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Sheta MS, Ghouraba RF, Ibrahim MT. Bone lid technique versus standard technique for treatment of mandibular lesions. BMC Oral Health 2024; 24:875. [PMID: 39095818 PMCID: PMC11295513 DOI: 10.1186/s12903-024-04594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Jaw lesions are frequent in the oral and maxillofacial areas. Different methods for enucleating jaw lesions in the oral and maxillofacial sites have been proposed, including the bone lid technique. PURPOSE The aim of this study was to compare the clinical and radiographic results of the bone lid technique employing a piezoelectric surgery to the traditional technique in individuals with mandibular lesions. MATERIALS AND METHODS A randomized controlled trial was conducted on 24 patients with mandibular lesions. They were randomly allocated into two groups (n = 12 for each group). Group I: the mandibular lesion was excised with bone lid technique using a piezoelectric device, followed by the fixation of the bony window after its repositioning. Group II: the lesion was excised with the traditional method using rotatory burs. Pain, soft tissue healing, bone exposure, bone lid integration, and the volume of the residual bone defect were all assessed clinically and radiographically after one week, one month, and six months. RESULTS All patients in both groups showed adequate soft tissue healing except for one case in group I experienced wound dehiscence and bone lid exposure. The bone lid group reported significantly less pain than the usual approach at the 3rd and 7th days. After six months, the volume of bone defect filling was considerably higher in the bone lid group compared to the conventional group. CONCLUSION The bone lid technique was an effective procedure in the management of mandibular lesions compared to the standard method. Besides, this technique provides better bone healing and reduces bone loss. TRIAL REGISTRATION This clinical trial was registered at clinicaltrials.gov on 14/8/2023 and had registration number NCT05987930.
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Affiliation(s)
- Mona S Sheta
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt.
| | - Rehab F Ghouraba
- Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt
| | - Marwa T Ibrahim
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt
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Ye L, He Y, Ma W, Zhou F, Liu J. Effect of platelet-rich fibrin on the recovery after third molar surgery: A systematic review and meta-analysis. J Craniomaxillofac Surg 2024:S1010-5182(24)00205-1. [PMID: 39003218 DOI: 10.1016/j.jcms.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/12/2024] [Accepted: 06/11/2024] [Indexed: 07/15/2024] Open
Abstract
This meta-analysis aimed to elucidate the effects of platelet-rich fibrin (PRF) on the recovery of alveolar bone after surgical removal of the mandibular third molars. PubMed, Cochrane Library, Web of Science, and Embase databases were searched from the inception to February 2023 for relevant studies on the application of PRF after the extraction of impacted mandibular third molars, with the language limited to English. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias tool was adopted for quality evaluation, and Stata 15.0 was used for statistical analysis. A total of 33 randomized controlled trials were included in the present study. Following surgical removal of the mandibular third molars, 1139 tooth sockets were filled with PRF, while 1138 sockets were sutured after conventional saline irrigation. The meta-analyses showed that PRF can relieve pain [(RR 0.454; 95% CI 0.23, 0.891); (SMD -0.74; 95% CI -0.97, 0.52)], improve swelling (SMD -1.48; 95% CI -1.90, -1.06), alleviate trismus (SMD -0.35; 95% CI -0.51, -0.19), reduce dry socket (SMD -0.18; 95% CI -030, -0.05), and promote bone tissue healing (SMD 2.34; 95% CI 0.18, 4.51). The current study confirms that PRF can reduce some postoperative complications. Local application of PRF after lower third molar extraction is a viable method for relieving pain and swelling, reducing the incidence of dry socket and trismus, and increasing bone density. However, whether it can promote soft tissue healing remains unclear. For patients undergoing complicated surgical extraction, local application of PRF into the sockets might be a good option.
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Affiliation(s)
- Lu Ye
- School of Basic Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Yun He
- School of Basic Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Weichao Ma
- Department of Neurosurgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Fengjuan Zhou
- Medical Center Hospital of Qionglai City, Qionglai, Sichuan, China
| | - Juan Liu
- School of Basic Medicine, Chengdu University, Chengdu, Sichuan, China.
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Gonçalves MWA, Souza MRF, Becheleni MT, Galvão EL, Al-Moraissi EA, Falci SGM. Does cyanoacrylate have the best postoperative outcomes after third molar extractions when compared to conventional sutures? A systematic review and meta-analysis. Heliyon 2024; 10:e23058. [PMID: 38163159 PMCID: PMC10755274 DOI: 10.1016/j.heliyon.2023.e23058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Tissue synthesis is extremely important for the attenuation of postoperative discomforts, as it keeps the tissues coapted, accelerates the healing process, and reduces the bleeding period of the surgical wound. Thus, this study aimed to systematically review the results of clinical trials that compared the use of cyanoacrylate with conventional sutures after third molars extraction. Materials and methods Searches were conducted on MEDLINE (via PubMed), Cochrane Central Registry of Controlled Trials (CENTRAL), Virtual Health Library (VHL), and Web of Science. Articles published up to February 20, 2022, were included. No restrictions were imposed on data or language of publication. Results A total of 8 studies (5 randomized controlled trials and 3 non-randomized comparative clinical studies) were included in this review and five studies were included in the meta-analysis, comprising 440 patients. The use of cyanoacrylate promoted better results in pain reduction in the first postoperative day when compared to the use of conventional suture (SMD: -1.01; 95%CI -1.90 to -0.12). Cyanoacrylate group promoted significant but borderline edema reduction compared to conventional sutures in the 7th postoperative day (SMD: -0.24, 95%CI -0.46 to -0.01, I2 = 0 %). For the trismus outcome, in all periods evaluated no differences were found between the groups. Conclusion Although promising results, there is no high-quality evidence to suggest the use of cyanoacrylate was better than conventional sutures.
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Affiliation(s)
| | - Marina Rocha Fonseca Souza
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Marco Túllio Becheleni
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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Bayram F, Demirci A. A randomized controlled trial comparing conventional and piezosurgery methods in mandibular bone block harvesting from the retromolar region. BMC Oral Health 2023; 23:986. [PMID: 38071300 PMCID: PMC10709954 DOI: 10.1186/s12903-023-03739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Although piezosurgery is now commonly used for various applications in maxillofacial surgery, its advantages over conventional rotary instruments in terms of postoperative edema, ecchymosis, postoperative morbidity, and prolonged osteotomy time have been questioned. MATERIALS AND METHODS This study aimed to compare the efficiency, postoperative morbidity, and complication rates of piezosurgery and conventional methods in harvesting autogenous ramus grafts. In this randomized controlled trial, 21 patients (32 sides) underwent autogenous graft harvesting from the ramus area, with 16 sites treated using piezosurgery and 16 using the conventional method. The primary outcomes measured were osteotomy time, total operation time, and postoperative morbidity. Complication rates were also evaluated. RESULTS The final analysis encompassed 19 patients, accounting for a total of 30 donor sites, following the exclusion of two patients who were unable to attend the scheduled follow-up visits. A total of 19 patients (30 donor sites) were included in the final analysis. No statistically significant difference was found in the mean osteotomy time between the piezosurgery group (mean: 10.35, SD: 2.74 min) and the conventional group (mean: 8.74, SD: 2.74 min) (95% CI: -3.67 to 0.442, p = 0.119). The total operation time, postoperative pain, and swelling were not significantly different between the two groups (p > 0.05). The complication rates, including wound dehiscence and inferior alveolar nerve exposure, were similar in both groups. CONCLUSIONS Piezosurgery can be safely used for harvesting autogenous ramus grafts and does not increase osteotomy or total operation time compared to the conventional method. The postoperative morbidity and complication rates were also similar, indicating that both techniques can be effectively employed in clinical practice. CLINICAL TRIAL REGISTRATION The protocol was registered on clinicaltrials.gov (ID: NCT05548049, First registration date: 21/09/2022).
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Affiliation(s)
- Ferit Bayram
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Basibuyuk Yolu 9/3, Basibuyuk, Maltepe, Istanbul, 34854, Türkiye.
| | - Ahmet Demirci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Basibuyuk Yolu 9/3, Basibuyuk, Maltepe, Istanbul, 34854, Türkiye
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Morales-Sambachi B, Andrade-Peñafiel A. [Effectiveness of piezoelectric versus straight hand piece at low speed within the surgical extraction of retained lower third molars]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 10:e129. [PMID: 38390602 PMCID: PMC10880708 DOI: 10.21142/2523-2754-1004-2022-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/22/2022] [Indexed: 02/24/2024] Open
Abstract
Objective Determine the effectiveness of the piezoelectric handpiece vs. the straight handpiece at low speed in surgeries of impacted lower third molars, in relation to post-surgical effects (edema, pain and trismus) and the operative time of the osteotomy, in patients attending the Maxillofacial Surgery Service of the "Hospital de Especialidades Fuerzas Armadas N°1". Method It is an observational, analytical, longitudinal prospective cohort clinical study. A sample of 40 patients of both sexes aged between 18 and 25 years was taken, divided into two groups of 20 patients each, in group A extractions were performed with piezoelectric and in group B with straight rotary handpiece at low velocity. The results were analyzed on the third, fifth and eighth day, the edema was measured with the method of Amin and Laskin, for the pain the Visual Analogous Scale (VAS) was used, and for the presence of trismus with the instrument foot of king. Results In group A, edema (11.72 mm), pain (4.67) and mouth opening (39.49 mm) were lower than in group B edema (12.29 mm), pain (4.8) and mouth opening (35.83 mm) and osteotomy time was significantly longer with piezoelectric (6.54 ± 3.05 min) compared to the straight handpiece (1.55 ± 0.57 mm). min) and there was a difference in edema, pain and trismus under normal conditions in contrast to what was obtained at 3, 5, 8 days between the two instruments. Conclusion the post-surgical effects of edema, pain and trismus of the extraction of retained lower third molars are less intense with the piezoelectric compared to the straight handpiece, the use of the piezoelectric being recommended.
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Affiliation(s)
- Bryan Morales-Sambachi
- Facultad de Odontología de la Universidad Central del Ecuador, Quito, Ecuador. , Universidad Central del Ecuador Facultad de Odontología Universidad Central del Ecuador Quito Ecuador
| | - Adriana Andrade-Peñafiel
- Facultad de Odontología de la Universidad Central del Ecuador, Quito, Ecuador. , Universidad Central del Ecuador Facultad de Odontología Universidad Central del Ecuador Quito Ecuador
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Sharma AK, Gupta A, Pabari HP, Pathak SK, Odedra NH, Beniwal J, Arora KS. Comparative and clinical evaluation between piezoelectric and conventional rotary techniques for mandibular impacted third molar extraction. Natl J Maxillofac Surg 2023; 14:208-212. [PMID: 37661971 PMCID: PMC10474546 DOI: 10.4103/njms.njms_333_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/13/2021] [Accepted: 06/20/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to evaluate and compare the operative and postoperative outcomes of the mandibular impacted third molar removal using piezoelectric technique and conventional rotary bur technique. Settings The study was conducted in the department of oral and maxillofacial surgery between January 1, 2019, and January 1, 2020. Materials and Methods Thirty patients, with an age of 18-40 years, with asymptomatic bilateral impacted mandibular third molars, were selected for the study and randomly surgical extraction was done either using piezoelectric or the conventional rotary bur technique on each site. The intraoperative time taken, postoperative pain, swelling, and trismus were assessed over a follow-up period of 7 days postoperatively. Results Study and control groups were compared using paired t-test. There was statistical significance in reduction of pain and swelling in the study group where the duration of surgery was increased in the study group. Conclusion Even if piezoelectric technique takes more time but can be used safely as another technique to conventional surgical method with surgical bur and handpiece for removal of impacted mandibular third molars.
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Affiliation(s)
- Amit Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Akshat Gupta
- Department of Oral and Maxillofacial Surgery, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Hemang P. Pabari
- Department of Oral and Maxillofacial Surgery, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Sanchaynee K. Pathak
- Department of Oral and Maxillofacial Surgery, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Nilesh H. Odedra
- Department of Oral and Maxillofacial Surgery, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Jyoti Beniwal
- Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Chandigarh, India
| | - Karandeep Singh Arora
- Department of Oral Medicine and Radiology, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
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Caputo A, Rubino E, Marcianò A, Peditto M, Bellocchio AM, Nucera R, Oteri G. Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial. BMC Oral Health 2023; 23:233. [PMID: 37085833 PMCID: PMC10120228 DOI: 10.1186/s12903-023-02910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/25/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Among the post-surgical complications of lower wisdom teeth surgery, swelling is considered by patients one of the most impairing, with both social and biological influences and impacting patients' quality of life. Aim of the study was to evaluate the swelling following the osteotomy when performed with drilling burs versus piezo-electric instruments in the mandibular impacted third molar extraction, using a facial reconstruction software. MATERIALS AND METHODS A randomized, split-mouth, single-blind study was conducted on patients, ranging between 18 and 40 years of age, requiring lower third molars extraction and referred at the Oral Surgery Unit of the School of Dentistry of the University of Messina. Twenty-two patients were recruited during an 8 months period according to the following criteria: good general health conditions; bilateral, symmetrical, impacted third molars; no use of medication that would influence or alter wound healing; no temporomandibular joint disorder history; no smoking. All patients underwent bilateral surgical removal. For each patient, a facial scan was obtained prior to the surgical procedures. The two extractions were conducted performing, in a randomized way, osteotomy with rotatory burs or use of piezo surgical instruments. Facial scans were repeated at 3 and 7 days after the surgical procedures. Volumetric differences were calculated via superimposition using a dedicated software. The data obtained were processed using paired t-test. RESULTS The results obtained from our study showed no significant differences between two groups regarding post-operative swelling. To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters. CONCLUSIONS The 3D digital analysis, in the evaluation of facial swelling, is a technique of simple application, objective, reproducible, reliable, decreasing the variables of error. Based on these data, it is possible to conclude that piezo surgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the post-operative swelling, it does not show an advantage over classical rotary instruments. TRIAL REGISTRATION Registered on ClinicalTrials.gov (ID: NCT05488028, on 04/08/2022). Approved by Ethical Committee of Messina: (ID 01-2020, on 27/04/2020).
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Affiliation(s)
- A Caputo
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - E Rubino
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - A Marcianò
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - M Peditto
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy.
| | - A M Bellocchio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - R Nucera
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - G Oteri
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
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Maihemaiti M, Ainiwaer A, Wang L. A clinical study of the piezosurgery, high-speed contra-angle handpiece, and the combined application of both for extraction of embedded supernumerary teeth. BMC Oral Health 2023; 23:147. [PMID: 36907866 PMCID: PMC10008595 DOI: 10.1186/s12903-023-02829-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES To compare the effectiveness of three methods: high-speed contra-angle handpiece (HSCAH), piezosurgery, and combined in the extraction of different locations and types of embedded supernumerary teeth. METHODS Sixty cases with different locations and different types of embedded supernumerary teeth were randomly divided into three groups for extraction by HSCAH, piezosurgery, and the combination of both, and the intraoperative and postoperative conditions of the three groups were compared and analyzed. RESULTS In the extraction of embedded supernumerary teeth in the inverted, horizontal, and root tip positions, the piezosurgery group required significantly longer operative time and reduced intraoperative bleeding compared with the HSCAH and the piezosurgery combined with the HSCAH; it could effectively relieve postoperative pain and facial swelling. In the extraction of oblique, orthodontic, middle, and crown segments of embedded supernumerary teeth, the use of a piezosurgery combined with an HSCAH can effectively reduce the operative time, while the factors of bleeding, postoperative pain, and facial swelling not statistically significant when compared with a piezosurgery. Compared with the HSCAH and combined piezosurgery, piezosurgery can significantly reduce the fear of patients. CONCLUSION Piezosurgery is effective in extracting embedded supernumerary teeth in inverted, horizontal, and apical positions, effectively reducing intraoperative and postoperative trauma and shortening the time required for healing. The piezosurgery combined with an HSCAH can effectively reduce intraoperative and postoperative trauma when extracting embedded supernumerary teeth in oblique, orthodontic, middle, and crown positions. piezosurgery is a technique suitable for the treatment of patients with fear.
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Affiliation(s)
- Maihepireti Maihemaiti
- Outpatient Department of Oral Surgery, The First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital), Ürümqi, Xinjiang, China
- Research Institute of Stomatology of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, 830054, China
| | - Ailimaierdan Ainiwaer
- Outpatient Department of Oral Surgery, The First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital), Ürümqi, Xinjiang, China
- Research Institute of Stomatology of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, 830054, China
| | - Ling Wang
- Outpatient Department of Oral Surgery, The First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital), Ürümqi, Xinjiang, China.
- Research Institute of Stomatology of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang, 830054, China.
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Blasi A, Cuozzo A, Marcacci R, Isola G, Iorio-Siciliano V, Ramaglia L. Post-Operative Complications and Risk Predictors Related to the Avulsion of Lower Impacted Third Molars. Medicina (B Aires) 2023; 59:medicina59030534. [PMID: 36984537 PMCID: PMC10051195 DOI: 10.3390/medicina59030534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.
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Affiliation(s)
- Andrea Blasi
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Alessandro Cuozzo
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Renata Marcacci
- Department of Oral Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy;
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
- Correspondence: ; Tel.: +39-095-378-2638
| | - Vincenzo Iorio-Siciliano
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Luca Ramaglia
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
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Comparison of Piezosurgery and Conventional Osteotomy for Orbital Hypertelorism Surgical Correction. J Craniofac Surg 2023; 34:817-819. [PMID: 36730438 DOI: 10.1097/scs.0000000000009129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to compare the safety and effect of piezosurgery with conventional osteotomy in a box-shifting procedure for orbital hypertelorism (ORH) correction surgery. This study retrospectively analyzed the clinical record of 10 ORH patients aged from 5 to 12 years, and they were second-degree ORH with an interorbital distance (IOD) of 35 to 37.8 mm. Three of them received the osteotomy with piezosurgery (the piezosurgery group), whereas the other 7 patients received osteotomy with the conventional osteotomy method (the control group). They were compared with age and preoperative IOD. All the patients' IOD was effectively improved to normal range after the surgery. The results showed that the application of piezosurgery did not prolong the surgery time (piezosurgery group: 8.3±0.5 hours; control group: 8.7±1.4 hours, P =0.68). Furthermore, the patients in the piezosurgery group had less drainage volume (piezosurgery group: 79.1±12 mL; the control group: 170±41.3 mL, P =0.0065) and shorter postoperative hospital stay (piezosurgery group: 8.3±2.0 d; control group: 12.43±2.29 d, P =0.029). There were 2 patients who had wound infections, 1 in the piezosurgery group and 1 in the control group, respectively. However, 1 patient in the control group suffered from cerebrospinal fluid leakage. On the basis of the results, the application of piezosurgery benefited the patients on a better and smoother recovery course with less drainage and shorter hospital stays. The advantages of piezosurgery are the fine and precise osteotomy and the protection for soft tissue, which make it a comparatively safe and effective tool for craniofacial surgery, especially for young patients.
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Nogueira DGDM, Leão JC, Sales PHDH, Silva PGDB, Gomes ACA. Piezoelectric Surgery Is Effective in Reducing Pain, Swelling, and Trismus After Removal of Impacted Lower Third Molars: A Meta-Analysis. J Oral Maxillofac Surg 2022; 81:483-498. [PMID: 36442532 DOI: 10.1016/j.joms.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Daniela Guimarães de Melo Nogueira
- PhD Student in Dentistry, Department of Prosthetics and Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Jair Carneiro Leão
- Full Professor, Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil
| | - Pedro Henrique da Hora Sales
- PhD Student in Dentistry, Department of Prosthetics and Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil
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Zhang YQ, Zhao YJ, Jiang JD, Cheng QT, Yang ZC, Lu MM. Assessment of immediate clotting after flapless extraction using piezosurgery or turbine handpiece in patients receiving dual antiplatelet therapy. J Oral Sci 2022; 64:294-299. [PMID: 36089374 DOI: 10.2334/josnusd.22-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE This study aimed to investigate the efficacy of piezosurgery (PI) in promoting immediate clotting after flapless extraction in patients undergoing dual antiplatelet therapy (DAPT). METHODS In this randomized controlled trial, 80 DAPT patients were equally divided into the PI and turbine handpiece (TH) groups. Accordingly, flapless extraction of a single tooth using PI or TH was performed on each patient, and the immediate clotting status was evaluated. The results of the preoperative hematological examinations, surgery-related variables and postoperative complications were recorded for analysis. RESULTS Both groups presented with low platelet aggregation and similar coagulation functions. The PI group exhibited a higher proportion of patients with normal intra-alveolar clotting (≤30 min) (70% vs. 40%, P = 0.007) and fewer intraoperative complications (25% vs. 47.5%, P = 0.036) than that in the TH group. Logistic regression analysis indicated that the applied instrument was an independent risk factor for prolonged immediate bleeding (odds ratio = 3.10, 95% confidence interval: 1.20-8.00, P = 0.019). Intergroup differences were insignificant in terms of the other surgery-related variables and postoperative complications, except for the longer surgical duration in the PI group. CONCLUSION The application of PI may contribute to better immediate clotting in DAPT patients after flapless extraction compared with the use of TH.
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Affiliation(s)
- Ya-Qiong Zhang
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
| | - Yi-Jie Zhao
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
| | - Ji-Dang Jiang
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
| | - Qing-Tao Cheng
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
| | - Zhi-Cheng Yang
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
| | - Meng-Meng Lu
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
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Saraiva Amaral J, Marto CM, Farias J, Alves Pereira D, Ermida J, Banaco Á, Campos Felino A, Caramelo F, Matos S. A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars. Bioengineering (Basel) 2022; 9:bioengineering9070276. [PMID: 35877327 PMCID: PMC9311873 DOI: 10.3390/bioengineering9070276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Joana Saraiva Amaral
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
- Correspondence: (J.S.A.); (S.M.)
| | - Carlos Miguel Marto
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical and Academic Centre of Coimbra (CACC), 3004-561 Coimbra, Portugal
| | - João Farias
- Private Clinical Practice, CliFarias, 3810-157 Aveiro, Portugal;
| | - Daniela Alves Pereira
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
- Centre for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Jorge Ermida
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
| | - Álvaro Banaco
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
| | - António Campos Felino
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-135 Porto, Portugal;
| | - Francisco Caramelo
- Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical and Academic Centre of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Sérgio Matos
- Centre for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Dentistry Department, Institute of Periodontology, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Correspondence: (J.S.A.); (S.M.)
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Abu hawa MH, Shehri Z, Alkhouri I. Comparison Between the Bone Lid Technique and the Traditional Technique in Surgical Treatment of the Posterior Mandibular Lesions: A Randomized Controlled Trial. Cureus 2022; 14:e26223. [PMID: 35911276 PMCID: PMC9312524 DOI: 10.7759/cureus.26223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Cystic lesions of the jaws and the impacted teeth are two of the most common cases that require surgical intervention in oral and maxillofacial surgery; however, surgeons also frequently use a traditional technique that involves the removal of the buccal bone plate. This study was conducted to compare the clinical and radiologic outcomes of the bone lid technique and the traditional technique. Methods This randomized controlled trial included 20 patients who were randomly divided into two groups (n = 10 each): the T group, in which the lesions were accessed using the traditional technique with classical rotating instruments, and the BL group, in which the lesions were accessed with the bone lid technique performed using a piezoelectric device, with repositioning of the buccal bone plate. Operative time, pain, edema, inferior alveolar nerve injury, and bone defect healing were measured during clinical and radiological follow-ups at 24 h, 72 h, one week, one month, and six months after the surgery. Results Normal soft tissue and bone healing were observed in all cases except one case in the BL group. The T group had a shorter mean operative time than the BL group. In terms of pain, edema, and inferior alveolar nerve injury, the groups did not differ statistically significantly. The percentage of bone defect healing was significantly greater in the BL group than in the T group after six months of follow-up. Conclusion The bone lid technique performed using a piezoelectric device was effective and safe for managing lesions in the posterior mandibular region and was not associated with increased postoperative complications. The disadvantages of this technique include a longer operative time and the need for fixation tools in some cases. In contrast, this technique outperforms the traditional technique in terms of reducing bone loss and improving the healing of bone defects.
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Comparison of the C-Reactive Protein Level and Visual Analog Scale Scores between Piezosurgery and Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction. Life (Basel) 2022; 12:life12060923. [PMID: 35743954 PMCID: PMC9229241 DOI: 10.3390/life12060923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/07/2022] [Accepted: 06/17/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to compare the C-reactive protein level and visual analog scale scores of piezo- and rotatory-based surgical extraction of the third molar. As a split-mouth study, the comparative groups consisted of 25 patients, each of whom underwent surgical removal of the third molar by piezo on one side and rotatory bur on the other side. C-reactive protein levels were quantitatively assessed (enzyme-linked immunosorbent assay) before and immediately post-extraction. The immediate postoperative blood sample (baseline) C-reactive protein levels were compared with 24 h and 72 h post-op samples, both within and between the groups. Pain was assessed using the visual analog scale at 24 h and 72 h post-operatively. The C-reactive protein levels were lower in the piezo group than in the rotatory group, although the difference was not significant (p > 0.05). The visual analog scale score was significantly (p < 0.01) lower in the piezo group than in the rotatory group. The C-reactive protein levels increased in both the rotary and piezo groups from the pre-op to the immediate post-op value, but in the piezo group, the levels dropped back after 24 h. On the contrary, in the rotatory group, the C-reactive level kept increasing until 24 h; the visual analog scale score dropped significantly from 24 to 72 h for both the rotatory and piezo groups. Surgical techniques that could spare the surrounding soft tissues, such as the piezo, could aid in reducing overall postoperative morbidity.
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Ghosh A, Aggarwal VR, Moore R. Aetiology, Prevention and Management of Alveolar Osteitis-A Scoping Review. J Oral Rehabil 2021; 49:103-113. [PMID: 34625985 DOI: 10.1111/joor.13268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra-alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient. OBJECTIVE This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra-alveolar chlorhexidine use. DESIGN A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra-alveolar chlorhexidine. RESULTS Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low-level laser therapies showed a significant reduction in pain and soft-tissue inflammation in the management of AO compared to Alveogyl. CONCLUSIONS Further understanding of the pathophysiology of AO is needed, in addition to large high-quality RCTs or long-term observational studies into the aetiology, prevention, and management of AO to produce up-to-date evidence-based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra-alveolar irrigant of choice.
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Affiliation(s)
- Anna Ghosh
- Department of Oral and Maxillofacial Surgery, Hull Royal Infirmary, Hull, United Kingdom of Great Britain and Northern Ireland
| | - Vishal R Aggarwal
- Department of Academic Oral Surgery & Oral Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Richard Moore
- Lecturer in Oral Surgery, Department of Academic Oral Surgery & Oral Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
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Civak T, Ustun T, Yilmaz HN, Gursoy B. Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. J Craniomaxillofac Surg 2020; 49:64-69. [PMID: 33298388 DOI: 10.1016/j.jcms.2020.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 08/04/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study compared patient postoperative pain, swelling, and trismus after usage of rotary instruments, piezosurgery, and Er:YAG lasers in mandibular third-molar extraction. MATERIALS AND METHODS This prospective study was executed with class II and position B vertically impacted mandibular third molars. Patients were divided into three groups according to the osteotomy system used to remove retentive bone: rotary instruments, piezosurgery, and Er:YAG laser. Postoperative pain was evaluated using VAS questionnaires at 12 h, 24 h, 48 h, and 7 days after procedures. Trismus was evaluated by measuring the distance between the maxillary and mandibular incisors at maximum mouth opening, and comparing preoperative measurements with those for postoperative days 2 and 7. Analyses of swelling were carried out via a stereophotogrammetry system. Operation times were measured using a digital stopwatch from the initial incision to the final suture. RESULTS There were no statistically significant differences between the groups in terms of pain, trismus, or swelling (p > 0.05). Pain persisted more in the rotary instrument group 24 h later (0 ± 1.3; p = 0.001). The pain scores obtained after 48 h for the piezosurgery (1.81 ± 2.29) and rotary (2.2 ± 2.12) groups were observed at 24 h in the laser group (2.19 ± 1.52). The mean operation time was highest using the laser (19.1 ± 3.85 min; p = 0.001) and lowest using rotary instruments (9.88 ± 2.97 min; p = 0.001). CONCLUSION Piezosurgery and Er:YAG laser are good alternatives to rotary instrument systems in third-molar extraction, but both systems are slower than traditional rotary instruments.
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Affiliation(s)
- Tayfun Civak
- Oral and Maxillofacial Surgery, Istanbul Yeni Yuzyil University, Faculty of Dentistry, Istanbul, Turkey.
| | - Tugba Ustun
- Orthodontist, Private Practice, Istanbul, Turkey
| | - Hanife Nuray Yilmaz
- Department of Orthodontics, Marmara University, Faculty of Dentistry, Istanbul, Turkey
| | - Bahar Gursoy
- Oral and Maxillofacial Surgery, University of Kyrenia, Faculty of Dentistry, Kyrenia, Cyprus
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Rashid N, Subbiah V, Agarwal P, Kumar S, Bansal A, Neeraj, Reddy SG, Chug A. Comparison of piezosurgery and conventional rotatory technique in transalveolar extraction of mandibular third molars: A pilot study. J Oral Biol Craniofac Res 2020; 10:615-618. [PMID: 32963954 DOI: 10.1016/j.jobcr.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives To compare the postoperative outcomes in impacted mandibular third molar extraction using piezosurgery and conventional rotary technique; and to assess the stress levels in both the techniques by measuring salivary cortisol levels. Methods Ten patients with symmetrical impacted lower third molars were included in this split mouth pilot study. Measurements for mouth opening and swelling were taken preoperatively on the day of surgery and 1 week after surgery. Pain was evaluated using Visual Analog Scale (VAS) from first postoperative day for six consecutive days. Saliva collection for analysis of cortisol levels was done at four time intervals - before starting the procedure, immediately after the procedure, 20 min and 1 week later. The mean in two groups was compared using paired t-test/Wilcoxon signed rank test as applicable. Friedman test was used to compare multiple readings of pain and salivary cortisol. Results Reduction in mouth opening was more in rotary group than piezosurgery group but was not statistically significant (p = 0.092). Increase in facial swelling was more in the rotary group than piezosurgery group with statistically significant values (p = 0.020). Rotary group had higher values for postoperative pain as compared to piezosurgery on all the days and the difference was statistically significant on each day except second postoperative day. Salivary cortisol levels were elevated in both the groups with the mean values higher in group I (rotary) than in group II (Piezosurgery). Conclusion Extraction of impacted lower third molar results in more favourable outcome when carried out by piezosurgery technique. Further studies are needed to compare the salivary cortisol response in rotary and piezosurgery techniques.
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Affiliation(s)
- Nouman Rashid
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Vivekanandhan Subbiah
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Padmanidhi Agarwal
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Shailesh Kumar
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Adity Bansal
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Neeraj
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Srinivas Gosla Reddy
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Ashi Chug
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
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Zandi M, Heidari A, Jamshidi S, Aminzadeh A, Rajaei S, Mousavi M, Mohammad Gholi Mezerji N. Histological evaluation of inferior alveolar nerve injury after osteotomy of mandibular buccal cortex using piezoelectric versus conventional rotary devices: a split-mouth randomised study in rabbits. Br J Oral Maxillofac Surg 2020; 59:561-566. [PMID: 33863596 DOI: 10.1016/j.bjoms.2020.08.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
Up until now, only a limited number of evidence-based studies with different results has evaluated traumatic nerve injury after maxillofacial surgery using piezoelectric devices versus rotary instruments. The present experiment was performed to evaluate damage to the inferior alveolar nerve (IAN), histologically, after osteotomy of the buccal cortex of the mandible using piezoelectric devices versus surgical handpieces. Forty rabbits underwent bilateral osteotomy of the mandibular buccal cortex. For the osteotomy of one side, piezoelectric devices were used, and for the other, conventional rotary handpieces. After cleavage of the osteotomised cortical bone segments, the exposed part of the IAN was excised and examined histologically for nerve injury. IAN damage was scored histologically from Grade 0 (no nerve damage) to Grade 4 (complete nerve transection). It was found that 25% and 17.5% of nerves had Grade 0; 17.5% and 10% had Grade 1; 25% and 20% had Grade 2; 17.5% and 27.5% had Grade 3; and 15% and 25% had Grade 4 injury in piezosurgery and rotary groups, respectively. Statistical analyses revealed no significant difference between groups in damage to the IAN. The present study showed that piezosurgery devices, similar to conventional rotary instruments, have the potential to cause severe nerve damage during surgery and should therefore be used with care.
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Affiliation(s)
- M Zandi
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - A Heidari
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - S Jamshidi
- Department of Oral and Maxillofacial Pathology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - A Aminzadeh
- Department of Oral and Maxillofacial Pathology, Islamic Azad University of Isfahan (Khorasgan Branch), Isfahan, Iran
| | - S Rajaei
- Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - M Mousavi
- Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - N Mohammad Gholi Mezerji
- Department of Biostatistics and Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
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Bailey E, Kashbour W, Shah N, Worthington HV, Renton TF, Coulthard P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev 2020; 7:CD004345. [PMID: 32712962 PMCID: PMC7389870 DOI: 10.1002/14651858.cd004345.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity. OBJECTIVES To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication. SELECTION CRITERIA Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth. DATA COLLECTION AND ANALYSIS Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies. MAIN RESULTS We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported. AUTHORS' CONCLUSIONS In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.
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Affiliation(s)
- Edmund Bailey
- Department of Oral Surgery, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wafa Kashbour
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Neha Shah
- Department of Oral Surgery, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tara F Renton
- Department of Oral Surgery, Dental Institute, King's College London, London, UK
| | - Paul Coulthard
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Zara F, De Sanctis CM, Dede FC, Bossù M, Sfasciotti GL. A split-mouth study comparing piezo electric surgery and traditional rotary burs on impacted third molars in young patients: an intraoperative and postoperative evaluation. ACTA ACUST UNITED AC 2020; 69:278-285. [PMID: 32407060 DOI: 10.23736/s0026-4970.20.04349-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Piezoelectric surgery has been used in many different medical fields, for instance it is used in the field of oral surgery, as a valuable alternative to traditional rotary burs. Its first use dates to 1975 by Horton even if the first effective device for use in dentistry, has been developed by Vercellotti after the year 2000. The hypothesis of this study is that piezosurgery technology is more suitable in terms of specific intra-operative and postoperative evaluations compared to the rotary technology in ostectomy for the avulsion of the third molar germ. The null hypothesis presented is the lack of significant differences between the two technologies after and during surgery. METHODS Intraoperative and postoperative aspects are evaluated for a comparison between traditional rotary instruments and piezosurgery during germectomies in young patients through a blind randomized study (split-mouth). The surgical technique to employ for each hemi-arch was randomly selected from a computer algorithm. Different criteria were considered during the surgical procedure, in order to compare the two techniques. RESULTS The piezoelectric technique demanded more time than traditional rotary method, and the difference was statistically significant both for the time of the entire procedure and the time only required for the ostectomy itself. Postoperative evaluations such as maximum mouth opening, facial swelling and postoperative pain showed no statistical difference. CONCLUSIONS Even if the adopted clinical trial did not highlight any statistical difference the following review of literature showed an encouraging reduction in postoperative discomfort given by the piezosurgery as opposed to the traditional rotary bur surgery. The time taken to complete the operation, however, was longer with piezosurgery compared to traditional burs.
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Affiliation(s)
- Francesca Zara
- Unit of Pediatric Dentistry, D.A.I Testa-Collo, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
| | - Claudio M De Sanctis
- Unit of Pediatric Dentistry, D.A.I Testa-Collo, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Fabia C Dede
- Unit of Pediatric Dentistry, D.A.I Testa-Collo, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Maurizio Bossù
- Unit of Pediatric Dentistry, D.A.I Testa-Collo, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Gian L Sfasciotti
- Unit of Pediatric Dentistry, D.A.I Testa-Collo, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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22
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Cicciù M, Stacchi C, Fiorillo L, Cervino G, Troiano G, Vercellotti T, Herford AS, Galindo-Moreno P, Di Lenarda R. Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instruments: a systematic review, meta-analysis, and trial sequential analysis. Int J Oral Maxillofac Surg 2020; 50:121-131. [PMID: 32284166 DOI: 10.1016/j.ijom.2020.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/27/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
The aim of this study was to evaluate whether piezoelectric bone surgery (PBS) for impacted lower third molar extraction reduces the surgical time and risk of intra- and postoperative complications in comparison with conventional rotary instruments. This meta-analysis followed the PRISMA guidelines and was registered in the PROSPERO database. The PubMed, Embase, Scopus, and OpenGrey databases were screened for articles published from January 1, 1990 to December 31, 2018. Selection criteria included randomized controlled trials (RCTs) comparing PBS with conventional rotary instruments for impacted lower third molar extraction and reporting any of the clinical outcomes (intra- and postoperative complications and duration of surgery) for both groups. A risk of bias assessment was performed using the Cochrane Collaboration tool. A meta-analysis was performed, and the power of the meta-analytic findings was assessed by trial sequential analysis (TSA). Strong evidence suggests that PBS prolongs the duration of surgery and low evidence suggests that PBS reduces postoperative morbidity (pain and trismus) in comparison with rotary instruments. Data were insufficient to determine whether PBS reduces neurological complications and postoperative swelling in comparison with burs.
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Affiliation(s)
- M Cicciù
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - C Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - L Fiorillo
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy; Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Cervino
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - G Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - T Vercellotti
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - A S Herford
- Department of Maxillofacial Surgery, Loma Linda University, Loma Linda, California, USA
| | - P Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - R Di Lenarda
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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23
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Glória JCR, Douglas-de-Oliveira DW, E Silva LDA, Falci SGM, Dos Santos CRR. Influence of ozonized water on pain, oedema, and trismus during impacted third molar surgery: a randomized, triple blind clinical trial. BMC Oral Health 2020; 20:41. [PMID: 32024498 PMCID: PMC7003333 DOI: 10.1186/s12903-020-1029-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/29/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of ozonized water on pain, oedema and trismus after impacted third molar mandibular surgeries when compared to double distilled water. A randomized triple blind trial was conducted. METHODS Patients with third molars class II-B of Pell-Gregory were included, and surgical extraction was performed. Irrigation was done with ozonized (group 1) or double distilled water (group 2). The type of irrigation and the side to be operated were randomized. Neither the patients nor the operator or evaluator were aware of the irrigation solution. Pain, oedema and trismus were evaluated at baseline, 24-h, 48-h, 72-h and 7-days after treatment. The data were evaluated by Friedman, Wilcoxon, Mann-Whitney tests, and size effect. RESULTS It was included 8 men and 12 women, with a mean age of 20.9y.o. The initial pain mean was 7.94 (±12.81) (group 1) and 5.50 (±9.12) (group 2) (p > 0,05). There was a statistically significant reduction of pain, oedema and trismus in intragroup analysis (p < 0.05). There was no statistically significant difference (p > 0.05) when comparing the oedema and trismus between groups. The size effect ranged from small (0.23) to large (1.29). CONCLUSIONS It was concluded that ozonized water was compatible as irrigation method, not inferior to double distilled water, and had satisfactory effects on management of pain, oedema and trismus after surgical removal of the third molar. TRIAL REGISTRATION This clinical trial was registered in ClinicalTrials.gov NCT03501225 on April 18, 2018.
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Affiliation(s)
- José Cristiano Ramos Glória
- Departament of Dentistry, Faculty of Biologic Sciences and Health, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Dhelfeson Willya Douglas-de-Oliveira
- Departament of Dentistry, Faculty of Biologic Sciences and Health, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil.
| | - Larissa Doalla Almeida E Silva
- Departament of Dentistry, Faculty of Biologic Sciences and Health, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Departament of Dentistry, Faculty of Biologic Sciences and Health, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Cássio Roberto Rocha Dos Santos
- Departament of Dentistry, Faculty of Biologic Sciences and Health, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
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24
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Menziletoglu D, Basturk F, Isik BK, Esen A. A prospective split-mouth clinical study: comparison of piezosurgery and conventional rotary instruments in impacted third molar surgery. Oral Maxillofac Surg 2019; 24:51-55. [PMID: 31811604 DOI: 10.1007/s10006-019-00817-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Our purpose was to compare the effects of piezosurgery and conventional rotary instruments on postoperative pain, swelling, trismus, and patients' comfort after mandibular third molar surgery. METHODS Thirty patients (27 women and 3 men) with bilateral impacted mandibular third molars were included in this split-mouth clinical study. Sixty impacted third molars were divided into a control group (n = 30), in which the osteotomies were performed using a conventional rotary handpiece technique and an experimental group (n = 30), in which the osteotomies were done by piezosurgery technique. Duration of the procedure was recorded. Postoperative pain was assessed using a visual analogue scale (VAS). All the patients were given a form containing verbal rating scale for evaluating the swelling. Trismus was evaluated using a caliper at maximum mouth opening (cm). In postoperative seventh day, patients were asked to fill a global quality of life (QoL) scale as well. RESULTS There was no significant difference in postoperative pain, trismus, and swelling between control and experimental groups (p > 0.05). However, time of the procedure increased in control group (p < 0.05). CONCLUSION Piezosurgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the postoperative morbidity, it does not have an advantage over conventional rotary instruments. Piezosurgery took longer to complete the osteotomy than the rotary handpiece technique.
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Affiliation(s)
- Dilek Menziletoglu
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey.
| | - Funda Basturk
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
| | - Bozkurt Kubilay Isik
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
| | - Alparslan Esen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
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25
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Al-Delayme RMA. Randomized clinical study comparing Piezoelectric Surgery with conventional rotatory osteotomy in mandibular third molars surgeries. Saudi Dent J 2019; 33:11-21. [PMID: 33473237 PMCID: PMC7801233 DOI: 10.1016/j.sdentj.2019.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this study was to evaluate the performance and to assess the postoperative sequel and quality of life after removal of impacted mandibular third molars using piezoelectric surgery compared with conventional rotatory osteotomy. Patients and methods A single blinded, randomized, control clinical study was performed. Sixty-three patients (44 males, 19 females) who presented with bilaterally asymptomatic impacted mandibular third molars were included in this analysis. Each patient was treated, at two separate sessions approximately 4 weeks apart, with a conventional rotatory hand piece on one side of the mandible and a piezoelectric device on the contralateral side. Patients were followed up on postoperative days 1, 3, 5, 7, and 15 to rate the pain, swelling and trismus. Inferior alveolar nerve paresthesia was evaluated up to 12 months postoperatively. Results The severity of the pain, trismus and swelling using the piezosurgery were significantly different from the rotary group. In both groups, pain was most intense and peaked during the first post-operative day, while swelling and trismus reached peak levels on the third postoperative day. The piezoelectric procedure resulted in a significantly longer procedural duration compared to the rotatory surgery (P < 0.001). Conclusion Piezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems and can improve a patient’s quality of life. Thus, piezoelectric surgery might be a preferred modality for patients undergoing complicated surgical extraction of impacted lower third molars.
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26
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Xiang X, Shi P, Zhang P, Shen J, Kang J. Impact of platelet-rich fibrin on mandibular third molar surgery recovery: a systematic review and meta-analysis. BMC Oral Health 2019; 19:163. [PMID: 31345203 PMCID: PMC6659259 DOI: 10.1186/s12903-019-0824-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/17/2019] [Indexed: 01/17/2023] Open
Abstract
Background The present study investigated and evaluated the efficacy and safety of platelet-rich fibrin (PRF) in patients during bilateral mandibular third molars extraction by systematic review and meta-analysis. Methods The PubMed, Embase, and Cochrane library databases were retrieved, and the effect of PRF on the healing process of the alveolar socket after surgical extraction of the mandibular third molars was evaluated by meta-analysis. The postoperative pain, swelling, trismus, osteoblastic activity, and soft tissue healing were assessed, and the incidence of alveolar osteitis, weighted mean difference (WMD)/standard mean difference (SMD), the risk ratio (RR), and the 95% confidence interval (CI) were calculated. Results The current results showed that the local application of PRF during lower third molar extraction prevented postoperative complications. Subsequently, the pain (SMD = − 0.53, 95% CI: − 1.02–-0.05, Pheterogeneity = 0.001, I2 = 75.7%) and swelling (WMD = − 0.55, 95% CI: − 1.08–-0.01, Pheterogeneity = 0.573, I2 = 0) were relieved and the incidence of alveolar osteitis was reduced (RR = 0.35, 95% CI: 0.16–0.75, Pheterogeneity = 0.597, I2 = 0%). However, no significant difference was observed in trismus, osteoblastic activity, and soft tissue healing between the PRF and non-PRF groups. Conclusion The current study confirms that PRF only reduces some of the postoperative complications but does not prevent all the postoperative complications. PRF significantly relieved the pain and swelling and reduced the incidence of alveolar osteitis after the extraction of an impacted lower third molar. Electronic supplementary material The online version of this article (10.1186/s12903-019-0824-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xu Xiang
- Department of oral and maxillofacial surgery, Tianjin Stomatological Hospital, Tianjin, 300041, China
| | - Ping Shi
- Department of oral and maxillofacial surgery, Tianjin Stomatological Hospital, Tianjin, 300041, China
| | - Ping Zhang
- Department of oral and maxillofacial surgery, Tianjin Stomatological Hospital, Tianjin, 300041, China
| | - Jun Shen
- Department of oral and maxillofacial surgery, Tianjin Stomatological Hospital, Tianjin, 300041, China
| | - Jian Kang
- Department of periodontics, Tianjin Stomatological Hospital, Tianjin, 300041, China.
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27
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Patil C, Jadhav A, K R, Bhola N, Borle RM, Mishra A. "Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae". J Oral Biol Craniofac Res 2019; 9:259-262. [PMID: 31249772 DOI: 10.1016/j.jobcr.2019.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/30/2019] [Accepted: 06/08/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose Piezosurgery is a relatively novel, precise and safe technique of ostectomy in the domain of oral and maxillofacial surgery. Our aim was to compare the inflammatory outcomes of osteotomy using piezosurgery and conventional bur in impacted mandibular third molar (IM3M) surgery. Subjects and method The study implemented a randomized, double-blind, crossover design. 120 sides in 60 patients were randomly allocated to the two interventions used, viz; conventional bur and piezosurgery. The primary outcome variables evaluated were facial swelling, trismus, pain, and paresthesia. Additionally, the duration of surgery and the frequency of soft tissue injuries with the use of two techniques were also evaluated. Results Pain, swelling, trismus, and soft tissue injuries emerged to be significantly higher with the use of bur as compared to the piezo. The duration of surgery was significantly extended in the piezo group and no significant difference was observed in the occurrence of paresthesia between the two groups. Conclusion The result suggests that piezosurgical osteotomy technique is superior to conventional bur in terms of the postoperative inflammatory outcomes in IM3M surgery.
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Affiliation(s)
- Chirag Patil
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Anendd Jadhav
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Rajanikanth K
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Nitin Bhola
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Rajiv M Borle
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Apoorva Mishra
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
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Charavet C, Lecloux G, Jackers N, Maes N, Lambert F. Patient-reported outcomes measures (PROMs) following a piezocision-assisted versus conventional orthodontic treatments: a randomized controlled trial in adults. Clin Oral Investig 2019; 23:4355-4363. [DOI: 10.1007/s00784-019-02887-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
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29
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Erbium Yttrium–Aluminum–Garnet Laser Versus Traditional Bur in the Extraction of Impacted Mandibular Third Molars: Analysis of Intra- and Postoperative Differences. J Craniofac Surg 2018; 29:2282-2286. [DOI: 10.1097/scs.0000000000004574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Gopal I, Morkel J, Titinchi F. Comparison of a piezoelectric and a standard surgical handpiece in third molar surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/ors.12382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- I. Gopal
- Department of Maxillo-Facial and Oral Surgery; Livingstone Hospital; Port Elizabeth South Africa
| | - J. Morkel
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre; University of the Western Cape; Cape Town South Africa
| | - F. Titinchi
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre; University of the Western Cape; Cape Town South Africa
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Liu J, Hua C, Pan J, Han B, Tang X. Piezosurgery vs conventional rotary instrument in the third molar surgery: A systematic review and meta-analysis of randomized controlled trials. J Dent Sci 2018; 13:342-349. [PMID: 30895143 PMCID: PMC6388871 DOI: 10.1016/j.jds.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/22/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background/purpose The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae. Different instruments such as piezosurgery and conventional rotary handpiece have been used to decrease such adverse events. There are controversial results from randomized controlled trials evaluating the effects of Piezosurgery in the mandibular third molar extraction, compared with conventional rotary instrument. This study was performed to determine the impact of piezosurgery versus conventional rotary instrument on postoperative reactions after extraction. Materials and methods A systematic review and meta-analysis was performed to combine relevant RCTs results. Results Five RCTs were eligible for this study, enrolling a total of 402 patients. Compared with conventional rotary instrument, pain score at 6 or 7 days and mouth opening at 1 day after surgery was significantly lower in Piezosurgery group (SMD -0.33, 95% CI: −0.56 to −0.10, P = 0.005), as well as swelling score at 7 days after surgery (SMD -1.95, 95% CI: −3.22 to −0.67, P = 0.003). Furthermore, mouth opening at 1 day after surgery was significantly better in patients treated with Piezosurgery (SMD 0.84, 95% CI: 0.19 to 1.49, P = 0.01). However, more operation time will be required for Piezosurgery (MD 6.23, 95% CI: 3.32 to 9.14, P < 0.0001). With regard to analgesic dosage, pooled results from two RCTs suggested there were no significant differences between Piezosurgery and conventional rotary instrument (SMD -1.45, 95% CI: −4.39 to 1.49, P = 0.33). Conclusion There might be some advantages on third mandibular molar extraction with piezosurgery compared to conventional rotary instrument. More multi-centre trials are required to get more conclusive results.
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Affiliation(s)
| | | | | | | | - Xiufa Tang
- Corresponding author. State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillary Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China. Fax: +028 85501428.
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Srivastava P, Shetty P, Shetty S. Comparison of Surgical Outcome after Impacted Third Molar Surgery Using Piezotome and a Conventional Rotary Handpiece. Contemp Clin Dent 2018; 9:S318-S324. [PMID: 30294165 PMCID: PMC6169275 DOI: 10.4103/ccd.ccd_354_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: One of the most commonly performed surgical procedures by oral and maxillofacial surgeons all over the world is the removal of impacted teeth. The most critical and important steps in third molar extraction are bone cutting or osteotomy. Many techniques are used for this purpose including chisels and mallet, rotary instruments, and ultrasonic-based bone cutting instruments. Piezotome is newer and innovative device for osteotomy based on piezoelectric vibrations. Piezotome is considered very efficient in performing osteotomy because of its selective cutting; being inert against soft tissues, including nerves and blood vessels. The aim of this study was to compare the surgical outcome of third molar surgery using conventional handpiece and piezotome with all other criteria remaining same for all the individuals. Materials and Methods: All patients reporting to the Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Mangalore, for impacted mandibular third molar removal were screened. A total of 30 patients with same Pederson difficulty index for bilateral impacted third molar were selected for the study. The study involved the use of piezotome on one side (Side A) and rotary technique (Side B) on the other side for osteotomy on the same patient with an interval of 1 month. Therapeutic management was same for both the sides. Operating time was recorded in each surgery. Patients were examined postoperatively on 1st, 3rd, and 7th day and pain, edema, trismus, paresthesia, and dry socket were evaluated and compared on both the sides. Data collected were analyzed statistically. Results: The mean operating time was 48.13 min in piezotome (Side A) and 32.90 min in conventional handpiece (Side B) which was statistically significant (P < 0.001). Furthermore, there was statistically significant difference (P < 0.001) in the level of pain (P < 0.001), number of analgesics taken (P < 0.001), and trismus (P < 0.01) on 1st, 3rd, and 7th days postoperatively. There was no statistically significant difference in edema between the two sides. Paresthesia was present in one patient (3.3%) in Side B, while no paresthesia was present in Side A. No incidence of alveolar osteitis was reported on both the sides. Conclusion: Operating time with piezotome was more than that of conventional handpiece, but the postoperative responses such as pain, trismus, and edema were less in piezotome. Hence, despite being a slower procedure, piezotome can be an effective alternative for osteotomy in impacted third molar surgery. We recommend using piezotome for bone cutting and conventional rotary handpiece for tooth sectioning in order to obtain favorable outcomes as well as decreasing the operating time.
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Affiliation(s)
- Pritika Srivastava
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Sameep Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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Mesiolingual root rotation for horizontal mandibular third molar extraction: position classification and surgical simulation. Sci Rep 2017; 7:14405. [PMID: 29089549 PMCID: PMC5663974 DOI: 10.1038/s41598-017-14914-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022] Open
Abstract
Extracting horizontal mandibular 3rd molars face considerable difficulty due to the large bone and adjacent tooth resistances. This study aims at evaluating the effectiveness of a novel method-mesiolingual root rotation to extract wisdom teeth of this type. In this study, 73 horizontal teeth extracted using piezosurgery were reviewed and classified based on impaction depth: position I, II, III refers to the highest portion of the crown on a level with upper 1/3, middle 1/3, lower 1/3 of the 2rd molar’s root. Based on the surgical simulations on their 3D CBCT reconstructions, traditional method(crown distal rotation) and novel method(root mesiolingual rotation) are applied. 79.17% of teeth in position I and 57.89% of teeth in position II were designed using traditional method, 83.33% teeth in position III were designed using the novel method(p < 0.05). The surgeries were performed according to the designs. Two cases in position II using traditional method were found temporary inferior alveolar nerve(IAN) injury; while only one case in position III using novel method got temporary IAN and lingual nerve injury. Our study suggested that root mesiolingual rotation is an effective method to extract the horizontal mandibular 3rd molars, especially the deep impacted ones.
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Troedhan A, Mahmoud ZT, Wainwright M, Khamis MM. Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-4634.000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Comparison between piezosurgery and conventional osteotomy in cranioplasty with fronto-orbital advancement. J Craniomaxillofac Surg 2017; 45:395-400. [DOI: 10.1016/j.jcms.2016.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/25/2016] [Accepted: 12/15/2016] [Indexed: 11/23/2022] Open
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Basheer SA, Govind RJ, Daniel A, Sam G, Adarsh VJ, Rao A. Comparative Study of Piezoelectric and Rotary Osteotomy Technique for Third Molar Impaction. J Contemp Dent Pract 2017; 18:60-64. [PMID: 28050988 DOI: 10.5005/jp-journals-10024-1990] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Bone removal is necessary for extracting the third molars that are erupted, partially erupted, and/or impacted in bone. Hence, it is necessary to choose a surgical method or instruments that conform to anatomic landmarks and are based on physiological principles. Many authors have reported injuries to the adjacent tooth, especially the distal part of periodontium after removal of second molar. Hence, the present study was undertaken to assess and compare the surgical and postsurgi-cal outcomes of third molar removal using piezoelectric surgery and rotary bur. MATERIALS AND METHODS A total of 30 healthy adult individuals who were in need of prophylactic removal of impacted man-dibular third molar tooth with ideal condition were included for the study. Individuals were divided randomly into study groups of 15 each, so that the difficulty of surgery will be the same in both the groups. Group I - piezoelectric osteotomy technique and group II - rotary osteotomy technique. The rotary device consists of a hand piece and a rotary speed ranging around 35,000 rpm was used. The piezoelectric device consists of a hand piece, and a frequency of 25 to 29 kHz with a microvibration of 60 to 200 mm/sec was used with a boosted working mode. Data were analyzed using unpaired t-test and qualitative data were analyzed using Fischer's exact test. RESULTS The average age of the study subjects in the piezo-surgery group and rotary group was 28.40 ± 2.69 and 30.06 ± 3.15 years respectively. The time taken for removal of impacted tooth by rotary bur was less than that by piezoelectric device, which was significant statistically (p < 0.05). Until the 4th postoperative day, severity of pain experienced was more in the rotary group, which was statistically significant (p < 0.005). Mouth opening was significantly better in the piezoelectric group as compared with rotary bur until the 7th postoperative day. CONCLUSION The piezosurgery method reduces postoperative pain, trismus, and swelling. Also, it may play an important role in increasing bone density within the extraction socket and decreasing the amount of bone loss of adjacent tooth in the distal aspect. CLINICAL SIGNIFICANCE In clinical practice, piezosurgery plays an important role because piezosurgery reduces postoperative pain, trismus, and also swelling.
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Affiliation(s)
- Sulphi A Basheer
- Department of Dentistry/Oral and Maxillofacial Surgery Sree Gokulam Medical College and Research Foundation Thiruvananthapuram, Kerala, India, Phone: +919656362236, e-mail:
| | - R Jay Govind
- Department of Orthodontics and Dentofacial Orthopaedics, PMS College of Dental Science & Research, Thiruvananthapuram Kerala, India
| | - Augustine Daniel
- Department of Oral and Maxillofacial Surgery, Al-Azhar Dental College, Thodupuzha, Kerala, India
| | - George Sam
- Department of Preventive Dental Sciences, College of Dentistry Prince Sattam bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia
| | - V J Adarsh
- Department of Conservative Dentistry and Endodontics, Mahe Institute of Dental Sciences and Hospital, Pallor, Puducherry, India
| | - Akshatha Rao
- Department of Oral and Maxillofacial Surgery, Century International Institute of Dental Sciences and Research Centre Poinachi, Kerala, India
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Malara P, Fischer A, Malara B. Selected toxic and essential heavy metals in impacted teeth and the surrounding mandibular bones of people exposed to heavy metals in the environment. J Occup Med Toxicol 2016; 11:56. [PMID: 27999610 PMCID: PMC5154102 DOI: 10.1186/s12995-016-0146-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 12/08/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The elemental composition of bones and teeth can allow exposure to heavy metals in the environment to be estimated. The aim of this study was to determine whether impacted mandibular teeth and the surrounding bones can be used as biomonitoring media to assess exposure to heavy metals. METHODS The research materials were 67 impacted lower third molars and samples of the cortical bone removed when the wisdom teeth were surgically extracted. The samples were from people living in two areas with different environmental concentrations of heavy metals. The cadmium, chromium, copper, iron, lead, manganese, and zinc concentrations in the samples were determined by atomic absorption spectrometry with flame atomization. RESULTS The cadmium and lead concentrations in the impacted third molars and the bones surrounding the teeth were significantly higher for people living in the relatively polluted Ruda Slaska region than for people living in Bielsko-Biala region. Significantly higher chromium, copper, manganese, and zinc concentrations were found in the bones surrounding the impacted teeth from people living in Ruda Slaska than in the bones surrounding the impacted teeth from people living in Bielsko-Biala. The cadmium concentrations in impacted teeth and the surrounding bones were significantly positively correlated. CONCLUSION The results indicated that impacted mandibular teeth and the surrounding mandibular bones may reflect the exposure of people to cadmium and lead in the environment. This conclusion, however, must be verified in future research projects designed to exclude the possibility of additional dietary, occupational, and other types of exposure to heavy metals.
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Affiliation(s)
- Piotr Malara
- Institute of Engineering Materials and Biomaterials, Silesian University of Technology, 18a Konarskiego str, 44-100 Gliwice, Poland
| | - Agnieszka Fischer
- Department of Toxicology, Medical University of Silesia, 4 Jagiellonska str, 41-200 Sosnowiec, Poland
| | - Beata Malara
- Institute of Medicine, Katowice School of Economics, 3 Harcerzy Wrzesnia str, 40-659 Katowice, Poland
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Badenoch-Jones EK, David M, Lincoln T. Piezoelectric compared with conventional rotary osteotomy for the prevention of postoperative sequelae and complications after surgical extraction of mandibular third molars: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2016; 54:1066-1079. [PMID: 27832920 DOI: 10.1016/j.bjoms.2016.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/25/2016] [Indexed: 01/12/2023]
Abstract
The purpose of this review was to determine if postoperative sequelae (facial swelling, trismus, pain) and neurological complications are reduced when mandibular third molars are surgically extracted using a piezoelectric device for osteotomy compared with conventional rotary burs, and to determine if there is a difference in operating time between the two techniques. Clinical trials were identified through a search (April 2015) on the PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases. Studies were assessed by study type, characteristics of participants, sample size, surgical technique, cointerventions, outcomes, risk of bias, and findings. We calculated a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in the effect estimates. We identified 2515 citations and found 15 eligible clinical trials. Patients who had osteotomies with the piezoelectric device had less facial swelling (standard mean difference -1.15; 95% CI -2.02 to -0.27; p<0.0001), trismus (greater maximum mouth opening, standard mean difference 0.78; 95% CI 0.56 to 1.00; p=0.33) and pain (standard mean difference -0.84; 95% CI -1.55 to -0.13; p<0.0001) at day 1, less facial swelling at day 7 (standard mean difference -0.98; 95% CI -1.52 to -0.44; p=0.05), and a reduced risk of neurological complications (odds ratio (OR) 0.28; 95% CI 0.09 to 0.89; p=0.79). Trismus at day 7 and pain at day 5 did not differ significantly between the two methods. Operating time was longer with the piezoelectric device (standard mean difference 0.83; 95% CI 0.57 to 1.09; p=0.001). The confidence in the effect estimates was low or very low across all outcomes. The findings raise the possibility of an improved clinical healing response to osteotomy with the piezoelectric device compared with one done with conventional rotary burs for surgical extractions of mandibular third molars.
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Affiliation(s)
- E K Badenoch-Jones
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
| | - M David
- The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - T Lincoln
- Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial. Int J Dent 2016; 2016:8169356. [PMID: 27597866 PMCID: PMC5002292 DOI: 10.1155/2016/8169356] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to test the effect of the surgical removal of impacted mandibular third molars using piezosurgery versus the conventional surgical technique on postoperative sequelae and bone healing. Material and Methods. This study was carried out as a randomized controlled clinical trial: split mouth design. Twenty patients with bilateral mandibular third molar mesioangular impaction class II position B indicated for surgical extraction were treated randomly using either the piezosurgery or the conventional bur technique on each site. Duration of the procedure, postoperative edema, trismus, pain, healing, and bone density and quantity were evaluated up to 6 months postoperatively. Results. Test and control sites were compared using paired t-test. There was statistical significance in reduction of pain and swelling in test sites, where the time of the procedure was statistically increased in test site. For bone quantity and quality, statistical difference was found where test site showed better results. Conclusion. Piezosurgery technique improves quality of patient's life in form of decrease of postoperative pain, trismus, and swelling. Furthermore, it enhances bone quality within the extraction socket and bone quantity along the distal aspect of the mandibular second molar.
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Magesty RA, Galvão EL, de Castro Martins C, Dos Santos CRR, Falci SGM. Rotary Instrument or Piezoelectric for the Removal of Third Molars: a Meta-Analysis. J Maxillofac Oral Surg 2016; 16:13-21. [PMID: 28286381 DOI: 10.1007/s12663-016-0938-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/18/2016] [Indexed: 11/24/2022] Open
Abstract
AIM The aim of this systematic review and meta-analysis was to compare, in the lower third molar surgery, the osteotomy techniques with rotary instruments and piezoelectric motors. METHODS An electronic search was conducted using the following databases: Pubmed, Web of Science, and the Cochrane Oral Health Group Trials Register. Inclusion criteria were: studies in humans, randomized or nonrandomized, comparing the extraction of third molars that required osteotomy and/or odontosection with rotary instrument and osteotomy and/or odontosection with piezoelectric motor assistance. The analysis and inclusion of articles was performed by two reviewers independently. An evaluation of the quality of articles and data extraction was carried out. RESULTS From a total of nine hundred seventy four (974) trials, eleven articles were included in the qualitative analysis, and seven were included in the quantitative analysis. Rotary instruments were faster than the piezoelectric surgery (95 % CI 0.34 to 1.16). The piezoelectric surgery showed better results when compared with roatry instruments when trismus was assessed in 2 (95 % CI 0.65 to 1.69), 3 (95 % CI 0.63 to 1.67) and 5 (95 % CI 0.03 to 2.26) days after surgery. Seven days after surgery, there were no differences between the techniques (95 % CI (-0.022) to (-1.49)). CONCLUSION The piezoelectric surgery was effective in reducing pain, swelling and trismus in third molar surgery, but the same requires greater surgical time than the rotary instruments.
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Affiliation(s)
- Rafael Alvim Magesty
- Departamento de Odontologia, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais Brazil
| | - Endi Lanza Galvão
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Carolina de Castro Martins
- Pediatric Dentistry, Faculdade de Odontologia, Universidade Federal de Minas Gerias, Belo Horizonte, Brazil
| | - Cássio Roberto Rocha Dos Santos
- Oral and Maxillofacial Surgery, Departamento de Odontologia, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais Brazil
| | - Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery, Departamento de Odontologia, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais Brazil
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Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis. Int J Oral Maxillofac Surg 2016; 45:383-91. [DOI: 10.1016/j.ijom.2015.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 09/27/2015] [Accepted: 10/08/2015] [Indexed: 11/23/2022]
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Mistry FK, Hegde ND, Hegde MN. Postsurgical consequences in lower third molar surgical extraction using micromotor and piezosurgery. Ann Maxillofac Surg 2016; 6:251-259. [PMID: 28299267 PMCID: PMC5343637 DOI: 10.4103/2231-0746.200334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: One of the most critical and crucial steps in surgical extraction is cutting the bone or osteotomy, for which many techniques are used, e.g., chisels and mallet, rotary instruments, and ultrasound bone-cutting instruments. If they are not used judiciously, they can be hazardous. Objectives: To assess the efficiency of piezosurgery unit over micromotor while performing surgical extraction of lower third molars by assessing the time taken for the surgery and measuring postoperative parameters such as pain, trismus, and swelling. Materials and Methods: Thirty patients having bilateral impacted third molars with the same difficulty index were selected for the study. One side surgical removal was done using micromotor and other side by piezosurgery with an interval of 15 days. After each surgery, time taken to finish was measured and patients were followed up on postoperative days 1, 3, 5, 7, and 15 for assessing pain, trismus, and swelling. Data obtained were statistically analyzed. Results: The mean time taken for the micromotor group is 37.90 min whereas by the piezosurgery group is 54.63 min, showing a statistically significant difference (P < 0.001). Furthermore, there is statistically significant difference (P < 0.001) in the level of pain, trismus, and swelling on postoperative days 1, 3, 5, and 7. Even the intragroup comparison of piezosurgical group for trismus and swelling showed no statistically significant difference on postoperative day 7, indicating faster recovery of trismus and swelling. On postoperative day 15, there was no difference in any parameter in both groups indicating complete symptom-free recovery in both groups. Conclusion: It takes more time to perform surgical extraction of third molars when piezosurgical unit is used. Despite that, it causes less pain postoperatively with faster improvement in trismus and quicker reduction in swelling.
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Affiliation(s)
- Freddy Kersi Mistry
- Department of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Nidarsh Diwakar Hegde
- Department of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Mithra Nidarsh Hegde
- Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Abstract
Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies.
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Affiliation(s)
- Stefan Stübinger
- Hightech Research Center of Cranio-maxillofacial Surgery, University of Basel, Allschwil, Switzerland
| | | | - Britt-Isabelle Berg
- Department of Cranio-maxillofacial Surgery, University Hospital Basel, Basel, Switzerland ; Division of Oral and Maxillofacial Radiology, Columbia University Medical Center, New York, NY, USA
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Jiang Q, Qiu Y, Yang C, Yang J, Chen M, Zhang Z. Piezoelectric Versus Conventional Rotary Techniques for Impacted Third Molar Extraction: A Meta-analysis of Randomized Controlled Trials. Medicine (Baltimore) 2015; 94:e1685. [PMID: 26469902 PMCID: PMC4616780 DOI: 10.1097/md.0000000000001685] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Impacted third molars are frequently encountered in clinical work. Surgical removal of impacted third molars is often required to prevent clinical symptoms. Traditional rotary cutting instruments are potentially injurious, and piezosurgery, as a new osteotomy technique, has been introduced in oral and maxillofacial surgery. No consistent conclusion has been reached regarding whether this new technique is associated with fewer or less severe postoperative sequelae after third molar extraction.The aim of this study was to compare piezosurgery with rotary osteotomy techniques, with regard to surgery time and the severity of postoperative sequelae, including pain, swelling, and trismus.We conducted a systematic literature search in the Cochrane Library, PubMed, Embase, and Google Scholar.The eligibility criteria of this study included the following: the patients were clearly diagnosed as having impacted mandibular third molars; the patients underwent piezosurgery osteotomy, and in the control group rotary osteotomy techniques, for removing impacted third molars; the outcomes of interest include surgery time, trismus, swelling or pain; the studies are randomized controlled trials.We used random-effects models to calculate the difference in the outcomes, and the corresponding 95% confidence interval. We calculated the weighted mean difference if the trials used the same measurement, and a standardized mean difference if otherwise.A total of seven studies met the eligibility criteria and were included in our analysis. Compared with rotary osteotomy, patients undergoing piezosurgery experienced longer surgery time (mean difference 4.13 minutes, 95% confidence interval 2.75-5.52, P < 0.0001). Patients receiving the piezoelectric technique had less swelling at postoperative days 1, 3, 5, and 7 (all Ps ≤0.023). Additionally, there was a trend of less postoperative pain and trismus in the piezosurgery groups.The number of included randomized controlled trials and the sample size of each trial were relatively small, double blinding was not possible, and cost analysis was unavailable due to a lack of data.Our meta-analysis indicates that although patients undergoing piezosurgery experienced longer surgery time, they had less postoperative swelling, indicating that piezosurgery is a promising alternative technique for extraction of impacted third molars.
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Affiliation(s)
- Qian Jiang
- From the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (QJ, YQ, CY, MC, ZZ); Rush Alzheimer's Disease Center (JY); and Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois (JY)
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Götz C, Reinhart E, Wolff KD, Kolk A. Oral soft tissue infections: causes, therapeutic approaches and microbiological spectrum with focus on antibiotic treatment. J Craniomaxillofac Surg 2015; 43:1849-54. [PMID: 26358301 DOI: 10.1016/j.jcms.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Intraoral soft tissue infections (OSTI) are a common problem in dentistry and oral surgery. These abscesses are mostly exacerbated dental infections (OIDC), and some emerge as postoperative infections (POI) after tooth extraction (OITR) or apicoectomy (OIRR). The main aim of this study was to compare OIDC with POI, especially looking at the bacteria involved. An additional question was, therefore, if different antibiotic treatments should be used with OSTI of differing aetiologies. The impact of third molars on OSTI was evaluated and also the rates of POI after removal of third molars were specified. MATERIAL AND METHODS Patient data was collected from the patients' medical records and the results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was the outpatient treatment of a patient with an exacerbated oral infection; the exclusion criteria were an early stage of infiltration without abscess formation; and a need for inpatient treatment. RESULTS Periapical exacerbated infections, especially in the molar region were the commonest cause of OIDC. In the OITR group, mandibular tooth removal was the commonest factor (p=0.016). Remarkably, retained lower wisdom teeth led to significant number of cases in the OITR group (p=0.022). CONCLUSIONS In our study we could not define differences between the causal bacteria found in patients with OIDC and POI. Due to resistance rates we conclude that amoxicillin combined with clavulanic acid seems to be the antibiotic standard for exacerbated intraoral infections independent of their aetiology.
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Affiliation(s)
- Carolin Götz
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany.
| | - Edeltraud Reinhart
- Department of Oral and Maxillofacial Surgery, Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany
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Kramer FJ, Bornitz M, Zahnert T, Schliephake H. Can piezoelectric ultrasound osteotomies result in serious noise trauma? Int J Oral Maxillofac Surg 2015; 44:1355-61. [PMID: 26227860 DOI: 10.1016/j.ijom.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 01/16/2023]
Abstract
The use of ultrasound to cut bone in oral and craniofacial surgery has increased. There is concern that the application of ultrasound to the craniofacial skeleton might represent a potential hazard to the inner ear because of sound transmission by bone conduction resulting in hearing trauma. Conventional and ultrasound osteotomies were performed on human specimens of temporal bone containing an intact middle and inner ear. The equivalent sound pressure was measured with a microphone at the round window, which had been calibrated with a bone conduction audiometer. Conventional osteotomy with a rose burr resulted in maximum sound pressures of 125dB(A) consisting of major frequency components at 2100, 7600, and 9300Hz. Ultrasound osteotomy resulted in maximum sound pressures of 122dB(A) and exhibited major frequency components at around 10kHz, 20kHz, and 26.5kHz. Ultrasound osteotomies have no acoustic advantage over conventional osteotomies. Both osteotomy techniques can produce noise-induced hearing trauma, especially when applied over longer durations of time. This appears to be more relevant for ultrasound osteotomies, because the bone cutting efficiency is usually poorer than in conventional osteotomies. Surgeons should consider the risk of noise-induced potential damage to the inner ear when selecting the method of osteotomy.
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Affiliation(s)
- F-J Kramer
- Department of Oral and Plastic Maxillofacial Surgery, George-August-University of Göttingen, Göttingen, Germany.
| | - M Bornitz
- Clinic of Otorhinolaryngology at the Technical University of Dresden, Department of Medicine, Dresden, Germany
| | - T Zahnert
- Clinic of Otorhinolaryngology at the Technical University of Dresden, Department of Medicine, Dresden, Germany
| | - H Schliephake
- Department of Oral and Plastic Maxillofacial Surgery, George-August-University of Göttingen, Göttingen, Germany
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Uyanık LO, Bilginaylar K, Etikan İ. Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes. Head Face Med 2015. [PMID: 26209242 PMCID: PMC4514981 DOI: 10.1186/s13005-015-0081-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction The aim of this study was the comparision of postoperative outcomes in impacted mandibular third molars that were treated using either platelet-rich fibrin (PRF), a combination of PRF and piezosurgery, or conventional rotatory osteotomy. Patient and methods The study included 20 patients; 40 extractions of impacted mandibular third molars were performed. Patients were divided into two main groups. In group A (n = 20), traditional surgery was performed on one side (Group 1, n = 10); traditional surgery was performed, and PRF was administered to the extracted socket on the other side of same patient (Group 2, n = 10). In group B (n = 20), on one side, piezosurgery was used for osteotomy, and PRF was administered (Group 3, n = 10); on the other side of same patient, traditional surgery was performed (Group 4, n = 10). Parameters assessed at baseline for each patient included pain, the number of analgesics taken, trismus, and cheek swelling. These variables were also assessed on postoperative days 1, 2, 3, and 7. Results Statistical analysis revealed a significant reduction in postoperative pain (sum of 1st, 2nd, 3rd and 7th days) and trismus (on postoperative day 1) in group 2 (traditional surgery + PRF group), and in postoperative pain, the number of analgesics taken (sum of 1st, 2nd,3rd and 7th days) and trismus (on postoperative day 1) in group 3 (piezosurgery + PRF group) compared to groups 1 and 4 (traditional surgery groups), (p ≤ 0.05). However, swelling on postoperative days 1, 3, and 7 did not differ among the groups (p > 0.05). Only difference was on second day between groups 1–4 and 2–4 (p ≤ 0.05). Conclusions The results of our study have shown that the use of PRF with traditional surgery and PRF combined with piezosurgery significantly reduced pain during the postoperative period. In addition, PRF in combination with piezosurgery significantly decreased the number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery. As a result of this study, PRF and combination use of PRF and piezosurgery have positive effects in reducing postoperative outcomes after impacted third molar surgery.
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Affiliation(s)
- Lokman Onur Uyanık
- Department of Oral and Maxillofacial Surgery, Near East University Faculty of Dentistry, Nicosia, Cyprus.
| | - Kani Bilginaylar
- Department of Oral and Maxillofacial Surgery, Near East University Faculty of Dentistry, Nicosia, Cyprus.
| | - İlker Etikan
- Department of Biostatistics, Near East University Faculty of Medicine, Nicosia, Cyprus.
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