Molar Surgical Extraction Research Articles

Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction

Impacted third molar extraction causes considerable swelling in the days immediately following surgery. The aim of the present investigation was to evaluate the efficacy of methylprednisolone as a single 40-mg intramuscular dose in controlling the complications of impacted lower third molar surgical removal. Thirty-five patients were evaluated within the framework of a consecutive sampling and double-blind study with intrasubject measurements. Extraction comprised ostectomy with tooth sectioning of both lower third molars under local anesthesia. The study group received 40 mg of methylprednisolone injected into the gluteal region, while the controls received no such medication. In each individual one molar was randomly assigned to the study group and the other to the control series - with extraction of the two teeth being spaced 1 month apart. Evaluations were made of postoperative pain, trismus and swelling, and measurements were obtained for oral aperture and various distances (tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye) before surgery and 2-7 days after extraction. Statistical correlations were made based on the Student t-test for the comparison of means of related samples. A statistically and clinically significant association was observed 2 days after surgery between methylprednisolone administration and increased oral aperture and diminished facial swelling. Likewise, less pain was recorded in the study group 6 h after surgery. The results confirm the efficacy of methylprednisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.

(773): Efficacy of a single dose of tapentadol HCl for analgesia after third molar surgery

Tapentadol HCl is a new dual mode analgesic (μ-agonism and norepinephrine reuptake inhibition). We investigated whether this compound produces high analgesic efficacy with improved tolerability compared to a pure μ-agonist. The efficacy and safety of single oral doses of tapentadol HCl (25, 50, 75, 100, or 200 mg), morphine sulfate (60 mg), ibuprofen (400 mg), and placebo were evaluated in a phase II, randomized, double-blind, double-dummy, placebo-controlled trial. Adult patients (N= 400) with moderate-to-severe dental pain following mandibular third molar surgical extraction were randomized within 6 hours of surgery. The primary efficacy endpoint, total pain relief over 8 hours after administration of study medication (TOTPAR-8), was measured by assessing pain relief compared with baseline pain on a 5-point verbal rating scale (0= none, 1= a little, 2= some, 3= a lot, 4= complete pain relief). TOTPAR-8 scores were greater for tapentadol HCl 75 mg (P≠ 0.05), 100 mg (P≠ 0.001), and 200 mg (P≠ 0.001) when compared with placebo; mean TOTPAR-8 scores for tapentadol HCl 200 mg and morphine sulfate 60 mg were 15.3 and 13.8, respectively. Total pain relief after 4 hours was higher and onset of action appeared to be more rapid for tapentadol HCl 200 mg than morphine sulfate 60 mg. The mean level of pain relief obtained with morphine sulfate 60 mg was between that achieved with tapentadol HCl 100 mg and 200 mg. The most commonly reported adverse events for tapentadol HCl 200 mg and morphine sulfate 60 mg were dizziness, nausea, vomiting, and somnolence. Most adverse events were considered mild or moderate in intensity. Thus, a single oral dose of tapentadol HCl from 75 to 200 mg is effective and well-tolerated for the relief of moderate-to-severe dental pain following third molar surgery. Tapentadol HCl is a new dual mode analgesic (μ-agonism and norepinephrine reuptake inhibition). We investigated whether this compound produces high analgesic efficacy with improved tolerability compared to a pure μ-agonist. The efficacy and safety of single oral doses of tapentadol HCl (25, 50, 75, 100, or 200 mg), morphine sulfate (60 mg), ibuprofen (400 mg), and placebo were evaluated in a phase II, randomized, double-blind, double-dummy, placebo-controlled trial. Adult patients (N= 400) with moderate-to-severe dental pain following mandibular third molar surgical extraction were randomized within 6 hours of surgery. The primary efficacy endpoint, total pain relief over 8 hours after administration of study medication (TOTPAR-8), was measured by assessing pain relief compared with baseline pain on a 5-point verbal rating scale (0= none, 1= a little, 2= some, 3= a lot, 4= complete pain relief). TOTPAR-8 scores were greater for tapentadol HCl 75 mg (P≠ 0.05), 100 mg (P≠ 0.001), and 200 mg (P≠ 0.001) when compared with placebo; mean TOTPAR-8 scores for tapentadol HCl 200 mg and morphine sulfate 60 mg were 15.3 and 13.8, respectively. Total pain relief after 4 hours was higher and onset of action appeared to be more rapid for tapentadol HCl 200 mg than morphine sulfate 60 mg. The mean level of pain relief obtained with morphine sulfate 60 mg was between that achieved with tapentadol HCl 100 mg and 200 mg. The most commonly reported adverse events for tapentadol HCl 200 mg and morphine sulfate 60 mg were dizziness, nausea, vomiting, and somnolence. Most adverse events were considered mild or moderate in intensity. Thus, a single oral dose of tapentadol HCl from 75 to 200 mg is effective and well-tolerated for the relief of moderate-to-severe dental pain following third molar surgery.

A comparative study of the effect of different third molar impactions on postoperative morbidity following lower third molar surgery

Background : The surgical removal of impacted lower third molar is one of the most frequently performed procedures in oral and maxillofacial surgery and represents a standard operation. Patients' complaints of pain, swelling and limitation in mouth opening associated with inflammatory response following lower third molar surgical extraction is an important factor affecting their daily life. The type of molar impaction has been associated with the increased postoperative morbidity following surgical removal. Objectives : The aim of this study is to compare the effect of different molar impactions according to George Winter on postoperative pain, swelling and trismus, which occur after lower third molar surgery. Patients and Methods : A comparative study of the effect of different lower third molar impactions on postoperative pain, swelling and trismus was carried out among 100 patients of both gender attending the oral and maxillofacial surgery unit of University of Nigeria Teaching Hospital, Enugu between January 2004 and February 2005. The molar impactions were mesioangular; 35, vertical; 26, horizontal; 23 and distoangular; 16. There were 40 (40%) males and 60 (60%) females all between the ages of 18-40 years. Pain, swelling and trismus were evaluated at 24 hours, 72 hours and 5 days postoperatively. The measurements obtained were recorded and converted to relative values, which provided numerical data for the comparative analysis. Results : The result of the study showed that mesioangular impaction had the highest reduction in all the postoperative variables followed by the horizontal impaction at all the evaluation periods while distoangular impaction had the least. Conclusion : The type of impaction according to Winter is associated with postoperative morbidity after lower third molar surgery. Distoangular impaction tends to have high rate of postoperative morbidity than others. This calls for adoption of extra measures in minimizing these postoperative variables by oral surgeons carrying out third molar surgery especially during distoangular disimpaction. Keywords : third molar surgery; different impactions; morbidity. Journal of College of Medicine Vol. 11 (2) 2006: 82-87

Dry Socket An Apriasal And Surgical Management

Dry socket is the most painful and annoying complication that occurs after dental extraction and mostly associated with mandibular third molar surgical extraction. This is also known by various terms like alveolitis, alveolalgia, alveolar osteitis, fibrinolytic osteitis and alveolitis Sicca doloerosa. These various terms reflect the uncertainty of etiopathlogcal process of dry socket. In this presentation, the review of the clinical appearance, risk factors related to this condition and to discuss the various etiopathlogcal theories of dry socket. An effort has been made to describe the various modalities in the management of this complication and stress has been made in prevention, analysis of various drugs used with their results. The surgical management of this condition has been presented which has contributed promptly the relief of pain as well as apprehension associated with dry socket.

Efficacy of rofecoxib and nimesulide in controlling post-extraction pain in oral surgery: a randomised comparative study

SUMMARYRofecoxib 50 mg day−1 for 6 days provided better postoperative analgesia than nimesulide 200 mg day−1 in a randomised trial in patients (n = 130) undergoing surgical extraction of third molars. The superiority of rofecoxib over nimesulide was especially marked during the first 2–3 postoperative days and in patients with fullyimpacted molars. The drugs had similar effects on clinical signs of local postoperative inflammation. The effectiveness of rofecoxib in this study, plus considerations of the toxicity profile of nimesulide, support the conclusion that rofecoxib is preferable to nimesulide for relief of post-operative pain in patients undergoing surgical extraction of molars.

In reply

We would like to thank Dr Üçok for his careful reading of our article. The omission of the article he cites in the letter demonstrates one of the limitations of systematic reviews. Computer database searches are used to identify articles for inclusion in these reviews. Because we were evaluating lingual nerve and third molars, these words, as well as the other combinations outlined in our review, were linked together for the search. If the individual indexing an article for the computer database does not include both terms, the article will not be found when searching for the combination of words. In fact, we repeated the search using the combinations of words and did not find the article. The article is cited when morbidity and third molars are used in combination. Because the combination of morbidity and third molars produced so many citations of unrelated articles, we decided not to use the combination. It is not surprising that the article was not found through use of our search methods. The title of the manuscript does not include comments related to sensory impairment, and the abstract does not report the incidence of sensory impairment associated with the 2 surgical techniques used to remove the third molars. In the article, the only mention of sensory function is in the last part of the last sentence in “Results,” which states, “… and no one experienced sensory impairment of the inferior alveolar or lingual nerves.” Although the article was missed, the results from the 20 patients who participated in the study do not alter the outcome of our systematic review. Temporary numbness of the lingual nerve caused by using the lingual split technique would be 9.54% instead of 9.63%, and permanent numbness would remain the same, 0.14%. Temporary numbness of the lingual nerve caused by using the buccal approach with a retractor would be 6.30% instead of 6.35%, and permanent numbness would be 0.62% instead of 0.63%. We certainly apologize for missing Dr Üçok's article and thank him for carefully reading our review and letting us know about our omission. Even though computer database searches sometimes miss an article, it is the best method currently available to systematically review the literature and find evidence to support clinical decisions. Dr Üçok's letter also gave us an opportunity to find 2 recent articles that were published after the submission of our systematic review. Gargallo-Albiol et al 1 Gargallo-Albiol Buenechea-Imaz R Gay-Escoda C. Lingual nerve protection during surgical removal of lower third molars. Int J Oral Maxillofac Surg. 2000; 29: 268-271 Abstract Full Text PDF PubMed Google Scholar reported the results of a randomized controlled trial comparing protection of the lingual nerve with and without a lingual retractor. This study meets our inclusion criteria for review and included the extraction of 300 third molars. These investigators did not find a significant difference in temporary numbness to the lingual nerve with and without the lingual retractor and no patients had permanent numbness. Adding these data to our results did not change the results of our review. The investigators found that 3 patients had numbness with the retractor and 1 patient had numbness without the retractor. A second study 2 Valmaseda-Castellon E Berini-Aytes L Gay-Escoda C. Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 567-573 Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar reported in this Journal found greater lingual nerve damage after third molar removal with a lingual retractor than without the retractor. This was a prospective clinical study involving consecutive patients having third molars removed by various surgeons. The decision to use the lingual retractor was based on the surgeon's preference. This study does not meet our inclusion criteria and would not have been considered for detailed analysis. These 2 articles demonstrate that systematic reviews must not be based on a particular outcome but on the validity of the study. The systematic review establishes inclusion and exclusion criteria to identify the “best” evidence available. Sometimes the studies available for review are inadequate to make a definite conclusion. The current evidence for the use of a lingual retractor when removing lower third molars indicates that there is greater tendency for temporary numbness of the lingual nerve. It is unclear whether the retractor protects the lingual nerve from permanent numbness, because permanent numbness is very low for extraction done with and without the lingual retractor.

Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions

The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury. We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury. Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model. Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. Older patients were at a higher risk for suffering permanent injuries.

Lingual nerve damage after third lower molar surgical extraction.

Our objectives were to establish the incidence of lingual nerve damage after surgical removal of lower third molars, to identify the causes of the damage, and to construct a predictive model to assess the risk of lingual nerve injury. We conducted a nonrandomized prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in a university department of oral surgery. Preoperative, intraoperative, and postoperative data were gathered, and causal factors of lingual nerve damage were identified by using nonparametric tests and Pearson chi-square and Fisher exact tests. A prediction of lingual nerve injury risk was obtained by using logistic regression. Of the extractions, 2.0% caused temporary nerve damage, though no lesion lasted more than 13 weeks. Lingual flap retraction, vertical sectioning of the tooth, surgeon inexperience, lingual angulation of the tooth, and prolonged operating time significantly increased the risk of nerve damage (P <. 05). The first 3 factors were included in a predictive logistic regression model. Anatomical factors such as lingual angulation of the third molar, surgical maneuvers such as retraction of the lingual flap or vertical tooth sectioning, and surgeon inexperience all increase the risk of lingual nerve damage, although permanent lesions seem to be very rare.