"Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae"

Piezoelectric Surgery Is Effective in Reducing Pain, Swelling, and Trismus After Removal of Impacted Lower Third Molars: A Meta-Analysis

PURPOSE

Surgery of impacted lower third molars may be associated with postoperative complications. The aim of this study is to determine whether piezoelectric surgery is effective in reducing pain, swelling, and trismus compared to conventional rotary instruments during extraction of impacted lower third molars.

METHODS

For this systematic review, the searches were performed independently by 2 researchers. Randomized clinical trials that used the piezoelectric instrument for the removal of impacted lower third molars in humans were included. The predictor variable was the study group (piezo surgery vs rotary instruments). The main outcome was the analysis of postoperative pain, swelling, and trismus. Data analysis included risk of bias assessment (RoB 2 Cochrane) and meta-analysis with heterogeneity based on random effects I² and 95% confidence interval.

RESULTS

In the initial results, 956 articles were revised and after applying inclusion/exclusion criteria, the final sample was composed of 18 publications, all being randomized clinical trials. The results of this meta-analysis demonstrated a significant reduction in pain scores with a Cohen's d of -0.95 [CI 95% = -1.23 to -0.67] of high clinical impact (P < .001). In the piezo group there was a significant increase in mouth opening of 4.29 [CI 95% = 2.33 to 6.25] mm (P < .001). Regarding swelling, Tragus-Ang and Go-eye, both showed a significant reduction in the piezo group (P < .001). There was a significant increase of 7.32 [CI 95% = 4.40 to 10.24] minutes in the piezo group (P < .00001), and none of the studies showed a significant risk of bias.

CONCLUSIONS

Piezo proved to be effective in reducing pain, swelling, and trismus in third molar surgeries even with longer surgical time, but due to the lack of standardization in primary studies regarding swelling, new, controlled and standardized studies should be carried out with the objective of proving the effectiveness of this therapeutic modality in the reduction of postoperative swelling.

Can Amoxicillin and Clavulanic Acid Impregnated Plaster of Paris Beads Serve as an Effective Alternative to Systemic Antibiotics for Third Molar Surgeries? A Split Mouth Randomized Clinical Trial

Purpose

The present work was a pilot study undertaken to evaluate the effectiveness of amoxicillin and clavulanic acid impregnated plaster of paris beads for prevention of infection of third molar extraction sockets.

Materials and Methods

This was a prospective, randomized, split mouth clinical trial done on 16 patients (32 sites) who required surgical extraction of mandibular third molars. Control arm patients were given Tab. amoxicillin 500 mg with clavulanic acid 125 mg (Tab. Klavimed 625 mg, Indomed, India), thrice daily for 3 days after extraction, whereas test arm patients received Antibiotic Impregnated Microbeads (AIM), containing Amoxicillin 500 mg and Clavulanic Acid 100 mg placed in situ in the extraction socket. The primary outcome parameter was infection and the secondary outcome parameters were pain, trismus, swelling and wound healing.

Results

None of the patients in either group had post operative infection. There was no significant difference in pain intensity between the two groups (1st day p = 0.41; 3rd day p = 0.38, 7th day p = 0.37). Both the groups were also similar with respect to swelling (p = 0.596, 0.146, 0.871, 0.820 on 1st, 3rd, 7th, 15th post-op day ,respectively).

Conclusion

Amoxycillin with clavulanic acid impregnated PoP beads appears to be as effective as oral 3 day amoxicillin with clavulanic acid regime for prevention of 3 M socket infection.

A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars

Background: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients’ quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. Methods: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. Results: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. Conclusions: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.

Comparing the Effect of Facial Compression Bandage to That of Systemic Dexamethasone on Postsurgical Sequels after Extraction of Impacted Mandibular Third Molars: A Split-mouth Randomized Clinical Trial

AIM: The present study aimed to compare the clinical efficiency of facial pressure bandage, to that of intramuscular injection of dexamethasone (8 mg) on postsurgical sequels (swelling, pain, and trismus) of extraction of impacted mandibular third molar. METHODS: The study implemented a randomized split-mouth design. Patients with symmetrical bilateral impacted molars were eligible for the present trial. Sides were randomly assigned to two groups: pressure bandage group and dexamethasone group. The evaluated postsurgical sequels were extraoral swelling, trismus, and pain after 48 h and 7 days. RESULTS: The study included 42 impacted third molars (n = 42) in 21 patients with a mean age of 23.4 years. Most participants were females (66.7%). The mean postoperative swelling rates after 48 h and 7 days in pressure bandage group were found to be comparable to those of dexamethasone group. No significant difference was found in the mean rates of postoperative trismus between study groups after 48 h and 7 days. Differences in mean pain level scores between the pressure bandage group and dexamethasone group were statistically insignificant after 48 h and 7 days. CONCLUSION: The study findings showed that the effect of the pressure bandage was comparable to dexamethasone effect on the postsurgical sequels after surgical extraction of impacted mandibular third molars.

Oral cancer awareness in North-Western Spain: a population-based study

Background

An early diagnosis depends greatly on patient awareness. Thus, the aim of this study was to investigate general awareness of oral cancer and knowledge about its risk factors, signs and symptoms.

Material and Methods

Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016.

Results

A total of 5,727 people entered the survey (response rate: 53%). When asked what cancers participants had heard about, 20.3% mentioned oral cancer. Regarding risk factors, tobacco was mentioned by 55.3% of the sample (n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248).

Conclusions

General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, individuals in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. In these circumstances, there is clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment.

Key words:Oral cancer, awareness, risk factors, surveys and questionnaires, Spain.

Comparison of postoperative morbidity between piezoelectric surgery and conventional rotary instruments in mandibular third molar surgery: a split-mouth clinical study

Background

The extraction of impacted third molar teeth is a common procedure in maxillofacial surgery. The aim of this study was to compare of piezoelectric surgical technique with the one with conventional rotary instruments in terms of edema, trismus and pain, in mandibular third molar surgery.

Material and Methods

20 individuals with symmetrically impacted lower mandibular third molars and 40 teeth were included in the study. Third molars on the left side of each patient were removed with piezosurgery, while the counterparts on the right side were removed with conventional rotary instruments. Postoperatively, the same antibiotic, analgesic, and mouthwash were recommended to both groups. Ultrasound, edema, trismus measurements were performed before surgery, postoperative, postoperative day 2 and postoperative day 7. VAS scale was used to evaluate the pain.

Results

The average age of 20 individuals included in the study was found to be 21.85 ± 3.08 years. The operation time of the individuals who underwent the surgery with conventional rotary instruments was found to be 12 minutes 31.70 ± 167.03 seconds, and the operation time in the Piezosurgery group was 19 minutes 10.60 ± 306.59 seconds. There was no significant difference between the two groups in terms of trismus, edema, and pain.

Conclusions

Piezosurgery is a safe method that can be used in molar removal, but in this split-mouth study, it is not found advantageous in terms of postoperative morbidity due to the longer working time compared to the one performed with conventional rotary instruments.

Key words:Edema, impacted third molar, pain, piezosurgery, trismus.

Systemic Use of Arnica Montana for the Reduction of Postsurgical Sequels following Extraction of Impacted Mandibular 3rd Molars: A Pilot Study

Background

Postsurgical sequels (PSS) are a group of complications commonly encountered following invasive dental surgical procedures such as bone grafting procedures, external sinus grafting, and 3^rd molar extractions. These include pain, intraoral and extraoral bruising, and edema. The aim of this study is to evaluate the clinical efficacy of arnica montana (AM) in the management of PSS following extraction of impacted mandibular 3^rd molars. The investigators null hypothesis includes no significant role of AM in reducing PSS following dental extraction.

Materials and Methods

The investigators implemented a case-control pilot study enrolling twenty-three patients with impacted mandibular 3^rd molars. These patients were allocated to AM or control group. Baseline clinical measurements were collected and included: (1) length of the surgical procedure, (2) pain score, (3) maximum mouth opening, and (4) facial measurements to evaluate edema levels. Subjects in active group received systemic AM tablets following the manufacturer instructions. All study subjects were followed up on Days 2, 4, and 7. Data was analyzed for statistical significance.

Results

A total of 30 impacted mandibular 3^rd molars were extracted, in which 22 completed with AM. There were 16 females, and the average age was 26 years. On Day 2, subjects in the AM group reported significantly lower VAS compared to control group (3.09 ± 2.22 versus 4.75 ± 1.28). In addition, bleeding, extraoral bruising, edema, and decrease in maximum mouth opening were significantly less reported in the AM group.

Conclusions

This study describes the potential benefit of AM in reducing PSS following dental extractions.

Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and "split-mouth" clinical study

Background

As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain, edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions.

Material and Methods

Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3, 7 and 14-days. The measured parameters were duration of surgery, pain, trismus and swelling.

Results

The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p>0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p=0.038; p<0,05). However, for the remaining analyzed periods there was no difference (p>0.05).

Conclusions

Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration.

Key words:Third molar, piezosurgery, flap, exodontia, ostectomy.