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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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Khiabani K, Amirzade-Iranaq MH, Babadi A. Does Minimal-Invasive Envelope Flap Reduce Side Effects Compared to Conventional Envelope Flap Following Impacted Third Molar Surgery? A Split-Mouth Randomized Clinical Trial. J Oral Maxillofac Surg 2021; 79:2411-2420. [PMID: 34391722 DOI: 10.1016/j.joms.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The surgical removal of impacted third molars can lead to various postoperative consequences, which can be influenced by modifiable factors such as flap design. The present study aimed to determine whether a minimal-invasive envelope flap (MIEF) can reduce surgical consequences and improve life quality compared to conventional envelope flap (CEF) after removing impacted mandibular third molars. MATERIAL AND METHODS This single-blinded, cross-over randomized clinical trial was conducted on adult patients with bilateral, symmetrically impacted mandibular third molars. The flap design for surgical removal of the third molar was the primary predictor variable. The primary outcome (pain) and secondary outcome variables (swelling, mouth opening limitation [MOL]) were recorded daily and on the second and seventh days after the surgery, respectively. Wound dehiscence and patients' postoperative quality-of-life scores (PPOQL) were recorded on the seventh day. The data were analyzed by Kolmogorov-Smirnov and paired sample t test using SPSS version 22. The P value < .5 was considered significant. RESULTS Sixty-eight impacted third molars of 34 subjects with a mean age of 22 ± 12.9 years (35% females) were followed. The postoperative pain level in the MIEF group at rest (0.80 ± 0.53) and chewing (2.10 ± 1.32) up to fifth day was significantly (P value < .01) lower than CEF group (2.40 ± 1.12 and 3.05 ± 1.13, respectively). The difference did not reach a significant level at rest and chewing on the sixth and seventh days (P value > .05). On the seventh day, the subjects in the MIEF group showed a significantly (P value < .001) lower level of swelling (1.13 ± 0.11) and MOL (8.28 ± 4.17) than the CEF group (3.2 ± 2.1 and 12.67 ± 4.92, respectively). Based on the PPOQL scale, patients in the MIEF group (1.82 ± 1.31) expressed a better recovery period than the CEF group (3.5 ± 2.1) (P value < .001). CONCLUSIONS Considering the reduction of pain, swelling, MOL, and wound dehiscence in MIEF cases, the application of MIEF in surgical removal of impacted mandibular third molars can lead to a significant reduction in postoperative consequences and also a noticeable improvement in PPOQL compared to CEF.
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Affiliation(s)
- Kazem Khiabani
- Associate Professor, Director of Residency Program, Department of Oral & Maxillofacial Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammad Hosein Amirzade-Iranaq
- Department Head, Department of Research, Arka Education and Clinical Research Consultants, Tehran, Iran; Researcher, Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Arman Babadi
- Private Practice, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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DE Marco G, Lanza A, Cristache CM, Capcha EB, Espinoza KI, Rullo R, Vernal R, Cafferata EA, DI Francesco F. The influence of flap design on patients' experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review. J Appl Oral Sci 2021; 29:e20200932. [PMID: 34105693 PMCID: PMC8232931 DOI: 10.1590/1678-7757-2020-0932] [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: 11/09/2020] [Accepted: 02/11/2021] [Indexed: 11/21/2022] Open
Abstract
Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane’s Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient’s perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon’s experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.
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Affiliation(s)
- Gennaro DE Marco
- Campania University Luigi Vanvitelli, Multidisciplinary Department of Medical, Surgical and Dental sciences, Naples, Italy
| | - Alessandro Lanza
- Campania University Luigi Vanvitelli, Multidisciplinary Department of Medical, Surgical and Dental sciences, Naples, Italy
| | - Corina M Cristache
- Carol Davila University of Medicine and Pharmacy, Faculty of Midwifery and Medical Assisting (FMAM), Department of Dental Techniques, Bucharest, Romania
| | - Estefani B Capcha
- Universidad Peruana Cayetano Heredia, Departamento de Clínica Estomatologica, Lima, Perú
| | - Karen I Espinoza
- Universidad Peruana Cayetano Heredia, Departamento de Clínica Estomatologica, Lima, Perú
| | - Rosario Rullo
- Campania University Luigi Vanvitelli, Multidisciplinary Department of Medical, Surgical and Dental sciences, Naples, Italy
| | - Rolando Vernal
- Universidad de Chile, Facultad de Odontología, Laboratorio de Biologia Periodontal, Santiago, Chile
| | - Emilio A Cafferata
- Universidad de Chile, Facultad de Odontología, Laboratorio de Biologia Periodontal, Santiago, Chile.,Universidad Científica del Sur, Departamento de Periodoncia, Escuela de Odontología, Lima, Perú
| | - Fabrizio DI Francesco
- Campania University Luigi Vanvitelli, Multidisciplinary Department of Medical, Surgical and Dental sciences, Naples, Italy
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Influence of Surgical Flap Design (Envelope and Szmyd) for Removal of Impacted Mandibular Third Molars on Clinical Periodontal Parameters: A Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094465. [PMID: 33922323 PMCID: PMC8122778 DOI: 10.3390/ijerph18094465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
The aim of the study was to assess the influence of flap designs (Envelope flap (EF) and Szmyd flap (SF)) for impacted mandibular third molar extraction, on periodontal pocket depth (PPD), clinical attachment loss (CAL) and bone levels (BL) of second molar. Sixty patients indicated for third molar extractions with healthy second molars were allocated into two groups: EF and SF (n = 30). Third molars were assessed for angulation, root patterns, depth of impactions and relation with ramus (Pell and Gregory classification). Extraction of third molars was performed and PPD, CAL and BL around second molars at 0, 3 and 6 month (mon) follow-ups (FU) were assessed clinically and radiographically. ANOVA, Chi-square and Fisher’s exact test were employed to compare periodontal factors between EF and SF groups, considering p ≤ 0.05 as significant. Sixty participants with a mean age of 23.22 ± 3.17 were included in the study. Based on angulation, the most common impaction in the EF and SF groups was mesio-angular (EF, 50%; SF, 36.7%). Buccal and distal PPD showed a significant increase (p < 0.001) in both EF and SF patients from baseline to 6 mon. EF patients showed significantly higher distal and buccal CAL (6.67 ± 0.18 mm; 6.91 ± 0.17 mm) and BL (7.64 ± 0.16 mm; 7.90 ± 0.15 mm) as compared to SF patients (CAL, 6.76 ± 0.26 mm; 6.91 ± 0.17 mm-BL, 7.42 ± 0.38 mm; 7.34 ± 0.34 mm) at 6 mon FU. SF showed better soft tissue attachment (PPD and CAL) and bone stability (less bone loss) around second molars compared to EF after third molar extractions regardless of the patient, tooth and operator factors.
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Iwanaga J, Kunisada Y, Masui M, Obata K, Takeshita Y, Sato K, Kikuta S, Abe Y, Matsushita Y, Kusukawa J, Tubbs RS, Ibaragi S. Comprehensive review of lower third molar management: A guide for improved informed consent. Clin Anat 2020; 34:224-243. [DOI: 10.1002/ca.23693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Fukuoka Japan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Masanori Masui
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kotaro Sato
- Department of Oral and Maxillofacial Surgery Nagoya University Graduate School of Medicine Nagoya Japan
| | - Shogo Kikuta
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yushi Abe
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yuki Matsushita
- University of Michigan School of Dentistry Ann Arbor Michigan USA
- Department of Clinical Oral Oncology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Structural & Cellular Biology Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System New Orleans Louisiana USA
- Department of Anatomical Sciences St. George's University St. George's Grenada
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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"Effects of flap modification on third molar extraction outcomes"-A randomised split mouth study. J Oral Biol Craniofac Res 2020; 10:619-624. [PMID: 32963955 DOI: 10.1016/j.jobcr.2020.08.010] [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: 10/11/2019] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022] Open
Abstract
Aim The main purpose of this experimental study was to compare whether modifications in flap design influence the post-operative outcome of third molar surgeries. Materials and methods This study was designed as a randomized, single-blinded,split-mouth cross-over comparative study. The predictor variables were the flap type; Conventional Ward's was used to expose the tooth with a difference in the anterior release incision between the groups.Oblique anterior releasing incision and vertical anterior releasing incisions were used for the control and study group respectively.The primary outcome variables were pain measured using VAS (Visual analogue scale), swelling in mm; mouth opening measured in mm, periodontal probing depth in a mm, wound healing by modified Landry's score and surgical accessibility. Statistical significance was set at 5% (α = 0.05). Result Twenty five patients with bilateral, mirror-image impacted mandibular third molars participated in the study.The study group was associated with moderate swelling that was not statistically significant. .The outcome variables i.e. pain, wound healing, mouth opening, and periodontal pocket depth had no statistical difference on comparing the two groups. In terms of accessibility, the control group was found to be better with the statistical significance of p = 0.00184. Conclusion Modifying conventional Ward's design influences the degree of swelling and surgical accessibility. Vertical anterior releasing incision in conventional Ward's has no advantage over conventional Ward's with oblique anterior releasing incision.
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Özveri Koyuncu B, Işık G, Özden Yüce M, Günbay S, Günbay T. Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: a randomized controlled clinical study. BMC Oral Health 2020; 20:222. [PMID: 32807173 PMCID: PMC7433081 DOI: 10.1186/s12903-020-01210-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The aim of this prospective study was to assess the effectiveness of concentrated growth factors (CGF) in preventing the development of alveolar osteitis (AO) after the extraction of partially-erupted mandibular third molars. Methods Seventy patients (26 men and 44 women) 18 years or older (mean age 25.86; range 18–35) underwent 140 third molar extractions. All the patients presented with bilateral, partially-erupted mandibular third molars and underwent surgical extractions. In each case, one socket received CGF and the other served as a control. The predictor variable was the CGF application and the sides were categorized as ‘CGF’ and ‘non-CGF’. The outcome variable was the development of AO during the first postoperative week. Other study variables included age and gender. Data were analyzed using Cochran’s Q test with the significance level set at a P value less than 0.05. Results The overall frequency of AO was 11.4% for the control group. The frequency of AO in the CGF group was significantly lower than in the non-CGF group (p < 0.001). Conclusions Based on the results of this study, application of CGF fibrin gel may decrease the risk of AO development after mandibular third molar surgery. Trial registration This study was registered in ClinicalTrials.gov database on November 1, 2019 (ID: NCT04151147, retrospectively registered).
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Affiliation(s)
- Banu Özveri Koyuncu
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey.
| | - Gözde Işık
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Meltem Özden Yüce
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Sevtap Günbay
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Tayfun Günbay
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
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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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Glera-Suárez P, Soto-Peñaloza D, Peñarrocha-Oltra D, Peñarrocha-Diago M. Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2020; 25:e233-e239. [PMID: 32062667 PMCID: PMC7103454 DOI: 10.4317/medoral.23320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. MATERIAL AND METHODS An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. RESULTS From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. CONCLUSIONS Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs.
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Affiliation(s)
- P Glera-Suárez
- Universitat de València Clínica Odontológica, Unidad de Cirugía Bucal Gascó Oliag 1, 46021. Valencia, Spain
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Lopes da Silva BC, Machado GF, Primo Miranda EF, Galvão EL, Falci SGM. Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 49:1073-1086. [PMID: 31974006 DOI: 10.1016/j.ijom.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary outcomes assessed were dehiscence, ecchymosis, alveolar osteitis, periodontal condition, and surgical time. The PRISMA guidelines and recommendations in the Cochrane Handbook were followed, and the review was registered before commencement (PROSPERO; CRD42018112373). The literature search was conducted in the Web of Science, PubMed, Virtual Health Library, Cochrane Library, and Scopus databases and in the grey literature; randomized clinical trials, indexed through November 2018 were included. Three reviewers independently examined the studies. Twenty studies were included in the qualitative analysis, of which 18 were included in the meta-analyses. The flap design did not influence pain, oedema, trismus, dehiscence, or osteitis. The triangular flap was associated with a greater occurrence of postoperative ecchymosis (odds ratio 4.58, 95% confidence interval 1.34 to 15.91, I2=0) and lower periodontal probing depth on day 7 postoperative (standardized mean difference -1.36, 95% confidence interval -2.68 to -0.03, I2=88%) when compared to the envelope flap in mandibular third molar surgeries.
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Affiliation(s)
- B C Lopes da Silva
- Oral and Maxillofacial Section, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, MG, Brazil
| | - G F Machado
- Oral and Maxillofacial Section, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, MG, Brazil
| | - E F Primo Miranda
- Oral and Maxillofacial Section, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, MG, Brazil
| | - E L Galvão
- Oral and Maxillofacial Section, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, MG, Brazil
| | - S G M Falci
- Oral and Maxillofacial Section, School of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, MG, Brazil.
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Loganathan K, Mohan J, Vaithilingam B, Chawla R, Gandhi N, Ganapathy S. A new flap design compared with other flap designs on postoperative pocket depth following surgical removal of mandibular third molar. JOURNAL OF THE INTERNATIONAL CLINICAL DENTAL RESEARCH ORGANIZATION 2020. [DOI: 10.4103/jicdro.jicdro_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 78:515-527. [PMID: 31883443 DOI: 10.1016/j.joms.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery. MATERIALS AND METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the inception date to November 2018. Randomized and nonrandomized controlled trials were included if they had met certain inclusion and exclusion criteria. The predictor variable was the flap design, envelope or triangular. The outcome variables were operation time, pain, trismus, alveolar osteitis (AO) incidence, wound dehiscence, and swelling. The methodologic quality assessment was performed in accordance with the Cochrane Collaboration guidelines. The meta-analysis was performed using Review Manager, version 5.2. RESULTS A total of 21 studies were included for qualitative synthesis, 18 of which were included in the meta-analysis. The use of envelope flaps required less operation time than triangular flaps (P < .00001; I2 = 9%). In the Pell and Gregory A and B subgroups, envelope flaps were associated with a significantly lower visual analog scale score at 3 (P = .05, I2 = 0%) and 7 (P = .02; I2 = 0%) postoperative days and with a greater postoperative interincisal distance at 7 postoperative days (P = .04; I2 = 0%). In contrast, envelope flaps were associated with a greater AO incidence in the subgroup of split-mouth randomized controlled trials (P = .001; I2 = 0%). CONCLUSIONS Envelope flaps required a shorter operation time than triangular flaps and were associated with less postoperative pain and trismus when applied to impacted mandibular third molars of Pell and Gregory Class A or B. In contrast, triangular flaps were associated with a decreased incidence of AO compared with envelope flaps.
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Şimşek Kaya G, Yapıcı Yavuz G, Saruhan N. The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split-mouth randomised clinical trial. J Oral Rehabil 2019; 46:828-835. [PMID: 31050816 DOI: 10.1111/joor.12814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/15/2019] [Accepted: 04/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical removal of impacted mandibular third molar is one of the most frequently performed interventions in oral and maxillofacial surgery. OBJECTIVES To compare two different flap designs in terms of sequelae and quality of life following surgical removal of impacted third molars. METHODS This prospective, randomised, split-mouth clinical study involved patients referred for surgical removal of bilateral symmetrical impacted mandibular third molars. Envelope flap and modified triangular flap techniques were used. The effects of flap design on trismus, swelling, wound dehiscence, alveolar osteitis, haematoma, infection and quality of life were evaluated on post-operative days 3 and 7. Pain levels were assessed on post-operative days 1, 3 and 7. RESULTS Significant differences were determined between the two groups in terms of trismus, pain and wound dehiscence scores on post-operative day 3. However, on post-operative day 7, this difference was observed only in trismus. Statistically significant differences were also determined between the two groups on post-operative day 3 for social isolation and eating subscale scores as well as total quality of life score. CONCLUSION Based on the study findings, the modified triangular flap may be superior to the envelope flap in terms of pain, trismus, and wound dehiscence in the first 3 days after impacted third molar surgery and may have a better impact on quality of life during this process.
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Affiliation(s)
- Göksel Şimşek Kaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Günay Yapıcı Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Nesrin Saruhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
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Zhang X, Wang L, Gao Z, Li J, Shan Z. Development of a New Index to Assess the Difficulty Level of Surgical Removal of Impacted Mandibular Third Molars in an Asian Population. J Oral Maxillofac Surg 2019; 77:1358.e1-1358.e8. [PMID: 30959010 DOI: 10.1016/j.joms.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to develop a straightforward and accurate index of impacted third molar removal difficulty through analyzing various factors to assess the difficulty level of impacted mandibular third molar (IMTM) extraction. MATERIALS AND METHODS This prospective cohort study included 203 patients who required IMTM extraction. All patients were selected using the preset selection criteria. The present study assessed operation difficulty with operating time. A mathematical model and regression analysis were performed to explore 6 main factors (age, number of roots, degree of bone impaction, shape of roots, and impaction angle and its relation). Appropriate correction coefficients were obtained to formulate a new IMTM removal difficulty predictive index. Consistency of the κ value was checked to evaluate performance. RESULTS Degree of bone impaction had the highest correlation coefficient (0.576), followed by shape of roots (0.359), and the lowest correlation coefficient was for number of roots. The Pederson index for these 203 patients showed that 75, 76, and 52 patients had low, moderate, and high difficulty levels, respectively, whereas the new index categorized 78, 85, and 40 patients as having low, moderate, and high difficulty. Comparison of the Pederson index and new index with operating time showed κ agreements of 65.30 and 77.9% (P < .01), suggesting that the prediction results of the new index are more objective and accurate. CONCLUSION The newly proposed index is straightforward and efficient and exhibited promising results in κ agreement. Because of its straightforward nature, it is better suited for Chinese public hospitals with a large volume of patients who require alveolar surgery. The detection of predictor variables could be useful for graduate students, professionals, and general dental practitioners contemplating IMTM removal to assess the difficulty level of IMTM extraction.
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Affiliation(s)
- Xiaoyu Zhang
- Resident, Outpatient Department of Oral and Maxillofacial Surgery, School of Stomatology, and Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Lingxiao Wang
- Resident, Outpatient Department of Oral and Maxillofacial Surgery and Department of Dental Implantology Center, School of Stomatology, Capital Medical University, Beijing, China
| | - Zhenhua Gao
- Attending Staff, Outpatient Department of Oral and Maxillofacial Surgery, School of Stomatology, Capital Medical University, Beijing, China
| | - Jun Li
- Professor, Department of Dental Implantology Center, School of Stomatology, Capital Medical University, Beijing, China
| | - Zhaochen Shan
- Department Head, Outpatient Department of Oral and Maxillofacial Surgery, School of Stomatology, Capital Medical University, Beijing, China.
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Kilinc A, Ataol M. How effective is collagen resorbable membrane placement after partially impacted mandibular third molar surgery on postoperative morbidity? A prospective randomized comparative study. BMC Oral Health 2017; 17:126. [PMID: 28982352 PMCID: PMC5629786 DOI: 10.1186/s12903-017-0416-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/25/2017] [Indexed: 11/12/2022] Open
Abstract
Background Collagen membranes have some benefits include promoting wound healing through isolation, clot stabilization, wound stability, and hemostasis, enhancing primary wound coverage through its chemotactic ability to attract fibroblasts, and augmenting flap thickness by providing a collagenous scaffold. The purpose of this study was to compare primary and secondary healing and collagen membrane-based primary healing after surgical removal of partial impacted mandibular third molars, evaluating the incidence of postoperative complications and analyzing the swelling, mouth opening, and pain. Methods This was a prospective, randomized controlled study. Patients were randomly assigned to three groups: the SC (Secondary closure) group, the PC (Primary closure) group, and the MBPC (membrane based primary closure) group. Data were collected on pain, mouth opening, swelling, and complications experienced by the patients. Results There was no statistically significant difference between the groups for the pain (p > 0.05), relatively. The swelling recorded on postoperative days 2 and 7 was lower in the SC group than in the PC (p = 0.046 and 0.00) and in MBPC (p = 0.005 and 0.002) groups, respectively. Mouth opening showed a statistically significant difference between the three groups at day 2 (p = 0.00). Wound dehiscence was shown in 6 patients in the PC (20%) group and 2 patients in the MBPC (6.7%) group. Dry socket was observed 3 patients in the SC group (10%), 2 patients in the PC group (6.7%), and no dry socket in the MBPC group. No cases of infection or postoperative bleeding were encountered. Conclusions The secondary closure provides a marked advantage over the primary closure in terms of swelling and mouth opening. However, the absence of alveolitis in the primary closure using the collagen membrane and minimal wound dehiscence, suggests that membrane use may support primary healing in terms of wound healing.
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Affiliation(s)
- Adnan Kilinc
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey.
| | - Mert Ataol
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
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Alqahtani NA, Khaleelahmed S, Desai F. Evaluation of two flap designs on the mandibular second molar after third molar extractions. J Oral Maxillofac Pathol 2017; 21:317-318. [PMID: 28932049 PMCID: PMC5596690 DOI: 10.4103/jomfp.jomfp_75_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The extraction of third molars is associated with some clinical outcomes and periodontal problems. It is imperative to note that the type of incision used in the surgery for the removal of the impacted third molar is critical. The design of the flap influences the healing of the surgically created defect and damage to the distal periodontal area of the adjacent second molar. However, till date, there have been conflicting reports on the influence of different flap designs used for the surgical removal of impacted third molars. AIM The present study aimed to comparatively evaluate the clinical outcomes and periodontal status of the adjacent second molar, when two different flap designs, namely, the envelope and the modified triangular flap designs were used. MATERIALS AND METHODS Sixty female patients with bilateral impacted third molars completed the study with envelope flap on one side and modified triangular flap design on the other side of the mandible for third molar removal. Clinical parameters including pain, dehiscence and swelling were assessed postoperatively and periodontal probing depth (PPD) on the distal aspect of adjacent second molar were assessed both pre- and post-operatively. RESULTS The results were assessed on 1, 3 and 8 days for pain using visual analog scale. The subjective perception of swelling was evaluated on 3, 7 and 15 days postoperatively in a similar manner. The results of the periodontal parameters were evaluated both preoperatively and 3 months postoperatively, with cautious exploration using a University of North Carolina (UNC)-15 periodontal probe. The statistically significant results for swelling and PPD were noted for the two flap groups using the Chi-square test (P < 0.05). CONCLUSION The study revealed that the modified triangular flap had lesser postoperative PPDs and dehiscence. The envelope flap was better when swelling was analyzed. The pain scores, though slightly higher for the modified triangular flap group, were not statistically significant.
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Affiliation(s)
- Nabeeh A Alqahtani
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, KSA
| | - S Khaleelahmed
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, KSA
| | - Farheen Desai
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, KSA
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Elo JA, Sun HHB, Dong F, Tandon R, Singh HM. Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:124-33. [PMID: 27055733 DOI: 10.1016/j.oooo.2016.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. STUDY DESIGN This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value < .05 was considered to be statistically significant. RESULTS One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides. CONCLUSIONS MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery.
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Affiliation(s)
- Jeffrey A Elo
- Associate Professor, Division of Oral and Maxillofacial Surgery, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA; Assistant Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
| | - Ho-Hyun Brian Sun
- Dental Student, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA
| | - Fanglong Dong
- Associate Professor, Biostatistician, Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California, USA
| | - Rahul Tandon
- Resident, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hardev M Singh
- Assistant Professor, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA
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Korkmaz YT, Mollaoglu N, Ozmeriç N. Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery? J Oral Maxillofac Surg 2015; 73:1031-41. [PMID: 25872465 DOI: 10.1016/j.joms.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the influence of the surgical removal of partially impacted third molars (3Ms) and compare the effects of a 3-cornered laterally rotated flap (LRF) with primary closure (flap 1) and an envelope flap with secondary closure (flap 2) on the short-term periodontal status of the adjacent second molars (2Ms). We also assessed the postoperative complications after removal of the partially impacted 3M. MATERIALS AND METHODS A split mouth, randomized clinical study was designed. The study sample included patients with bilateral partially impacted 3Ms. The primary predictor variable was the type of flap design (flaps 1 and 2). The primary outcome variable was periodontal status (gingival recession [GR], probing depth [PD], plaque index [PI], and gingival index) of the 2Ms measured preoperatively and 90 days postoperatively. The secondary outcome variables were postoperative complications, including pain, facial swelling, alveolitis, and local wound infection. The other variables included gender, position of the 3Ms, and surgical difficulty. We performed descriptive, comparative, correlation, and multivariate analyses. RESULTS The sample included 28 patients aged 18 to 28 years. The GR, PD, and PI values with the flap 2 design were greater than those with the flap 1 design (P < .05). Facial swelling with the flap 1 design was significantly greater than with the flap 2 design on the second postoperative day (P < .05). The pain levels with the flap 1 design were significantly greater than those with the flap 2 design on the first and second postoperative days (P < .05). According to the multivariate regression analyses, flap design was closely related to the periodontal status of the 2Ms and postoperative discomfort. CONCLUSION The results of the present clinical study have shown that the flap design in partially impacted 3M surgery considerably influences the early periodontal health of the 2Ms and postoperative discomfort. However, although the 3-cornered LRF design might cause more pain and swelling, it could be the method of choice for partially impacted 3M surgery because of the early periodontal healing.
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Affiliation(s)
- Yavuz Tolga Korkmaz
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
| | - Nur Mollaoglu
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Nurdan Ozmeriç
- Professor, Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Veale B. Alveolar osteitis: a critical review of the aetiology and management. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B. Veale
- Oral and Maxillofacial Surgery; Charles Clifford Dental Hospital; Sheffield Teaching Hospitals; South Yorkshire UK
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Pathak S, Vashisth S, Mishra S, Singh SP, Sharma S. Grading of Extraction and Its Relationship with Post-operative Pain and Trismus, along with Proposed Grading for Trismus. J Clin Diagn Res 2014; 8:ZC09-11. [PMID: 25121055 DOI: 10.7860/jcdr/2014/8560.4470] [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: 01/20/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extraction of mandibular third molars are somewhat a matter of interest because of its malpositioning , curved roots, proximity to vital structures due to this the procedure is often associated with post operative complications like pain and trismus. The extraction of third molar was classified in four grads according to the difficulty of the procedure. AIMS The purpose of this paper is to find any significant relationship between grading of extraction and post operative complications like pain and trismus. MATERIALS AND METHODS A total number of 180 patients need to go for extraction of third molar was included in the study. The variables taken into account were grading of extraction, pain six hour post operatively trismus one day after extraction, and trismus five day after extraction. The four grades of extractions as described by Parent in 1974 were statistically analyzed by computing pearson product moment correlation coefficient with post operative pain and trismus first and fifth day to find any co relation between them. RESULTS The grading of extraction was found significantly correlated with post operative pain, trismus one day after and fifth day of surgery.
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Affiliation(s)
- Sachin Pathak
- Assistant Professor, Department of Dental Science, Sri Ram Murti Medical College , India
| | - Shirin Vashisth
- Reader, Department of Oral Medicine and Radiology, Kalka Dental College , Meerut, India
| | | | - Surendra Pratap Singh
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Krishna Dental College , Gaziabad,India
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