Removal Of Third Molars Research Articles

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

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

Lingual nerve injury during extraction of mandibular third molars: Are we extracting correctly?

Introduction: Neurological injuries including lingual nerve damage are among the most devastating complications of mandibular third molar extraction. Various causes of lingual nerve damage have been proposed in literature including the surgical technique.
 Objective: This study aims to assess the adverse outcomes of the removal of mandibular third molars in terms of the frequency of lingual nerve injury (LNI).
 Methodology: This prospective case series was carried out at Maroof International Hospital, Islamabad. Surgical extraction was performed after raising both lingual and buccal mucoperiosteal flaps for surgical access. Ostectomy and tooth sectioning was performed while protecting the lingual flap with a passively placed periosteal elevator. Patients were recalled for the assessment of lingual nerve status, one week postoperatively. 
 Results: Out of the total of 1487 teeth extracted temporary lingual nerve injury was observed in just two cases (0.13%) both of which were extracted because of recurrent pericoronitis. None of the patients had a permanent neurological deficit. 
 Conclusion: For improving civility in nursing college, insight into incivility among students and faculty members is to be developed and policies to be in place to address unacceptable behaviors in a timely and effective manner. A surgical technique using careful lingual flap elevation and passive retraction results in the prevention of iatrogenic lingual nerve injury.

Study of pattern and prevalence of maxillary impacted third molars in Ghaziabad population

Objective: To evaluate the prevalence and pattern of upper impacted third molar with the help of orthopantomograms (OPG). Methodology: A total of 276 preoperative orthopantomograms were screened from the year 2020 – 2022 of the patients who reported to the Santosh Dental College and Hospital. Result: Out of 276 OPGs, 108 Orthopantomograms were excluded from the study as they did not fit under our inclusion criteria. Among 168 orthopantomograms, 96 were male patient (57.14%) and 72 were female patient (42.85%). The most common pattern of angulation seen in maxillary third molar was vertical (36% on right side and 31.2% on left side) followed by distoangular (11.71% on right side and 11.41% on left side), mesioangular (9% on right side and 12% on left side) and horizontal (0.57%). Class A impaction was common in maxilla. Conclusion: Surgical removal of the impacted maxillary third molar requires proper evaluation and assessment on the basis of different criteria.

The Effect of Local Melatonin Application Following the Removal of an Impacted Mandibular Third Molar

Pain, swelling, limitation of the mouth opening, development of intra-bony defects, and bone loss are common side effects of removing the impacted third molar. The purpose of this study was to measure the association of applying melatonin in the socket of an impacted mandibular third molar with osteogenic activity and the anti-inflammatory effects. This prospective, randomized, blinded trial comprised of patients who required removal of the impacted mandibular third molar. The patients were divided into two groups (n=19) as follows: melatonin group (3mg of melatonin into 2ml of 2% hydroxyethyl cellulose gel was packed into the socket) and placebo group (2ml of 2% hydroxyethyl cellulose gel was placed in the socket). The primary outcome was bone density, measured using Hounsfield unit immediately after surgery and 6months later. Secondary outcome variables included serum osteoprotegerin level (Ng/ml) that measured immediately, 4weeks and 6months postoperatively. Other clinical outcome measures were pain by visual analog scale, maximum mouth opening (MMO) (millimeter), and swelling (millimeter) that were evaluated immediately, 1, 3, and 7days postoperatively. The data were analyzed by independent t-test of Wilcoxon's rank-sum, analysis of variance, and generalized estimating equation (P≤.05). Thirty-eight patients (25 female and 13 males) with a median age of 27years were enrolled in the study. There was no statistical significance in bone density observed in both groups [melatonin group: 978.5(951.3-1015.8), control group: 965.8 (924.6-998.7), P=.1]. Alternatively, there were statistically significant improvements in osteoprotegerin levels (on week 4), MMO (on day1), and swelling (on day 3) in the melatonin group compared to those in the placebo group [1.9(1.4-2.4), 39.68±1.35, and 14.36±0.80 versus 1.5(1.2-1.4); 38.33±1.20, and 14.88±0.59; P=.02, .003, 0.031, respectively]. The pain values showed statistically significant improvement throughout the follow-up period in the melatonin group compared to the placebo group [5(3-8), 2(1-5), and 0(0-2) versus 7(6-8), 5(4-6), and 2(1-3); P<.001, respectively]. The results support the anti-inflammatory effect of melatonin in reducing the pain scale and swelling. Furthermore, it plays a role in the improvement of MMO. On the other hand, the osteogenic activity of melatonin could not be detected.

Third molars: not so NICE? risk factors for distal caries in mandibular second molars

UK guidelines currently advise against the prophylactic removal of mandibular third molars. However, growing evidence shows that asymptomatic impacted mandibular third molars may contribute to the formation of distal caries in mandibular second molars. Patients should be made aware that these guidelines do not necessarily prevent the potential development of decay or loss of mandibular second molars. A retrospective review, over 6 months, analysed the incidence and evaluated the risk for developing caries on the distal aspect of mandibular second molars, in patients referred for assessment of impacted third molars. Distal caries in the mandibular second molar was present in 24.1% of cases. Of these patients, 9% demonstrated caries bilaterally. In those who developed distal caries in the mandibular second molar, 76% of adjacent third molars demonstrated mesio-angular impaction, 91% of third molars were partially erupted, and 95% of third molars were either touching or in close proximity to the ACJ of the second molar tooth. The prophylactic removal or coronectomy of mesio-angluar or horizontally impacted third molars that are partially erupted and closely related to the ACJ of mandibular second molars may result in improved long-term patient outcomes. CPD/Clinical Relevance: The prophylactic removal or coronectomy of certain third molars may result in improved long-term patient outcomes.

COMPARISON OF ANTI-INFLAMMATORY EFFECT OF DEXAMETHASONE VS KETOROLAC AS PREEMPTIVE ANALGESIC IN IMPACTED MANDIBULAR THIRD MOLAR SURGERIES

Introduction: Impacted tooth is a tooth which is completely or partially unerupted and is positioned against another tooth, bone or soft tissue so that its further eruption is unlikely, described according to its anatomic position. Most common complications associated with the removal of the third molar include damage of the pain, sensory nerve leading to paresthesia, dry socket, infection, and hemorrhage. Severe trismus, oro-antral stula, buccal fat herniations, iatrogenic damage to the adjacent second molar, and iatrogenic mandibular fracture may also occur, though very rarely. This double-blind, and ra Aim: ndomized study was aimed to compare the efcacy of dexamethasone and ketorolac tromethamine, through the evaluation of pain, edema, and limitation of mouth opening. Methodology: The study group was composed of 20 adult individuals, who were indicated for surgical removal of mandibular third molars with total or partial bone impaction. Group 1 individuals received 1 capsule of 10 mg ketorolac tromethamine 1 h before surger6. Group 2 received 1 capsule of 8 mg dexamethasone 1 h before surgery. The values obtained during the study were compared us Results: ing the t test or Mann Whitney test, depending on the distribution of values. The level of signicance was set at 5%. The statistical program SPSS version 26.0 was used. There was no statistically signicant difference between the groups for varied pain across time (2, 6, 12, and 24 h). Post-operatively, for the dexamethasone group, mouth opening after 24 hrs, 48 hrs and 72 hrs was 42.20mm, 42.90mm and 43.60mm respectively, which was statistically signicantly higher as compared to ketorolac group. Post-operatively, edema after 24 hrs, and 48 hours was lower in the dexamethasone group as compared to the ketorolac group but it was statistically insignicant . The results Conclusion: obtained with the use of 8 mg dexamethasone 1 hour prior to the surgical procedure at a single dose and 10 mg of ketorolac 1 hour before the employed distinctly are effective in the control of postoperative inammation on the pain, edema, and limitation of mouth opening in the extraction of the third inferior molars.

Efficacy of intraosseous saline injection for pain management during surgical removal of impacted mandibular third molars: a randomized double-blinded clinical trial.

Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group). The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

Efficacy of Celecoxib and Diclofenac Sodium in the Management of Postoperative Pain, Swelling and Mouth Opening after Surgical Removal of Impacted Third Molars: A Split-mouth Randomised Clinical Study

Introduction: The surgical removal of mandibular third molars is generally followed by complaints of pain, trismus, and swelling. The duration of surgery and the reflection of a mucoperiosteal flap have been shown to affect the intensity and frequency of postoperative complaints. Pain from third molar surgery typically begins within one to three hours after surgery and ranges in intensity from moderate to severe. Numerous analgesics have been used to minimise pain and discomfort following the surgical removal of impacted third molars. Commonly used agents include ibuprofen, diclofenac sodium, paracetamol, or their combinations. Newer drugs, such as selective COX inhibitors, have not been extensively used for minor oral surgical procedures. Aim: To compare the clinical efficacy of celecoxib and diclofenac sodium on pain, swelling, and mouth opening after the surgical removal of impacted mandibular third molars. Materials and Methods: A split-mouth randomised controlled clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at BharatiVidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India. The study duration was six months, from August 2022 to January 2023. A total of 21 subjects (11 males and 10 females) who required surgical extraction of an impacted mandibular third molar were selected. All subjects were randomly allocated to receive one of the following treatments twice a day for five days after surgery: celecoxib 200 mg (n=11) or diclofenac sodium 75 mg (n=10). Pain scores were evaluated using the Visual Analogue Scale (VAS) on postoperative day one, two, and three. Swelling and mouth opening were evaluated on Postoperative Day (POD) two and seven. Intergroup comparison was done using Student’s t-test. Results: The mean age of the study participants was 28±1.5 years, and the mean VAS score for pain evaluation with celecoxib was 6.61, 5.38, and 5.00 on day 1 (p=0.027), 2 (p=0.972), and 3 (p=0.809), respectively. The difference in swelling values for the celecoxib group was significant, while there were no significant differences in the values of mouth opening. Conclusion: It was concluded that celecoxib 200 mg is a better analgesic and anti-inflammatory compared to diclofenac sodium 75 mg. Celecoxib was easily tolerable and comfortable for the patients. There was no significant difference in the values of mouth opening.

Comparison of Clinical Efficacy of Bromelain with Paracetamol on Postoperative Sequelae after Surgical Removal of Impacted Mandibular Third Molar: A Split-mouth Randomised Clinical Study

Introduction: The most frequent oral and maxillofacial surgical operation carried out in an outpatient setting is the surgical extraction of impacted mandibular third molars. The removal of impacted mandibular third molars involves surgical trauma in a highly vascularised area, which causes inflammatory changes referred to as “sequelae,” including pain, swelling, and trismus. These symptoms gradually appear, peaking two days after the extraction. To limit these postsurgical inflammatory complications, surgeons have advised the patients to use proteolytic enzymes, such as bromelain, along with routine antibiotics, analgesics, and corticosteroids. Aim: To compare the clinical efficacy of bromelain with that of paracetamol on pain, swelling, and trismus after the surgical removal of bilateral impacted mandibular third molars with similar difficulty indices. Materials and Methods: The present study was a split-mouth randomised clinical trial conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India, over a period of six months from August 2022 to January 2023. Twenty subjects requiring surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly assigned to receive one of the following treatments for five days after surgery: Cap. bromelain 500 mg-BD 24 hours preoperatively and continued until the 4th day postoperatively (n=10, Group A) or Tab. paracetamol 500 mg-TDS (n=10, Group B). Pain scores were evaluated using the Visual Analog Scale (VAS) on postoperative days 1, 2, and 3. Swelling and mouth opening were assessed on postoperative days 2 and 7. Intergroup comparison was done using Student’s t-test. Results: The mean VAS scores for pain evaluation were 6.60, 5.80, and 5.20 for bromelain on days 1 (p=0.001), 2 (p=0.001), and 3 (p=0.001), respectively. The difference between the swelling values for the bromelain group was significant, while there were no significant differences in the values of trismus. Conclusion: It was concluded that bromelain is a better analgesic and anti-inflammatory drug compared to paracetamol. There were no significant differences in the values of trismus.

Characteristics of preoperative and postoperative anxiety in adults undergoing surgical extraction of impacted third molars

Background/Aim: Surgical removal of impacted third molars is associated with possible complications that are primarily comprehended as expected. Increase in incidence and severity of complications is directly related to the depth of impaction, and to the age of the patient as well. The aim of this research was to investigate the possible influence of the treatment duration relating to age and gender of the patients, the occurrence of pain, and the existence of previous anxiety experience connected with surgical wisdom tooth removal. Material and Methods. The study included adults of both gender indicated for surgical removal of impacted third molars. The existence of previous wisdom tooth removal experience was determined during the first examination, and the subjects' anxiety and pain levels were determined pre-, and postoperatively. Results: There were no differences concerning the place of treatment (dental office/operating room) and the duration of surgery. Younger participants showed the lowest levels of preoperative anxiety and the highest levels of postoperative anxiety, and frequently reported postoperative pain. Female participants showed higher levels of preoperative and postoperative anxiety, and also frequently reported postoperative pain. Conclusions: Anxiety and pain scores were lower when there was a previous experience with removal of impacted wisdom teeth.

Why choose articaine over lidocaine for the removal of third molars? Systematic review and meta-analysis

Why choose articaine over lidocaine for the removal of third molars? Systematic review and meta-analysis

Reduction of NrF2 as coadjuvant during the development of persistent periapical lesions.

Persistent periapical lesions (PPL) are the result of pulpar necrosis induced by bacterial infection resulting in bone degradation and culminating with the loss of dental piece. Pathological changes in the peripapice are associated with the presence of free radicals. The transcription factor Nrf2 is the main regulator of the endogenous antioxidant response against oxidative stress and has been implicated in the regulation of osteoclastogenesis.The aim is to determine the oxidative condition in samples from patients with Persistent Periapical Injuries as a detonating factor of tissue damage. An observational, descriptive, cross-sectional study was carried out in samples with PPL (cases) and samples by removal of third molars (controls) obtained in the clinic of the specialty in endodontics, University of Guadalajara. Samples were submitted to histological staining with Hematoxylin-Eosin, lipoperoxide analysis, Superoxide Dismutase (SOD), Glutathione-Peroxidase (GPx) and Catalase (CAT) activities were determined by immunoenzymatic assays and NrF2 by Western Blot analysis. Samples from PPL patients histologically showed an increased presence of lymphocytes, plasma cells, and eosinophils, as well as a decrease in extracellular matrix proteins and fibroblast cells. There was a rise in lipid peroxidation, GPx and SOD activities, but an important decline (36%) in Catalase activity was observed (p<0.005); finally, NrF2-protein was diminished at 10.41%. All comparisons were between cases vs controls. The alterations in antioxidants endogenous NrF2-controlled are related to osseous destruction in patients with PPL.

Assessment of preoperative and postoperative anxiety in adults during extraction of impacted third permanent molars

Background: Dental fear and anxiety (DFA) is ubiquitous among the adult population. The anxiety component of DFA is more strongly expressed in adults, and includes a physiological and psychological component, and is more often analyzed in research. Oral-surgical interventions represent a significant source of stress for the appearance of anxiety in subjects. The research aim was to analyze the presence of anxiety with the use of the revised Corah Dental Anxiety Scale (DASR) and the Spielberger State Trait Anxiety Inventory (STAI) in adult patients during the treatment of extraction of impacted third permanent molars by oral surgery. Material and Methods: The study included adult patients of both sexes, who were previously scheduled for oral-surgical removal of third permanent molars. Anxiety levels were assessed preoperatively and postoperatively as follows: 1st measurement (day of examination)-DASR, and STAI (X1 and X2); 2nd measurement (immediately before the intervention)-STAI (X1 and X2); 3rd measurement (day after the intervention)-STAI (X1 and X2). Results: Preoperatively, the presence of high levels of general anxiety, situational anxiety, and dental anxiety was determined. The levels were decreased before the planned surgery and were significantly reduced in the postoperative period. The STAI scale could be used to assess the presence of situational anxiety in the dental office on an equal footing with other known measuring instruments (e.g. DASR). Conclusions: Adequate therapy should be considered to prevent preoperative anxiety, which would increase the satisfaction of patients and therapists while reducing complications related to this type of intervention.

Pulsatile hemorrhage posterior to the mandibular third molar due to abnormal branching of the inferior alveolar artery: A case report

AbstractBackgroundThe retromolar canal and foramen posterior to the mandibular third molar are rare anatomical variants through which branches of the inferior alveolar neurovascular bundle may pass.Case PresentationPulsatile hemorrhage occurred when the removal of a mandibular third molar and a surrounding cystic lesion was attempted in a 56‐year‐old woman. On imaging, well‐developed inferior alveolar artery branch was observed in the retromolar canal, and the facial artery could not be identified on the same side.ConclusionClinicians must be aware of this anatomical variant to avoid complications.

Efficacy of Lornoxicam as a Pre-emptive Analgesic in Mandibular Third Molar Surgery - A Comparative Study.

The most common complication following third molar surgery is pain. The purpose of the study is to determine the efficacy of lornoxicam as a preventive analgesic in patients undergoing surgical removal of impacted mandibular third molars. This study included 26 participants aged 18-28 years with bilateral symmetrical third molars. Group A, the control group, received lornoxicam 8 mg 1 h after surgery, whereas Group B, the study group, received lornoxicam 8 mg 1 h before surgery. All patients were evaluated for pain at the 1st, 2nd, 4th, 6th, 8th and 12th post-operative hours. The number of rescue analgesics taken within 24 h of the procedure, as well as the first occurrence of pain postoperatively, was recorded and analysed. Using the Mann-Whitney U-test and Friedman's analysis, the resulting data were statistically analysed. When Group B was compared to Group A, there was a significant difference in pain reduction levels in the immediate post-operative hours. When compared to Group A, Group B had a lower need for rescue analgesics within the first 24 h postoperatively. Following mandibular third molar surgery, pre-emptive use of lornoxicam is effective in reducing post-operative pain and reducing the need for rescue analgesic consumption.

Reliability of two difficulty indexes in predicting the surgical extraction difficulty of impacted mandibular third molars

Introduction: The aim of this study was to compare the reliability and the agreement of the Pederson and Pernambuco difficulty indexes in predicting the surgical extraction difficulty of the impacted mandibular third molars. Materials and methods: A prospective observational cohort study was conducted on 83 patients who had undergone surgical removal of impacted mandibular third molar. The difficulty of extraction was determined preoperatively according to the total scores obtained from the Pederson and Pernambuco difficulty indexes, the operative difficulty was determined by the surgical technique and the duration of extraction. The accuracy of prediction of the surgical difficulty and the degree of agreement of the two indexes were calculated. Results: The accuracy of Pederson and Pernambuco indexes in predicting the operative difficulty measured by duration of surgery was 36.1% and 55.4% respectively, and with operative difficulty measured by the technique was 21.7% and 37.3% respectively with statistically significant differences. The agreement between the 2 indexes was poor. Conclusion: Both indexes were limited in predicting the surgical difficulty of impacted mandibular third molars although the Pernambuco index was better than the Pederson index and the agreement between the two indexes was poor.

Evaluation of Efficacy of Low-Intensity Pulsed Ultrasound on Comorbidities Following Mandibular Impacted Third Molar Surgery: A Prospective Study.

Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar. The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm2)/sham, ultrasound therapy was given on 1st, 2nd and 3rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days. The quantitative variables of the study were assessed using independent sample t-test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups. Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique.

Evaluation of the effect of green tea extract on postoperative pain management following surgical removal of impacted mandibular third molar.

Pain following surgical removal of impacted molars has remained a principal concern among practitioners. Since green tea has anti-inflammatory and anti-bacterial properties, the current study aimed to evaluate the efficacy of green tea extract local application in controlling postoperative pain following surgical extraction of the impacted mandibular third molar teeth. In a double-blinded randomized controlled trial study with a split-mouth design, 32 patients underwent bilateral removal of impacted third molars in a 2-month time interval; afterward, the sterile gauzes impregnated with green tea extract and saline were applied randomly to the surgical sites. Postoperative pain was evaluated 6, 12, 24, and 48 h after surgery using a questionnaire based on the Visual Analog Scale (VAS) and the number of analgesics used after surgery. Data were subjected to exact and Chi-square tests with the significance level set at 0.05. There was a decrease in the mean scores of the VAS and the mean number of analgesic consumptions in the first 2 days after surgery. Chi-square test results showed a significant reduction in the VAS scores after applying the green tea extract only 6 and 12 h after surgery (P < 0.05). Moreover, the number of analgesic consumptions was significantly lower in the green tea group compared to the control group. Green tea extract may be an appropriate and safe choice for postoperative pain control after surgical extraction of the impacted mandibular third molar teeth.

Systemic Enzymes and their Role in the Reduction of Post-Operative Edema After Surgical Removal of Lower Third Molars: A Randomized Controlled Double-Blind Study

Systemic Enzymes and their Role in the Reduction of Post-Operative Edema After Surgical Removal of Lower Third Molars: A Randomized Controlled Double-Blind Study

Buccal Nerve Trunk Block Anesthetizes the Buccal Mucosa Beyond the Papilla of the Parotid Duct

The limited area of anesthesia of the buccal mucosa with concomitant conventional buccal nerve block (conventional BNB) may be involved in failed inferior alveolar nerve block (IANB). The aims of this study were to examine the extent of anesthesia by buccal nerve trunk block (BNTB) and compare the success rates of IANB with BNB. This prospective parallel-group randomized single-blinded clinical trial included patients scheduled for removal of a mandibular third molar at the Nippon Dental University Hospital between September 2021 and March 2022. The primary predictor variable was the approach for BNB (BNTB vs conventional BNB). The primary outcome was the extent of tactile sensory loss and anesthesia of the buccal mucosa. The secondary outcomes included onset time and duration of BNBs and the success rate of the IANB with concomitant BNB for third molar extraction, assessed by the proportions of intraoperative pain perception and supplemental infiltration anesthesia. The other study variables were sex, age, and injection side. Comparisons were analyzed by Fisher's exact test or the Mann-Whitney U test. The P value was set to .05. A total of 38 patients (14 male, 24 female) with a mean age of 28.9years (range, 18 to 67years) were enrolled, with 19 patients each in the BNTB group and conventional BNB group. The effective tactile sensory loss rates at ∼5mm above the height of the papilla of the parotid duct of the premolar and molar regions were greater following BNTB (71 and 95%, respectively) than following conventional BNB (37%; P<.01 and 58%; P<.01, respectively). The proportions of intraoperative pain perception of the BNTB group and the conventional BNB group were 10 and 42% (P=.06), respectively, and those of supplemental infiltration anesthesia were 5 and 26% (P=.18), respectively. BNTB provided a wider extent of anesthesia of the buccal mucosa than conventional BNB and may improve the anesthesia success of IANB for removal of mandibular third molars.