Removal Of Third Molars Research Articles

Single-centre retrospective study of postoperative complications after removal of mandibular third molars using a straight lowspeed handpiece

ObjectiveWe aimed to analyze the incidence of postoperative complications after the removal of impacted mandibular third molars using a dental straight, low-speed handpiece. MethodsThis single-center retrospective descriptive study was conducted from January 2018 to December 2021. Inclusion criteria for the enrolled patients were complete medical records, no history of systemic disease, and received surgical removal of impacted mandibular third molars using a straight, low-speed handpiece. ResultsA total of 1050 patients underwent mandibular third molar removal with a straight, low-speed handpiece under local anesthesia. Most complications occurred in cases involving horizontal angulation (15.4%) and those categorized as level B (13.3%) and class II (13.9%) impactions. The difficulty index indicated moderate difficulty in most cases (55.3%), with the most and least common postoperative complications being pain (5.7%) and paresthesia (1.5%), respectively. ConclusionMost complications reported in this study were minor, transient, and within the ranges reported in the literature. No major complications, such as emphysema, were reported, while paresthesia was the least frequently reported complication. Thus, third molar removal using a straight, low-speed handpiece was associated with few complications and might be used as one of the safe procedures.

Palatal approach for surgical removal of mesioangularly impacted maxillary third molar - a pilot study

ObjectiveThis study aimed to investigate the application of the palatal approach for surgical removal of IMTM, and to evaluate its success rate, surgical duration, postoperative outcomes, and incidence of complications.MethodPatients with mesioangularly IMTM (Archer Classification Class B) in the none-buccal position to the adjacent second molar, which were indicated for surgical removal, were enrolled in this study. The patients were assigned into two groups according to the surgical approach: the buccal or palatal approach. The impacted tooth positions, diagnosis, past dental and medical history, and radiographic examination were recorded pre-operatively. The duration, surgery details, and surgical complications were documented during the surgery.Result40 teeth were enrolled in our study. All teeth were removed completely. The operation time was significantly shorter in the palatal approach group compared to the buccal approach group (13.3 ± 2.8 min vs. 22.3 ± 5.5 min, P<0.001). The incidence of traumatic ulcers of the lips was significantly higher in the buccal approach group than in the palatal approach group (7/20 vs. 0/20, P = 0.008).ConclusionIt is more efficient to perform surgery with a palatal approach if a Class B mesioangularly IMTM is located in the non-buccal aspect of the adjacent second molar.Clinical trial registration numberChiCTR2000040063

Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases.

The present report describes 2 cases of arterial bleeding after removal of the upper third molar that were successfully treated with selective transarterial embolization. The first patient underwent removal of the left upper third molar. A few hours later, facial swelling and massive bleeding appeared near the extraction socket involving the posterolateral wall of the maxillary sinus. Angiography showed a pseudoaneurysm involving the posterior superior dental artery, and the lesion was selectively embolized with an N-butyl cyanoacrylate (NBCA)-lipidiol mixture. The second patient underwent removal of the left upper third molar, and massive bleeding occurred from the extraction socket involving the greater palatine foramen. Angiography revealed the pseudoaneurysm of the greater palatine artery, and the lesion was selectively embolized with an NBCA-lipiodol mixture. Both patients were discharged uneventfully, and no recurrent bleeding was observed during the 82- and 5-month follow-up periods. Massive arterial bleeding after a third molar extraction occurs from either the posterior superior dental artery or the greater palatine artery, which is associated with the location of the extraction socket. Selective transarterial glue embolization is a useful option for the treatment of arterial bleeding after the removal of the upper third molars.

Mechanical Obstruction by Malposed Upper Third Molar: A Rare Cause of Trismus

Trismus is a multifactorial symptom which is most commonly presented after the removal of lower third molars. Upper third molar is a rare but true cause of trismus and must be included in the differential diagnosis. We present a rare case of trismus caused by the presence of malposed upper third molar, obstructing the forward movement of coronoid process of the mandible and restricting further mouth opening.

Can the Position of the Impacted Third Molars Be an Early Risk Indicator of Pathological Conditions? A Retrospective Cone-Beam Computed Tomography Study.

The aim of this retrospective study was to evaluate the prevalence of pathologies associated with impacted third molars in relation to tooth position on cone-beam computed tomography images. In 348 cone-beam computed tomography images, the position of 640 impacted third molars (mesiodistal angulation, buccolingual inclination, impaction depth, and contact point localization) and the presence of pathologies (distal caries, external root resorption, marginal bone loss, and pathological follicular space) were evaluated. The data were analysed statistically with a significance level set at P < 0.05. Distal caries was mostly detected in relation to Class A (20.4%) and contact point at (12.5%) and above (10.5%) the cementoenamel junction (CEJ) (P = 0.000; P < 0.05). External root resorption and marginal bone loss were more common in mesioangular angulation (52.3% and 80.1%, respectively), Class C (53% and 73.8%, respectively), and contact point below the CEJ (53.2% and 73.3%, respectively) (P = 0.000; P < 0.05). Lingual inclination was identified as a new risk factor for associated pathologies (P < 0.05). Pathological follicular space was significantly more likely to occur in those with inverted angulation (100%) and absence of contact (31.5%) (P = 0.000 and P = 0.010, respectively; P < 0.05). Pathologies arising in second molars in relation to impacted third molars are significantly associated with the three-dimensional position of impacted third molars, and watchful monitoring or prophylactic removal of impacted third molars should be considered, taking into account the relevant risk parameters for the related pathologies.

Does the “Root Removal First” strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position? — a randomized clinical trial

ObjectiveTo evaluate the clinical outcomes of the “Root Removal First” strategy in the surgical removal of impacted mandibular third molar (IMTM) in the class C and horizontal position.Materials and methodsA total of 274 cases were finally included in the statistics. The positions of IMTM in the horizontal position were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the “Root Removal First” strategy was applied in the new method (NM) group, and the conventional “Crown Removal First” strategy was executed in the traditional method (TM) group. The clinical information and relevant data upon follow-up were recorded.ResultsThe duration of the surgical removal and the incidence rates of lower lip paresthesia in the NM group were significantly lower than those in the TM group. The degree of mobility of the adjacent mandibular second molar (M2) in the NM group was significantly lower than that in the TM group at 30 days and 3 months post-operation. The distal and buccal probing depth of the M2, as well as the exposed root length of M2 in the NM group, were significantly lower than those in the TM group 3 months post-operation.ConclusionsThe “Root Removal First” strategy can reduce the incidence rate of inferior alveolar nerve injury and periodontal complications of the M2 in the surgical removal of IMTM in class C and horizontal position with high efficiency.Trial registrationChiCTR2000040063.

Role of Prophylactic Dose of Oral Amoxicillin Trihydrate in Prevention of Bacteremia Post Surgical Removal of Impacted Mandibular Third Molar: A Clinical Study.

The current study is designed to evaluate the efficacy of pre-operative prophylactic antibiotic for prevention of bacteremia after surgical removal of impacted mandibular third molar SRIMTM. The study was carried out as an open clinical trial. Fifty patients who fulfilled the criteria were included. Twenty five randomly selected patients (study group) were administered two grams oral dose of amoxicillin trihydrate, one hour prior to the procedure. Twenty five patients (control group) were not administered any antibiotic prior to the procedure. All patients underwent surgical removal of impacted mandibular third molar through intraoral approach under local anesthesia. Blood culture for detection of aerobic and anaerobic micro-organisms was done for all 50 patients. Eleven out of the twenty five patients (44%) in the control group showed positive growth, including mixed growth (aerobic and anaerobic). Seven patients showed purely anaerobic, 2 patients purely aerobic and two mixed growth. In the study (antibiotic) group, 7 out of the 25 patients (28%) showed positive growth, including mixed growth. Three patients showed purely anaerobic, 2 patients purely aerobic and 2 mixed type of growth. The study suggests that the judicious use of antibiotic prophylaxis, in conjunction with optimal oral health care serves to minimize the adverse effects of antibiotic therapy; and at the same time reduce the significant morbidity and mortality associated with systemic infections that might occur due to bacteremia resulting from surgical procedures of the oral cavity.

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.

Comparative Evaluation Of The Effectiveness Of Dexamethasone And Adrenaline With 2% Lignocaine For Pterygomandibular Nerve Blocks: A Randomized Controlled Clinical Study

Background and Aim: Dexamethasone, a glucocorticoid, has been used in local anesthetics as an additive for various locoregional nerve blocks. Although, its use in the dental field has not been unexplored and concealed. The current study was conducted to evaluate and compare the calibre of anesthesia, their hemodynamic response, vasoconstrictive effects, and control of pain while administering pterygomandibular nerve blocks using 2% Lignocaine hydrochloride solution with Dexamethasone(4mg/ml) with that of the standard 2% Lignocaine hydrochloride solution and Adrenaline bitartrate (1:80000). Materials and Methods: This triple-blind randomized controlled study included 80 healthy subjects, aged between 18-45 years with an indication for surgical removal of impacted mandibular third molars. With the aid of a computer-generated sequence, the subjects were arbitrarily assigned into 2 groups (40/group)- Group 1: patients administered with 2% Lignocaine hydrochloride and Dexamethasone Sodium Phosphate (4mg/ml) solution, and Group 2: patients administered with 2% Lignocaine hydrochloride with Adrenaline bitartrate (Adr) 1: 80,000 (12.5 μgm/ml) solution. The variables were assessed based on their time of onset, depth (pain) and duration of anesthesia, systolic, diastolic, and mean arterial blood pressures, heart rate, and blood loss. Results: Statistically significant difference (P&lt;0.05) was noticed for the onset (shorter onset in Group 1) and duration of action (prolonged in group 1) and number of analgesics required (less in grp 1). Statistically non-significant difference between 2 groups (P&gt;0.05) for pain, blood loss, cardiovascular variables (systolic, diastolic and mean arterial blood pressures and heart rate) at various intervals was noted. Conclusion: Dexamethasone added to Lignocaine shortens onset, prolongs duration of action and yields better control of post-operative pain as compared to Lignocaine with Adr. Vasoconstrictive properties, hemodynamic variables and intra-op pain control were comparable. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.172-178

Risk factors observed in 2-dimensional radiographs for permanent injury of the inferior alveolar nerve after removal of mandibular third molars: a case-control study

To assess whether differences exist in signs observed in 2D radiographs of mandibular third molars between a case group of patients with and a control group without permanent sensory disturbance of the inferior alveolar nerve (IAN) after removal. Three observers blinded to patient status assessed radiographs from the case group (n=162) and the control group (n=172). Two new signs, craniocaudal relation of the roots and the mandibular canal and position of the canal over the roots; and 4 "classic" signs, interruption of the white borders of the canal, darkening of the roots, narrowing of the canal lumen, and diversion of the canal over the roots were registered. Chi-square tests assessed differences in distribution of radiographic signs between the groups. Odds ratios expressed the association between radiographic signs and permanent sensory disturbance. Inter- and intraobserver reliability values were calculated. We found significantly more teeth with roots positioned inferiorly to the canal borders (P<0.001; OR 4.1-5.3) and with the canal superimposed over the upper or middle third of the roots (P<0.001; OR 2.6-3.9) in the case group than in the control group. Inter- and intraobserver reproducibility was excellent for roots inferior to the canal borders and fair to good for canal superimposition. Two radiographic signs are valid predictors of permanent sensory disturbance of the IAN in 2D radiographs.

Preoperative Submucosal Dexamethasone Injection for Minimizing Postoperative Pain, Trismus, and Oedema Associated with Impacted Mandibular Third Molar Surgery

Aim: Is To evaluate the relative ability of 4mg dose of preoperative Dexamethasone, administered submucosally, to reduce the postoperative pain, swelling and trismus after third molar surgery.&#x0D; Methods: The total 40 patient required surgical removal of a single mandibular third molar were included and divided into two groups, The experimental group (20 cases) received intraoperative submucosal injection of 4 mg Dexamethasone buccally around the tooth at three points after the onset of anesthesia and the control group (20 cases) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at post-surgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS).&#x0D; Results: There was a statistically significant reduction in the severity of postoperative edema in the experimental group by the second postoperative day. While both groups saw a reduction in discomfort and trismus, there were no statistically significant differences between them.&#x0D; Conclusion: The findings support submucosal injection of Dexamethasone (4 mg) to decrease postoperative edema. Low-dose Dexamethasone injection at the surgical site enhances drug concentration at the injury site without loss owing to diffusion or excretion. The submucosal technique was significantly effective in reduction of postoperative swelling and trismus.

Evaluation of the efficacy of topical rifamycin application on postoperative complications after lower impacted wisdom teeth surgery

PurposeThis study aimed to evaluate the efficacy of a single-dose topical rifamycin application on postoperative complications after impacted lower third molar surgery. Materials and methodsThis prospective, controlled clinical study consisted of individuals with bilaterally impacted lower third molars that would be extracted for orthodontic reasons. The extraction sockets were irrigated with 3 ml/250 mg of rifamycin solution in Group 1, while in Group 2 (control group) the extraction sockets were irrigated with 20 ml of physiological saline. Pain intensity was measured daily for 7 days by using visual analog scale. Trismus and edema were evaluated preoperatively and on the postoperative days 2 and 7 by calculating the proportional changes in maximum mouth opening and mean distance between reference points of the face, respectively. Paired samples t-test, Wilcoxon signed rank test and Chi-square test were used to analyze the study variables. Results35 patients (19 female, 16 male) were included in the study. The mean age of all participants was 22.19±4.98. Alveolitis was observed in 8 patients, (6 in the control group, 2 in the rifamycin group). There was no statistically significant difference between groups in terms of trismus and swelling measurements on the 2nd and 7th postoperative days (p>0.05). VAS scores were significantly low in rifamycin group on postoperative days 1 and 4 (p<0.05). ConclusionWithin the limits of the present study, topical rifamycin application reduced the incidence of alveolitis, prevented infection, and provided analgesic effect after surgical removal of impacted third molars.

The Influence of the Hyaluronic Acid Gel on the Postoperative Sequelae following Surgical Removal of the Impacted Mandibular Third Molar in Comparison with the A-PRF: A Randomized Controlled Trial.

One of the most common procedures in oral surgery is the removal of impacted mandibular third molars, often followed by pain, swelling, alveolitis, and trismus. Purpose. To compare the outcomes of the intrasocket application of 1% hyaluronic acid oral gel (HA) and advanced platelet-rich fibrin (A-PRF) on the expected postoperative complications, pain, swelling, and trismus follow the surgical extraction of the impacted mandibular third molar. Material and Methods. A randomized controlled trial was conducted at the Oral and Maxillofacial Surgery Unit, Dental Teaching Hospital. Healthy patients who required surgical removal of the impacted mandibular third molar were divided randomly into three groups. The extraction site of the group (A) patients remained without the addition of any material, just suturing of the wound with simple interrupted sutures, while in group (B) patients, the extraction site was filled with 1 cc of 1% hyaluronic acid gel (periokin®), and in group C patients, the extraction site was filled with A-PRF. Results. Sixty-six eligible patients participated in this study; both hyaluronic acid gel 1% (periokin®) and advanced platelet-rich fibrin showed a significant reduction in pain, swelling, and trismus on the 1st, third, and seventh postoperative days when compared to the control group, while the comparison between HA and A-PRF showed no significant differences except for the pain on the third postoperative day. There was a significant pain decrease in the A-PRF group than HA group. Conclusion. Intrasocket application of 1% hyaluronic acid gel (periokin®) or advanced platelet-rich fibrin can be an effective primary way to significantly reduce postoperative pain, trismus, and edema compared to the control group following mandibular third molar surgery.

Evaluation of the Efficacy of Oral and Intramuscular Administration of Dexamethasone on Postoperative Pain, Swelling, and Trismus After Surgical Removal of Impacted Third Molar: A Comparative Split-Mouth Study.

Context Over the past 60 years, several researchers have conducted extensive studies on the use of dexamethasone to reduce the postoperative complications of lower third molar surgery, namely, pain, edema, and trismus. In this study, we compared the oral and intramuscular methods of dexamethasone administration. Purpose The aim of this research was to assess pain, edema, and trismus in the postoperative period following the surgical removal of the lower third molar using 8 mg of dexamethasone given orally or by intramuscular injection. Method A split-mouth technique was employed for the study, in which each of the two bilaterally impacted mandibular third molars was removed one at a time, separated by at least two weeks. There were 26 participants in this experiment. Two groups were created from the research sample: group A (injection dexamethasone) and group B(tablet dexamethasone). The pain was assessed on the first, second, and third postoperative days. On the first, third, and seventh postoperative days, the parameters, such as edema and trismus, were evaluated. Results As per our study, in terms of edema and trismus, there was less of a statistically significant difference between the two interventions at all time points. While the pain score had a significant difference between both interventions. Conclusion Hence, we conclude that oral dexamethasone is an effective alternative to intramuscular dexamethasone. Oral dexamethasone is comparatively simple, less invasive, painless, and easy for the surgeonand for apprehensive patients, and it offers a cost-effective solution for the suffering often associated with the extraction of impacted lower third molars.

Lingual Nerve Injury During Impacted Mandibular Third Molar Surgery.

To determine the frequency of lingual nerve injury (LNI) during the surgical removal of mandibular third molar and the associated risk factors. Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, from January to June 2021. A total of 121 patients were included in this study who had undergone impacted third molar surgery. Data were collected on a proforma via interview. Patients were followed up after 1 week, 1 month, and 3 months of duration. Frequency of LNI and its association with various surgical procedure steps were determined. This study shows that out of 121 patients, frequency of LNI was found to be 3.3% (n=4). The type of impaction (p=0.047), lingual flap retraction (p<0.001), tooth splitting (p=0.029), and longer duration of surgery were found to be significantly associated with it. The frequency of LNI during mandibular impacted third molar surgery was 3.3% in this study, and significantly associated with horizontal impaction, lingual flap retraction, tooth splitting, and duration of surgery longer than 30 minutes. Lingual nerve injury, Tooth, Impaction, Third molar, Lingual flap retraction, Tooth splitting.

Efficacy of Intranasal Atomized Dexmedetomidine for Sedation in Surgical Removal of Impacted Mandibular Third Molars: A Prospective Study.

To assess the efficacy of dexmedetomidine atomized intranasally for sedation during surgical removal of impacted mandibular third molars. A prospective randomized trial was conducted on 25 anxious patients between the ages of 18 and 40 who had impacted the lower third molars. An intranasal atomization device was used to give the medication 30 minutes prior to the surgical procedure. The Ramsay sedation score and Observer's assessment of alertness/sedation score were used to assess intranasal sedation. The results of our study state that the sedative effect began to take effect between 30 and 45 minutes later and was nearly back to baseline by 105 minutes after the administration of intranasal dexmedetomidine. Intranasal delivery of 1.5mg/kg atomized dexmedetomidine for patients undergoing surgical removal of impacted mandibular third teeth is safe, feasible, and clinically efficient in daycare settings based on the sedation scores, and secondary variables which were assessed.

Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing.

To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars. A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6months prior to BSSO (control group), comprising at least 1year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique. A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020). The results obtained support concomitant molar extraction with BSSO as a feasible option.

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.

Improvement of the Impacted Level of Lower Third Molars After Orthodontic Treatment

The early or delayed surgical removal of an asymptomatic lower third molar (M3) in orthodontic patients remains controversial. This study aimed to determine the changes in the impacted level of M3 such as angulation, vertical position, and eruption space, after orthodontic treatment in 3 groups, namely non-extraction (NE), first premolar (P1) extraction, and second premolar (P2) extraction. Relevant angles and distances related to 334 M3s from 180 orthodontic patients were assessed pre- and posttreatment. Angle between lower second molar (M2) and M3 (M3-M2) was used for evaluating M3 angulation. For M3 vertical position, distances from occlusal plane to the highest cuspid (Cus-OP) and fissure (Fis-OP) of M3 were used. Distances from the distal surface of M2 to anterior border (J-DM2) and centre (Xi-DM2) of the ramus were used for assessing M3 eruption space. Pre- and posttreatment values of the angle and distance in each group were compared using a paired-sample t test. Measurements of the 3 groups were compared using analysis of variance. Hence, multiple linear regression (MLR) analysis was used to determine significant factors that impacted changes in M3s' related measurements. Independent factors used for MLR analysis included sex, treatment starting age, pretreatment respective angle/distance, and premolar extraction (NE/P1/P2). M3 angulation, vertical position, and eruption space at posttreatment were significantly different from those at pretreatment in all 3 groups. MLR analysis showed that P2 extraction significantly improved M3 vertical position (P < .05) and eruption space (P < .001). P1 extraction significantly decreased Cus-OP (P=.014) and eruption space (P < .001). Treatment starting age was significant factor that affected Cus-OP (P=.001) and M3 eruption space (P < .001). After orthodontic treatment, M3 angulation, vertical position, and eruption space changed in favour of the impacted level. These changes in the 3 groups were clearer in order: NE, P1, and P2, respectively.

An Evaluation of the Effectiveness of Local Delivery of Zoledronic Acid in Accelerating Bone Healing After the Extraction of Mandibular Third Molars.

Background and objective Zoledronic acid (ZA) has been reported to aid with the formationof new bone, inhibit osteoclastic bone resorption, and improve osteoblast proliferation. This split-mouth randomized clinical research aimed to evaluate the effect of the local application of ZA on bone regeneration after the removal of bilateral mandibular third molars. Methods A randomized, split-mouth study involving 12 patients aged 19-35 yearsrequiring extraction of bilaterally mandibular third molars was conducted. The extraction ofmandibular third molars on both sides was conducted in one session for all patients. In each participant, a gelatin sponge (Gelfoam) soaked with ZA was randomly applied to one cavity of the extraction socket. A gelatin spongesoaked with normal saline wasapplied to the opposite cavity; all patients were blinded asto which socket the drug was applied to. The study was conducted over a period of two months. The changes in bone density (BD) in the socket were assessed through cone-beam CT (CBCT) images; two images were taken for each patient at two different time points: immediately after extraction (T0) and after two months (T1). Results BD values in the socket on both sides of extraction increased from T0 to T1. There were statistically significant differences when comparing the amount of change in radiographic BD from T0 to T1 between the two sides of the extraction (p<0.05); the increase in radial BD between the two different time points was more significant in the ZA group. Conclusions Within the limitation of this study, the local application of ZAradiographically improved bone healingin a statistically significant manner and could be a cost-effective and simple way to activate bone regeneration.