Removal Of Maxillary Third Molars Research Articles

Le fort I osteotomy with or without concomitant removal of upper third molars: A prospective cohort study of intraoperative findings, related complications, and level of pterygomaxillary separation after down-fracture

The main objective of our study was to assess the clinical implications of concomitant intraoperative removal of maxillary third molars (M3M) with the Le Fort I osteotomy ‘twist’ technique (LF1twist). A prospective comparative study was carried out regarding the necessity of bone trimming around the pedicle, intra- and postoperative complications, surgery time, and the level of pterygomaxillary junction (PMJ) separation following LF1twist with concomitant intraoperative removal of M3M (test group) versus LF1twist alone (control group). Outcome parameters were assessed from clinical and radiographic measurements. In total, 100 surgery sites were included (50 in each group). The mean surgery time was 53.4 ± 7.8 min, with nonsignificant differences between groups. The frequency of intraoperative complications was negligible, with no significant differences between groups — though all bleeding events (n = 4) occurred when M3M was not removed concomitantly. No postoperative complications were recorded. Percentages of disarticulations occurring at the PMJ were similar in both groups. In conclusion, the results demonstrate that removal of M3M in conjunction with LF1twist does not imply additional surgery time, or differences regarding the level of PMJ separation or perioperative complications. Furthermore, the concomitant procedure reduces the amount of maxillary and palatal bone in the disjunction area, which facilitates down-fracture and field clearing for maxillary repositioning.

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial.

BackgroundLignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique.MethodsThis was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure.ResultsThe onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate.ConclusionRopivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

Assessment of the complications encountered during and after surgical removal of maxillary third molar: An observational study

Aim: To evaluate the prevalence of different complications during and after maxillary third molar extraction. Materials and Methods: An observational study was conducted at Ruby Dental Clinic and Implant Centre, Kunnamkulam, Kerala, India from April 2018 to March 2019. Total 120 Patient who were planned for surgical extraction of maxillary third molar were included in this study. All surgical extractions of maxillary third molar were performed under local anesthesia by a qualified and experienced oral and maxillofacial surgeon. Results: A total of 120 patients of surgical extraction of maxillary third molar were carried out under local anaesthesia over a scheduled period of study. 38 patients were having intra-operative or postoperative complications. Out of 120 patients, 75 were males and 45 were female patients. Most common complications in our study were maxillary tuberosity fracture seen in 13 patients (34.2%). The second most commonly found complication was delayed wound healing 6 (15.8%), postoperative pain 5 (13.2%) and post-operative infection 4 (10.5%). Conclusion: The risk of complications in third molar surgery will always exist and increases in proportion to the surgical difficulty.

Study of complications of surgical removal of maxillary third molar

Introduction: Removal or extraction of wisdom tooth is routine dental treatment. Maxillary or mandibular third molars extraction is advised in case of odontogenic infection, badly caries tooth causing trauma to buccal mucosa, recurrent pericoronal infections or any other reason. These are the most frequently impacted teeth in the oral cavity, which are difficult for removal and associate with the complications. This research was done to assay the complications during and after maxillary third molar extraction. Materials and Methods: The study was done retrospectively and data of 3 years was assessed. Patient who were planned and followed by extraction of maxillary third molar were included in this study. Only those patients were included in study whose follow up were done after surgical extraction. All of these surgical extractions were performed by a qualified and experienced oral and maxillofacial surgeon under local anaesthesia on dental chair. Results: A total of 230 patients surgical extraction of maxillary third molar were carried out. Out of these, 60 patients were found to be having postoperative or intra-operative complications. Age group of more than 40 were found more complications (30.30%) than other age groups. Out of 230 patients, Male patients had 27.86% complications and females had 24.07% complications. Most common complications present in following study were fracture of the maxillary tuberosity seen in 19 patients (31.66%). The second most commonly found complications were delayed wound healing (11 patients, 18.33%). Other less commonly found complications are post-operative pain, post-operative infection, iatrogenic injury to palate (5.0%), displacement into sinus (5.0%), haemorrhage (3.33%), Herniation of buccal fat pad into surgical site (1.66%) and Displacement into infratemporal fossa (1.66%). Conclusion: Although maxillary third molar removal is routine and secure surgical procedure, risk of complications is always present. It is importan

Removal of dental surgical bur from maxillary sinus: a case report

The most commonly performed surgical procedure in Oral and Maxillofacial Surgery practices are the removal of impacted third molars. Extensive training, skill and experience allow this procedure to be performed in an atraumatic approach. The aim of this study was to drawing attention to the importance of the correct management of the complications cases of foreign body inside maxillary sinus after surgical removal of maxillary third molars. This is an unusual clinical case of a dental surgical bur accidentally displacement into the maxillary sinus during an upper third molar extraction surgery. After removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

Risk factors in oroantral communication while extracting the upper third molar: Systematic review.

The removal of the upper third molar is a procedure commonly performed in oral and maxillofacial surgery. Maxillary third molars are generally less difficult to extract than mandibular third molars. The surgical removal of maxillary third molars is usually associated with low complication rates and low morbidity. This procedure involves the risk of developing complications such as oroantral communication, displacement into adjacent anatomic spaces, fracture of the maxillary tuberosity, and root fracture. Orthopantomograms are the standard preoperative imaging modality, but there is no proven tool for predicting oroantral communication. New possibilities have been offered by cone-beam computed tomography, which is increasingly used in dentistry and is an innovative technique that provides more information as it eliminates the superimposition of surrounding structures and allows the acquisition of 3-dimensional images and their qualitative assessment. The aim of this systematic review was to assess risk factors during the extraction of the upper third molar using orthopantomograms and cone-beam computed tomography.

Erratum to: Comparing the Efficiency of Two Different Extraction Techniques in Removal of Maxillary Third Molars: A Randomized Controlled Trial

[This corrects the article DOI: 10.1007/s12663-016-0935-1.].

Comparing the Efficiency of Two Different Extraction Techniques in Removal of Maxillary Third Molars: A Randomized Controlled Trial

Extractions are routine procedures in dental surgery. Traditional extraction techniques use a combination of severing the periodontal attachment, luxation with an elevator, and removal with forceps. A new technique of extraction of maxillary third molar is introduced in this study-Joedds technique, which is compared with the conventional technique. One hundred people were included in the study, the people were divided into two groups by means of simple random sampling. In one group conventional technique of maxillary third molar extraction was used and on second Joedds technique was used. Statistical analysis was carried out with student's t test. Analysis of 100 patients based on parameters showed thatthe novel joedds technique had minimal trauma to surrounding tissues, less tuberosity and root fractures and the time taken for extraction was <2min while compared to other group of patients. This novel technique has proved to be better than conventional third molar extraction technique, with minimal complications. If Proper selection of cases and right technique are used.

Maxillary tuberosity fracture and ophthalmologic complications following removal of maxillary third molar

AbstractThird molar removal is one of the most common procedures performed by dentists and oral surgeons. Removal of maxillary third molar is associated with a lower rate of complication compared to the mandible, and maxillary tuberosity fracture or ophthalmologic complications after removal of maxillary third molar are very rare. We report maxillary tuberosity fracture and ophthalmologic complications following removal of maxillary third molar. A 35‐year‐old female underwent removal of left maxillary third molar at private dental clinic. Following the complete extraction, excessive haemorrhage occurred and maxillary tuberosity fracture was seen and the patient was brought by ambulance to our hospital. The bleeding was controlled by vacuum‐formed splint and nasal packing. Computed tomography revealed that lateral maxillary tuberosity and posterior wall of the maxillary sinus was defect and there was a slight intraorbital haematoma via the inferior orbital fissure as well as with extension in the maxillary sinus and adjacent spaces such as buccal, masticator, pterygomaxillary and infratemporal spaces. Because an ophthalmologist noted only slight diplopia in lateral gaze without abnormal signs in other examinations and nasal and oral bleeding were controlled, the surgical treatment was not required. The patient was immediately hospitalised for close observation. Intravenous antibiotics and steroids were administered. Because swelling of the cheek and buccal mucosa was gradually decreasing without further haemorrhage, the patient was discharged 4 days after the extraction. The diplopia was recovered completely 11 days after the extraction.

Managing displaced maxillary third molar teeth located between the mandibular ramus and medial pterygoid muscle: a case report

Care is required during the surgical removal of maxillary third molars. The tooth can easily be displaced laterally into the space between the mandibular ramus and medial pterygoid muscle.

A comparison of two anesthesia methods for the surgical removal of maxillary third molars: PSA nerve block technique vs. local infiltration technique

Objectives: The purpose of this study was to compare the effect of PSA block injection with infiltration technique regarding local anesthesia for surgical extraction of upper third molar. Material and Methods: A prospective, intra individual, single-blind randomized controlled trial was designed to study the severity of pain during injection and after surgical extraction of the bilaterally and symmetrically similar upper third molar in a total of 53 patients, in addition to evaluating the need to repeat the injection and requirement of post operative anti-inflammatory tablets. Result: Although the average pain score for all studied times in PSA side was lower than the average pain score in infiltration technique, repeated statistical measures demonstrated that no significant pain reduction occurred in the two techniques. Conclusion: The both tested methods have the same statistic equivalence for the surgical extraction of maxillary third molars. Key words:Surgical extraction, maxillary third molars, PSA block, infiltration.

Removal of a Maxillary Third Molar Displaced into Pterygopalatine Fossa via Intraoral Approach

The removal of impacted maxillary third molars is one of the most common procedures performed in oral and maxillofacial surgery units with low rates of complications and morbidity. A few cases of accidental displacement of third molars into adjacent anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, buccal space, or the lateral pharyngeal space, during surgical interventions have been reported. In this paper, a case of a maxillary third molar accidentally displaced into the pterygopalatine fossa is presented, and the removal of the tooth via intraoral approach is described.

Buccal Injection of 2% Lidocaine With Epinephrine for the Removal of Maxillary Third Molars

The aim of the study was to demonstrate if 2% lidocaine hydrochloride with 1:200,000 epinephrine could provide palatal anesthesia in maxillary tooth removal with a single buccal injection. The subjects included in the clinical study were those requiring extraction of the maxillary third molar of either side. For the purpose of comparison, the sample was randomly divided into 2 main groups: group 1 (study group) included 100 subjects who were to receive a single injection before extraction, and group 2 (control group) included 100 subjects who were to receive a single buccal injection and a single palatal injection before extraction. After 5 minutes the extraction was performed. All patients were observed for Faces Pain Scale during extraction and asked for the same on a 100-mm visual analog scale after extraction. According to visual analog scale and Faces Pain Scale scores, when maxillary third molar removal without palatal injection (study group) and with palatal injection (control group) were compared the difference was not statistically significant (P > .05). Removal of maxillary third molars without palatal injection is possible by depositing 2 mL of 2% lidocaine hydrochloride with 1:200,000 epinephrine to the buccal vestibule of the tooth.

Delayed Removal of a Maxillary Third Molar Accidentally Displaced Into the Infratemporal Fossa

The removal of an impacted maxillary third molar is an easy procedure for an oral and maxillofacial surgeon. The most commonly seen complications associated with this type of surgery are excessive hemorrhage, infection, pain, swelling, trismus, and root fractures. Although rarely encountered, unexpected complications may also arise during this procedure, such as the displacement of the tooth into an anatomic space. In this article, a case of a maxillary left third molar accidentally displaced into the infratemporal fossa is presented, and the delayed removal of the tooth after 3 weeks from the initial unsuccessful attempt is described, along with the correlating reasons. The role of the radiologic analysis in determining the localization of the tooth, including the routine panoramic radiographs and more importantly the volumetric computed tomographic scans, is stated. The different surgical treatment options are classified, and the potential for morbidity in the surgical removal of the tooth from the infratemporal fossa is presented by ranging the vital anatomic structures running through it.

Removal of a Maxillary Third Molar Accidentally Displaced Into the Infratemporal Fossa via Intraoral Approach Under Local Anesthesia: Report of a Case

The surgical removal of impacted maxillary third molars is a procedure routinely carried out by dentists and oral surgeons, and it is usually associated with low rates of complications and morbidity. 1 Gulbrandsen S.R. Jackson I.T. Turlington E.G. Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach. J Oral Maxillofac Surg. 1987; 45: 279 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar These complications frequently include fracture of the tuberosity, tooth root fracture, perforation of the maxillary sinus, prolapse of the buccal fat pad, and displacement of the roots or tooth into the maxillary sinus, all of which may be easily managed. 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar , 3 Sverzut C.E. Trivellato A.E. Lopes L.M. et al. Accidental displacement of impacted maxillary third molar: A case report. Braz Dent J. 2005; 16: 167 Crossref PubMed Scopus (23) Google Scholar Although the displacement of an entire tooth into the infratemporal fossa was once considered a rare complication, 3 Sverzut C.E. Trivellato A.E. Lopes L.M. et al. Accidental displacement of impacted maxillary third molar: A case report. Braz Dent J. 2005; 16: 167 Crossref PubMed Scopus (23) Google Scholar it has been reported more frequently in the literature in the last 4 decades. 1 Gulbrandsen S.R. Jackson I.T. Turlington E.G. Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach. J Oral Maxillofac Surg. 1987; 45: 279 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar , 4 Dimitrakopoulos I. Papadaki M. Displacement of a maxillary third molar into the infratemporal fossa: Case report. Quintessence Int. 2007; 38: 607 PubMed Google Scholar , 5 Winkler T. von Wowern N. Odont L. et al. Retrieval of an upper third molar from the infratemporal space. J Oral Surg. 1977; 35: 130 PubMed Google Scholar , 6 Oberman M. Horowitz I. Ramon Y. Accidental displacement of impacted maxillary third molars. Int J Oral Maxillofac Surg. 1986; 15: 756 Abstract Full Text PDF PubMed Scopus (44) Google Scholar , 7 Grandini S.A. Barros V.M. Salata L.A. et al. Complications in exodontia—Accidental dislodgment to adjacent anatomical areas. Braz Dent J. 1993; 3: 103 PubMed Google Scholar , 8 Patel M. Down K. Accidental displacement of impacted maxillary third molars. Br Dent J. 1994; 23: 57 Crossref Scopus (44) Google Scholar , 9 Paoli J.R. Gence E. Vives P. et al. Removal through the coronal approach of the upper wisdom teeth Apropos of a case of bilateral migration into the temporal fossa [in French]. Rev Stomatol Chir Maxillofac. 1995; 96: 392 PubMed Google Scholar , 10 Durmus E. Dolanmaz D. Kucukkolbsi H. et al. Accidental displacement of impacted maxillary and mandibular third molars. Quintessence Int. 2004; 35: 375 PubMed Google Scholar , 11 Orr II, D.L. A technique for recovery of a third molar from the infratemporal fossa: Case report. J Oral Maxillofac Surg. 1999; 57: 1459 Abstract Full Text PDF PubMed Scopus (25) Google Scholar

A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars

A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars

Palatal anaesthesia for the removal of maxillary third molars as practised by oral and maxillofacial surgeons in Australia and New Zealand

Injections of local anaesthetic to the palate are well known to be poorly tolerated. The absolute requirement of a palatal injection for the removal of maxillary third molars has never been investigated. The aim of this study was to document the current practice of palatal anaesthesia for extraction of these teeth with local anaesthesia as practised by oral and maxillofacial surgeons. A postal survey was sent via the ANZAOMS office to all oral and maxillofacial surgeons who were members of the Australian and New Zealand Association, a total of 131. A response rate of 64 per cent (n = 84) was achieved. The frequency of administration and the factors that determined the decision to administer a palatal injection were assessed, as well as the methods employed for reducing the injection discomfort. The majority (77 of the 84) "always" gave a palatal injection for the removal of maxillary third molars, four respondents administered an injection "most of the time", and two respondents "occasionally". Significantly, one respondent "never" gave a palatal injection. The majority (76 per cent) utilized at least one adjunct in order to reduce the discomfort of the injection. The results of this survey suggest that for removal of maxillary third molars the requirement of the poorly tolerated palatal injection may not be absolute as conventionally taught and demonstrates the need for further investigation.

A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars

Routine use of a palatal injection for the removal of maxillary third molars has never been validated. The purpose of this blinded, randomized, controlled trial was to assess the requirement of a separate palatal injection for the extraction of maxillary third molars. Fifty-one patients requiring the removal of bilateral maxillary third molars were enrolled. Each patient acting as their own control received buccal infiltrations of lignocaine bilaterally, then 0.2 mL of lignocaine without vasoconstrictor was administered to one side of the palate and the same amount of normal saline administered to the other side. Sides were randomized as to the active ingredient and both the patient and operator were blinded. All extractions were performed by a single operator using a consistent technique and no additional sedative or anaesthetic agents were utilized. Data relating to the pain of the extractions and of the palatal injection were obtained on a Visual Analogue Scale (VAS). Verbal Response Scale (VRS) data were obtained additionally for a subset of 21 patients. Statistical analysis confirmed clinical equivalence between saline and lignocaine to the palate (95% CI −1.7 to 6.2 mm, equivalence range −6.75 to 6.75 mm). No patients requested additional lignocaine to the palate in order to ensure comfortable extraction. This study provides evidence that the poorly tolerated palatal injection of local anaesthetic for the removal of maxillary third molars may not be required.