Surgical Removal Of Third Molars Research Articles

Influence of the maxillary third molars and the surrounding cortical plate during maxillary tooth movement with TADS- A CBCT Study.

To determine the influence of the presence/absence of third molars and intact/loss of cortical plate of the maxillary tuberosity on the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary dentition with mini-implants. Thirty six maxillary tuberosity sites were evaluated in eighteen young adult patients. The distal movement of the entire maxillary dentition was performed with mini-implants with 200g of distalising force applied from the mini-implant placed in the maxillary posterior buccal region to attachments placed on the arch wire between the maxillary lateral incisor and canine bilaterally. The distal movement of the maxillary first permanent molars was measured on lateral cephalograms. The maxillary tuberosity sites with intact cortical plate due to congenitally missing third molars or atraumatic extraction of third molars (G1), partial loss of cortical plate due to surgical removal of third molars (G2), fully erupted third molars (G4), third molars located at (G3), and below the cementoenamel junction (G5) were evaluated with cone beam computed tomography. One way Anova and Fisher LSD test was done. The order of greater to lesser amount of distal movement of the maxillary first permanent molar depending on the integrity of maxillary of tuberosity was partial loss of cortical plate, third molars at the cementoenamel junction, third molars below the cementoenamel junction, intact cortical plate and fully erupted third molars. The integrity of the cortical plate and the relative position of the maxillary third molar to the second molar influence the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary teeth with TADS. The amount of distal movement of the maxillary dentition appears to depend on the presence or absence of the third molars and the condition of the cortical plate in the region of the maxillary tuberosity and thereby greatly influence the outcome of treatment.

Impact of Suturing Techniques on the Periodontal Health Status of Mandibular Second Molar After Extraction of Fully Impacted Third Molars

Mandibular third molars are appeared to be the most common congenitally impacted teeth the fact that may cause many problems in different fields of dentistry. surgical removal of the impacted tooth seems to be the only solution for these problems. An important complication to address is the risk of developing periodontal breakdown ( loss of attachment) and deep periodontal pocket on the distal aspect of the adjacent mandibular second molar after surgical removal of third molar. The aim of the present study is to evaluate and compare the effect of 4 suturing techniques: (Simple loop , Figure 8 suture, Anchor suture and Closed anchor suture) on the periodontal health status on the distal aspect of the adjacent mandibular second molar after surgical removal of lower impacted third molar.Forty patients having fully impacted mandibular third molars were enrolled in this study and divided to 4 groups (Group A: Simple loop , Group B: Figure 8 suture, Group C: Anchor suture and Group D: Closed anchor suture), each group consisted of 10 patients. Surgical extraction of impacted third molars were carried out for them. Probing pocket depth (PPD) and clinical attachment level (CAL) were recorded preoperatively and 6 months after surgery. On 6 months after surgery the mean values of PPD and CAL were significantly increased on the distal surface of the adjacent mandibular second molar in simple loop & figure 8 techniques. On the other hand, no significant difference has been noticed between anchor & closed anchor techniques in comparison with preoperative values. After 6-months, PPD and CAL values of were significantly higher in thesimple loop and figure 8 techniques compared to anchor andclosed anchor techniques. The present study concluded that closedanchor suture & anchor suture techniques are preferable to closethe flaps in surgical removal of impacted mandibular third molarsto maintain a good health status on the distal side of the adjacentmandibular second molar.

Occurrence and Predictors of Postoperative Preauricular and Masticatory Muscle Pain Symptoms After Surgical Removal of Third Molars: A Single-Blind Randomized Controlled Trial Comparing Dental Assistants Supporting the Mandible and the Restful Jaw Device

During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support instead of the DA. This study compared the occurrence of postoperative preauricular and masticatory muscle pain symptoms (PMMPS) between the device and DAs providing mandibular support, using two outcome measures. Secondary aims identify predictors of outcome and providers' opinions of the device. In this multisite, single-blind, two-arm parallel randomized trial, participants without preoperative PMMPS had surgical removal of third molars, with sedation and bite blocks were randomly assigned to manual support or the device. The exposed group was randomly assigned to the device and the nonexposed group to manual support. The primary outcome was patient-reported PMMPS. Two secondary outcomes were pain assessed with the temporomandibular disorder Pain Screener and providers' views on the device. Outcomes were assessed at 1-, 3-, and 6-month postsurgery. The covariates are baseline demographics (eg, sex), clinical characteristics (eg, eruption status), and third molar surgeries. For occurrence of pain, generalized estimating equations assessed differences between groups. Logistic regression analysis assessed predictors of pain at 1month, per the Screener. The level for statistical significance was 5%. Enrollment was 86 and 83 participants in the device and DA groups, respectively. The average age was 20.8years; the majority were female (65%) and Caucasian (66%). The retention rate was ≥95.9%. The groups did not differ significantly for occurrence of pain using the primary and secondary outcome measures at any follow-up (P≥.46). Fully impacted molars were associated with occurrence of pain (odds ratio=3.44; 95% confidence interval 1.49-7.92; P=.004). Occurrence of pain using the primary and secondary outcome measures did not differ significantly between groups at any follow-up and was associated with removal of fully impacted third molars. Four out of five surgeons reported wanting to use the device on a regular basis when performing this procedure in sedated patients.

Surgical removal of third molars in a young adult: review of indications and surgical techniques.

Germectomy is a surgical method most typically performed in young adults. The indications for treatment are controversial. The purpose of this review was to determine the correct indications for germectomy and to discuss the advantages and disadvantages of the procedure. We reviewed the surgical techniques (anesthetic methods, patient preparation, and flap designs) and complications. Germectomy for orthodontic purposes is a common indication for surgical removal of tooth germ among young patients. Several studies have supported removal at an earlier age to produce fewer surgical complications. Several surgical techniques have been described in the literature.

Conventional Rotary Technique and Piezosurgical Technique in the Removal of Impacted Mandibular Third Molar: A Comparative Study.

To compare the operating time, postoperative pain, edema, trismus, and patient acceptance following surgical removal of impacted third molar using piezosurgery and conventional rotary technique. About 42 patients with impacted mesioangular mandibular third molars were included in this study. Subjects are divided into two groups: group I (treated with conventional rotary technique) and group II (treated with piezosurgery). Duration of surgery, pain, trismus, and swelling were assessed. The patients were evaluated on the 1st, 3rd, and 7th postoperative days. Postoperative pain, trismus, and edema were reduced with piezosurgery compared with conventional technique. Even though the duration of time was longer with piezosurgery, patient comfort was found to be better. Piezosurgery is a meticulous and innovative ultrasonic technique with selective bone cutting and better postoperative outcomes. However, it is expensive, and the operating time is prolonged. Piezosurgery is an alternative in the surgical removal of third molars as it ensures precise and selective cutting, with no injury to the surrounding soft tissues. Postoperative outcome and patient acceptance are improved with piezosurgery.

Dentists’ perception of third molar surgery in the Kingdom of Saudi Arabia: A cross sectional pilot study

Concerns about the indications for the surgical removal of third molars have not yet reached a decisive agreement. The aim of the study was to evaluate the perception and practice of Saudi' dentists when encountering third molars clinical situations including diagnosis, treatment, and postsurgical care. A cross-sectional survey was conducted and approved by the ethics research committee at Prince Sattam Bin Abdulaziz (PSAU). The survey comprised of four sets of questions with multiple-choice answers including the participants' details and type of practice (private or government), clinical awareness and attitude regarding lower third molars surgery, and the confidence level of dentists when performing third molars extraction. The survey was published online with a timeframe of three months to respond. 196 participants responded to the designated survey (55 dental interns and 141 general dental practitioners (GPs)). Most responses (80.1%) were from Riyadh province (central region). There was a significant difference between GPs and interns in terms of impacted third molars with associated cystic lesions, bony impactions, and diffuse pain (P<0.05). Male dentists tend to prescribe antibiotics more than female dentists (P=0.001) and GPs more than interns (P=0.027). The results also indicated that male dentists were more confident than females when performing third molar extraction. Generally, female dentists preferred to have further training on such surgery (P<0.05). Continuing professional development programs both during dental internship and general practice are recommended to improve the required skills of third molar extraction.

Historical aspects about third molar removal versus retention and distal surface caries in the second mandibular molar adjacent to impacted third molars.

This paper provides an insight into the historical recommendations regarding removal of mandibular third molars, as set out by the Royal College of Surgeons of England and the National Institutes of Health in the USA, as well as regional guidance from the National Institute for Health and Care Excellence and the controversy that surrounds surgical removal of third molars. The influences of third molar management as it developed in the UK, the historical economic evaluations, and the available evidence base on third-molar removal versus retention are described. This article seeks to address the growing concerns regarding the increasing frequency of distal surface caries (DSC) in mandibular second molar teeth when the decay is associated with asymptomatic, partially erupted, mandibular third molars, especially when they are mesially or horizontally impacted. Lastly, we illustrate radiographs of patients affected by DSC and how guidance that has been issued by a guideline institution regarding third molar surgery, even though it is based on insufficient evidence, is perceived as a strictly compulsory clinical strategy, and has been used in clinical practice in the UK for more than 20 years.

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study

This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

Bromelain vs trypsin-chymotrypsin in management of complications following surgical removal of mandibular third molar

Surgical removal of third molars is still the most common routine surgical procedure done by oral and maxillofacial surgeons which is usually associated with postoperative sequelae. In order to avoid or minimize post-surgical complications such as swelling, pain and trismus, patients are advised to use proteolytic enzyme and NSAID’s along with routine antibiotics. 50 patients who have bilateral symmetrical impacted mandibular third molars were included in the study. Post operatively, all patients were given antibiotics and analgesics for 5 days. Patients were given bromelain for 5 days after the procedure on one side and trypsin-chymotrypsin for 5 days on the other side with an interval of 21 days between the two procedures. Patients were recalled on day 1, day 3 and day 7 for assessment of post- operative trismus, pain and swelling based on measuring inter-incisal distance, visual analogue scale and, facial reference points. Data was gathered and statistical assessment was done using SPSS software by using descriptive statistics and chi square test. The conclusion drawn from the study was that bromelain has a significant effect on swelling, mouth opening and pain after surgical removal of impacted third molar than chymotrypsin. We suggest its usage in reduction of swelling and pain post operatively after surgical removal of third molar. However further studies with larger sample size and randomizations are required to confirm the same.

Oral surgery waiting lists at an Australian university dental school

AbstractObjectiveThe aim of this study was to investigate the waiting times experienced by patients referred to an Australian University oral surgery clinic over a 2‐year period.Materials and methodA single‐centre retrospective study was conducted to determine the waiting times for oral surgery services at the Griffith University postgraduate clinic. The first 233 patients were selected out of a total of 587 randomised patients and data collected regarding referral sources, procedures undertaken and the number of days from referral to consultation, then to treatment collected from the clinic's management software.ResultsOf the 233 referrals, 121 were female (52%) and 112 male (48%). Many patients were between 20 and 29 years representing approximately 40% (n = 93) of the sample. Analyses of referred patients showed that a significant number of public (i.e. non‐private‐paying) patients (73%, n = 170) were treated in the study period. Most patients waited only 1–2 weeks to be seen for a consultation from date of referral and treatment from date of consultation. Nearly half (49.7%, n = 116) were treated within 2 months of being referred. Once the patient was referred, the overall mean waiting time was 44 days from referral to treatment. Treatment comprised of either procedures undertaken under local anaesthesia (LA) (76.7%, n = 179) or consultations only with patients either declining treatment, deemed not in need of surgical intervention, or referred for more advanced management such as the need for general anaesthesia (23.3%, n = 54). Surgical removal of third molars (36.1%, n = 84) was the most common reason for referral.ConclusionA variety of minor oral surgery procedures can be provided under local anaesthesia with acceptable accessibility and shorter public oral surgery waiting lists.

Influence of a novel suturing technique on periodontal health of mandibular second molar following impacted third molar surgery: a split-mouth randomized clinical trial

BackgroundSurgical extraction of the third molar is the most common surgical procedure in the oral surgery field and is associated with several complications. This study aimed to compare the effects of a newly presented suturing technique with the routine suture after surgical removal of the third molar on the postoperative complications.Materials and methodsThis randomized clinical trial was designed as a split-mouth double-blinded investigation. Twenty patients were involved in the current study. After the surgical removal of the third molar, the new suturing technique was used to close the wound on one side of the patient randomly (case side), and the other side was sutured by the routine simple interrupted stitches (control side). Pain, edema, trismus, pocket depth, and the attachment loss of the distal of the second molar were assessed following the surgery. The data were statistically analyzed and compared between the sides.ResultsPain and edema following the surgery in the control side were significantly less than in the case side. The pocket depth and the gingival attachment loss of the distal aspect of the second molar in the case side were significantly less than in the control side. No case of dry socket was observed in the case side.ConclusionIt seems that the newly presented suturing technique is able to keep the wound margins close to each other and may be helpful in reducing the periodontal complication of the second molar following the surgical removal of the impacted third molars.

Characteristics of Juxta-apical Radiolucency as Risk Factor of Inferior Alveolar Injury

Introduction: Juxta-apical radiolucency (JAR) is introduced as a new risk factor for inferior alveolar nerve (IAN) injury; following the removal of the third molar. Thus, the aim of the present study was to examine the relationship of JAR to IAN, cortical plates, and its position with regards to IAN and tooth angulation.&#x0D; Materials and Methods: The present case-control study comprising a sample of 545 Cone Beamed CT scans of mandibular third molars examined 75 JAR cases and 75 control teeth. The relationship of JAR to IAN, its position with regards to IAN, lingual cortical plate thinning, teeth position and angulation were investigated. Descriptive analyses, chi-square and fisher exact tests were performed with a value of 0.05 considered significant.&#x0D; Results: Mesioangular teeth were the most common in both groups. Based on tooth angulation, no significant difference was detected between case and control groups (p value = 0.346). There was no significant difference between the two groups, with regards to JAR and tooth proximity to IAN (p value = 0.578). Although, the most prevalent position in the JAR group was lingual and superior in the control group, but no significant difference was observed between them (p value = 0.122). Most cases of JAR (84.0%) and most cases of control group (77.3%) showed some degree of cortical thinning. Based on this, no significant difference was present between the JAR and control groups (p value = 0.626).&#x0D; Conclusion: JAR is generally in contact with mandibular canal and some degree of cortical thinning manifest in most of these cases. These findings suggest a possible increase in the risk of nerve injury during surgical removal of third molars.

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.

Risk factors of complications subsequent third molar extractions: A prospective cohort study

Objective: The aim of this study was to determine the complications that were associated with the surgical removal of third molars (M3s), and to assess the association of patient, anatomic, and surgical risk factors with the postoperative complications of surgically removed impacted M3s. Material and Methods: This study was a cohort prospective study conducted on patients, aged 17 and older, admitted to the oral and maxillofacial surgery clinic. All patients who needed 1 or more extractions were included and totalled 268 patients with 314 extracted teeth. Risk factors were divided into patient factors, anatomic factors and surgical factors. The postoperative complication variables mainly included: pain, alveolar osteitis, infection, bleeding, swelling, trismus. Statistical analysis used: Chi-square test was used for the bivariate analyses while Pearson correlation coefficient (1- tailed) test was used for the purpose of determining the association between the study variables. The significance of associations was considered statistically significant at P &lt; 0.05. Results: Patients aged of 25 years and above experienced more complications, 39 (88.6%). With respect to gender, females experienced more complications, 29 (65.9%). Mandibular M3s had more complications than maxillary M3s, 34 (8.0%), followed by distoangular inclined M3s, 23 (52.3%), and last was full bony impaction, 13 (29.5%). Pain was the most frequent complication, 18 (40.9%), followed by alveolar osteitis 12 (27.3%). Conclusion: The results indicated that the most frequently complications were pain, infection, alveolar osteitis. These complications were associated with common risk factors such as age, gender, medical history, M3 angulation, impaction level, bone removal, tooth sectioning, and number of M3 removed per session. Keywords Complications; Surgical extraction; Third molar.

Evaluating the presence of IAN injury in patients with juxta-apical radiolucency after third molar surgery: a retrospective cohort study

BackgroundJuxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with IAN injury in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates.MethodsOf an initial sample of 545 mandibular third molars, a total of 75 JAR+ and 75 JAR− teeth were evaluated by CBCT. We assessed the relationship between the presence of JAR in cone-beam computed tomography (CBCT) images and the presence of IAN injury after mandibular third molar surgeries. Moreover, we investigated whether the presence of IAN injury is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. Descriptive statistics, Chi-square test, and Fisher’s exact test were performed for statistical analysis.ResultsA significant relationship was found between JAR and temporary IAN injury (P = 0.036). However, there was no case of permanent IAN injury. IAN injury showed no significant relationship with the tooth angulation, position to IAN and proximity to the mandibular canal, lingual cortical plate thinning, sex, and age.ConclusionsJAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary IAN injury. JAR may increase the risk of nerve injury during the surgical removal of third molars.

Post Treatment Complications after Removal of impacted third molar: A Retrospective Study

AbstractIntroduction: Removal of third molar is that the most typical intervention performed procedure related to an honest array of complications. the foremost commonly encountered complications are pain, paraesthesia, trismus, swelling and mandibular fractures.&#x0D; Aim: The objective of this study was to study the complication associated with extraction of impacted third molar with age.&#x0D; Materials and Method: All the surgical removal of third molars which were performed within a private clinic during 1-year period from October 2019 – October 2020 were retrospectively analysed and included within the study. Presence of post-operative complications like pain (more than 3 days), paraesthesia, mandibular fracture, Alveolar osteitis (dry socket), bleeding, trismus or edema in conjunction with demographic features and thus the type of impaction was noted. Data was arranged during a tabulated form and analyzed using Epi Info software. Result: There are 59 males and 56 females who underwent transalveolar extraction of third molar. The mean age of females was 47.21 12.2 years and males were 48.32 11.5 years. It had been found that pain was the foremost commonly encountered complication, seen in 57.4% of the patients. Pain was followed by swelling which was seen in 42.2% of the themes. Trismus ranked third, seen in 23.2% of subjects. It was found that pain was most frequently seen among the age group of 20(21.6%) and least frequently seen amongst 20-40 years aged (15.2%). &#x0D; Conclusion: Pain was the foremost common complication followed by swelling and Trismus. Keywords: pain, paraesthesia, third, molar, complication.

Lingual split bone technique – Revisited as a standard operating procedure for surgical removal of third molar during COVID pandemic

Objectives: The objective of the study is to revisit the forgotten art of Lingual split bone technique during the COVID pandemic as a Standard Operating Procedure (SOP) for the surgical removal of impacted mandibular third molars. It was originally introduced in early 90’s by Sir William Kelsey Fry and also we have compared its advantages over the bone guttering technique. Materials and Methods: Twenty seven cases were operated during COVID pandemic in our institution using Davi’s modified lingual split technique under strict COVID protocol. Results: All impacted mandibular third molars were successfully removed. With regards to post-operative complication; 3 patients had nerve injury (11%), 2 patients had lingual paraesthesia (7.6%), 1 patient had alveolar osteitis (3.8%), 2 patients had postoperative infection (7.6%), 3 patients had trismus (19%). The overall success rate was 100%. Also the results of a comparison between bone guttering and chisel-mallet technique were stated. Conclusion: The use of lingual split bone technique deserves consideration during this COVID time as an alternate for bone guttering in surgical removal of third molar as it ensures minimal cross infectivity rate among both dentists and patients. Thus, patient care can be delivered with confidence even during pandemic.

Does Minimal-Invasive Envelope Flap Reduce Side Effects Compared to Conventional Envelope Flap Following Impacted Third Molar Surgery? A Split-Mouth Randomized Clinical Trial

The surgical removal of impacted third molars can lead to various postoperative consequences, which can be influenced by modifiable factors such as flap design. The present study aimed to determine whether a minimal-invasive envelope flap (MIEF) can reduce surgical consequences and improve life quality compared to conventional envelope flap (CEF) after removing impacted mandibular third molars. This single-blinded, cross-over randomized clinical trial was conducted on adult patients with bilateral, symmetrically impacted mandibular third molars. The flap design for surgical removal of the third molar was the primary predictor variable. The primary outcome (pain) and secondary outcome variables (swelling, mouth opening limitation [MOL]) were recorded daily and on the second and seventh days after the surgery, respectively. Wound dehiscence and patients' postoperative quality-of-life scores (PPOQL) were recorded on the seventh day. The data were analyzed by Kolmogorov-Smirnov and paired sample t test using SPSS version 22. The P value < .5 was considered significant. Sixty-eight impacted third molars of 34 subjects with a mean age of 22 ± 12.9 years (35% females) were followed. The postoperative pain level in the MIEF group at rest (0.80 ± 0.53) and chewing (2.10 ± 1.32) up to fifth day was significantly (P value < .01) lower than CEF group (2.40 ± 1.12 and 3.05 ± 1.13, respectively). The difference did not reach a significant level at rest and chewing on the sixth and seventh days (P value > .05). On the seventh day, the subjects in the MIEF group showed a significantly (P value < .001) lower level of swelling (1.13 ± 0.11) and MOL (8.28 ± 4.17) than the CEF group (3.2 ± 2.1 and 12.67 ± 4.92, respectively). Based on the PPOQL scale, patients in the MIEF group (1.82 ± 1.31) expressed a better recovery period than the CEF group (3.5 ± 2.1) (P value < .001). Considering the reduction of pain, swelling, MOL, and wound dehiscence in MIEF cases, the application of MIEF in surgical removal of impacted mandibular third molars can lead to a significant reduction in postoperative consequences and also a noticeable improvement in PPOQL compared to CEF.

Pathologies Associated with Second Mandibular Molar Due to Various Types of Impacted Third Molar: A Comparative Clinical Study.

Impacted third molars are associated with various degrees of damage to the second molars. The possible complications also include distal cervical caries, root resorption of second molar, periodontal problems, odontogenic cysts, etc. Whether a particular impacted third molar is going to affect second molar depends upon its position and orientation in the bone. This study was carried out in 418 cases. Three examiners evaluated the patient clinically and radiographically and only those cases were included in this study where at least two observers agreed. A total of 341 cases (163 males and 178 female), age range (15-40years) with impacted mandibular third molars, were included. Clinically and radiographically, the impacted mandibular third and second molars were evaluated; simultaneously, the prevalence of various pathologies associated with mandibular second molar (dental caries, periodontal pockets, root resorption) due to impacted third molar was also evaluated and compared among various types and positions of impactions. Statistical analysis was carried out using Pearson Chi-square and Asymp. Sig. (two-sided) test. Prevalence of mesioangular impactions was maximum (50.1%). Mesioangular impaction and position B (Pell and Gregory classification) were significantly associated with dental caries (32.20% and 33.90%, respectively), and periodontal pockets were seen higher with position B impactions (26.8%) {horizontal (14.7%), disto-angular (12.10%), vertical (14.5%) mesioangular (16.4%%)} in adjacent mandibular second molar. Root resorption was seen maximally in horizontal impaction (17.30%) with position c type (12.30%). The order of pathologies associated with second molar due to impacted third molar was dental caries (19.9%) > periodontal pockets (15.2%) > root resorption (8.5%). Evidence regarding pathologies are associated with second molar due to impacted third molar aids in decision making for surgical removal of third molars. Different types of impaction and the prevalence of pathologies related to them would aid in treatment planning of the impacted tooth as certain types have high probability of pathologies associated.

Clinicopathological Correlation of Cyclooxygenase 2 Expression in Oral Submucous Fibrosis: An Immunohistochemical Study.

ABSTRACTBackground:Oral submucous fibrosis (OSMF) has a high prevalence in Southeast Asia with increased malignant transformation rates. Numerous biomarkers are currently being investigated to predict the disease prognosis and for early detection of malignant changes.Materials and Methods:A prospective study was conducted comprising 40 subjects with clinically and biopsy-proven OSMF being included in the study as experimental group (n = 28) and patients with no tobacco/betel nut habit, who underwent surgical removal of third molar, being included as control group (n = 12). About 5-μm sections from formalin-fixed paraffin-embedded tissue blocks were obtained for immunohistochemical (IHC) study. The expression of cyclooxygenase 2 (COX 2) was evaluated in the experimental group and compared in morphologically normal oral epithelium. The intensity of stain was assessed at different levels of epithelium (basal, stratum spinosum, superficial level) and connective tissue.Results:Based on IHC expression of COX 2, all the patients of the control group were negative for COX 2, and among the OSMF group, 19 patients (67.9%) were positive and 9 patients (32.1%) were found to be negative for COX 2. The association of COX2 expression on comparison of controls with OSMF was found to be statistically significant (χ2 =21.955; P = 0.000). On comparison of immune expression of COX 2 in different clinical stages based on functional staging, we found significant association of COX 2 expression with the stage of OSMF (χ2 = 7.368; P = 0.025).Conclusion:The significant expression of COX 2 in different clinical stages of OSMF when compared with normal shows the role of COX 2 in the pathogenesis of OSMF and could serve as a potent biomarker for assessing the disease progression.