Impacted Third Molar Surgery Research Articles

Correlation of Blood Pressure, Heart Rate and Pain with Anxiety, and Importance of its Prevention in Surgery of Impacted Third Molars Under Local Anesthesia

Aim: To examine whether there is a correlation between blood pressure, heart rate, and pain with the level of preoperative and postoperative anxiety in surgery of impacted third molars under local anesthesia. Subjects and Methods: In the study, which included adult patients of both sexes with an indication for surgical extraction of impacted third molars, research parameters were measured as follows: 1st measurement (day of examination) - blood pressure, heart rate, preoperative anxiety with Spielberger’s State-Trait Anxiety Inventory (STAI); 2nd measurement (immediately before the intervention) - blood pressure, heart rate, preoperative anxiety with STAI; 3rd measurement (day after intervention) - blood pressure, heart rate, postoperative anxiety with STAI, postoperative pain with visual analog scale. Results: The values of preoperative and postoperative anxiety and the measured parameters of blood pressure, heart rate, and postoperative pain were statistically significantly positively correlated with each other during all measurements. Conclusion: In order to increase the satisfaction of both the patient and the ordinarius, and to prevent possible complications in this type of oral surgical intervention, it would be useful to consider adequate therapy in order to prevent the development of anxiety, considering the confirmed correlation with the measured parameters.

Clinical and microbiological comparison of knotless/barbed and silk sutures for impacted third-molar surgery.

Several types of suture materials are available for oral surgery. However, the most used non-resorbable suture in oral surgery is 3/0 silk. The aim of the present study was to compare the effectiveness of knotless/barbed sutures with silk sutures during the postoperative period after the third molar surgery in terms of clinical and microbiological parameters. The study comprised 38 patients who underwent surgical extraction of a mandibular impacted third molar. The patients were divided into two groups. The mucoperiosteal flap was closed using 3/0 knotless/barbed sutures for the test group and 3/0 silk sutures for the control group. The duration of suturing was recorded during surgery. Pain level, postoperative edema, and trismus were measured at 3 and 7 days after surgery. The status of plaque formation on the sutures was scored using the Plaque Index at 3 and 7 days after the surgery. At 7 days, the suture materials were removed and submitted to the laboratory for microbiological analysis. The level of pain during suture removal was also recorded by a Visual Analog Scale. The duration of suturing in the barbed sutures group was found significantly lower than in silk sutures (P<0.05). There was no significant difference between the suture types in terms of trismus and edema at 3 and 7 days after surgery (P>0.05). On the third day after surgery and during suture, removal pain scores were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). The Plaque Index values of the barbed sutures were statistically significantly lower than that of the silk sutures at 3 and 7 days after surgery (P<0.05). Aerobic, anaerobic, and aerobic/anaerobic mean colony forming units (CFUs) were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). Barbed sutures increase the ease of operation and patient comfort with less postoperative pain than silk sutures. Additionally, less plaque accumulation and lower bacterial colonization were found on the barbed/knotless sutures than on the silk sutures.

Effect of Heartfulness Meditation on Anxiety and Perceived Pain in Patients Undergoing Impacted Third Molar Surgery

Oral-maxillofacial surgical procedures like impacted third molar surgery (ITMS) may lead to increased perioperative anxiety and pain perception in patients. Psychological interventions like meditation have been shown to decrease acute anxiety levels in individuals. The purpose of this study was to investigate the effect of heartfulness (HFN) meditation during ITMS. We hypothesized that heartfulness meditation would reduce the intraoperative anxiety and pain perception in patients undergoing ITMS procedures. The prospective interventional study included 60 participants. They were randomly assigned to heartfulness meditation group (26 participants) and control group (34 participants). The heartfulness meditation group was given meditation before their ITMS procedure. Perioperative anxiety and pain perception were assessed using the Spielberger State - Triat Anxiety Inventory (STAI - T, STAI - S), Modified Dental Anxiety Scale (MDAS) and Numerical Rating Scale (NRS). Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe the data. Inferential statistics such as Chi-square test, Unpaired T test and Pearson correlation were used to analyze the data. The heartfulness meditation group reported less intraoperative anxiety (STAI - S) compared to the control group which was statistically significant (P < 0.002). There was a positive correlation between triat and situational anxiety levels of the participants. There was no significant difference between the groups in relation to dental anxiety and intraoperative pain perception. A single session of heartfulness meditation was effective in reducing the intraoperative anxiety levels in impacted third molar surgery. However, its effectiveness in reducing dental anxiety and pain perception was not significant.

Bibliometric analysis of international publication trends in impacted third molar surgery research (2000–2020)

In scientific fields, various methods of statistical analysis such as bibliometric analysis have been used to determine the effectiveness of journals, research, and articles. The aim of this study was to conduct a bibliometric analysis to systematically and understandably characterise publications on impacted third molar surgery (ITMS) from 2000 to 2020. The articles were retrieved on the same day (1 January 2021) from the Web of Science Core Collection (WoSCC) database of the Web of Science to prevent bias due to daily updates of the databases. A total of 3326 publications from 2000 to 2020 were analysed. The United States of America (USA) had the highest number of publications and h-index value. The highest number of co-citations were of Pell GJ. ITMS research was collected under nine ‘clusters’. In this study, developments, the most influential publications, journals, and countries in the research of ITMS were determined based on the evidence gained through bibliometric analysis.

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.

Efficacy of NSAID (Lornoxicam) After Impacted Third-Molar Surgery With/Without Conscious Sedation: A Double-Blind Randomized Clinical Study

Aim: Pain and swelling following surgery for impacted third molars can be controlled by various methods. This study compared the analgesic and anti-inflammatory efficacy and tolerability of lornoxicam, aspirin and a placebo with and without conscious sedation in impacted mandibular third-molar surgery. Materials and Methods: 60 patients undergoing third-molar surgery were divided into 2 groups of conscious sedation and routine local anesthesia (n=30). Both groups were divided into three subgroups (n=10) that received either Lornoxicam, aspirin, or a placebo postoperatively. Results: In both the conscious sedation and local anesthesia groups, swelling reduction was significantly greater with Lornoxicam compared to aspirin and placebo (pConclusion: Conscious sedation resulted less pain and swelling. Moreover, Lornoxicam was found to be an effective analgesic and anti-inflammatory agent for use in conjunction with oral surgery.

Lower Impacted Third Molar Surgery - Small Things, Big Improvements

Lower, impacted third molar surgery (ITMS) is a common procedure in oral & maxillofacial surgery around the world. By its nature, it often results in pain, swelling, trismus, bleeding, nerve dysfunction and postoperative infection. The author presents clinical study on 18 patients where ITMS were performed. Modified incision as a minimally invasive approach to lower impacted third molars jointly with suitable preoperative and surgical management significantly reduce postoperative symptoms usually accompanied with this type of surgery.

Assessment of pain, swelling and trismus following impacted third molar surgery using injection dexamethasone submucosally: A prospective, randomized, crossover clinical study

Background: Corticosteroids are known to reduce inflammation, fluid transudation, and edema. Secreted from the adrenal glands, these compounds have a significant role in maintaining metabolism. One of the essential roles played by steroids is their anti-inflammatory role. Aims and Objectives: This prospective, randomized, crossover, clinical study was conducted with the following aims and objectives: (a) to assess pain, swelling and trismus in patients undergoing surgical removal of impacted third molars, (b) to compare the pain, swelling and mouth opening with injection of submucosal dexamethasone 4 mg administered preoperatively, and (c) to compare the results with similar studies conducted elsewhere. Materials and Methods: The study sample involves 20 patients (40 impacted teeth-split arch) with the following inclusion criteria: Patient's reporting for surgical removal of symptomatic impacted mandibular third molars aged between 18 and 45, impacted mandibular third molar with similar anatomical position, and similar surgical difficulty (Pell-Gregory classification was followed), no allergies to medicines prescribed in the postoperative period, patients who are nonsmokers, nonalcoholics and without any systemic diseases, and not systemically compromised or not under long-term steroid therapy. Syndromic patients, patients with periapical pathologies were excluded from the study. Results: The results of the present study suggest that there is a significant reduction of pain, swelling and improvement in mouth opening following submucosal injection of dexamethasone at the end of the 1st postoperative day and the results are statistically significant. Conclusion: (a) Corticosteroids decrease pain, edema and swelling by exerting their anti-inflammatory role, (b) there is statistically significant difference in reduction of pain, swelling and improvement of mouth opening at the end of 1st postoperative day, (c) submucosal injection of dexamethasone is less traumatic, less painful and is effective in limiting postoperative discomfort to the patient, and (d) a similar prospective study is suggested comparing the efficacy of intravenous dexamethasone versus submucosal administration of dexamethasone.

Awareness of the Complications from Impacted Third Molar Surgeries among General Dental Practitioners

Introduction: Surgery of impacted third molars and the resultant complications are common occurrences in dental offices. Therefore, the present study was undertaken to determine the awareness of general dental practitioners in Tabriz of complications of surgeries of impacted third molars. Materials and methods: In the present study a researcher-made questionnaire was completed by 186 randomly selected general dentists in Tabriz. After collecting the questionnaires and extractions of data, descriptive statistical methods and chi-squared test were used to evaluate the relationship between personal demographic variables (independent) and the dependent variable of the study with SPSS 14. Statistical significance was set at P&lt;0.05. Results: The mean ± standard deviation of the awareness of the subjects of complications of surgery of impacted third molars was 9.87±2.66, with minimum and maximum scores of 2 and 16, respectively. Of 186 dentists included in the study, 15 (8.1%) had low awareness, 152 (81.7%) had moderate awareness and 19 (10.2%) had high awareness. Chi-squared test showed no significant relationship between awareness and other variables (age, gender and job experience) (P&gt;0.05). Conclusion: Based on the results, the awareness of general dental practitioners in Tabriz of the complications of impacted third molar surgeries was at a moderate level. Key words: Awareness; general dental practitioner; impacted third molar; complications

Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study.

Bromelain is the name given to a family of proteolytic enzymes obtained from Ananas comosus, the pineapple plant. It is considered a potent anti-inflammatory and antiedematous substance. Surgery of impacted third molars in the outpatient setting is one of the procedures most often associated with postoperative pain and swelling. The aim of this study was to evaluate the efficacy of bromelain in reducing postoperative pain and swelling. 80 patients were recruited to the study from patients attending the Maxillofacial Surgery Unit of the Istituto Stomatologico Italiano, Milan, Italy, for impacted third molar surgery. At time 0 when surgery was performed, patients started simultaneous antibiotic and analgesic therapy. On the following day, patients were divided into two groups. Patients in group 1 were prescribed bromelain. Patients in group 2 were prescribed only the analgesic if required. Three parameters were evaluated: pain, edema, and erythema. The first evaluation visit was performed 3 hours after surgery, the second 48 hours after surgery, and the final evaluation 7 days after surgery. Postoperative pain, edema, and erythema were significantly lower in the study group than in the control group. Analgesic consumption, both in terms of days of treatment and number of tablets taken, was slightly lower in the study group. Only one adverse event was recorded, which occurred in a patient in the control group. The present study demonstrates an important anti-inflammatory and anti-edematous effect of bromelain. Statistical analysis shows that in the group treated with bromelain the inflammatory response was significantly less than in the control group.

Comments on “Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery”

Comments on “Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery”

Effect of antibiotics on postoperative inflammatory complications in lower impacted third molar surgery

下颌第三磨牙阻生发生率很高,常引起冠周炎、邻牙远中龋、牙间骨吸收,少数可引起颌骨周围软组织间隙感染、颌骨骨髓炎、颌骨囊肿等并发症[1].下颌阻生第三磨牙拔除术后如何规范应用抗菌药物具有重要临床意义,但围手术期抗菌药物的选择和剂量并无明确的应用指南,国内外文献报道不一.不合理应用抗菌药物可能导致感染病菌的高度耐药而难以控制感染;另一方面加大了患者就医和整个社会的经济负担.现对下颌阻生第三磨牙拔除术围手术期应用抗菌药物能否预防术后炎性并发症的相关文献综述,以期对临床应用提供参考。

Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery

This study aims to evaluate the efficacy of the ozone and laser application in the management of pain, swelling, and trismus after third-molar surgery. Sixty consecutive patients with asymptomatic impacted mandibular third molars were recruited into the study. Patients were randomized into three treatment groups of 20 patients each: two study groups (group 1 = low-level laser therapy (LLLT), group 2 = ozone therapy) and a control group (no-LLLT or ozone therapy). Twenty teeth extractions were performed in each group. Evaluations of postoperative pain, the number of analgesics tablets taken, trismus, swelling, and quality of life (Oral Health Impact Profile-14 questionnaire) were made. The sample consisted of 28 female and 32 male patients, whose total mean age was 23.5 ± 3.4 (range, 18-25) years. The pain level and the number of analgesics tablets taken were lower in the ozonated and LLLT applied groups than in the control group. This study showed that ozone and low power laser therapies had a positive effect on the patients' quality of life. Trismus in the LLLT group was significantly less than in the ozonated and control groups (p = 0.033). Ozone application showed no superiority in regards of postoperative swelling; however, LLLT group had significantly lower postoperative swelling. This study demonstrates that ozone and laser therapies are useful for the reduction of postoperative pain and they increase quality of life after third-molar surgery. Although the ozone therapy had no effect on postoperative swelling and trismus after surgical removal of impacted lower third molars, LLLT had a positive effect.

Factors associated with facial swelling severity following impacted lower third molar surgery: A prospective study

The ultimate purpose of this prospective study is to estimate and measure swelling associated with surgical extraction of impacted mandibular third molars in different four post-operative times and to identify the risk factors associated with determination of their risk degree. Material and Methods: In this prospective cohort study 159 consecutive cases in which removal of impacted lower third molars in 107outpatients were evaluated. Five groups of variables have been studied which are regarded as a potential factor for swelling after mandibular third removal which will enable the surgeon to predict and counsel high risk patients in order to offer a preventive strategy. Results: Facial measurements were carried out on 1 st, 2nd days, 1st and 2nd week postoperatively to measure the swelling area in each time respectively The peak level of swelling was noted on the second post-operative day and subside by seven days but in some cases the swelling was still in minor degree while in most patients it was zero by day 14. Conclusions: The degree of difficulty of the surgical extraction was the main indicators of risk factors for the swelling in all post-operative days because it involves all the other risk factors together.

Efficacy of ibuprofen versus lornoxicam after third molar surgery: a randomized, double-blind, crossover pilot study

The aim of this study is to compare the analgesic efficacy and tolerability of a pre-emptive/post-surgery 4-day regimen of oral ibuprofen 400 mg with that of lornoxicam 8 mg. Sixteen patients received ibuprofen or lornoxicam, respectively, before and after surgery of impacted third molars in two separate appointments, in a double-blind, randomized, and crossover design. The postoperative analgesic and rescue medication consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 6, 24, 48, and 72 h, postoperatively. No statistically significant differences were found between ibuprofen 400 mg and lornoxicam 8 mg with respect to study medication (p = 0.34) or rescue analgesic consumption (p = 0.5) (SUMstudy and SUMrescue). Ibuprofen: SUMstudy median 7.5 interquartile range IQR (4.25-8), 95% CI (4.6-7.7); SUMrescue median and IQR 0, 95% CI (-0.6-4.6). Lornoxicam: SUMstudy median 7 IQR (3.75-9), 95% CI (7.7-4.9); SUMrescue median and IQR 0, 95% CI (-0.7-2.7). The area under the pain intensity curve (AUC(2-72) PI) over the 4 days of investigation did not reveal significant differences between the two medications (p = 0.32). AUC(2-72) PI ibuprofen: median 1,509.7 IQR (712.36-2,444.65); 95% CI (1,078.7-2,156.5). AUC(2-72) PI lornoxicam: median 1,166.9 IQR (783.4-2,221.2), 95% CI (1,032-2,130.6). Moreover, patient satisfaction and incidence of adverse events did not reveal any significant differences between treatment groups. Ibuprofen 400 mg and lornoxicam 8 mg were rated as equal and effective pain treatment medication after wisdom tooth surgery. In comparison, neither of the drugs provided clinical advantages nor did side effects occur more frequently after one of the analgesics.

Mandibular impacted third molar Surgery and Drains: a review of the literature.

Pain, swelling and trismus are the most common causes of discomfort and postoperative morbidity after the surgical removal of impacted lower third molars under local anesthesia. A review of literature shows that the existence of these postoperative variables after the surgical removal of impacted lower third molar are well known and could lead to a reduction in the postoperative quality of life of patients. Reducing or minimizing these postoperative variables seems a laudable goal especially if wound healing is not compromised. Several studies carried out have not pointed on any systemic or local agent used without any adverse effect. Oral surgeons have used drains after the surgical removal of mandibular impacted third molars to minimize postoperative morbidity with varying degrees of success. The use of a drain in association with primary suture after the surgical removal of the impacted lower third molars allows the patient to experience a more comfortable postoperative period in relation to pain, swelling and trismus, because it permits the drainage of fluids located in the tissue spaces. The purpose of this study is to review the effects of drains after the surgical removal of impacted lower third molar so that oral surgeons carrying out lower third molar extraction may be properly informed to consider the use of drains to minimize the postoperative discomfort. Keywords : third molar surgery-morbidity-use of drain Journal of College of Medicine Vol. 12 (2) 2007: pp. 80-84

A technique to manage gingival complications of third molar surgery.

Iatrogenic damage to the gingiva of the mandibular second molar is an often overlooked complication associated with surgery of impacted mandibular third molars. During impaction surgery, the peripheral gingival soft tissues may be damaged on flap elevation or destroyed during bone removal or tooth sectioning with rotary instruments. Loss of the often-thin band of keratinized gingiva of the second molar predisposes a patient to pain, plaque retention, inflammation, gingivitis, pocket formation, periodontitis, and alveolar bone loss. The surgically-induced bone defect associated with impaction removal exacerbates the aforementioned problems, which are difficult to treat with conventional techniques. This article attempts to address this issue and presents an new technique to manage such gingival complications.

Pain development and consumption of analgesics after oral surgery in relation to personality characteristics

In the present study a survey has been performed of the pain development and analgesic intake in 100 patients following elective oral surgery of impacted third molars in relation to preoperative assessment of personality characteristics. Our results show that no sex differences existed preoperatively concerning personality characteristics, concerning postoperative pain development or analgesic consumption. Fourteen patients reported no pain at all and 40 patients did not use any analgesics in the postoperative period. We also found a good correlation between total sum of pain scores and analgesic intake. Patients undergoing surgery in the morning reported a lower total sum of pain scores, reported pain at fewer occasions and tended to require less analgesics than patients being subjected to surgery in the afternoon. The patients who reported a total sum of pain scores in the upper percentile during the postoperative period rated their general health worse, as rated on the General Health (GH) questionnaire, and used more analgesics than did patients in the lower percentile. Also, patients not using any analgesics reported less symptoms of distress according to the GH scale as compared to patients using analgesics. In general, however, less than 10% of the variance in postoperative pain and consumption of analgesics could be explained by the preoperative factors studied.