results: There were 16 males and 14 females in group I, 12 males and 18 females in group II and 10 males and 20 females in group III. The mean VAS at 24 hours in group I was 32.4, at 48 hours was 33.1 and at 7 days was 25.2, in group II was 28.5, 28.2 and 25.0 and in group III was 38.5, 39.1 and 35.7 at 24 hours, 48 hours and 7 days respectively. The difference was significant (P&lt; 0.05).

The Co-Analgesic Efficacy of Preoperative Single Dose Gabapentin after Surgical Removal of Lower Third Molars

The Co-Analgesic Efficacy of Preoperative Single Dose Gabapentin after Surgical Removal of Lower Third Molars

Prevalence of juxta-apical radiolucency and its association to inferior alveolar nerve injury during removal of impacted mandibular third molars

This study aimed to investigate the prevalence of juxta-apical radiolucency (JAR)- a well-defined area of radiolucency that is apical or lateral to the roots of the lower third molar. , and assessing its association to injury of the inferior alveolar nerve (IAN) during surgical removal of lower third molars. We evaluated 1250 panoramic radiographs and 1960 third molars for the presence of JAR. The patients were assessed based on the presence or absence of JAR. These were further classified according to the impacted third molar’s angulation in relation to the adjacent second molar. The radiographic relationship of the mandibular canal and third molar was also noted. JAR was identified in 88 patients (4.4%). Out of the 88, 28 (31.8%) were males and 60 (68.1%) were females, which was statistically significant (P&lt;0.02). There also was an association with teeth that were mesioangularly impacted which was not statistically significant. Radiographic signs of proximity to the mandibular canal were present in 48 (54.5%) of JAR cases. One (1.13%) of them reported with inferior alveolar nerve injury after the surgical procedure postoperatively. JAR was prevalent in 4.4% patients.

Efficacy of Levobupivacaine and Ropivacaine in Postoperative Pain control after Surgical Removal of Impacted Mandibular Third Molar: A Split Mouth Randomized Clinical Trial

Objectives: The aim of the present clinical trial study is to compare the efficacy of 0.75% levobupivacaine with that of 0.75% ropivacaine for pain control after surgical removal of impacted mandibular third molars.&#x0D; Methods: This prospective study included 40 patients (30 females and 10 males) who had been referred to the Department of Oral and Maxillofacial Surgery for surgical removal of third molars of similar difficulty index in two separate sessions under local anaesthesia. Within each patient, levobupivacaine was used to anesthetize one extraction side and for the other side, ropivacaine was used. Onset of anaesthesia, duration of surgery, timing of pain appearance and analgesic consumption were evaluated. Data collected was statistically analysed and results obtained.&#x0D; Results: In this study we observed, there were no significant differences in onset of anaesthesia and duration of surgical procedure between the two groups (P&gt; 0.05). Timing of pain appearance and of first drug consumption was earlier in the ropivacaine group than levobupivacaine group and the results were statistically significant (P&lt; 0.05). Patients with levobupivacaine anaesthesia had significantly lower visual analogue (VAS) pain scores at 1 and 2 hours postoperatively than those with ropivacaine anaesthesia. &#x0D; Conclusion: Within the limitations of the present study, Levobupivacaine is a valid alternative to traditional local anaesthetics for surgical removal of lower third molars. It presents better pain relief when compared to ropivacaine in the immediate postoperative period as evidenced by lower VAS scores.

Lower third molar coronectomy: What do we know so far?

AbstractCoronectomy is a treatment option for lower third molars with high risk of inferior alveolar nerve (IAN) injury. When it was first described, clinicians were sceptical of this new technique and were concerned about complications such as infection or pathological changes. Over the years, coronectomy has been proven to be effective in preventing IAN injury for high‐risk cases and is a safe technique in the long term. The other surgical morbidities of lower third molar coronectomy such as infection, pain and swelling are minimal, and occur at incidences similar to those of the conventional total removal of lower third molars. There is a small chance of root exposure which may require a second operation for its removal. It was found that most of the retained roots would migrate to a small extent, and that the migration rate would decrease with time and gradually cease, causing the root complex to remain embedded in the alveolar bone. Coronectomy has also been suggested as a treatment option for dentigerous cyst when the root of the involved tooth is in close proximity to the IAN. The benefit of adjacent second molar bone regeneration after third molar coronectomy has been demonstrated in pilot studies. With current evidence, coronectomy of lower third molar is a safe alternative for the prevention of IAN injury.

1592 An Audit on Prophylactic Prescribing for Third Molar Surgery

Abstract Introduction Over-prescription of antibiotics gives rise to problems including increased risk of adverse antimicrobial reaction and antimicrobial resistance. Despite this, the ‘routine’ prescription of prophylactic antibiotics following lower third molar removal (LTMR) remains common practice. The current body of evidence shows minimal to no statistically significant difference in the incidence of postoperative infection between prescribing and withholding prophylactic antibiotics for LTMR in healthy individuals. There is currently no published guidance on appropriate antibiotic usage following LTMR. Method A single centred, retrospective review of 100 successive patients undergoing LTMR. In the absence of current guidance, standards of specific criteria to justify antibiotic prophylaxis were formed. Primary outcome measures included appropriate prescription of prophylactic antibiotics, and record of clinical indication for antibiotic prescription. Following dissemination of results and implementation of suggested improvements, a 2nd audit cycle has commenced. Results Cycle 1 (n = 100) (Nov 2019 - April 2020) 52% of patients received prophylactic antibiotics following LTMR. Only 9% had a clear appropriate justification for use. 27% of antibiotics were not prescribed in accordance with BNF or SDCEP guidance. There were 0 postoperative infections within this cohort. Conclusions Over-prescription of antibiotic prophylaxis with inadequate documented justification for use is clear. All clinicians have a duty to consider the rising incidence of antimicrobial resistance and reflect this in their practice. The use of prophylactic systemic antibiotics in LTMR should be limited to cases where it may be deemed to show clinical benefit in patient best interest on both an individual and community scale.

CORRELATION OF IMPACTED MANDIBULAR THIRD MOLAR WITH INCIDENCE OF IPSILATERAL ANGLE AND CONDYLAR FRACTURES IN MANDIBULAR TRAUMA

Objective: This study aims to evaluate association of impacted lower third molars with incidence of ipsilateral mandibular angle and condylar fractures.&#x0D; Study design: Observational study.&#x0D; Place of study: Maxillofacial Surgery Department Armed Forces Institute of Dentistry&#x0D; Materials and methods: Patients reporting to armed forces institute of dentistry maxillofacial surgery department OPD were diagnosed on the basis of history, clinical signs and symptoms and radiological examinations were categorized as Mandibular Angle and Condylar fractures and impacted lower third molars. A total number of 234 radiographs of patients were examined.&#x0D; Duration of study: 01 year from 01 January 2019 to 31st December 2019.&#x0D; Results: &#x0D; Out of total sample size of 234 patients, 70% (79 patients) Mandibular angle fractures occurred with patients with impacted lower third molars (112 patients) and 65% (80 patients) mandibular condylar fractures occurred with patients without impacted lower third molars (122 patients). Statistically significant P-value was 0.000 that is &lt;0.05 that signifies positive correlation of impacted mandibular third molars to cause ipsilateral mandibular angle fractures and indirectly preventing condylar fractures.&#x0D; Conclusion: Patients that do not have impacted lower third molars are more prone to suffer Condylar fractures in case of mandibular trauma which is associated with more postoperative risks and morbidity as compared to mandibular angle fractures that occur more commonly in patients with impacted lower third molars. As mandibular fractures are common, practice for prophylactic removal of lower third molars should be discontinued.&#x0D; Keywords: Mandibular Condylar fracture, Mandibular Angle fracture, Impacted mandibular third molars

Late mandibular fracture after attempted third molar surgery: case report

Removal of lower third molar corresponds to one of the most common procedures in oral surgery. The extraction can result in several intraoperative or postoperative complications, especially when fully impacted molars are involved. This case report describes a mandibular angle fracture following removal of a fully impacted lower third molar of a 41 years old male patient. The fracture occurred 3 days after the attempt to extract the tooth 38 by a dentist surgeon. Several factors influencing the possibility of fracture including gender, age, dental position, and angulation were reviewed and associated with the injury. A fracture line in the angular region of the jaw was observed in radiological and tomographic analysis, both essential to perform the diagnosis. Open reduction internal fixation treatment approach was realized to ensure the best patient’s recovery. We conclude that the difficult to maintain a soft diet and the complete dentition factor could have been determinant to cause the fracture.Descriptors: Mandibular Fractures; Fracture Fixation; Molar, Third.ReferencesAl-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg. 2009; 67(4):856-61.daBodner L, Brennan PA, McLeod NM. Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 2011;49(7):567-72.Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007; 19(1):117-28.Joshi A, Goel M, Thorat A. Identifying the risk factors causing iatrogenic mandibular fractures associated with exodontia: a systemic meta-analysis of 200 cases from 1953 to 2015. Oral Maxillofac Surg. 2016;20(4):391-96.Libersa P, Roze D, Cachart T, Libersa JC. Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 2002;60(2):163-66.Perry PA, Goldberg MH. Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2000;58(8):858-61.Pires WR, Bonardi JP, Faverani LP, Momesso GAC, Muñoz XMJP, Silva AFM et al. Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases. Int J Oral Maxillofac Surg. 2017;46(1):46-53.Krimmel M, Reinert S. Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 2000;58(10):1110-12.Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 2005;34(7):722-26.Ethunandan M, Shanahan D, Patel M. Iatrogenic mandibular fractures following removal of impacted third molars: an analysis of 130 cases. Br Dent J. 2012;212(4):179-84.Ellis E 3rd. Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am. 2009;21(2):163-74.Pell GJ, Gregory GT. Report on a ten year study of a tooth division technique for removal of impacted teeth. Am J Orthodont Surg. 1942; 28:660-71.Antoun JS, Lee KH. Sports-related maxillofacial fractures over an 11-year period. J Oral Maxillofac Surg. 2008;66(3):504-8.Chrcanovic BR, Custódio AL. Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature. Oral Maxillofac Surg. 2010; 14(2):71-80. Iizuka T, Tanner S, Berthold H. Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 1997;26(5):338-43.Woldenberg Y, Gatot I, Bodner L. Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?. Med Oral Patol Oral Cir Bucal. 2007;12(1):E70-2.Miyaura K, Matsuka Y, Morita M, Yamashita A, Watanabe T. Comparison of biting forces in different age and sex groups: a study of biting efficiency with mobile and non-mobile teeth. J Oral Rehabil. 1999;26(3):223-27.Bezerra TP, Studart-Soares EC, Pita-Neto IC, Costa FW, Batista SH. Do third molars weaken the mandibular angle?. Med Oral Patol Oral Cir Bucal. 2011;16(5):e657-63.Grau-Manclús V, Gargallo-Albiol J, Almendros-Marqués N, Gay-Escoda C. Mandibular fractures related to the surgical extraction of impacted lower third molars: a report of 11 cases. J Oral Maxillofac Surg. 2011;69(5):1286-90.

Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials.

To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and Vazirani-Akinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction. A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes. Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P= 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB. GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB. GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia.