Modified envelope flap, a novel incision design, can relieve complications after extraction of fully horizontal impacted mandibular third molar

Removal of Horizontally Impacted Mandibular Third Molars Using the Three-Piece or T-Shaped Tooth Sectioning Method

BACKGROUND

The extraction of horizontally impacted mandibular third molars (HM3) can be a complicated surgery. Appropriate tooth sectioning methods can reduce the operation time and postoperative complications.

PURPOSE

The current study compares operative time and postoperative pain between HM3 removed using the three-piece or T-shaped tooth sectioning techniques.

STUDY DESIGN, SETTING, SAMPLE

A randomized single-blind prospective clinical trial on HM3 extraction was carried out between June and December 2022 in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University. Patients with local or systemic infection, poor oral hygiene, and systemic disease were excluded.

PREDICTOR VARIABLE

The predictor variable was the tooth sectioning method. The subjects were randomized to a three-piece or T-shaped group.

MAIN OUTCOME VARIABLE(S)

The primary outcome variables were the operative time and postoperative pain measured using a visual analog scale (VAS). The secondary outcome variables were the rates of primary bleeding, mouth opening reduction, swelling, patient satisfaction measured using a VAS, and quality of life measured using a postoperative symptom severity scale.

COVARIATES

The covariates included age, sex, side and classification of HM3, and the relationship of HM3 to the inferior alveolar nerve canal.

ANALYSES

The data were analyzed using the independent samples t-test, paired t-test, χ2, and rank sum test. A significance level set at P < .05.

RESULTS

The sample included 60 patients in the three-piece group and 66 patients in the T-shaped group. The operative time of the three-piece group (14.73 ± 3.21 minutes) was shorter than that of the T-shaped group (19.25 ± 4.29 minutes) (P < .05). On days 3 and 7, VAS of pain were 2.24 ± 1.89 and 0.15 ± 0.40 in the three-piece group and 3.95 ± 2.44 and 0.48 ± 0.68 in the T-shaped group (P < .05). The VAS of patient satisfaction in the three-piece group (6.05 ± 1.29) was better than the T-shaped group (4.90 ± 1.05) on day 7 (P < .05).

CONCLUSION AND RELEVANCE

The three-piece tooth sectioning for HM3 removal was associated with shorter duration, slighter postoperative symptoms, and higher patient satisfaction and may be considered as a recommended practice for dentists.

Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial

Background

Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus.

Materials and Method

It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study.

Result

Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups.

Conclusion

LBTF shows no edge over BBTF during mandibular third molar disimpaction.

Influences of ultrasound osteotome on wound infection and wound complications following removal of mandibular wisdom teeth

We conducted this study to assess the effect of ultrasound osteotome on surgical site wound infection and pain following removal of mandibular wisdom teeth. A computerised search of Embase, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for publicly available randomised controlled trials (RCTs) on the clinical effects of applying ultrasound osteotome to extract mandibular wisdom teeth was conducted from the inception of the databases to September 2023. Two researchers independently screened the retrieved results for literature screening, quality assessment and data extraction. RevMan 5.4 software was applied for data analysis. A total of 17 RCTs were included in this study, including 848 cases in the ultrasound osteotome group and 842 cases in the control group. The analysis revealed, compared with the control group, the ultrasound osteotome group showed a significantly lower incidence of postoperative wound infection (1.42% vs. 5.46%, odds ratio [OR]: 0.30, 95% confidence intervals [CI]: 0.17-0.53, p < 0.0001), fewer postoperative complications (6.35% vs. 22.12%, OR: 0.23, 95% CI: 0.17-0.32, p < 0.00001), shorter operative time (standardised mean differences [SMD]: -1.30, 95% CI: -1.97 to -0.64, p = 0.0001) and lower wound pain scores (SMD: -2.26 95% CI -2.80 to -1.73, p < 0.00001). Strong evidence suggests that ultrasound osteotome applied to extract mandibular wisdom teeth is more advantageous in terms of lower postoperative wound infection, less wound pain, fewer postoperative complications and shorter operative time compared with conventional treatment methods, but large-scale, multicentre RCTs are still needed to obtain more accurate results.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps

BACKGROUND

As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery.

METHODS

Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2).

RESULTS

No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2.

CONCLUSIONS

Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Comparison of buccal based triangular flap and lingual based triangular flap on postoperative course after impacted mandibular third molar surgery: a prospective randomized controlled study

Introduction: The present study is to compare the buccal based triangular flap with lingual based triangular flap on postoperative pain, swelling and trismus after mandibular third molar surgery. Materials and methods: This study comprised of 100 patients, of which, 50 patients underwent buccal based triangular flap technique and 50 patients underwent lingual based triangular flap. The patients in both the groups were evaluated for pain, swelling and trismus on 1st, 3rd and 7th postoperative days. The wound healing was assessed on the 7th postoperative day. The obtained data's were statistically analyzed using SPSS software. Results: Patients in lingual based triangular flap group had less pain on all three postoperative days (P < 0.001). While, the amount of swelling was less on the 3rd postoperative day (P < 0.05) and the degree of trismus was less on 1st and 3rd postoperative days (P < 0.05). The patients in buccal based triangular flap group showed statistical significance for swelling on 1st and 7th postoperative days (P < 0.05) and for trismus on 7th postoperative day (P < 0.05). 2 Patients reported with tissue dehiscence in lingual based triangular flap group. In buccal based triangular flap group, 7 patients presented with wound gaping and 2 patients developed dry socket. Conclusion: Lingual based triangular flap was found to be superior and effective flap design in controlling pain, swelling and trismus with reduced postoperative complications when compared to buccal based triangular flap.

Lingual bone thickness in the apical region of the horizontal mandibular third molar: A cross-sectional study in young Japanese

Background

Perforation of the lingual plate in the apical region of mandibular third molars will increase the risk of aberration and migration of the root tip and the risk of lingual nerve injury. The aim of this study was to analyze anatomical information, including relationships between the apical region of horizontally impacted mandibular third molars and lingual plates, in young Japanese.

Methods

Japanese patients, with horizontally impacted third molars, who underwent CT examination as a preoperative assessment for mandibular third molar extraction were included, and anatomical characteristics in the apical region of the right mandibular third molar were analyzed, in this study.

Results

A total of 121 patients were included based on the inclusion and exclusion criteria of this study. The mean and standard deviation of the bone thickness on the lingual side of the mandibular third molar in the apical region was 1.5 ± 1.6 mm, and the absence of lingual cortical bone in the apical region, namely, “perforation”, was observed in 44 patients. The statistical analysis revealed the predictors of cases with perforation as follows: gender, age, and the available space evaluated by Pell and Gregory classification.

Conclusions

This study clarified that “perforation” was sometimes observed in young Japanese, and that the predictors of those cases were as follows: gender, age, and the available space evaluated by Pell and Gregory classification.