Concept: Wisdom teeth
The aim of this study was to assess the efficacy of a single prophylactic dose of amoxicillin and/or dexamethasone in preventing postoperative complications (PC) after a surgical removal of a single mandibular third molar (M3).
Purpose The aim of this prospective comparative split-mouth study was to evaluate the role of socket irrigation with a normal saline solution routinely used at the end of extraction on the development of alveolar osteitis (AO) after removal of impacted mandibular third molars (MTMs).Materials and methods Thirty-five patients who satisfied the inclusion criteria were involved in the study and underwent extraction of four third-molars. To be included in the study, the mandibular third molars had to be impacted (partial or full bone) and require an osteotomy for extraction with use of a motorised drill. All surgeries were done under local anaesthesia or IV sedation. This was a prospective split-mouth study. The patient’s left (assistant) side was a control side; it had a standard extraction technique of an impacted mandibular third molar that required a buccal full-thickness flap, buccal trough (osteotomy) and extraction of the tooth (with or without splitting the tooth into segments), followed by a traditional end-of-surgery debridement protocol consisting of a gentle curettage, bone filing of the socket walls, socket irrigation with approximately 5 ml of sterile normal saline solution and socket suctioning. The patient’s right (operator) side was an experimental side; it also had a standard extraction technique of an impacted mandibular third molar at the beginning with a flap and osteotomy, but it was followed by a modified end-of-surgery protocol. It consisted of gentle curettage but the socket was not irrigated and not suctioned. It was simply left to bleed. The gauze was placed on top of the socket for haemostasis on both sides and the patient was asked to bite. On both sides, the buccal flap was positioned back without the suture. All patients were seen for a follow-up appointment four to seven days after the surgery to assess healing and check for symptoms and signs of alveolar osteitis, if present, on both irrigated and non-irrigated sides. This study followed the ethical guidelines of human subjects based on the Helsinki Declaration.Results Thirty-five patients or 70 sockets were evaluated. Eleven out of 35 patients in the study were subjected to a dry socket syndrome (31.4%). The higher number of AO was likely related to specifics of MTM selection in this study - only impacted (partial and full bone) MTMs were chosen. Among eleven patients with AO, two patients had a bilateral condition. By excluding two patients with bilateral dry sockets from the study, there were nine patients (18 extraction sites) with unilateral AO in the study. Seven out of nine patients (14 extraction sites) developed unilateral dry socket on the control (irrigated) side (77.8%) and only two (four extraction sites) on the experimental (non-irrigated) side (22.2%). Therefore, in this study there were 3.5 times more patients (extraction sites) with dry socket syndrome on the irrigated (control) side than patients (extraction sites) in the non-irrigated (experimental) side.Conclusion A noticeable difference of dry socket syndromes (77.8% on the irrigated versus 22.2% on non-irrigated side) was demonstrated between the traditional extraction protocol versus modified approach without the end-of-surgery irrigation. The study demonstrated that the post-extraction socket bleeding is very important for the proper uncomplicated socket healing. If it’s not washed away with irrigation solution at the end of extraction, the normal blood clot has a higher likelihood to form, and therefore, can potentially lead to an uncomplicated socket healing without development of alveolar osteitis. Socket bleeding at the extraction site creates a favourable environment for the formation of a blood clot - a protective dressing - necessary for a favourable osseous healing of the socket.
The relative risk of neurosensory deficit following removal of mandibular third molar teeth: the influence of radiography and surgical technique
- Oral surgery, oral medicine, oral pathology and oral radiology
- Published over 7 years ago
The aim of this study was to identify the relative risk of damage to the inferior dental (ID) and lingual nerves in patients undergoing lower third molar removal.
Sutureless technique following mandibular third molar surgery is an endearing concept in modern oral and maxillofacial surgery: regardless, few articles appear in literature with different methods, results, and flaps. A modern state of the art of this technique does not exist.In this article, an overview of studies regarding sutureless technique in mandibular third molar surgery is presented: relation to postoperative infection, recovery, and proper flap are discussed.
Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years.
To prospectively evaluate the longitudinal subjective and objective outcomes of the microsurgical treatment of lingual nerve (LN) and inferior alveolar nerve (IAN) injury after third molar surgery.
The purpose of the present study was to compare the effect of oral bromelain (4 × 250 mg) versus oral diclofenac sodium (4 × 25 mg) on pain, swelling, trismus, and quality of life (QOL) after surgical removal of impacted lower third molars.
Our aim was to compare the effects of the surgical drain and kinesiotape applications on postoperative morbidity after mandibular third molar surgery in a split-mouth study design.
Data sourcesMedline/PubMed, Cochrane central, Scopus and Google scholar.Study selectionRandomised controlled trials (RCTs) published in English between January 2010 and December 2015 were identified by two reviewers. Unpublished studies were not considered.Data extraction and synthesisStandard Cochrane Collaboration assessment tools were used to carry out a risk of bias assessment. The following data were collected from the articles; sample size, country, mean age of participants, diagnosis of alveolar osteitis (AO), type of intervention and outcomes. Heterogeneity (I2) was calculated to determine the statistical model to be used for meta-analysis.ResultsTen randomised control trials (RCTs) were included, with 862 participants. Eight studies used 0.2% chlorhexidine (CHX) gel in the experimental group, 1% CHX gel in one study, and in one study the concentration was not specified. Two studies used adjunctive antibiotics, and one study gave 400mg Ibuprofen to all participants.Six of the RCTs were at low risk of bias, three studies showed possible selection and/or performance bias, and one study gave no information on bias. Heterogeneity was low level (I2= 40%) and a funnel plot presented a low level of publication bias.The included RCTs used Blum’s criteria for diagnosis of AO. Six of the RCTs were conducted double-blinded. The risk ratio (RR) was calculated for each RCT and also for the pooled effect. The overall pooled effect of CHX gel placed in the extraction socket following mandibular 3rd molar removal was calculated to have prevented 57% of AO instances (RR = 0.43, 95% CI: 0.32, 0.58; p<0.00001). Subgroup analysis of the effect of CHX gel in participants who smoked/used the oral contraceptive pill (OCP) was calculated to have prevented 40% of AO (RR = 0.60, 95% CI: 0.41, 0.87; p = 0.007). In the studies that used a split-mouth design, CHX gel prevented 71% of AO incidence (RR = 0.29, 95% CI: 0.16, 0.50; p <0.0001).ConclusionsThis meta-analysis and systematic review concluded 'clinically significant evidence that CHX gel application in the extraction socket of mandibular 3rd molar has reduced the incidence of alveolar osteitis'.
Third molar removal surgery is the most frequently performed surgery in the oral and maxillofacial field with a wide range of items in the quantification of postoperative complications. For their measure, in 2014 a previous scale design was presented. The aim of this study was to determine the reliability and validity of a scale designed to measure and quantify postoperative complications in third molar surgery (TMS).