Third Molar Extraction Research Articles

A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study

BackgroundThe extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically.Materials and methodsA total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant.ResultsIn PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05).ConclusionBoth two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians.Trial registrationThis study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.

Evaluation of platelet-rich fibrin in post-exodontic bone regeneration: systematic review

Objective: To analyze the use of platelet-rich fibrin in bone regeneration of postexodontic tooth sockets by means of a systematic review of updated randomized controlled clinical trials. Materials and methods: the present descriptive, documentary, cross-sectional study was carried out following PRISMA 2020 standards, a search of 25 scientific articles of randomized controlled clinical trials with a minimum of 8 patients who needed dental extractions was carried out, who were divided into two groups, one test group containing platelet-rich fibrin and the other control group without platelet-rich fibrin, articles were collected from databases such as Google Scholar, PubMed, Scielo, Redalyc, Embase, which were within the last 8 years, articles that did not meet the objectives that served for this study were excluded. Results: Of the 25 articles included in this systematic review, 15 were based on the extraction of bilateral impacted lower third molars, 8 on extractions of teeth due to endodontic failure and coronary fracture and 2 on the extraction of teeth prior to rehabilitation treatment with dental implants. Platelet-rich fibrin improves clinical and imaging conditions in post-exodontic patients, showing in the imaging evaluation after taking radiographs during the control weeks a better healing of soft tissues, a notable difference in bone filling and the formation of new bone. Conclusion: the use of platelet-rich fibrin is effective in the preservation of the alveolar ridge post-exodontia, maintaining vertical dimensional stability, beneficial also in cellular proliferation which improves bone loss, despite this there is no significant difference in the test sites treated with platelet-rich fibrin compared to control sites treated with physiological healing.

Assessing impacted third molars: Cellular activity in dental follicles and dentigerous cysts

ABSTRACT Background: Dentigerous cysts are among the most prevalent odontogenic cysts associated with impacted teeth, particularly impacted third molars. Understanding the clinicopathological correlation between impacted teeth and factors contributing to cyst formation is essential. Aim: This study aimed to investigate the clinicopathological correlation between impacted teeth and the factors associated with dentigerous cyst formation. Materials and Methods: The study analyzed a total of 30 cases, which were categorized into two subgroups: 16 cases of dental follicles and 14 cases of dentigerous cysts. Retrospective data were collected from the departmental archive, and demographic data along with clinical parameters were correlated. In addition, the Ki-67 index was assessed through immunohistochemical analysis for both study groups. Results: A clinical correlation between impacted teeth along with Ki-67 index in both dental follicles and dentigerous cysts was observed. Conclusion: Based on the findings, it is hypothesized that prophylactic extraction of impacted third molars should be mandatory, irrespective of their symptomatic or asymptomatic status.

Is Injectable Platelet-Rich Fibrin Really Effective in Reducing Expected Side Effects of Removing Impacted Third Molar Surgery?

Common side effects of third molar (M3) operations including pain, edema, and trismus have an adverse effect on patient quality of life. Injectable platelet-rich fibrin (i-PRF) may ameliorate some of the side effects of the operation. The primary purpose of this study is to measure and compare differences in pain, swelling, trismus, and quality of life between i-PRF side and a control side of subjects undergoing M3 removal. This study is a single-center, split-mouth, randomized prospective clinical trial conducted at Ordu University Faculty of Dentistry. Patients who presented between March and August 2022 for the extraction of impacted third molars due to various reasons were included in the study. The exclusion criteria were local conditions and systematic comorbidities. Additionally, patients with differences that could cause bias between the sides were excluded from the study. The predictor variable is treatment i-PRF or control. The outcome variables of interest are the pain level and analgesic consumption values on the Visual Analog Scale, the distance between determined reference points, maximum mouth opening, and the Postoperative Symptom Severity scale data. A Postoperative Symptom Severity scale was created using questions commonly employed in the clinical evaluation of patients following the extraction of third molars. This scale was further divided into subscales corresponding to the 7 primary adverse effects identified in a prior study. Covariate variables, sex, age, and operation times. The normality of the distribution of the study data was assessed using the Kolmogorov-Smirnov test. Depending on whether the data exhibited a normal distribution or not, the data were analyzed using either the paired t-test or the Wilcoxon test. A P value < .05 was considered statistically significant. The study included 35 patients with a mean age of 19.97±2.07years. The i-PRF side significant success in postoperative edema measurements. There was a statistically significant difference observed between the control side and the i-PRF side on the second day (control: 9.74±0.57mm, i-PRF: 9.46±0.51mm) and seventh day (control: 9.33±0.59mm, i-PRF: 9.12±0.50mm) in lateral canthus-angulus measurements (P: .01 and P: .04, respectively). Additionally, on the second day, there was a statistically significant difference in tragus-commisura measurements (control: 11.53±0.62mm, i-PRF: 11.31±0.58mm) with a P value of .02. There was no significant difference observed between the sides in terms of postoperative pain (P>.05). However, analgesic consumption in the i-PRF side was significantly lower at the sixth hour (control: 1.8±0.58 dose, i-PRF: 1.14±0.35 dose), 24th hour (control: 1.77±0.54 dose, i-PRF: 1.14±0.35 dose), and second day (control: 1.8±0.47 dose, i-PRF: 1.4±0.73 dose) postoperatively (P: .000, P: .000, and P: .012). Mouth opening was significantly lower in the i-PRF side on the second day (control: 27.88±6.48mm, i-PRF: 25.51±5.56mm) (P: .025). However, i-PRF had no significant effect on postoperative quality of life (P>.05). According to the study results, i-PRF had a limited effect on the management of postoperative pain, but i-PRF was effective in reducing postoperative edema. Further studies with larger patient sides are now needed to yield more detailed findings on the subject.

The Palatal Elevation Technique (PET) for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars.

Intra-alveolar extraction of maxillary third molars always poses a challenge to dental practitioners owing to limited accessibility and minimal space for dental forceps application. Dental elevators facilitate the extraction of such teeth. In the traditional technique as described in the literature, the elevator is always introduced from the mesiobuccal aspect of the tooth to engage the space between the interdental bone and the offending tooth to use it as a fulcrum. However, certain situations prevent proper application of the elevator from the buccal aspect of the offending tooth to bring about luxation. One such situation is a grossly decayed third molar tooth, especially from the mesiobuccal aspect with destruction of the tooth substance extending below the cementoenamel junction.Another such situation is observed in patients presenting with thick and inextensible cheeks but a good interincisal opening. In either situation, it becomes very challenging to achieve a good purchase for luxation of the offending third molar. The authors have therefore described a modified technique of tooth elevation, the palatal elevation technique (PET), using the palatal bone instead of the buccal bone as the fulcrum which was observed to be effective in such situations. In the authors' view, PET is simple and quick and can effectively be employed as an alternative to the traditional technique of tooth elevation in all cases that require an intra-alveolar extraction of maxillary third molars.

Radiographic Evaluation of Impacted Third Mandibular Molar According to the Classification of Winter, Pell and Gregory in a Sample of Cameroonian Population.

The extraction of impacted third molars (M3) is a common surgical procedure in dentistry and oral surgery. Various complications, including inferior alveolar nerve (IAN) damage, may occur during and after extraction of this tooth. Radiographic examination should provide information about the M3 itself, but also about the surrounding bony structure and the relationship of the roots to the IAN and the adjacent second molar, which is often traumatized during this extraction. The aim of our study was to evaluate the depth and angulation of impacted mandibular third molars (M3) from panoramic radiographs, according to the classifications proposed by Winter and Pell & Gregory. Radiographic signs present on the orthopantomogram showing M3 depth, and retromandibular available space according to the Pell & Gregory classification were evaluated. Evaluation of the M3 angulation relative to the M2 according to Winter's classification was also done. Student's t test was used to determine the association between side or sex and different variables. The depth of impaction of the M3 crown was level A accounting for 54.4% (n=260) of the PR while level B constituted 35.7% (n=171) of the images. Regarding the availability of retromandibular space, Class I constituted 36.8% (n=176). The Class II accounted for 55.9% (n=267) of PR. Our study showed that 54.4% of M3 were located at the same level as the occlusal plane of the second molar, while in 56% of PR the space between the second molar and the ramus of the mandible is less than the mesiodistal diameter of the third molar. This research showed that 23.1% of M3 had a level of vertical angulation, a level that allows for less painful luxation of the impacted molars. These results seem to show a relatively high level of difficulty in mobilizing and extracting M3 from Cameroonian patients.

Depth and proximity of third molars to the inferior alveolar canal in panoramic radiographs of a Latin American population

Introduction: extraction of lower third molars involve the possible occurrence of complications such as injury of the content of the Inferior Alveolar Canal. Methods: a cross-sectional study was conducted with a sample of 6488 lower molar records of digital panoramic radiographs of patients from 6 Latin American countries from 2010-2015. The variables studied were the depth of lower third molar according to the Pell and Gregory classification, and the proximity of a third molar to the Inferior Alveolar Canal that was evaluated according to the proposed classification, based on a modification of the Langlais et al classification.20 Descriptive and bivariate statistical analyses were performed. Results: in terms of the proximity, the highest frequency was Intact with 27.45%(n=1781). Regarding the depth of the lower third molar, the most frequent were the Position B with 46.90%(n=3043) and Position A with 46.75%(n=3033). The proximity and depth of the lower third molar had statistical difference according to age(p&lt;0.01) and sex (p&lt;0.001). The overall proximity of the lower third molar to the Inferior alveolar canal, according to depth was 37.52%(n=1766) in Position A, in Position B it was 54.51%(n=2566) and Position C was 7.97%(n=375) and had association between variables(p&lt;0.001). Conclusions: taking into consideration the modified classification of Langlais et al.20, lower third molars are close to the Inferior Alveolar Canal, and according to the Pell and Gregory classification for the depth, the most frequent positions are A and B. In addition, proximity and depth were associated with each other, and with the co-variables country, age, and sex.

Chronic suppurative osteomyelitis secondary to endodontic treatment and posterior extraction of mandibular third molars: An uncommon case

Chronic suppurative osteomyelitis secondary to endodontic treatment and posterior extraction of mandibular third molars: An uncommon case

Radiographic evaluation before surgical extraction of impacted third molar to reduce the maxillary sinus related complication.

Surgical extraction of maxillary third molars is routine in departments devoted to oral and maxillofacial surgery. Because maxillary third molars are anatomically adjacent to the maxillary sinus, complications such as oroantral fistula and maxillary sinusitis can occur. Here we explore the factors that can cause radiographic postoperative swelling of the maxillary sinus mucosa after surgical extraction. This retrospective study reviewed the clinical records and radiographs of patients who underwent maxillary third-molar extraction. Preoperative panoramas, Waters views, and cone-beam computed tomography were performed for all patients. The patients were divided into two groups; those with and those without swelling of the sinus mucosa swelling or air-fluid level in a postoperative Waters view. We analyzed the age and sex of patients, vertical position, angulation, number of roots, and relation to the maxillary sinus between groups. Statistical analysis used logistic regression and P<0.05 was considered statistically significant. A total of 91 patients with 153 maxillary third molars were enrolled in the study. Variables significantly related to swelling of the maxillary sinus mucosa after surgical extraction were the age and the distance between the palatal cementoenamel junction (CEJ) and the maxillary sinus floor (P<0.05). Results of the analysis show that the relationship between the CEJ and sinus floor was likely to affect postoperative swelling of the maxillary sinus mucosa. Maxillary third molars are anatomically adjacent to the maxillary sinus and require careful handling when the maxillary sinus is pneumatized to the CEJ of teeth.

Efficacy and safety of parenteral and local application of tramadol in mandibular third molar extraction: a qualitative systematic review of current evidence.

To assess the efficacy and safety of perioperative parenteral administration or submucosal infiltration of tramadol for perioperative pain control on the basis of pain intensity or analgesics consumption and perioperative outcomes in mandibular third molar surgery. An electronic database search was conducted up to 10 November 2022 to retrieve all randomized controlled trials (RCTs), assessing the analgesic efficacy of parenteral use of tramadol implemented as an adjunct to local anesthesia or intraoperative sedation/general anesthesia, in surgical extraction of mandibular third molars. Modified Jadad scale and Cochrane bias tool were used for the qualitative appraisal. Nineteen RCTs were selected for qualitative analysis. Nine studies involved intravenous, and 5 intramuscular administration of tramadol, while 5 evaluated submucosal infiltration with tramadol. Intravenous or intramuscular tramadol provided a weaker analgesic effect compared with non-steroidal anti-inflammatory drugs (NSAIDs), while intravenous tramadol induced an enhanced analgesic effect than oral tramadol. Parenteral administration of tramadol improved the quality of postoperative analgesia versus placebo. No notable adverse effects were recorded. Parenteral or submucosal infiltration of tramadol constitutes an effective and safe alternative analgesic approach in surgical extraction of mandibular third molars, yet the nociceptive effect of this analgesic modality could not supersede that of NSAIDs. PROSPERO No CRD42021227574.

Analgesic Efficacy of Bupivacaine as an Infiltration Injection Technique after Extraction of Impacted Mandibular Third Molars: A Randomized Controlled Study

Background: Pain after surgery is a common adverse effect that patients experience after having their lower third molars surgically removed. Objective: To assess how well local injection of bupivacaine reduces pain after surgical extraction of an impacted mandibular third molar. Methods: A single-blinded, randomized, controlled clinical trial included a total of 56 patients that were randomly selected according to Microsoft Office Excel sheets and divided into two groups. The study includes 29 patients who received a 2 ml dose of bupivacaine 0.5% through local infiltration near the extraction site using an insulin syringe to avoid intravenous or intraneural infiltration. The other 27 patients who served as the control group received a 2 mL dose of normal saline using the same administration technique. Both groups underwent a surgical procedure to remove their impacted mandibular third molars while under the influence of local anesthesia. Pain was evaluated using a numeric rating scale (NRS) at 4, 8, 12, and 24 hours post-operatively. Results: The study group exhibited significantly lower pain scores compared to the control group at 4, 8, 12, and 24 hours following the surgical procedure (p=0.0001). Conclusions: There were no major problems associated with the local injection of bupivacaine; it lowers postoperative pain 4, 8, 12, and 24 hours after the surgical extraction of impacted mandibular third molars.

Analgesic effect of a lidocaine-ropivacaine mixture for extraction of impacted mandibular third molars: a randomized controlled trial.

The painless postoperative period can be significantly prolonged by using long-acting local anesthetics such as ropivacaine, though these local anesthetics are known for their slower onset of action. To compensate for this, a mixture of short-onset (e.g., lidocaine) and long-acting local anesthetics is used. However, the efficacy of such an anesthetic cocktail has not been elucidated in the field of oral and maxillofacial surgery. To address the research purpose, this prospective randomized controlled trial included 56 patients scheduled for impacted mandibular third molar extraction. All patients received the inferior alveolar nerve block (IANB) using either 2% lidocaine with epinephrine or a 1:1 mixture of 2% lidocaine with epinephrine and 0.75% ropivacaine. Patients anesthetized using the lidocaine-ropivacaine mixture showed significantly prolonged postoperative analgesia and pain control than those anesthetized using lidocaine only. IANB using a lidocaine-ropivacaine mixture can provide prolonged postoperative anesthesia and pain control with extraction of mandibular third molars. This method can be a noteworthy addition to existing methods of local anesthesia for the extraction of mandibular third molars. Trial registration number University Hospital Medical Information Network (No. UMIN000044315).

The effectiveness of photobiomodulation therapy on inferior alveolar nerve injury: A systematic review and META-analysis.

The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to orthognathic surgeries, extraction of impacted third molars and mandibular fractures. A electric search was conducted by a combination of manual search and four electric databases including Pubmed, Embase, Cochrane library and Web of Science, with no limitation on language and publication date. Gray literature was searched in ClinicalTrials.gov and googlescholar. All retrieved articles were imported into ENDNOTE software (version X9) and screened by two independent reviewers. All analysis was performed using the REVMAN software (version 5.3). Finally, 15 randomized controlled trials met the inclusion criteria for qualitative analysis and 14 for META-analysis from 219 articles. The results showed that PBM therapy had no effect on nerve injury in a short period of time (0-48h, 14 days), but had significant effect over 30 days. However, the effect of photobiomodulation therapy on thermal discrimination was still controversial, most authors supported no significant improvement. By calculating the effective rate of PBM, it was found that there was no significant difference in the onset time of treatment, whether within or over 6 months. The results of this META-analysis show that PBM therapy is effective in the treatment of IAN injures no matter it begins early or later. However, due to the limited number of well-designed RCTs and small number of patients in each study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.

Preemptive Analgesic Efficacy of Dexamethasone and Diclofenac in Mitigating Post-surgical Complications After Mandibular Third-Molar Surgery: A Systematic Review.

Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive administration of non-steroid anti-inflammatory drugs (NSAIDs) and steroids has been employed, resulting in a notable decrease in postoperative complications like pain, facial swelling, trismus, and alveolar osteitis. This systematic review's primary goal was to investigate the efficacy of preemptive analgesia with dexamethasone and diclofenac in minimizing the post-surgical complications following the surgical extraction of the mandibular third molars. The systematic search was carried out to identify relevant literature in digital databases including PubMed®, Cochrane Library, Web of Science, and Scopus, from January 1990 to January 2022. The search used specific keywords. The randomized clinical trials assessing the efficacy of dexamethasone and diclofenac or dexamethasone alone compared to diclofenac or placebo as preemptive analgesics were consideredinclusion criteria for this systematic review. Case reports, literature reviews, letters to the editor, and non-English publications were not included. Two authors screened the titles and abstracts, and articles fulfilling the study criteria were included. After reading the full text and data collection, analysis was performed. The included article's bias was evaluated by the Risk of Bias 2 (RoB 2) tool. Adigital database search yielded a total of 207 articles. After excluding duplicates and articles written in languages other than English, 90 were removed. Based on the title and abstract, out of 177, 95 studies were excluded.After full-text reading of 22 articles, 17 were eliminated because they did not meet the inclusion and exclusion criteria. The remaining five studies were found eligible and included in the systematic review. Four studies were of low risk, while one study had some concerns. Two studies evaluated the combination of dexamethasone with diclofenac, while three evaluated dexamethasone alone. Total samples included samples of 436 third-molar surgeries in 420 patients. There was a substantial decrease in the mean pain score and swelling measurement when diclofenac alone was compared with coadministration of diclofenac and dexamethasone. Preemptive administration of dexamethasone and diclofenac has been shown to effectively reduce pain and facial swelling, with the exception of trismus, in third-molar surgeries when compared to diclofenac alone. As a result, it is recommended to administer these drugs prior to the commencement of third-molar extraction. However, further research is mandatory, specifically good quality randomized controlled trials involving large cohorts, in order to assess any significant variations and validate these findings.

Effect of Leukocyte- and Platelet-Rich Fibrin in Postoperative Recovery Following Impacted Mandibular Third Molar Surgery: A Split Mouth Study

Objective: The surgeries for extraction of impacted lower third molars are more associated with complications such as pain and postoperative edema. The purpose of the present study was to evaluate the impact of the use of Leukocyte- and Platelet-Rich Fibrin (L-PRF) on pain and edema after extraction of impacted mandibular third molars.&#x0D; Material and Methods: A cross-sectional split-mouth study was conducted with 15 volunteer patients who had both impacted mandibular third molars with indication for extraction. The removal surgery was performed one side at a time, with an interval of 14 days. One side received L-PRF while the other did not. Patients were evaluated on the 2nd and 7th postoperative days for mouth opening, pain and edema.&#x0D; Results: In total, data from 14 patients (4 men and 10 women), with a mean age of 21.83 ± 2.8 years were evaluated. There was no statistically significant difference regarding mouth opening, pain and edema on the 7th postoperative day. On the second postoperative day, greater edema was observed in the control group with a statistically significant difference (p = 0.01).&#x0D; Conclusions: Under controlled conditions, the L-PRF does not appear to alter postoperative recovery after extraction of the lower third molars in terms of pain, edema and the ability to open the mouth. Despite the statistically significant difference in edema on the second day, the means were very close and were not clinically relevant.

Factors affecting number of third molars extracted in a single visit

Objective This cross-sectional study evaluated the number and characteristics of third molars extracted in a single visit in primary care and their associations with patient’s age and sex and operator’s experience. Materials and methods The data included all appointments where routine and surgical extractions of third molars were performed in 2016 in primary care of the City of Helsinki. Statistics included χ 2 and Mann–Whitney U tests, and binomial logistic regression. Results In total of 10,894 appointments, the number of extracted third molars was 12,728, yielding an average of 1.2 third molars per visit. Mean age of patients (55% women, 45% men) at extraction was 32.2 years (range 12 − 97 years). Most appointments (83.7%, n = 9,118) comprised extraction of one, 15.8% two, 0.4% three, and 0.1% four third molars. Number of teeth extracted at a time did not differ by sex. Increasing age was associated with a reduction in the likelihood of several third molar extractions in a visit (OR 0.96; 95% confidence interval (CI) 0.96–0.97). Multiple third molars were extracted significantly more likely if the operator was experienced (OR 2.32; 95%CI 1.90–2.84). Multiple extractions were also associated with the mandible, operative extractions, unerupted teeth and caries. Conclusions Third molars were typically extracted one at a time. In health care units, it is appropriate to consider extraction of several third molars in a single visit, if need for extraction of other third molars exist. Concentrating the extractions of younger patients on experienced operators would reduce the number of patients’ visits.

Prevalence of Pre-Existing Lingual Cortex Perforation Prior to Extraction of Mandibular Third Molars

The research aims to determine the relationship between the mandibular third molars and the nearby lingual cortical bone as well as to determine the frequency of lingual cortex perforation.The analysis was carried out by “CBCTs (cone beam computed tomographic scans)” of 18-65 years old patients. Lingual cortex fenestration at both root tips was observed. Almost three-quarters of radiographs showed the majority of the lingual area on the upper portion of a root (51.2% and 52.8%). The most lingual region and the area surrounding the root tip were both 1.25 mm thick. Mandibular third molars and perforated across both base levels were shown to be significantly related (P value.001). More than 50% of patients had lingual cortical perforation brought on by mandible third-molar teeth. The likelihood of lingual cortical rupture following extraction of the mandibular third molars is a sign of a prior problem rather than surgery.

Story of a Displaced Tooth – A Case Report

Various iatrogenic complication may be seen during extraction of mandibular 3rd molar. Displacement of mandibular 3rd molar into pterygomandibular space is usual but displacement into an unusual space like submandibular space or sublingual space is very rare. This can cause significant physical and psychological problems for the patient. The treatment for this kind of complications may vary from a conservative treatment to surgical procedure, what will depend on clinical features, symptoms, the location of the tooth, and its relation to adjacent structures. The present case report illustrates a rare complication of extraction of impacted mandibular third molar that was displaced into the sublingual region. Upon locating the tooth, successful removal of tooth was performed. Healing was uneventful after a 3 month of follow up.

Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study.

Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction. We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction. Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%). A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury.

Extraction of impacted mandibular third molars (IMTMs) is the most common surgery performed in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher in cases of IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. From August 2019 to June 2022, 23 patients underwent IMTM extraction by Dr. Zhao at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, and were found to have IMTMs in close proximity to the IAC. Due to high IAN injury risk, these patients underwent coronectomy-miniscrew traction to extract their IMTMs. The time between coronectomy-miniscrew insertion and complete removal of the IMTM was 32.65 ± 2.110days, which was significantly shorter than that of traditional orthodontic traction. Two-point discrimination testing revealed no IAN injury, and no injury was reported by patients during follow-up. Other complications, such as severe swelling, severe bleeding, dry socket, and limited mouth opening, were not observed. Postoperative pain levels were not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. For IMTMs that are in close proximity to the IAC and must be extracted, coronectomy-miniscrew traction is a novel approach to minimize the risk of IAN injury in a less time-consuming way with a lower possibility of complications.