Removal Of Mandibular Third Molars Research Articles

Assessment of efficacy of diclofenac sodium in oral and transdermal patch in the management of postoperative pain following surgical removal of impacted mandibular third molars

Background: Pain is one of the most commonly experienced symptoms in surgery and as such is a major concern to the surgeon. The present study was conducted to assess analgesic efficacy of diclofenac sodium in oral and transdermal patch in the management of postoperative pain following surgical removal of impacted mandibular third molars. Materials & Methods: 80 patients with bilateral impactions of mandibular third molar of both genders were divided into 2 groups of 40 each. In group I, patients received diclofenac sodium 100 mg once a day for 3 days on one side and in group II, diclofenac sodium transdermal patch 100 mg once a day for 3 days on second side. The postoperative pain was recorded on visual analog scale (VAS) at 2 hours, 4 hours, 8 hours, 12 hours and 24 hours postoperatively. Results: Out of 80 patients, males were 35 and females were 45. VAS on day 1 in group I and II at 2 hours was 4.6 and 5.3, at 4 hours was 4.3 and 4.7, at 8 hours was 3.2 and 4.1, at 12 hours was 2.7 and 4.0 and at 24 hours was 2.4 and 3.2 respectively.

Mystery revealed on efficacy of intravenous dexamethasone vs methylprednisolone on post-operative sequelae after 3rd molar surgery

Background: Owing to its potent mode of action and lengthy half-life, dexamethasone has been used in oral surgery for many years. Several dexamethasone delivery methods for third molar surgery have been proposed. Dexamethasone administration has been a source of debate, with studies being unable to agree on the best effective method for reducing post-extraction complications. Aim: To carry out comparative evaluation of effect of intravenous 8 mg Dexamethasone and 40 mg Methylprednisolone on pain, swelling and trismus post-operatively after mandibular impacted 3rd molar surgery. Methods and Materials: The study used a split mouth technique, in which the impacted mandibular 3rd molars were extracted one at a time, separated by at least 21 days. Following surgical removal of an impacted mandibular third molar, the patient was given 8mg Dexamethasone intravenously at the first appointment. The surgical removal of the mandibular third molar on the contralateral side was performed on the same patient at the second session after 21 days, and 40 mg Methylprednisolone was administered intravenously post-operatively. Results: For the 2nd, 5th, and 7th day postoperative evaluations, patients showed decreased swelling with the Dexamethasone protocol compared to the Methylprednisolone protocol. There was a statistically significant difference between the two groups.

Effect of Photobiomodulation Therapy on Reducing Acute Pain and Inflammation Following Surgical Removal of Impacted Mandibular Third Molars: A Randomized, Split-Mouth Clinical Trial.

Objective: This study aimed to compare the effects of photobiomodulation therapy (PBMT) on analgesic and inflammatory reduction with that of ibuprofen following surgical removal of impacted mandibular third molars (IMTMs). Methods: A randomized, split-mouth clinical trial was performed on patients undergoing bilateral IMTM removal. PBMT [gallium aluminum arsenide (GaAlAs) laser] with specific parameters (wavelength of 810 nm, power of 0.5% ± 20% W, and energy density of 4 J/cm2) was applied randomly on one side of the mouth immediately after surgery and 1 and 2 days after surgery. The pain level was self-rated with a Likert scale at 2, 4, 6, 24, and 48 h postoperatively. Swelling and trismus were measured on the first and second day after surgery. Saliva was collected for measuring pre- and postoperative salivary immunoglobulin A (sIgA) concentrations with the sandwich ELISA test. Results: The study sample included 25 patients (average age of 22.88 years) with 50 bilateral symmetrical IMTMs. Pain level was highest at 2 h after surgery in both groups and gradually decreased over time (p < 0.01). Swelling and trismus at 48 h were higher than at 24 h (p < 0.01). Within the first 48 h postoperatively, pain level, swelling, and trismus were significantly lower in the PBMT group (p < 0.05). Postoperative sIgA was also significantly lower in the PBMT group (p < 0.05). Conclusions: In short-term and specific conditions of this study, it was found that PBMT helped promote postoperative pain relief and anti-inflammation after surgical removal of IMTMs. The results suggested that there may be a link between a decrease in salivary sIgA levels and decrease in inflammatory processes after PBMT. Trial Registration No. NCT04280809 at ClinicalTrials.gov.

RADIOLOGICAL PREDICTION OF INFERIOR ALVEOLAR NERVE INJURY FOLLOWING SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR- A COMPARATIVE STUDY BETWEEN PANORAMIC RADIOGRAPH AND CONE BEAM COMPUTED TOMOGRAPH

The chances of neurological complications following surgical removal of impacted mandibular third molar increase when there is close contact between the inferior alveolar nerve and the tooth root. Thus, it is important to evaluate the topographic relationship between them preoperatively. AIMS AND OBJECTIVES- To assess the possible nerve injury following extraction of impacted mandibular third molar by comparing the relevant panoramic features with cone beam computed tomography (CBCT) ndings and evaluate the diagnostic accuracy of OPG. MATERIAL AND METHODS –A total number of 30 patients requiring surgical removal of impacted mandibular third molar under local anesthesia and having a close relationship between impacted mandibular third molar and inferior alveolar canal in panoramic radiograph were included in the study and were advised for CBCT evaluation. Statistically signicant association w RESULTS - as found between darkening of the root in OPG and absence of narrowing of the canal in CBCT with P value 0.008 (P&lt;0.05) while distribution of darkening of the root (OPG) according to presence or absence of corticalisation (CBCT) was not statistically signicant . The panorami CONCLUSION - c radiographs may be useful to assess the close relationship between mandibular canal and third molar root tip but it cannot appraise the type of intimate relationship present between them for which CBCT is the reliable tool.

Effect of plasma rich in growth factors on quality of life following mandibular third molar removal: a double-blind randomized controlled trial

The objective of this study was to investigate the effect of plasma rich in growth factors (PRGF) on patient- and clinician-reported outcomes following mandibular third molar removal. Seventy-four patients requiring surgical removal of a unilateral impacted mandibular third molar under local anaesthesia were recruited into the study. PRGF was prepared for all patients irrespective of study arm allocation. Reviews were conducted 3 days (T1) and 7 days (T2) postoperatively. Primary outcome measures were pain (numerical rating scale, NRS), OHIP-14 (Oral Health Impact Profile-14), and postoperative symptom severity scale (PoSSe) data. Secondary outcome measures including mouth opening, dry socket, socket healing, and analgesic consumption were also explored. The statistical analysis was performed using analysis of covariance and the χ2 test. NRS pain scores were higher in the PRGF group at T1, demonstrating borderline significance (mean difference 1.0; P = 0.06), with no difference at T2. PoSSe scores did not differ between the groups, with the exception of the ‘interference with daily activities’ subscale at T1, where PRGF group patients scored 1.2 units higher (P = 0.02). OHIP-14 scores demonstrated a 25% increased likelihood of PRGF patients reporting discomfort on eating at T1 (P = 0.02), with no statistical significance at T2. Secondary outcomes did not differ between the groups. No difference in clinical or quality of life outcomes was observed for patients receiving adjunctive PRGF in third molar sockets.

English

BACKGROUND Surgical removal of the lower impacted third molar is the most classic procedure performed in oral surgery. This procedure is often linked with hard and soft tissue manipulation leading to activation of acute-phase inflammatory response. This has led to the development of serum inflammatory biomarkers which has given the advantage of reducing the prolonged use of prophylactic antibiotics and an analgesic. The purpose of this study was to determine the analgesic and antiinflammatory effects of two NSAIDs in patients undergoing third molar surgery and assess the serum CRP levels preoperatively and postoperatively. METHODS Our study was carried out on twenty (20) healthy volunteering young adults who reported to the Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College &amp; Hospital, Chennai, for the surgical removal of impacted mandibular third molars. Patients were enrolled in two groups. Each group was subjected to the withdrawal of a venous blood sample of 2 ml preoperatively, immediately 1 hr after the surgery and on the third postoperative day. A turbidimetric test was done for CRP level on all these samples and the results were analyzed. RESULTS An investigation was performed to find the association of gender, age, difficulty index, duration of surgery and pain scores by using a biochemical marker – C - reactive protein. The ibuprofen group showed increased postoperative 72 hr CRP levels and diclofenac group showed decreased postoperative 72 hr CRP levels in comparison to initially measured preoperative CRP levels regardless of an increase or decrease in the duration of the surgery. CONCLUSIONS Thus, it can be concluded that a non-steroidal anti-inflammatory drug like diclofenac is a better analgesic and anti-inflammatory drug than ibuprofen in controlling the pain perception and inflammation responses based on inflammatory biomarker–C-reactive protein levels. An inflammatory biomarker like CRP is a reliable and potent indicator of various inflammatory responses. KEY WORDS NSAIDS, CRP, Molar, Analgesics.

Comparative Study of the Efficacy of Low-Level Laser Therapy and Dexamethasone in Reducing the Severity of Post-Operative Inflammatory Response Following Surgical Extraction of Mandibular Third Molars.

To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Trismus (4.61 ± 0.26cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Effectiveness of Knotless Barbed Sutures for Intraoral Closure after Impacted Mandibular Third Molar Surgery: A Split Mouth Randomized Clinical Trial

Objectives: The purpose of this clinical trial is to assess the efficiency of 3-0 knotless barbed suture (polydioxanone) with 4-0 polyglactin 910 (vicryl) in wound closure following impacted mandibular third molar surgery.&#x0D; Methods: The split-mouth study involved 20 patients who were referred to the Oral Surgery Clinic at the Department of Oral and Maxillofacial Surgery for bilateral mandibular third molar impaction with equal difficulty index. Simple randomization was used to distribute the samples. Following extraction, the wounds were closed with 3-0 knotless sutures for the study group and 4-0 polyglactin 910 (vicryl) for the control group. Following surgical extraction in relation to infected mandibular molars under local anesthesia, the clinical outcome parameters that were measured were (1) time taken to achieve wound closure and hemostasis, and (2) post-operative wound healing using "Landry's wound healing index" on the 1st, 3rd, and 7th post-operative days.&#x0D; Results: In this study, we discovered that the average time taken to approximate a wound was 2.69 minutes for the study group and 4.27 minutes for the control group. The research and control groups had a statistically significant difference in suturing time (p-value&lt; 0.05). On all postoperative review days, wound healing in the study group was shown to be better and statistically significant than in the control group (p-value &lt;0.05).&#x0D; Conclusion: Within the limitations of the present study, knotless barbed suture is a promising alternative to conventional sutures for intra-oral wound closure as it reduces suturing time and facilitates effective wound closure following surgical removal of impacted mandibular third molars.

Comparative Study of the Efficacy of Advanced Platelet-rich Fibrin and Standard Platelet-rich Fibrin in Mandibular Third Molar Surgery.

Background:Disimpaction of mandibular of third molar is one of the commonest minor oral surgical procedures. Platelet-rich fibrin (PRF) plays a vital role in both hard and soft tissue healing. There are various subtypes of PRF used for different surgical sites.Objective:The purpose of this study is to compare and evaluate the effectiveness of Advanced PRF (A-PRF) and Standard PRF (S-PRF) in the healing process of the surgical sites after the removal of mandibular third molars. Changes in swelling, pain, and mouth opening were evaluated.Materials and Methods:10 patients (3 men, 7 women; 18–35 years old) were selected for the removal of bilateral impacted mandibular third molar teeth. A-PRF and S-PRF were placed in the right-hand side for 5 patients in each group. In both the groups, the left side of the patients was taken as the control group. Postoperative pain was measured using a visual analogue scale (VAS), postoperative swelling was calculated using the distance between multiple facial landmarks (method) and mouth opening measured interincisally on the 1st postoperative day, 3rd day, and the 7th day, respectively. SPSS version 26.0 was used for data analysis.Results:Advanced PRF group recorded noteworthy improvement in pain (P = 0.063), swelling (P = 0.001), and mouth opening (P = 0.013) when compared to the standard PRF group. There was statistically substantial variance between the advanced PRF and standard PRF groups.Conclusion:Advanced PRF group showed decreased swelling, pain, and increased mouth opening compared to standard PRF group.

Socket Preservation Using Autogenous Bone Graft and Dentin Autograft after Surgical Removal of Impacted Mandibular third Molar – A Split-Mouth Study Design

Introduction: In our study, we have compared the efficacy of dentin bone graft for purpose of ridge preservation and have compared it with autogenous bone graft (ABG). A total of 15 patients were included in this study requiring extraction of bilaterally impacted third molar. On the one side, the socket was filled with processed dentin graft prepared after extraction of the third molar, and on the other side, the socket was filled with ABG harvested from external oblique ridge. The two were compared on the basis of various soft tissue and hard tissue parameters. Aims: This study aimed to evaluate and compare the efficacy of the dentin autograft with ABG for preservation of socket defect after removal of mandibular third molars clinically and radiographically. Materials and Methods: A total of 15 patients were included undergoing extraction for bilaterally impacted third molar. The socket on one side after extraction was filled with processed dentin from the same extracted tooth, and the other side of the socket was filled with ABG harvested from the external oblique ridge. Results: It was seen that dentin graft had the regenerative properties and showed potential for ridge preservation. Conclusions: Ridge preservation is essential for placement of implant and other prostheses. Preservation of ridge immediately after extraction bypasses the need for extensive ridge augmentation procedure. Hence, dentin graft can be used for this purpose as it has potential for bone regeneration.

Use of antibiotics after lower third molar surgery - useful or harmful procedure? A randomized, double-blind, placebo-controlled trial

Introduction/Objective. The aim of the present study was to investigate the effects of moxifloxacin and cefixime in preventing postoperative infection following mandibular third molar surgery. Methods. Double-blind study was completed by 157 patients undergoing surgical removal of mandibular third molars. The patients were randomly assigned to the following three groups: moxifloxacin (M), cefixime (C), and placebo (P). Patients in each group were classified into two subgroups: subgroup (a), without previous history of pericoronitis, and subgroup (b), with previous history of pericoronitis. All the patients were evaluated at the postoperative follow-ups on the first, second, and seventh postoperative day. Results. Postoperative infections were registered only in patients with a history of pericoronitis. Antibiotic prophylaxis with cefixime and moxifloxacin reduced the occurrence of postoperative infection. Overall incidence of postoperative infections was 6.4%. All postoperative infections were registered in the placebogroup, where the incidence of postoperative infection was 19.2%. Microbiological tests verified the clinically obtained results. Isolated microflora was resistant to penicillin-derived antibiotics in 50% of the cases. Conclusion. Prophylactic use of antibiotics after third molar surgery should be weighed against potential risks and benefits and could be considered in cases with previous history of pericoronitis, when complicated surgical extraction is performed.

Effectiveness of low-level laser therapy after surgical removal of impacted mandibular third molars: A randomized clinical trial.

Introduction:The low-level laser therapy has been accepted globally as cell bio-modulator, used to reach ideal therapeutic effects, acting in the reduction of the pain response, with anti-inflammatory effects, stimulating local micro-circulation and wounds repair, promoting a rapid recovery, which brings a better quality of life to the patient. In this study, we aim to to determine the effectiveness of low-level laser therapy on reducing the pain and swelling after removal of impacted third molars.Materials and Methods:In this present prospective randomized clinical study, third molar surgeries were performed in thirty patients who were divided into two equal groups (placebo group and study group) a placebo group with routine treatment and a study group with low-level laser therapy which was applied both intraorally and extraorally after the surgical extraction of mandibular third molar.Results:The parameters such as postoperative pain, edema, and trismus were assessed on 1st and 7th day. All these parameters showed statistically significant results in patients with low-level laser therapy.Conclusions:Low-level laser therapy was effective in reducing the postoperative pain, edema, and trismus in the third molar surgeries.

Can associated pathology influence pain perception and oral health-related quality of life after surgical removal of impacted mandibular third molars? A comparative study in a Saudi Arabia population

Can associated pathology influence pain perception and oral health-related quality of life after surgical removal of impacted mandibular third molars? A comparative study in a Saudi Arabia population

Effect of probiotic Lactobacillus paracasei on tumor necrosis factor-alpha level in gingival crevicular fluid of patients undergoing impacted third molar removal.

This study was conducted to evaluate the effects of the probiotic Lactobacillus paracasei in patients undergoing removal of impacted mandibular third molars, focusing on tumor necrosis factor alpha (TNF-α) levels in gingival crevicular fluid, pain, swelling, trismus, and interincisal distance. Thirty patients were divided into two groups: (1) wound irrigation with the probiotic, and (2) irrigation with 0.9% normal saline. The data were collected at the baseline, and at 24 h and 7 days after the operation. The TNF-α level in gingival crevicular fluid was determined using the ELISA technique. In the experimental group, the probiotic L. paracasei MSMC39 reduced the TNF-α level in gingival crevicular fluid to a significantly greater degree than in the control group (P < 0.05). Pain, swelling and trismus evaluated in terms of a visual analog scale (VAS) score were lower in the experimental group than in the control group, but not to a statistically significant degree (P > 0.05). The mean interincisal distance in the experimental group was higher than that in the control group (P = 0.014). The probiotic L. paracasei is able to reduce the level of TNF-α in gingival crevicular fluid and can ameliorate postoperative complications after mandibular molar removal.

Sub-mucosal Dexamethasone for Post-operative Pain and Oedema Control in Lower Third Molar Surgery.

Background:Surgical excision of the problematic mandibular third molars causes substantial tissue damage and an inflammatory response. Discomfort and edema are common postoperative signs and symptoms caused by the latter. To find out whether dexamethasone may help with the edema and pain that come along with the surgical removal of impacted mandibular third molars, researchers have performed clinical studies.Methods:Twenty individuals with bilaterally affected mandibular third molars who were scheduled for extraction participated in a prospective trial. At two separate sessions, teeth were raised and cut after buccal ostectomy. Since the surgical operation on the left foot, both patients were administered a mixture of 4 mg dexamethasone submucosal injection and antibiotics for 3 days. On the 1st, 3rd, and 7th postoperative days, edema and pain were assessed.Results:At the 1st, 3rd, and 7th postoperative days, there was a clinically meaningful decrease in the level of edema and discomfort in both arms.Conclusions:The current report offers empirical proof that administering a 4 mg dexamethasone submucosal injection during surgery greatly reduced post-surgical edema and discomfort.

The Use of Cryotherapy in Conjunction with Surgical Removal of Mandibular Third Molars: a Single-Blinded Randomized Controlled Trial.

ABSTRACTObjectivesCryotherapy is frequently used to diminish postoperative sequelae following mandibular third molar surgery. The objective of this single-blinded randomized controlled trial was to assess the therapeutic efficiency of 30 minutes continuous cryotherapy on postoperative sequelae following surgical removal of mandibular third molars compared with no cryotherapy.Material and MethodsThirty patients (14 male and 16 female) including 60 mandibular third molars were randomly allocated to 30 minutes of immediately cryotherapy or no cryotherapy. Outcome measures included pain (visual analogue scale score), maximum mouth opening (trismus) and quality of life (oral health impact profile-14). Outcome measures were assessed preoperatively and one day, three days, seven days and one month following surgical removal of mandibular third molars. Descriptive and generalized estimating equation analyses were made. Level of significance was 0.05.ResultsNo cryotherapy following surgical removal of mandibular third molars revealed a statistically significant lower visual analogue scale score of pain compared to thirty minutes of continuous cryotherapy after one day (P < 0.05). However, no statistically significant difference in trismus or oral health-related quality of life were revealed at any time point compared with no cryotherapy.ConclusionsThe therapeutic effect of 30 minutes continuous cryotherapy following surgical removal of mandibular third molars seem to be negligible. Thus, further randomized controlled trials assessing a prolonged application period of cryotherapy, alternative devices or use of intermittent cryotherapy are needed before definite conclusions and evidence-based clinical recommendations can be provided.

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.

COMPARISON IN ANXIETY LEVELS AMONG DENTISTS/ DENTAL STUDENTS AND NON-DENTAL PATIENTS UNDERGOING MANDIBULAR THIRD MOLAR SURGICAL REMOVAL

Objective:&#x0D; To compare the age, reasons for surgical removal, awareness about impacted mandibular third molar, anxiety &amp; panic factor, and the type of dental setup preferred among the patients when they are dentists/dental students or otherwise, nondental patients in Peshawar.&#x0D; Materials and Methods:&#x0D; A sample of ten dentists and forty non dental patients was selected using stratified sampling techniques. The data was collected in local hospitals and dental clinics from January 2017 to January 2018. Preoperative factors such as depth of impaction, tooth position, and bony coverage were considered using orthopantomograms and intraoral periapical radiographs.&#x0D; Results:&#x0D; The results showed that anxiety and panic factor is high among dentists/dental students when undergoing surgical removal of the impacted mandibular third molar. The results further suggested that dentists themselves believe in the quality and techniques of the hospitals, as 50% of the dentist/dental students opted for dental hospitals for their impactions.&#x0D; Conclusion:&#x0D; The finding concluded that 100% of the nondental patients did their surgical removal after facing problems because of the impacted mandibular third molars.

Efficacy of Piroxicam and Tramadol as a Pre-Emptive Analgesic Agent for Mandibular Third Molar Surgery

Objectives: The purpose of this clinical trial is to examine the effectiveness of 20 mg piroxicam with 50 mg tramadol as a pre-emptive analgesic for mandibular third molar surgery.&#x0D; Methods: In this prospective study, 30 patients were referred to the Department of Oral and Maxillofacial Surgery in Chennai for surgical removal of impacted mandibular third molars with similar difficulty indexes under local anesthetic. Patients were randomly distributed to one of two groups: Group A received 20 mg piroxicam intramuscularly (IM) 50 minutes before surgery, while Group B received 50 mg tramadol IM 50 minutes before surgery. The time to analgesic re-medication, Pain intensity (VAS Scores) at 1st, 2nd, 12th, 24th hour, total analgesic consumption was evaluated.&#x0D; Results: When compared to the group getting 50 mg of tramadol IM, the group receiving 20 mg of piroxicam IM demonstrated differences in pain intensity as measured by the visual analog scale and total analgesic consumption [lesser values], and the results were statistically significant(p&lt;0.05). However, there were no statistically significant differences between the two groups in terms of time to first rescue analgesic medication, number of patients requiring the rescue analgesic procedure (10 mg of oral ketorolac), and number of patients without the need for analgesic during the evaluation period. (P &gt;0 .05).&#x0D; Conclusion: Within the limits of the study, patients who received 20 mg of piroxicam before surgery had less pain intensity and total analgesic consumption than those who received 50 mg of tramadol before surgery. In comparison to pre-emptively administered tramadol, piroxicam showed superior analgesic effects for intermediate surgical operations when given preoperatively.

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.