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Baig FAH, Beniwal SK, Samir PV, Venkateshwar G, Singh M, Pendyala SK. Evlaution of Different Suturing Techniques in Deep Third Molar Surgery: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2658-S2660. [PMID: 39346242 PMCID: PMC11426757 DOI: 10.4103/jpbs.jpbs_401_24] [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: 04/07/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose The purpose of this study was to compare the efficacy of various suturing methods used in deep third molar extraction procedures. Methods A total of four suturing method groups-simple interrupted, horizontal mattress, vertical mattress, and figure-of-eight-were randomly allocated to 100 patients having deep third molar surgery. Assessments were conducted on wound healing, operation time, intraoperative problems, postoperative pain scores, swelling measures, and patient satisfaction questionnaires. Appropriate tests were used for statistical analysis, with P < 0.05 being regarded as significant. Results Compared to other procedures, the figure-of-eight technique showed better results in terms of postoperative pain scores, swelling measures, wound healing percentages, and patient satisfaction (P < 0.05). There was no discernible difference in the operating time or intraoperative problems between the groups. Conclusion In conclusion, there seems to be a benefit to using the figure-of-eight suturing approach for deep third molar surgery in terms of improved postoperative results and patient satisfaction. It is recommended that clinicians give this strategy some thought to improve patient care and surgical results.
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Affiliation(s)
- Fawaz Abdul Hamid Baig
- Department of Oral and Maxillofacial Surgery, King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia
| | - Sunil Kumar Beniwal
- Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College and Hospital, Jansla, Punjab, India
| | - P. V. Samir
- Department of Pedodontics and Preventive Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Gokul Venkateshwar
- Department of OMFS, DY Patil University School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
| | - Mamta Singh
- Department of Oral and Maxillofacial Surgery, Index Institute of Dental Sciences and Hospital Indore, Madhya Pradesh, India
| | - Siva Kumar Pendyala
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, AIMST University, Semeling, Bedong, Kedah, Malaysia
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Shahi AK, Vishal, Sharma S, Prajapati VK, Prakash O, Khaitan T. Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial. J Maxillofac Oral Surg 2024; 23:574-580. [PMID: 38911423 PMCID: PMC11190112 DOI: 10.1007/s12663-023-02092-2] [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: 10/22/2022] [Accepted: 12/06/2023] [Indexed: 06/25/2024] Open
Abstract
Background Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus. Materials and Method It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study. Result Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups. Conclusion LBTF shows no edge over BBTF during mandibular third molar disimpaction.
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Affiliation(s)
- Ajoy Kumar Shahi
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Vishal
- Department of Oral and Maxillofacial Surgery, Rama Dental College and Research Centre, Kanpur, India
| | - Swati Sharma
- Department of Pedodontics and Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
| | - V. K. Prajapati
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Om Prakash
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Tanya Khaitan
- Department of Oral Medicine and Radiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
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Albanese M, Zangani A, Manfrin F, Bertossi D, De Manzoni R, Tomizioli N, Faccioni P, Pardo A. Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study. Dent J (Basel) 2023; 11:238. [PMID: 37886923 PMCID: PMC10605236 DOI: 10.3390/dj11100238] [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: 08/18/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.
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Affiliation(s)
| | | | | | | | | | - Nicolò Tomizioli
- Dentistry and Maxillofacial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A, Scuro 10, 37134 Verona, Italy; (M.A.); (A.Z.); (D.B.); (R.D.M.); (P.F.); (A.P.)
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Zhao J, Zhang Y, Cheng Y, Xie S, Li DD, Zhang PF, Ren XY, Wang X. Effects of modified triangular flap for third molar extraction on distal periodontal health of second molar: A randomized controlled study. Heliyon 2023; 9:e16161. [PMID: 37234672 PMCID: PMC10208835 DOI: 10.1016/j.heliyon.2023.e16161] [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: 02/03/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Objective The aim of this study was to assess the effect of flap design for impacted mandibular third molar extraction on the distal periodontal tissue of their neighbors clinically, immunologically, and microbiologically. Study design This randomized controlled study comprised 100 patients who were allocated randomly to receive either a triangular flap or a modified triangular flap. The distal periodontal pocket depth, plaque index, bleeding on probing, the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia, and the level of interleukin-1β, interleukin-8 and matrix metalloproteinase-8 of adjacent second molars were measured at baseline, and 1, 4 and 8 weeks after surgery. Results After 1 and 4 weeks, distal periodontal conditions of adjacent second molars deteriorated, along with an increase in subgingival microbiota and inflammatory factors in both groups. And compared to the modified triangular flap group, the triangular flap group significantly increased (p < 0.05). Prevotella intermedia, interleukin-1β and probing depth were positively correlated in both groups. After 8 weeks, they returned to the preoperative level. Conclusions In this study, both flap designs for impacted mandibular third molar extractions was associated with worse clinical periodontal indices, increased inflammatory biomarkers of gingival crevicular fluid, and more subgingival pathogenic microbiota within 4 weeks. But compared with the triangular flap, the modified triangular flap was better for distal periodontal health of adjacent second molars, which provides certain directions for clinical treatment.
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Affiliation(s)
- Jing Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | - Yuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | - Yongfeng Cheng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | - Si Xie
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | | | - Peng-Fei Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | - Xiu-Yun Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, China
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Rajendran B. Comparison of buccal based triangular flap and lingual based triangular flap on postoperative course after impacted mandibular third molar surgery: a prospective randomized controlled study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2023. [DOI: 10.1051/mbcb/2023003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: The present study is to compare the buccal based triangular flap with lingual based triangular flap on postoperative pain, swelling and trismus after mandibular third molar surgery. Materials and methods: This study comprised of 100 patients, of which, 50 patients underwent buccal based triangular flap technique and 50 patients underwent lingual based triangular flap. The patients in both the groups were evaluated for pain, swelling and trismus on 1st, 3rd and 7th postoperative days. The wound healing was assessed on the 7th postoperative day. The obtained data's were statistically analyzed using SPSS software. Results: Patients in lingual based triangular flap group had less pain on all three postoperative days (P < 0.001). While, the amount of swelling was less on the 3rd postoperative day (P < 0.05) and the degree of trismus was less on 1st and 3rd postoperative days (P < 0.05). The patients in buccal based triangular flap group showed statistical significance for swelling on 1st and 7th postoperative days (P < 0.05) and for trismus on 7th postoperative day (P < 0.05). 2 Patients reported with tissue dehiscence in lingual based triangular flap group. In buccal based triangular flap group, 7 patients presented with wound gaping and 2 patients developed dry socket. Conclusion: Lingual based triangular flap was found to be superior and effective flap design in controlling pain, swelling and trismus with reduced postoperative complications when compared to buccal based triangular flap.
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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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Yuan L, Gao J, Liu S, Zhao H. Does the Lingual-Based Mucoperiosteal Flap Reduce Postoperative Morbidity Compared With the Buccal-Based Mucoperiosteal Flap After the Surgical Removal of Impacted Third Molars? A Meta-analysis Review. J Oral Maxillofac Surg 2021; 79:1409-1421.e3. [PMID: 33766455 DOI: 10.1016/j.joms.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/25/2021] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The lingual-based mucoperiosteal flap, a novel flap, was unclear about the effects on the prognosis of surgery for impacted mandibular third molars. This study aimed to compare the lingual- and buccal-based mucoperiosteal flaps with respect to postoperative responses and complications. MATERIALS AND METHODS A systematic review with a meta-analysis was designed and the PubMed, Cochrane Library, EMBASE, and Web of Science databases and Google Scholar from January 1, 2000 to April 30, 2020 were searched for randomized clinical trials. The predictor variable was buccal- or lingual-based flap in the surgery, and the outcome variables were pain, swelling, trismus, operative time, and wound dehiscence. Other study variables were sex and retention depth of impacted teeth. RevMan 5.3 software was used for data analysis. Mean differences or standardized mean differences and risk ratios were computed to assess associations between 2 variables, where statistical significance was set at P < .05. RESULTS Seven publications met the inclusion criteria, contributing 370 subjects who had 590 teeth removed to sample. The lingual-based flap failed to significantly reduce postoperative discomfort. However, subgroup analysis revealed that subjects who underwent comma flap (a type of lingual-based flap) surgeries complained of milder pain than those who underwent buccal-based flap surgeries on day 1 (mean difference = -1.18, 95% confidence interval [CI] [-1.53, -0.83], P < .001) and day 7 (mean difference = -1.80, 95% CI [-2.13, -1.48], P < .001) after surgery. Significant differences were also observed on days 1, 3, and 7 regarding postoperative swelling and trismus (P < .01). In addition, the lingual-based flap was reported to cause a significantly lower rate of wound dehiscence (relative risk = 0.46, 95% CI [0.30, 0.69], P = .0002). CONCLUSIONS The lingual-based flap was associated with better primary wound closure in third molar removal. The comma flap, as a subtype, was preferable for relieving postoperative pain, swelling, and trismus over the buccal-based flap.
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Affiliation(s)
- Lingyu Yuan
- Resident, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - Jian Gao
- Resident, Department of Stomatology, Xintai Hospital of Traditional Chinese Medicine, Taian, Shandong, China
| | - Shaopeng Liu
- Resident, College of Stomatology, Wuhan University, Wuhan, Hubei Province, China
| | - Huaqiang Zhao
- Professor, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China.
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Effect of drain application on postoperative complaints after surgical removal of impacted wisdom teeth-a randomized observer-blinded split-mouth clinical trial. Clin Oral Investig 2020; 25:345-353. [PMID: 32691298 DOI: 10.1007/s00784-020-03464-5] [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: 04/19/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this randomized observer-blinded split-mouth-study is to objectively assess the influence of a rubber drain on postoperative swelling using 3D face scans as measurement method and additionally evaluate pain, trismus and complications after the osteotomy of lower third molars. MATERIAL AND METHODS Seventy-two patients with symmetrically impacted lower wisdom teeth were recruited. Before the operation, patients rated pain using the visual analogue scale, the interincisal distance was measured, and 3D face scans were taken with an optical scanner. Each patient underwent two procedures which were at least 30 days apart. On one side, a rubber drain was inserted randomly before closure, the contralateral control side was closed without drainage. On the third and tenth postoperative day, face scans to quantify the swelling, pain evaluation and trismus measurements were performed. Due to loss of follow-up, 32 patients were excluded which resulted in 40 out of 72 patients remaining in the study. RESULTS There was no statistical difference in using a drain on swelling and trismus on the third and tenth day (p > 0.05). Pain was slightly worse on the third day on the treatment side, but the difference was not significant (p > 0.05). We observed no differences in the number of wound infections. CONCLUSIONS The insertion of a rubber drain does not have any influence on swelling, pain or trismus and has no impact on the number of wound infections. CLINICAL RELEVANCE The use of a rubber drain cannot be recommended as no reduction of postoperative discomfort was detected.
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