Third Molar Extraction Research Articles

UNRAVELING THE OUTCOMES: A RETROSPECTIVE ANALYSIS OF ABERRANTLY POSITIONED IMPACTED THIRD MOLAR EXTRACTIONS

In the realm of dentistry, the extraction of third molars occupying abnormal positions poses a formidable challenge. These enigmatic teeth, deviating from their anticipated anatomical location, demand meticulous evaluation and specialized approaches to ensure their successful removal. Intriguingly, the evaluation of such cases has remained unexplored in the context of Kazakhstan until now. Aim: The objective of this study is to examine the occurrence of mandibular third molar impaction and its correlation with factors such as impaction type, impaction side, age, and gender among patients. Methods: A retrospective review was conducted on the medical records of 2351 patients who underwent surgical extraction of impacted mandibular third molars. Results: The findings revealed a remarkable prevalence of mesioangular impaction (56.15%) in the lower third molars. The highest number of patients were observed in the age group of 18–30 years (25.05%), and a majority of cases involved the left side (75.75%). A notable female predominance (66.35%) was also observed. The most frequent indication for surgical removal was recurrent pericoronitis (24.25%). Conclusion: This pioneering study in Kazakhstan provides insights into extraction success for impacted third molars. It reveals a remarkable prevalence of mesioangular impaction in the lower molars, predominantly on the left side with a notable female predominance. Recurrent pericoronitis is the primary reason for surgical removal. Early removal of symptomatic impacted molars prevents future complications, but careful patient selection is crucial. Further research is needed to understand these findings in the Kazakhstani population.

Como o uso de fibrina rica em plaquetas pode beneficiar as exodontias de terceiros molares mandibulares?

Surgery for the removal of third molars is a surgical procedure commonly performed in Dentistry. It is associated with inflammatory events and possible complications, being more evident after the removal of lower molars, since in most cases there is a need for more invasive approaches. It is essential for the dentist to minimize such effects, providing a more peaceful postoperative period with less morbidity for the patient. In this context, platelet-rich fibrin (PRF) was developed, which is considered a platelet aggregate obtained by centrifugation of the patient's own blood and proposes to minimize inflammatory effects, accelerate healing and repair processes, and reduce postoperative complications. A literature review on the effect of L-PRF in sockets after the removal of mandibular third molars was conducted, evaluating its efficacy on pain, swelling, trismus, and healing. A bibliographic survey was performed on the PubMed, Web of Science, and Elsevier databases, using the following descriptors: 'platelet rich fibrin', 'third molar', and 'surgery', limiting to articles written in English published from 2013 to 2023. Thus, we have a current scientific overview of the real effect of using this platelet aggregate in the extraction of lower third molars. The studies reviewed, for the most part, showed positive results in improving pain, swelling, trismus, and healing.

EXPLORING CYTOLOGICAL ASPECTS OF SOCKET HEALING OPTIMIZATION AFTER ATYPICALREMOVAL OF THE THIRD LOWER MOLAR

This study aims to investigate the cytological characteristics of socket healing after atypical removal of the lower third molar, utilizing osteoplastic synthetic material in conjunction with platelet-rich gel and plasma enriched with thrombocyte factors, to enhance local osteogenesis. Materials and Methods For this comparative clinical study, smears of alveolar content were collected following atypical extraction of the lower third molar. Cell elements were quantified for cytological analysis. Data collection utilized a template developed in Microsoft Excel version 16.34. Statistical processing was performed using RStudio 2023.03.1 Build 446 (Posit Software, PBC). Smears were air-dried, fixed in a 1:1 mixture of alcohol and acetone for 5 minutes, stained first with May-Grünwald’s methylene blue (15 minutes), followed by Romanowsky-Giemsa’s azure-eosin stain (30 minutes). Smear images were captured with the Leica morpho densitometric complex: DM 1000 microscope, DFC-320 camera, images were obtained in jpg format at 400x magnification. Results The study encompassed 30 patients divided into control and experimental groups. Cytological analysis was conducted on the 2nd, 5th, and 10th days of post- operation. In both groups, on the 2nd day, alveolar smears showed the presence of erythrocytes (n = 6) and neutrophils (n = 2). On the 5th day, the experimental group exhibited neutrophils (n = 3) and abundant cocci microflora (n = 6). On the 10th day, epitheliocytes (n = 8) primarily indicated proliferation. Conclusions The obtained results underscore the effectiveness of employing osteoplastic synthetic material in combination with plateletrich gel and plasma enriched with thrombocyte factors for enhancing local osteogenesis following atypical removal of the third molar. This approach demonstrates significant elevation in epithelialization activity, fibroblastic activity, and other markers of the reparative process in comparison to the control group.

Proposal and Validation of a New Index to Assess the Difficulty of Lower Third Molar Extraction.

A prospective cohort study on a sample of patients of the Master of Oral Surgery of the University of Seville in which multiple linear regression coefficients were calculated with a subsequent validation study of the results in the sample of patients operated in the Hospital Palmaplanas of Mallorca. The regression line obtained after applying the statistical methodology to the cohort of patients from the University of Seville obtained significant dependent variables such as depth, roots, and odontosection. Once applied to the cohort of patients from the Palmaplanas Hospital in Mallorca, a regression coefficient was obtained between the data received and the estimated 0.770. The formula proposed in this article presents significant validity in the prediction of the surgical time of extraction of the lower third molars included.

Application of Fractal Analysis in Detecting Trabecular Bone Characteristics Around Mandibular Impacted Third Molars on Dental Panoramic Radiographs

Purpose: Surgical extraction of third molars can be difficult for many reasons, including increased bone density, which causes bone structures to lose their elastic properties. The aim of this study is to compare the trabecular structure around the impacted mandibular third molar(M3M) and the normal alveolar trabecular pattern using the fractal analysis method. Materials and Methods: Panoramic images of 47 patients were included in the study. ROI1 is the area between the distal root of the second molar and the mesial of the third molar tooth. On the other hand, ROI2 was selected between the distal root of the first molar tooth and the mesial root of the second molar tooth. Fractal Dimension (FD) and Bone Marrow Dimension analyzes were applied to the selected ROIs using the ImageJ software. Results: The mean FD values of 47 patients were found to be 1.135 for ROI1 and 1.105 for ROI2, respectively (p=0,078).The mean Bone Marrow Dimension values were found to be 1.591 for ROI1 and 1.587 for ROI2(p=0.731). There was no significant difference in FD and Bone Marrow Dimension analysis when ROI1 and ROI2 were compared. It is very important to know the pattern of trabecular structure before surgical procedure on M3M. The bone density around the impacted M3M may be higher than the healthy alveolar bone, however, the fact that males have denser bone than females should not be ignored during the operation. Conclusion: The method of FD analysis can be useful for evaluating the trabecular structure of impacted M3M. Key words: fractal dimension; bone structure; panoramic imaging; impacted tooth; third molars

Computer-Guided Bone Lid Technique for Surgical Extraction of Deeply Impacted Mandibular Third Molars: A Technical Report

The extraction of mandibular impacted third molars is one of the most common procedures in oral surgery. One of the extraction methods consists of the preparation of a buccal bone lid to obtain access and remove the tooth. This technique aims to reduce bone loss, promote bone healing distal to the second molar, and increase the accessibility to the impacted tooth, particularly in cases of concomitant pathologies or proximity to the mandibular canal. The procedure benefits from the application of 3D printing technologies to produce cutting guides that, combined with piezosurgery, allow deeply impacted third molar extractions with excellent preoperative planning and extreme localisation precision, as well as predictable repositioning and fixation of the bone lid. The objective of this article is to present two clinical cases of the application of the bone lid technique to extract deeply impacted third molars using 3D printed guides with different designs and piezosurgery.

Osteomyelitis of right coronoid process of mandible following extraction of mandibular third molar-A case report

In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible is often odontogenic in origin. The involvement of site other than the dentate area is very rare. We hereby report a unique case of pathological fracture of coronoid process leading to osteomyelitis following extraction of an infected third molar. It was successfully managed by pre-surgical course of antibiotics followed by resection of the coronoid process and sequestrectomy. Patient followed up for 6months no signs of recurrence.

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study.

Background and objective This study aims to explore the concept of preemptive analgesia, which is the technique of administration of analgesic agents before the painful stimulus. This bridges the time gap between the onset of action of the analgesic agentsand the wear-off of local anesthesia. Existing literature also brings up the concept of central sensitization, which is the hyper-activity of the nervous system in response to a noxious stimulus. Administration of preemptive analgesia prevents central sensitization and hence provides prolonged analgesia to the patient. For the benefit of this study, tab. Etoricoxib 90 mg was used as the analgesic agent. In addition, this study aims to investigate the effects of the administration of tab. Etoricoxib 90 mg 30 minutes before extraction of a single mandibular third molar on the effects of pain experienced by the patient after tooth extraction as compared to a placebo. Methodology This was a double-blinded, prospective, observational study. The pain experienced by 50 participants in each group was measured at 1 hour, 6 hours, 12 hours, and 24 hours postoperatively using a visual analog scale (VAS). The independent samples t-test was then conducted to evaluate the results and draw out conclusions. Results The average difference in pain experienced was maximum in the first hour after the procedure. The mean VAS score reported by patients was 3.14 in the study group but was 6.40 in the control group within the first hour. This difference was reduced in the first six hours after the procedure, with the average score being 3.82 in the study and 7.16 in the control group. The difference was the least after 12 hours, with the study group experiencing a VAS score of 4.64 and controls experiencing a VAS score of 6.14. After the first 24 hours, the mean VAS score was 3.80 in the study group and 5.60 in the control group. Conclusions Preemptive administration of tab. Etoricoxib 90 mg can reduce postextraction pain in healthy adult patients as compared to placebo tablets, with a maximum difference in pain reduction seen at the end of the first six hours (P= 0.012) and the minimum at the end of 12 hours (P= 0.0197).

Impact of Single-Session Intraoral and Extraoral Photobiomodulation on Pain Control after Extraction of Impacted Mandibular Third Molar: A Pilot Study

This study aims to evaluate the impact of a single session of intraoral and extraoral photobiomodulation (PBM) on controlling pain and improving a patient’s daily activities following surgical extraction of the impacted mandibular third molar, using combined three wavelengths: “445 nm, 660 nm, and 970 nm”. A pilot study was conducted on 22 patients undergoing extraction of an impacted mandibular third molar. The patients were randomly divided into two groups: (1) The Test Group consisted of patients subjected to immediate postoperative PBM. The extraoral PBM parameters were power = 550 mW and spot area = 5 cm2, while the intraoral parameters were power = 200 mW and spot area = 2 cm2. (2) The Control Group consisted of the patients not subjected to PBM. For all the patients, the pain was evaluated via a Numeric Rating Scale (NRS) on day 0, day 1, day 3, and day 7 after surgical intervention. The patient’s daily activities were evaluated on day 7 via a custom-made questionnaire. A statistically significant difference was observed between groups in the pain NRS scores on day 0 (p = 0.022), day 1 (p = 0.047), and day 7 (p = 0.028). No significant difference was found on day 3 (p = 0.153). A marginal statistical significance was observed with the number of painkillers taken (p = 0.054). No significant difference was observed with the questionnaire score (p = 0.206). This pilot study showed a significant reduction in postoperative pain on days 0, 1, and 7 with a single session of intraoral and extraoral PBM. However, the number of painkillers taken and the scores of the daily activities questionnaire did not show statistical significance despite the observed better results in patients subjected to PBM.

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.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve.

Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. All IMM3s were extracted easily without symptoms of IAN injury after extraction. Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

EFFICACY OF SUBLINGUAL VERSUS ORAL PIROXICAM IN MANAGEMENT OF POST-SURGICAL PAIN, SWELLING AND TRISMUS AFTER LOWER 3RD MOLAR SURGERY- A RANDOMIZED CONTROL CLINICAL TRIAL

Background of the study: Third molar surgical removal is a common procedure in oral and maxillofacial surgery, causing moderate to severe pain, swelling, and trismus. Postoperative pain control improves patient recovery and oral function, with commonly used analgesics including Ibuprofen, Aceclofenac, Ketorolac, Tramadol, Paracetamol, Nalbuphine, Nimusulide, and Buprenorphine. Aim and Objective: The study compares oral and sub-lingual Piroxicam for managing post-surgical pain after extraction of impacted third molars, focusing on analgesia onset, pain intensity, swelling, and trismus degree. Materials and method: A randomized control trial was conducted on 30 patients who underwent surgical removal of mandibular impacted third molars. The patients were divided into two groups: Group I (Study) and Group II (Control). All patients underwent the procedure by a single surgeon. Post-operative medications were prescribed according to the study design, with Piroxicam 20mg administered sub-lingually (Group I) and 20mg orally (Group II). The parameters were assessed and measured for both groups, and the results and statistical analysis were compared. Result: The results revealed that the inter-group difference for the post-operative symptoms evaluated using a t-test for Equality of means by comparing the pre-op, POD 2, POD 7 values was statistically significant. Mean onset time taken and pain perception by Group I (Sub-lingual) in the first dose was 32.3 minutes and for Group II was 51.21 minutes which was established to be significantly (P<0.05) low for the sub-lingual group by statistical analysis. Conclusion: The study found that the sublingual route of administering Piroxicam had a faster onset of action and better analgesia postoperatively compared to the oral route. This is crucial for patients and surgeons to improve compliance and comfort post-operatively after impaction surgery, as potent analgesics are essential for effective pain management.

Systematic Analysis of Lower Second Molar Periodontal Health after Autogenous Dentine Graft from Wisdom Tooth Extraction

Introduction: Postoperative complications stemming from lower wisdom tooth extractions are often overshadowed by the immediate need to address pain and existing disease. Nevertheless, an emerging body of evidence suggests the importance of preventing potential periodontal damage to the adjacent second molar resulting from the extraction surgery. To avert periodontal complications involves promoting bone formation within the extracted socket defect. Allogenic and artificial bone, as well as the patient’s bone, have conventionally filled the osseous void post-surgery. These approaches are costly and may extend the patient’s recovery. An Autogenous Dentine Graft (ADG), derived from the recently extracted wisdom tooth, presents, as a particulate with osteoconductive and osteoinductive properties, is ideal for preserving bone integrity. This review assesses the available evidence supporting the use of ADG in safeguarding against periodontal morbidity resulting from the surgical extraction of a lower third molar. Materials and methods: A systematic review of the literature was conducted, focusing on the periodontal health of the second molar and the bone height of the osseous defect postwisdom tooth extraction. Out of 76 identified articles, four studies were selected for the review. Results: Three months post-surgery, the mean periodontal probing depth distal to the second molar was 4.7mm in control sites and 2.83mm in sites treated with ADG. Over 12 months, the mean bone height exhibited a negative loss of 1.25mm in control sites and a positive gain of 0.9mm in sites treated with ADG. Conclusion: Presently, there is insufficient evidence to unequivocally support the use of an autogenous dentine graft following the surgical extraction of a wisdom tooth. However, early results are promising, and given the biocompatibility of a material derived from the patient, ADG is considered a safe option for patients at high risk of an osseous defect. Further research is needed to substantiate these findings and guide clinical decision-making.

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.

ENHANCING OSTEOGENESIS: OSTEOPLASTIC MATERIAL WITH PLASMOGEL AND PLATELET-ENRICHED PLASMA

This article is a comprehensive exploration of the clinical and radiological findings derived from the utilization of osteoplastic synthetic material, combined with plasma gel and platelet-rich plasma, to facilitate and augment local osteogenesis subsequent to the atypical extraction of the lower third molar. The study, comprising 80 patients, was meticulously divided into two distinct groups: the experimental group and the control group. The strategic utilization of osteoplastic synthetic material in conjunction with plasmogel for bone wound filling, along with the introduction of plasma enriched with platelet factors into the transitional fold of the surgical site, emerged as a pivotal approach. This multifaceted technique not only acted as a robust defense against wound infections but also exhibited a remarkable reduction in the frequency of postoperative inflammatory complications, impressively plummeting from 10% to a mere 2.5%. Radiological assessments, notably through X-ray examinations, provided compelling evidence of an accelerated and substantially reinforced reparative regeneration of bone tissue within the void left by the extracted lower third molar. The primary and overarching objective of this comprehensive study was to meticulously scrutinize and document the outcomes arising from the meticulous implementation of osteoplastic synthetic material in conjunction with plasmogel and platelet-rich plasma. This innovative approach was systematically applied to catalyze and amplify local osteogenesis, predominantly in the aftermath of the intricate and atypical extraction of the lower third molar, shedding light on the transformative potential of this multifaceted intervention in clinical practice.

Comparison of the Efficacy of Corticosteroids With Enzymatic Agents in the Postoperative Sequelae for Lower Third Molar Surgery: A Prospective Study.

Introduction The presence of impacted third molars is a prevalent problem associated with varying degrees of difficulty in extraction and potential consequences, including pain, swelling, and trismus. According to studies, enzymatic combinations, such as bromelain, rutoside, trypsin, and serratiopeptidase, are known to have a very promising role in reducing inflammation and promoting wound healing. This study compared natural enzymatic agents with corticosteroids for postoperative pain, swelling, and trismus in the impacted lower third molar surgery. Objectives The present study aimed to compare the efficacy of prednisolone, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain, and serratiopeptidase in the postoperative sequelae after surgical extraction of impacted mandibular third molars. The primary objective was to assess the difference in swelling between the three groups. The secondary objectives were to assess the difference inpostoperative painand trismus between the three groups. Materials and methods A total of 150 patients who presented to the department of oral and maxillofacial surgery for surgical removal of an impacted mandibular third molar with a moderately difficult score of 5-7 in the Pederson difficulty index were chosen for a prospective study. Patients were categorized into three groups based on the postoperative drug prescribed. In group 1, prednisolone 10 mg was prescribed;in group 2, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was prescribed;and in group 3, serratiopeptidase 15 mg was prescribed. All patients were prescribed a combination drug of aceclofenac 100 mg and paracetamol 325 mg twice daily as a standard analgesic. Swelling, pain, and trismus in each patient were recorded preoperatively and at postoperative day one and day seven.The Friedman test was employed to evaluate the variation in pain levels within the groups over time, while the Kruskal-Wallis test was utilized to investigate the disparity in pain levels between the groups. The difference in swelling and trismus within the groups across the timeline was measured by repeated measures analysis of variance (ANOVA), and the difference in swelling and trismus between the groups was measured by one-way ANOVA.A p-value below 0.05 was deemed to be statistically significant. Results Group 1 showed less swelling, pain, and trismus on both postoperative dayone and day seven compared to group 2 and group 3, which was a statistically significant difference (P < 0.05). It was found that swelling, pain, and trismus measurements in postoperative dayone and day seven in group 2 were comparatively less than in group 3.Neither group demonstrated any side effects or other complications during the follow-up period. Conclusion It can be concluded that the use of prednisolone postoperatively following surgical removal of the mandibular third molar provided better relief with regardto pain, trismus, and swelling compared to the enzymatic agents. Among enzymatic agents, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papainwas better in reducing pain, trismus, and swelling than serratiopeptidase drug.

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6–9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Expression Profiling of EMT Transcriptional Regulators ZEB1 and ZEB2 in Different Histopathological Grades of Oral Squamous Cell Carcinoma Patients.

Pakistan has a high burden of oral cancers, with a prevalence rate of around 9%. Oral Squamous Cell Carcinoma (OSCC) accounts for about 90% of oral cancer cases. Epithelial to Mesenchymal Transition (EMT) gets highly stimulated in tumor cells by adopting subsequent malignant features of highly invasive cancer populations. Zinc Finger E-Box binding factors, ZEB1 and ZEB2, are regulatory proteins that promote EMT by suppressing the adherent ability of cells transforming into highly motile cancerous cells. The present study aimed to analyze the expression of EMT regulators, ZEB1 and ZEB2, and their association with the clinicopathological features in different grades of OSCC patients. Tissue samples were collected for both case and control groups from the recruited study participants. Cancer tissues (cases) were collected from the confirmed OSCC patients, and healthy tissues (controls) were collected from third-molar dental extraction patients. The study participants were recruited with informed consent and brief demographic and clinical characteristics. The case group was further segregated with respect to the histological cancer grading system into well-differentiated (WD), moderately differentiated (MD), and poorly differentiated (PD) squamous cell carcinoma (SCC) groups. RNA was extracted from the tissue samples for expression profiling of ZEB1 and ZEB2 genes through quantitative real-time PCR (qRT-PCR). All of the recruited participants had a mean age of 46.55 ± 11.7 (years), with most of them belonging to Urdu speaking ethnic group and were married. The BMI (kg/m2) of the healthy participants was in the normal range (18-22 kg/m2). However, BMI was found to be reduced with the proliferation in the pathological state of cancer. The oral hygiene of patients was better than the healthy participants, possibly due to the strict oral hygiene practice concerns of consultants. Every recruited OSCC patient had one or multiple addiction habits for more than a year. Patients reported health frailty (46.6%), unhealed mouth sores (40%), swallowing difficulties and white/reddish marks (80%), and restricted mouth opening (64.4%). Furthermore, 82.2% of the recruited patients observed symptoms within 1-12 months, and buccal mucosa was the most exposed tumor site among 55.6% of the patients. Expression profiling of EMT regulators showed gradual over-expressions of ZEB1 (8, 20, and 42 folds) and ZEB2 (4, 10, and 18 folds) in respective histological cancer grades. High expressions of ZEBs have been significantly associated with cancer progression and poor health. However, no association was found between OSCC with other clinicopathological features when compared to healthy controls.

Comparison of the effects of two different styles of orally prescribing prednisolone on postoperative sequelae of surgical extraction of an impacted mandibular third molar: a single-blind randomized study.

Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don't have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.

Determination of Anti-Inflammatory and Analgesic Efficacy of Ascorbic Acid after Impacted Third Molar Surgery

Objective: To evaluate the clinical efficacy of Ascorbic acid in relieving pain and inflammation following surgical removal of the third molar. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jan to Mar 2023. Methodology: Sixty participants who required surgical extraction of the impacted third molar were included and segregated equally into two groups. Group-A received Amoxicillin with Clavulanic acid (625 mg) thrice a day and Metronidazole (400 mg) twice daily, while Group-B received Amoxicillin with Clavulanic acid (625 mg) thrice daily, Ascorbic acid (500 mg) twice daily and Metronidazole (400 mg) twice daily. Both the groups received Naproxen Sodium as per requirement (550 mg). Pain, trismus, facial swelling, and requirement of analgesic consumption were evaluated on the seventh post-operative day. Results: There was a statistically significant difference in reducing the intensity of pain (p&lt;0.01), severity of facial swelling and trismus (p&lt;0.01) and requirement of analgesic consumption between Group A and B (p&lt;0.001). Conclusion: Our study concluded that Ascorbic acid after surgery effectively reduces pain intensity, the severity of facial swelling and trismus, and the requirement for analgesic consumption so that ascorbic acid may be used as an adjuvant therapy with other conventional drugs.