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Tang SM, Liu DX, Xiong ZY, Shao YQ, Jiang J, Chen L, Xiong Q, Wu SY, Xuan DY. Comparison of immediate vs. delayed guided tissue regeneration in Infrabony defect of second molars after adjacent third molar extraction: a retrospective study. BMC Oral Health 2024; 24:830. [PMID: 39044179 PMCID: PMC11265319 DOI: 10.1186/s12903-024-04591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The distal aspect of the second molar (d-M2) often exhibits infrabony defects due to the adjacent third molar. Although the defects can be treated by guided tissue regeneration (GTR) after removing the third molar, the optimal timing remains uncertain following third molar removal in clinical decision-making. This study aimed to compare delayed and immediate GTR treatments to assist in clinical decision-making. METHODS D-M2 infrabony defects with a minimum 1-year follow-up were collected and divided into three groups: Immediate GTR group, which underwent third molar extraction and received GTR simultaneously; Delayed GTR group, which underwent delayed GTR at least 3 months after third molar extraction; and Control group, which underwent only scaling and root planing during third molar extraction. The clinical and radiographic parameters related to the infrabony defect before GTR and post-surgery were evaluated using the Kruskal-Wallis test or one-way ANOVA, followed by post-hoc Dunn's test or the Bonferroni test for pairwise comparisons. RESULTS A total of 109 d-M2 infrabony defects were assessed. No significant differences were found between the two GTR groups, although both of them showed significant reductions in infrabony defect depth: the immediate GTR group (2.77 ± 1.97 mm vs. 0.68 ± 1.03 mm, p < 0.001) and the delayed GTR group (2.98 ± 1.08 mm vs. 0.68 ± 1.03 mm, p < 0.001) compared to the control group. CONCLUSION GTR can effectively improve d-M2 infrabony defects when the third molar is removed, whether simultaneously or delayed. Patients may experience less discomfort with immediate GTR treatment as it requires only one surgery.
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Affiliation(s)
- Si-Min Tang
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Di-Xin Liu
- Department of Periodontology, Hangzhou Stomatology Hospital, 1 Pinghai Road, Hangzhou, Zhejiang Province, China
| | - Zi-Yun Xiong
- Department of Periodontology, Hangzhou Stomatology Hospital, 1 Pinghai Road, Hangzhou, Zhejiang Province, China
| | - Yi-Qian Shao
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Jiang
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Chen
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qin Xiong
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuo-Yan Wu
- College of Dentistry, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dong-Ying Xuan
- Department of Periodontology, Hangzhou Stomatology Hospital, 1 Pinghai Road, Hangzhou, Zhejiang Province, China.
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Sánchez-Labrador L, Martín-Ares M, Cortés-Bretón Brinkmann J, López-Quiles J, Martínez-González JM. Assessment of Changes in the Outcome of Autogenous Tooth Grafts Over Time: A Clinical Study Evaluating Periodontal Healing in Bone Defects After Lower Third Molar Removal. J Oral Maxillofac Surg 2024:S0278-2391(24)00331-8. [PMID: 38851213 DOI: 10.1016/j.joms.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The removal of impacted lower third molars (ILTMs) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects. PURPOSE The primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM. STUDY DESIGN, SETTING, SAMPLE This split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted. MAIN OUTCOME VARIABLE PD on the distobuccal, distomedial, and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2), and 36 months (T3) postoperatively. COVARIATES Sex, age, surgical time, ILTM situation and position between groups were assessed. ANALYSES ANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval of 95% (P < .05). RESULTS The sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68 ± 2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (P < .001, 95% confidence interval) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3), and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74 ± 0.28 (P < .001) and 0.54 ± 0.3 (P = .43) were observed in test and control groups, respectively. CONCLUSION AND RELEVANCE ATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.
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Affiliation(s)
- Luis Sánchez-Labrador
- Assistant Professor, Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain.
| | - María Martín-Ares
- European University of Madrid, Madrid, Spain; Surgical and implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, Madrid, Spain
| | - Jorge Cortés-Bretón Brinkmann
- Adjunct Professor, Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain; Surgical and implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, Madrid, Spain
| | - Juan López-Quiles
- Associate Professor and Director of Master Program in Oral Surgery and Implant Dentistry, Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - José María Martínez-González
- Full Professor, Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain; Surgical and implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, Madrid, Spain
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Pang SL, Yeung WKA, Hung KF, Hui L, Chung HZJ, Leung YY. Third Molar Coronectomy vs Total Removal in Second Molar Periodontal Healing. Int Dent J 2024; 74:246-252. [PMID: 37666687 PMCID: PMC10988259 DOI: 10.1016/j.identj.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES The objective of this randomised controlled trial was to compare the periodontal healing at the distal of the adjacent second molar after coronectomy or surgical removal and the surgical morbidities of the 2 techniques. METHODS This is a pilot study of a split-mouth randomised clinical trial comparing the periodontal healing of the adjacent second molar after coronectomy or total removal of lower third molars, which was registered with the University of Hong Kong Clinical Trial Centre as HKUCTR-2948 on 21 February 2020. Cone beam computed tomography (CBCT) scans were taken preoperatively and at 6 months postoperatively. Changes in the bone level from the cemento-enamel junction, periodontal probing depth (PPD), and clinical attachment level (CAL) at the distal of the adjacent second molar were compared. Surgical morbidities in terms of pain, infection, neurologic deficit, root exposure, and need for second surgery for removal were assessed. RESULTS Forty patients (22 male, 18 female) with mean age of 26.7 years were evaluated at 6 months postoperatively. Both coronectomy and total removal groups demonstrated statistically significant reduction in PPD and CAL. There was an alveolar bone gain of 1.28 ± 0.88 mm in the coronectomy group and 1.13 ± 0.73mm in the control group, which was statistically significant (P < .001 for both groups). CONCLUSIONS Early findings show the periodontal healing at the adjacent second molar of coronectomy was as good as that of total removal of lower third molar. There were no differences in terms of surgical morbidities between both groups.
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Affiliation(s)
- Si Ling Pang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Wai Kan Andy Yeung
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Kuo Feng Hung
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Liuling Hui
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Hui Zhen Jasmine Chung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Feng Y, Zhao R, Li J, Yuan Z, Xu X, Gong J. Efficacy of autogenous particulated dentin graft for alveolar ridge preservation: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36391. [PMID: 38050282 PMCID: PMC10695520 DOI: 10.1097/md.0000000000036391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP. METHODS MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339). RESULTS A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups. CONCLUSION Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP.
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Affiliation(s)
- Yuxia Feng
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou City, P. R. China
| | - Ruimin Zhao
- Department of Stomatology, Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou people’s hospital, 100 Minjiang Dadao, Smart New City, Quzhou City, P. R. China
| | - Jianxue Li
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou City, P. R. China
| | - Zhenfei Yuan
- Department of Stomatology, Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou people’s hospital, 100 Minjiang Dadao, Smart New City, Quzhou City, P. R. China
| | - Xu Xu
- Department of Stomatology, Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou people’s hospital, 100 Minjiang Dadao, Smart New City, Quzhou City, P. R. China
| | - Jiaming Gong
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou City, P. R. China
- Department of Stomatology, Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou people’s hospital, 100 Minjiang Dadao, Smart New City, Quzhou City, P. R. China
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Lu Y, Wang Y, Chai Y, Chen M. Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study. Clin Oral Investig 2023; 27:6089-6096. [PMID: 37610460 DOI: 10.1007/s00784-023-05224-7] [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: 05/31/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. MATERIALS AND METHODS A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. RESULTS The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6 months after operation (P > 0.05 for all). CONCLUSIONS Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. CLINICAL RELEVANCE This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.
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Affiliation(s)
- Yeping Lu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiwen Wang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Ying Chai
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Minjie Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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Wang B, Sun R, Li T, Sun Y, Zheng L, Zhao J. Does the "Root Removal First" strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position? - a randomized clinical trial. BMC Oral Health 2023; 23:391. [PMID: 37316782 DOI: 10.1186/s12903-023-03086-9] [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: 03/09/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of the "Root Removal First" strategy in the surgical removal of impacted mandibular third molar (IMTM) in the class C and horizontal position. MATERIALS AND METHODS A total of 274 cases were finally included in the statistics. The positions of IMTM in the horizontal position were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the "Root Removal First" strategy was applied in the new method (NM) group, and the conventional "Crown Removal First" strategy was executed in the traditional method (TM) group. The clinical information and relevant data upon follow-up were recorded. RESULTS The duration of the surgical removal and the incidence rates of lower lip paresthesia in the NM group were significantly lower than those in the TM group. The degree of mobility of the adjacent mandibular second molar (M2) in the NM group was significantly lower than that in the TM group at 30 days and 3 months post-operation. The distal and buccal probing depth of the M2, as well as the exposed root length of M2 in the NM group, were significantly lower than those in the TM group 3 months post-operation. CONCLUSIONS The "Root Removal First" strategy can reduce the incidence rate of inferior alveolar nerve injury and periodontal complications of the M2 in the surgical removal of IMTM in class C and horizontal position with high efficiency. TRIAL REGISTRATION ChiCTR2000040063.
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Affiliation(s)
- Bing Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
| | - Rui Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
- Department of Oral Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
| | - Yuqi Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
| | - Linwei Zheng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
| | - Jihong Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China.
- Department of Oral Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Cubuk S, Oduncuoglu BF, Alaaddinoglu EE. The effect of dental pulp stem cells and L-PRF when placed into the extraction sockets of impacted mandibular third molars on the periodontal status of adjacent second molars: a split-mouth, randomized, controlled clinical trial. Oral Maxillofac Surg 2023; 27:59-68. [PMID: 35141806 DOI: 10.1007/s10006-022-01045-2] [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: 03/25/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the clinical and radiographic effectiveness of dental pulp stem cells (DPSCs) seeded onto L-PRF and L-PRF alone in the extraction socket of mandibular third molars. METHODS This study analyzed 13 patients who required surgical removal of impacted bilateral mandibular third molars. The main outcome measures were the probing pocket depth (PPD) and clinical attachment levels (CAL) that were recorded for the adjacent second molars (LM2) at the baseline and 6 months after surgery. The secondary outcomes were radiographic vertical bone loss (VD) and relative bone density (rBD) distal to the LM2. RESULTS Twenty-six LM2s were evaluated. After 6 months, the L-PRF and L-PRF + DPSC groups showed a significant reduction in PPD (1.65 ± 1.01 mm and 1.54 ± 0.78 mm) and CAL (2.23 ± 1.45 mm and 2.12 ± 0.74 mm), respectively. There was no difference between the groups for any periodontal parameters. No significant differences were found between the groups regarding the VD or rBD at the sixth month. CONCLUSIONS This study found that there was a significant improvement regarding the PPD, CAL, and VD measurements with the application of L-PRF, both alone and with the addition of DPSC, at the extraction socket. DPSC did not significantly contribute to the results compared to L-PRF therapy alone. TRIAL REGISTRATION This study was registered on 23 December 2020 on ClinicalTrials.gov under the number NCT04641533.
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Affiliation(s)
- Seçil Cubuk
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, 82. Sok. No:26, Bahçelievler, 06490, Ankara, Turkey.
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Iwaki J, Imamura K, Tanaka K, Sugito H, Saito A. Treatment of Stage III Grade C Periodontitis with Periodontal Regenerative Therapy including Guided Tissue Regeneration (GTR) and Recombinant Human Fibroblast Growth Factor (rhFGF)-2: A Case Report. THE BULLETIN OF TOKYO DENTAL COLLEGE 2023; 63:189-198. [PMID: 36384760 DOI: 10.2209/tdcpublication.2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes a case of periodontitis treated with periodontal surgery including guided tissue regeneration (GTR) and recombinant human fibroblast growth factor (rhFGF)-2. The patient was a 54-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 30.4% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 57.7%. The plaque control record (PCR) score was 66.1%. Radiographic examination revealed vertical bone defects in the molar region. Based on these findings, the clinical diagnosis was generalized chronic periodontitis (Stage III, Grade C). Initial periodontal therapy yielded an improvement in periodontal conditions, with the PCR score reducing to 13.8%. Periodontal surgery was performed for teeth with a residual PD ≥4 mm. Guided tissue regeneration was performed on #37 and 47. A series of periodontal regenerative treatments comprising application of rhFGF-2 was performed on angular bone defects in #14, 15, 25, and 27. Open flap debridement was performed on #16, 17, 26, 36, and 46. Following evaluation, oral function was restored by placing all-ceramic crowns on #21 and 26. The patient was then placed on supportive periodontal therapy. In the present case of generalized chronic periodontitis, periodontal regenerative therapy with GTR and rhFGF-2 yielded stable periodontal conditions.
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Affiliation(s)
- Juri Iwaki
- Department of Periodontology, Tokyo Dental College
| | | | | | - Hiroki Sugito
- Department of Operative Dentistry, Cariology and Pulp Biology, Tokyo Dental College.,Department of Dental Hygiene, Tokyo Dental Junior College
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Pang SL, Leung KPY, Li KY, Pelekos G, Tonetti M, Leung YY. Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis. Clin Oral Investig 2022; 27:1547-1565. [PMID: 36418503 DOI: 10.1007/s00784-022-04777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery. MATERIALS AND METHODS Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors. RESULTS Fourteen studies were included in the quantitative synthesis. At 6 months, the PPD reduction was 1.06 mm (95% CI, 0.72 to 1.39 mm) and the remaining PPD was 3.81 mm (95% CI, 3.00 to 4.62 mm). Baseline PPD was strongly correlated with the remaining PPD at 6 months (p < 0.001, adjusted R2 = 70.05%). CONCLUSIONS Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6 months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects. CLINICAL RELEVANCE This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.
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Li LY, Chen J, Yu M, Li YL, Zhou G. Effects of Low-Level Laser Therapy on Osseous Defects Distal to Mandibular Second Molar after Extraction of Impacted Third Molar. Appl Bionics Biomech 2022; 2022:9900146. [PMID: 35498143 PMCID: PMC9050336 DOI: 10.1155/2022/9900146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficiency of low-level laser therapy on the distal osseous defects of the mandibular second molar (M2) after the adjacent impacted third molar (M3) extraction. Methods A total of 59 clinic cases were screened out, whose M3 were impacted and the distal alveolar bone of M2 had been destroyed horizontally. They were randomly divided into 2 groups based on whether they would have laser irradiation or not after M3 extraction. Then, postoperative complications of the 2 groups were compared. The alveolar bone level distal to M2 was established before and 3 to 6 months after M3 extraction by radiographic evaluation, which was compared between two groups. Results The incidence of severe pain and mouth-opening limitation was significantly lower in the LLLT group than that in the control group. The amount of bone formation in the LLLT group was higher than that in the control group 3 months after the operation, and the difference was statistically significant. But the difference was not statistically significant 6 months after surgery. Conclusion LLLT may alleviate postoperative complications and improve early osteogenesis. It is a viable option for use in the treatment of osseous defects distal to mandibular second molars following extraction of impacted third molars.
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Affiliation(s)
- Ling-Yu Li
- Dental Comprehensive Department, The Dental Center, Jiading District, Shanghai, China
| | - Jie Chen
- Oral and Maxillofacial Surgery, The Dental Center, Jiading District, Shanghai, China
| | - Ming Yu
- Oral and Maxillofacial Surgery, The Dental Center, Jiading District, Shanghai, China
| | - Yue-Ling Li
- Oral and Maxillofacial Surgery, The Dental Center, Jiading District, Shanghai, China
| | - Gang Zhou
- Oral and Maxillofacial Surgery, The Dental Center, Jiading District, Shanghai, China
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Feasibility and Efficacy of a Degradable Magnesium-Alloy GBR Membrane for Bone Augmentation in a Distal Bone-Defect Model in Beagle Dogs. Bioinorg Chem Appl 2022; 2022:4941635. [PMID: 35371192 PMCID: PMC8967573 DOI: 10.1155/2022/4941635] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023] Open
Abstract
We explored the feasibility and efficacy of a degradable magnesium (Mg) alloy guided bone regeneration (GBR) in the treatment of bone defects after tooth extraction. A GBR membrane (MAR-Gide (MG)) was used to treat a mandibular second molar (M2M)-distal bone defect (DBD). In eight beagle dogs, bilateral mandibular second and fourth premolars were hemi-sected. The distal roots were removed to create a two-wall bony defect of dimension 5 mm × 5 mm × 5 mm to simulate M2M-DBD. Thirty-two bone defects were assigned randomly into four groups according to GBR membranes (MG and Bio-Gide (BG)) applied and the time of killing (3 months and 6 months after surgery). The osteogenesis of bone defects and MG degradation were analyzed using micro-CT, histology (staining, tartrate-resistant acid phosphatase), and inductively coupled plasma mass spectrometry. MG did not increase the prevalence of infection, wound dehiscence, or subcutaneous emphysema compared with those using BG. Trabecular volume/total volume at 3 months (63.71 ± 10.4% vs. 59.97 ± 8.94%) was significantly higher in the group MG than that in the group BG. Implanted MG was degraded completely within 3 months, and "island-shaped" new bone was found near MG degradation products. A significant difference was not found in vertical bone height or percent of new bone formation (45.44 ± 12.28% vs. 43.49 ± 7.12%) between the groups. The concentration of rare-earth elements in mandibular lymph nodes of the group MG was significantly higher than that of the group BG (P ≤ 0.017) but did not lead to histopathological changes. In summary, MG exhibited good biocompatibility and clinical applicability compared with BG in vivo. The osteogenic effect of MG could be enhanced by regulating the degradation rate of Mg-alloy.
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Kumari CBN, Ramakrishnan T, Devadoss P, Vijayalakshmi R, Alzahrani KJ, Almasri MA, Al-Ahmari MM, Al Dira HS, Suhluli M, Bhati AK, Ahmad ZH, Raj AT, Bhandi S, Patil S. Use of Collagen Membrane in the Treatment of Periodontal Defects Distal to Mandibular Second Molars Following Surgical Removal of Impacted Mandibular Third Molars: A Comparative Clinical Study. BIOLOGY 2021; 10:biology10121348. [PMID: 34943263 PMCID: PMC8698821 DOI: 10.3390/biology10121348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 06/01/2023]
Abstract
The study aims to assess the efficacy of using collagen membrane in the treatment of distal periodontal defects of mandibular second molars following the removal of mesioangularly or horizontally impacted mandibular third molars surgically. Forty sites in twenty patients with bilaterally impacted mandibular third molars (mesioangular or horizontal) were considered for the study. In 20 test sites (Group A), after surgical removal of the mandibular third molar, a resorbable collagen membrane barrier was placed on the distal aspect of the mandibular second molar to cover the post-surgical bone defect. In the other control 20 sites (Group B), the same surgical procedure was repeated without placing any membrane barrier. The clinical parameters recorded were Oral Hygiene Index Simplified (OHI-S), Probing pocket depth (PPD), Clinical attachment level (CAL), and radiographic assessment of alveolar bone level (ABL). OHI-S score of most of the patients was observed to be satisfactory. Group A was observed to achieve a statistically significant reduction in PPD, CAL, and ABL gain compared to Group B. The improvements indicated that the use of collagen membrane facilitates early wound stabilization and promotes primary closure of the defect. This recovery is achieved through its unique property to assist fibrinogenesis over osteoconduction. Further longitudinal studies are needed to confirm the present findings.
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Affiliation(s)
- C. Burnice Nalina Kumari
- Department of Periodontology and Implantology, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai 600095, India; (T.R.); (R.V.)
| | - Thiagarajan Ramakrishnan
- Department of Periodontology and Implantology, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai 600095, India; (T.R.); (R.V.)
| | - Pradeep Devadoss
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai 600095, India;
| | - Rajaram Vijayalakshmi
- Department of Periodontology and Implantology, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai 600095, India; (T.R.); (R.V.)
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif 11099, Saudi Arabia;
| | - Mazen A. Almasri
- Department of Oral Maxillofacial Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Manea Musa. Al-Ahmari
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia;
| | - Hajar Saeed Al Dira
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (H.S.A.D.); (M.S.)
| | - Malath Suhluli
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (H.S.A.D.); (M.S.)
| | - Ashok Kumar Bhati
- Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia;
| | - Zeeshan Heera Ahmad
- Dental College Hospital, King Saud University Medical City, Riyadh 11362, Saudi Arabia;
| | - A. Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India;
| | - Shilpa Bhandi
- Department of Restorative Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia;
| | - Shankargouda Patil
- Division of Oral Pathology, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
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Aniko-Włodarczyk M, Jaroń A, Preuss O, Grzywacz A, Trybek G. Evaluation of the Effect of Surgical Extraction of an Impacted Mandibular Third Molar on the Periodontal Status of the Second Molar-Prospective Study. J Clin Med 2021; 10:2655. [PMID: 34208701 PMCID: PMC8234538 DOI: 10.3390/jcm10122655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Dental injury to the second molar (SM) caused by the surgical extraction of the impacted third molar tends to be underestimated. The necessity of assessment of the impact of the removal of the wisdom tooth in the mandible on the second molar arose. The study group (n = 60) was the one with the second molar on the surgical side, and the control group (n = 60) was the one with the tooth on the opposite side of the alveolar arch. Before the surgery, the difficulty level was assessed according to the Pederson scale. The periodontal status of the SM was assessed by probing depth (PD), gingival index (GI), tooth mobility (TM) examination by the percussion method and resonance frequency. Measurements were taken before and after the surgery, 7 days and 8 weeks after the surgery. The study demonstrated the significant impact of the surgical removal of the wisdom tooth on the PD, GI and TM of the SM. The predicted degree of difficulty of the very difficult surgery had an influence on the increase in PD on the distal buccal and lingual surface of the SM, and on the GI in the proximity of the examined tooth. The results of the presented research confirm the necessity of the clinical assessment of the lower SM before and after the surgical removal of the impacted wisdom tooth in the mandible.
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Affiliation(s)
- Magda Aniko-Włodarczyk
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 72 Powstańców Wlkp. St., 70-111 Szczecin, Poland; (M.A.-W.); (A.J.); (O.P.)
| | - Aleksandra Jaroń
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 72 Powstańców Wlkp. St., 70-111 Szczecin, Poland; (M.A.-W.); (A.J.); (O.P.)
| | - Olga Preuss
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 72 Powstańców Wlkp. St., 70-111 Szczecin, Poland; (M.A.-W.); (A.J.); (O.P.)
| | - Anna Grzywacz
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, 11 Chlapowskiego St., 70-204 Szczecin, Poland;
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 72 Powstańców Wlkp. St., 70-111 Szczecin, Poland; (M.A.-W.); (A.J.); (O.P.)
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Canullo L, Rossi-Fedele G, Camodeca F, Menini M, Pesce P. A Pilot Retrospective Study on the Effect of Bone Grafting after Wisdom Teeth Extraction. MATERIALS 2021; 14:ma14112844. [PMID: 34073339 PMCID: PMC8198454 DOI: 10.3390/ma14112844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022]
Abstract
This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups.
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Affiliation(s)
- Luigi Canullo
- Department of Periodontology, University of Bern, 3000 Bern, Switzerland;
| | | | | | - Maria Menini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16100 Genoa, Italy;
| | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16100 Genoa, Italy;
- Correspondence:
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Zhang Y, Chen X, Zhou Z, Hao Y, Li H, Cheng Y, Ren X, Wang X. Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar. Ther Clin Risk Manag 2021; 17:235-247. [PMID: 33790564 PMCID: PMC7997553 DOI: 10.2147/tcrm.s298147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/05/2021] [Indexed: 12/19/2022] Open
Abstract
The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.
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Affiliation(s)
- Yuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xiaohang Chen
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Zilan Zhou
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Yujia Hao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Huifei Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Yongfeng Cheng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xiuyun Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
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Ku JK, Jeong YK. Effectiveness of Bone Graft for an Alveolar Defect on Adjacent Second Molar After Impacted Mandibular Third Molar Extraction. J Oral Maxillofac Surg 2020; 79:756-762. [PMID: 33359105 DOI: 10.1016/j.joms.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This retrospective study examined distal bone healing on the adjacent second molar between the demineralized bone matrix incorporated with recombinant human bone morphogenetic protein-2 (DBM/rhBMP-2) and a collagen sponge in the mandibular third molar extraction socket. MATERIALS AND METHODS From 2018 to 2020, 26 extraction patients (male, average 21.5 years), who received a graft (each of 13 using DBM/rhBMP-2 and collagen plug, respectively) on the extraction socket without primary closure, were enrolled in this study. The bony defect was measured by computed tomography before and 6 months after the extraction. The difference in the bone healing was analyzed between the DBM/rhBMP-2 and collagen plug groups using a Mann-Whitney U test. RESULTS No complications, such as infection and food packing, were encountered. The DBM/rhBMP-2 and collagen plug groups showed a similar distribution of preoperative bony defect (median 5.8 and 5.0 mm, respectively). After 6 months, more bone healing was observed in the DBM/rhBMP-2 group than in the collagen plug group (median 3.85 and 2.37 mm, respectively, P = .029) CONCLUSIONS: A DBM/rhBMP-2 graft after a third molar extraction does significantly alter the bony defect on the distal aspect of the second molar compared with a collagen plug.
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Affiliation(s)
- Jeong-Kui Ku
- Captain, Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Armed Forces Medical Command, Seongnam, Republic of Korea; and Department Head, Department of Oral and Maxillofacial Surgery, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam, Republic of Korea.
| | - Yeong Kon Jeong
- Captain, Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Armed Forces Medical Command, Seongnam, Republic of Korea
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Petsos H, Fleige J, Korte J, Eickholz P, Hoffmann T, Borchard R. Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes. J Oral Maxillofac Surg 2020; 79:520-531. [PMID: 33338418 DOI: 10.1016/j.joms.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal. PATIENTS AND METHODS Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05. RESULTS From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (-0.50 ± 0.61 mm, P = .001), 60 months (-0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (-0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL-6 months: -0.37 ± 0.59 mm, P = .004; BL-60 months: -0.67 ± 0.55 mm, P < .0001; 6 to 60 months: -0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes. CONCLUSIONS Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.
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Affiliation(s)
- Hari Petsos
- Dentist, Private Practice, Soest, Germany; and Research Assistant, Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.
| | | | - Jörg Korte
- Dentist, Maxillofacial Surgeon, Private Practice, Soest, Germany
| | - Peter Eickholz
- Professor, Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Thomas Hoffmann
- Professor, Dresden International University, Dresden, Germany
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Ku JK, Chang NH, Jeong YK, Baik SH, Choi SK. Development and validation of a difficulty index for mandibular third molars with extraction time. J Korean Assoc Oral Maxillofac Surg 2020; 46:328-334. [PMID: 33122457 PMCID: PMC7609930 DOI: 10.5125/jkaoms.2020.46.5.328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives This study aimed to validate the effectiveness of a recently proposed difficulty index for removal of impacted mandibular third molars based on extraction time and suggest a modified difficulty index including the presence of pathologic conditions associated with third molars. Materials and Methods This retrospective study enrolled 65 male patients younger than 25 years with third molars. Extraction time was calculated from start of the incision to the last suture. The difficulty scores for third molars were based on spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points) using cone-beam computed tomography. The difficulty index was defined as follows I (3-4 points), II (5-7 points), III (8-10 points), and IV (11-12 points). The modified difficulty score was calculated by adding one point to the difficulty score if the third molar was associated with a pathologic condition. Two modified difficulty indices, based on the presence of pathologic conditions, were as follows the half-level up difficulty index (HDI) and the one-level up difficulty index (ODI) from the recently proposed difficulty index. Results The correlations between extraction time and difficulty index and or modified difficulty indices were significant (P<0.001). The correlation coefficient between extraction time and difficulty index was 0.584. The correlation coefficients between extraction time and HDI and ODI were 0.728 and 0.764, respectively. Conclusion Extraction time of impacted third molars exhibited a moderate correlation with difficulty index and was strongly correlated with the modified indices. Considering the clinical implications, the difficulty index of surgical extraction should take into consideration the pathologic conditions associated with third molars.
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Affiliation(s)
- Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam, Korea
| | - Na-Hee Chang
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeong-Kon Jeong
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun-Kyu Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
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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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Low SH, Lu SL, Lu HK. Evidence-based clinical decision making for the management of patients with periodontal osseous defect after impacted third molar extraction: A systematic review and meta-analysis. J Dent Sci 2020; 16:71-84. [PMID: 33384781 PMCID: PMC7770311 DOI: 10.1016/j.jds.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
Background/purpose Extraction of impacted mandibular third molar (MTM) is one of the most common procedures in clinical dental treatment; building a decision tree to perform MTM extraction can be prudent in alleviating periodontal diseases. This study is to review the latest research on the management of periodontal osseous defect (POD) after MTM extraction and rebuild a new clinical decision tree. Materials and methods Current study was conducted according to PRISMA statement. Medline, Embase, Scopus, and Google Scholar were searched concerning treatment of MTM extraction up to Oct.2019. Three focused questions revolving around asymptomatic versus disease site, age, and necessity of ridge preservation after >6 months follow up will be answered. Results A total of 7 studies were included for meta-analysis. Evidences were inadequate in regards to asymptomatic vs disease site of MTM extraction in the long-term follow-up. For patients with age <25 years, postoperative probing depth (PD) always remained at < 4 mm. However, for patients with age >25 years with initial PD > 7 mm, residual pockets still remained at 5 mm. For ridge preservation, significant positive effect in reduction of second molar distal site PD was observed, regardless of different biomaterials being placed (z = 4.69, p < 0.00001). Conclusion Age is of utmost importance in preoperative evaluation during impacted MTM extraction. The timing for ridge preservation is essential determinant for achieving optimal treatment outcome. The clinical decision tree as proposed could serve as guidance when dealing with POD after impacted MTM extraction.
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Affiliation(s)
- Soo-Hoong Low
- Department of Periodontology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sao-Lun Lu
- Department of Periodontology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsein-Kun Lu
- Department of Periodontology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
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Sánchez-Labrador L, Martín-Ares M, Ortega-Aranegui R, López-Quiles J, Martínez-González JM. Autogenous Dentin Graft in Bone Defects after Lower Third Molar Extraction: A Split-Mouth Clinical Trial. MATERIALS 2020; 13:ma13143090. [PMID: 32664303 PMCID: PMC7411779 DOI: 10.3390/ma13143090] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 02/08/2023]
Abstract
Various biomaterials are currently used for bone regeneration, with autogenous bone being considered the gold standard material because of its osteogenic, osteoconductive, and osteoinductive properties. In recent years, the use of autogenous dentin as a graft material has been described. This split-mouth clinical trial assesses the efficacy of autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar extraction. Fifteen patients underwent bilateral extraction surgery (30 third molars) using dentin as a graft material on the test side, and leaving the control side to heal spontaneously, comparing the evolution of the defects by evaluating probing depth at three and six months post-operatively. Bone density and alveolar bone crest maintenance were also evaluated six months after surgery, and pain, inflammation, mouth opening capacity on the second and seventh days after surgery. Probing depth, radiographic bone density, and alveolar bone crest maintenance showed significant differences between the test and control sides. Autogenous dentin was found to be an effective biomaterial for bone regeneration after impacted lower third molar extraction.
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22
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Kim JW, Seong TW, Cho S, Kim SJ. Randomized controlled trial on the effectiveness of absorbable collagen sponge after extraction of impacted mandibular third molar: split-mouth design. BMC Oral Health 2020; 20:77. [PMID: 32183831 PMCID: PMC7079387 DOI: 10.1186/s12903-020-1063-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background The purpose of this study was to compare the effectiveness of absorbable collagen sponge insertion in tooth extraction sites for socket healing of the impacted mandibular third molar. Methods Thirty-six patients with bilateral mandibular impacted third molars based on Pell-Gregory and Winter classification were included in this study. This study was a randomized clinical trial utilizing a split-mouth design with one side assigned as collagen sponge insertion and the other side assigned as the control. Post-operative clinical complications, periodontal integrities, and radiographic outcomes were assessed at 1, 2, and 14-weeks post operatively. Results Five patients were excluded during the follow-up period due to loss of follow-up. The study was conducted on 31 patients in total. The mean VAS score of collagen sponge insertion side at 1 week post operation was 1.42 ± 1.26, which was significantly lower than the control side (P < 0.05). The mean probing depth of collagen sponge insertion side at 2-week post operation was 5.55 ± 2.28 mm, which was significantly lower than the control side (7.13 ± 1.86; P < 0.05). Other various measurements including radiographic outcomes showed no significant group differences. Conclusions Placement of collagen sponge after extraction of mandibular impacted third molar reduced early stage post-operative complications and enhanced initial healing of soft tissues and periodontal defects. Trial registration This study was retrospectively registered at the WHO ICTRP platform and Clinical Research Information Service, KCT0003363. Registered 21 Sep 2018.
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Affiliation(s)
- Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Tae-Whan Seong
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sura Cho
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sun-Jong Kim
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.
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Kattimani V, Lingamaneni KP, Yalamanchili S, Mupparapu M. Use of eggshell-derived nano-hydroxyapatite as novel bone graft substitute-A randomized controlled clinical study. J Biomater Appl 2019; 34:597-614. [PMID: 31324126 DOI: 10.1177/0885328219863311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vivekanand Kattimani
- 1 Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, India
| | | | - Samatha Yalamanchili
- 2 Department of Oral Medicine and Radiology, Sibar Institute of Dental Sciences, Guntur, India
| | - Muralidhar Mupparapu
- 3 Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Leechanavanichpan P, Rodanant P, Leelarungsun R, Wongsirichat N. Postoperative Pain Perception and Patient's Satisfaction After Mandibular Third Molar Surgery by Primary Closure With Distal Wedge Surgery. J Clin Med Res 2019; 11:489-494. [PMID: 31236167 PMCID: PMC6575117 DOI: 10.14740/jocmr3841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/04/2019] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to compare periodontal conditions of the distal aspect of mandibular second molar and patient's satisfaction between standard surgical technique and primary closure with or without distal wedge surgery used for the removal of mandibular third molar impaction (MTMI). Methods Twenty-four patients, aged 18 - 25 years, were invited to participate in this prospective, single-blinded, split-mouth randomized controlled study. Each participant owned similar bilateral impacted mandibular third molar. Periodontal parameters (i.e. probing depth (PD), gingival index (GI), plaque index (PI) and the distance from cusp tip to gingival margin (CT-GM)) were measured. The standard mandibular third molar surgery was performed on one side while for the other side the distal wedge surgery with or without osseous contouring was added to the protocol. Information about satisfaction was taken from questionnaire. Results At the site where distal wedge was performed, significant change in CT-GM occurred at all aspects and a significant PD reduction was observed at disto-buccal and mid-distal sites. Distance between cemento-enamel junction (CEJ) and gingival margin reduced significantly at all sites. No significant difference between two groups was found in GI, PI and patient's satisfaction. Conclusions Incorporating distal wedge surgery into MTMI removal protocol does improve periodontal health of adjacent second molar and does not affect patient's satisfaction.
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Affiliation(s)
- Poompat Leechanavanichpan
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Pirasut Rodanant
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Rachatawan Leelarungsun
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.,Walailak University International College of Dentistry, Phaya Thai District, Bangkok 10400, Thailand
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Sculean A, Stavropoulos A, Bosshardt DD. Self-regenerative capacity of intra-oral bone defects. J Clin Periodontol 2019; 46 Suppl 21:70-81. [DOI: 10.1111/jcpe.13075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/31/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | | | - Dieter D. Bosshardt
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
- Robert K. Schenk Laboratory of Oral Histology; School of Dental Medicine; University of Bern; Bern Switzerland
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Pham TAV, Nguyen NH. Periodontal Status of the Adjacent Second Molar after Impacted Mandibular Third Molar Surgical Extraction. Contemp Clin Dent 2019; 10:311-318. [PMID: 32308296 PMCID: PMC7145245 DOI: 10.4103/ccd.ccd_634_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the change in periodontal status of the adjacent second molar of the impacted mandibular third molar after surgical extraction and its association with the third molar condition in the presurgical stages, including position, eruption level, and local complications. MATERIALS AND METHODS The study was based on a 6-month follow-up of 38 patients (19 males and 19 females; Mean age: 21.89 ± 2.74) recruited consecutively after surgical extraction of an impacted lower third molar. The third molar's presurgical position, eruption level, and local complications were examined. Periodontal status, including Plaque Index (PI), Gingival Index (GI), and gingival bleeding on probing (BOP), of the teeth in the adjacent sextant was clinically evaluated. The pocket depth (PD) and the distance between the epithelial attachment and the adjacent second molar's occlusal surface were clinically measured; and the distance between the alveolar bone crest and cementoenamel junction (AC-CEJ) of the adjacent second molar was evaluated by the periapical film. All measures were recorded at the time of surgery and 1, 3, and 6 months after surgery. RESULTS The values of PI, GI, BOP, PD, and EA-OS were significantly reduced after 1, 3, and 6 months compared to baseline data. The AC-CEJ was decreased after 1 month but significantly increased after 3 and 6 months. Presurgical local complications of the impacted third molar mostly were significantly associated with the periodontal status of the adjacent sextant. CONCLUSION There was a significant improvement of periodontal conditions of the second molar and adjacent sextant after impacted third molar surgery.
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Affiliation(s)
- Thuy Anh Vu Pham
- Department of Periodontology, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nam Hoang Nguyen
- Department of Oral and Maxillofacial Surgery, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
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Passarelli PC, Lajolo C, Pasquantonio G, D'Amato G, Docimo R, Verdugo F, D'Addona A. Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars. J Periodontol 2019; 90:847-855. [PMID: 30825324 DOI: 10.1002/jper.18-0415] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/27/2018] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction. METHODS Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters. RESULTS Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0 mm) and disto-lingual (T0-5.4/T1-3.2 mm) sites. The average attachment gains at T1 were 1.9 and 2 mm, respectively (P < 0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD ≥ 4mm at baseline healed at 6 months recall without periodontal pockets. Older age (mean 55 years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7 mm was more likely to be associated with PPD ≥ 4 mm 6 months postextraction (P < 0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4 mm after healing (OR = 41.4; 95% CI = 10.9 to 156.5, P < 0.05). CONCLUSION Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.
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Affiliation(s)
- Pier Carmine Passarelli
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Carlo Lajolo
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Guido Pasquantonio
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe D'Amato
- Department of Head and Neck, Maxillofacial Surgery Unit, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Raffaella Docimo
- Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy
| | - Fernando Verdugo
- Department of Periodontics, VA Hospital, Greater Los Angeles Healthcare System, private practice, Los Angeles, CA, USA
| | - Antonio D'Addona
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Rome, Italy
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Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9061208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Silk mat originates from the cocoon of the silkworm and is prepared by a simple method. The material has been used for guided bone regeneration (GBR) in animal models. In this study, the silk mat used for a clinical application was compared with a commercially available membrane for GBR. A prospective split-mouth, randomized clinical trial was conducted with 25 patients who had bilaterally impacted lower third molars. High-density polytetrafluoroethylene (dPTFE) membrane or silk mat was applied in the extraction socket randomly. Probing depth (PD), clinical attachment level (CAL), and bone gain (BG) were measured at the time of extraction (T0) and then at three months (T1) and six months after extraction (T2). There was no missing case. GBR with silk mat was non-inferior to GBR with dPTFE for PD reduction at T1 and T2 (pnon-inferiority < 0.001). PD and CAL were significantly decreased at T1 and T2 when compared with those at T0 in both membrane groups (p < 0.001). BG at T2 was 3.61 ± 3.33 mm and 3.56 ± 3.30 mm in the silk mat group and dPTFE group, respectively. There was no significant complication from the use of silk mat for the patients. The results for patients undergoing GBR with silk mat for third-molar surgery were non-inferior to GBR with dPTFE for PD reduction.
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Stability of Periodontal Healing Distal to the Mandibular Second Molar After Third Molar Coronectomy: A 3-Year Follow-Up Study. J Oral Maxillofac Surg 2019; 77:254-261. [DOI: 10.1016/j.joms.2018.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022]
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Kim E, Eo MY, Nguyen TTH, Yang HJ, Myoung H, Kim SM. Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis. Maxillofac Plast Reconstr Surg 2019; 41:4. [PMID: 30915316 PMCID: PMC6434842 DOI: 10.1186/s40902-018-0187-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background The mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction. Methods Four series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson’s difficulty index (DI) and RID. Results A large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID. Conclusions Additional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.
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Affiliation(s)
- Eugene Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Truc Thi Hoang Nguyen
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
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Hard Tissue Preservation in Minimally Invasive Mandibular Third Molar Surgery Using In Situ Hardening TCP Bone Filler. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5274754. [PMID: 30534563 PMCID: PMC6252188 DOI: 10.1155/2018/5274754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022]
Abstract
Background Maintenance of hard tissue in the case of impacted third molars (M3M) with close relationship to the mandibular canal is still a surgical challenge which may be overcome using the inward fragmentation technique. Methods A consecutive case series of 12 patients required the extraction of 13 impacted M3M with a close relationship to the inferior alveolar nerve (IAN). Via occlusal miniflaps, M3M were exposed occlusal under endoscopic vision and removed by inward fragmentation. All patients received socket preservation with resorbable in situ hardening TCP particles to reduce the risk of pocket formation at the second molar. Results All 13 sites healed uneventfully. Bone height was assessed using CBCT cross-sectional reformats pre- and 3 months postoperatively. The bone height was reduced by 1.54 mm lingual (SD 0.88), 2.91 mm central (SD 0.93), and 2.08 mm buccal (SD 1.09). Differences were significant at a 0.05% level. No tissue invagination at the extraction sites was observed. Conclusions Major bone defects can be avoided safely using inward fragmentation surgery. The self-hardening bone filler appears to enhance the mineralization of the intrabony defect.
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Camps-Font O, Caro-Bonfill C, Sánchez-Garcés MÀ, Gay-Escoda C. Periodontal Regenerative Therapy for Preventing Bone Defects Distal to Mandibular Second Molars After Surgical Removal of Impacted Third Molars: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Oral Maxillofac Surg 2018; 76:2482-2514. [DOI: 10.1016/j.joms.2018.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/22/2018] [Accepted: 07/22/2018] [Indexed: 12/15/2022]
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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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Gandevivala A, Sangle A, Shah D, Tejnani A, Sayyed A, Khutwad G, Patel AA. Autologous Platelet-rich Plasma after Third Molar Surgery. Ann Maxillofac Surg 2017; 7:245-249. [PMID: 29264293 PMCID: PMC5717902 DOI: 10.4103/ams.ams_108_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim and Objective: The aim of this study is to compare the efficacy of autologous platelet-rich plasma (PRP) in the third molar impactions, with respect to: pain, swelling, healing, and periodontal status distal to the second molar in patients who need surgical removal of bilateral impacted mandibular third molars. Materials and Methods: Twenty-five patients of both sexes aged between 16 and 60 years who required bilateral surgical removal of their impacted third molars and met the inclusion criteria were included in the study. After surgical extraction of the third molar, primary closure was performed in the control group, whereas PRP was placed in the socket followed by primary closure in the case group. The outcome variables were pain, swelling, wound healing, and periodontal probe depth that were follow-up period of 2 months. Quantitative data are presented as mean. Statistical significance was checked by t-test. Results: There was a difference in the pain (0.071) and facial swelling (0.184), reduction between test and control on day 3, but it was not found to be significant. Periodontal pocket depth (0.001) and wound healing (0.001) less in case group compared with the control group was found to be significant. Conclusion: The use of PRP lessens the severity of immediate postoperative sequelae and decreases preoperative pocket depth.
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Affiliation(s)
- Adil Gandevivala
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Amit Sangle
- Department of Oral and Maxillofacial Surgery, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, Maharashtra, India
| | - Dinesh Shah
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Avneesh Tejnani
- MDS in Periodontology, Private Practitioner, Coral Dental Advance Care and Implant Center, Mumbai, Maharashtra, India
| | - Aatif Sayyed
- Department of Oral and Maxillofacial Surgery, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, Maharashtra, India
| | - Gaurav Khutwad
- Department of Oral and Maxillofacial Surgery, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, Maharashtra, India
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Vignudelli E, Monaco G, Gatto MRA, Franco S, Marchetti C, Corinaldesi G. Periodontal Healing Distally to Second Mandibular Molar After Third Molar Coronectomy. J Oral Maxillofac Surg 2017; 75:21-27. [DOI: 10.1016/j.joms.2016.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
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Ranganathan M, Balaji M, Krishnaraj R, Narayanan V, Thangavelu A. Assessment of Regeneration of Bone in the Extracted Third Molar Sockets Augmented Using Xenograft (CollaPlug TN Zimmer) in Comparison with the Normal Healing on the Contralateral Side. J Pharm Bioallied Sci 2017; 9:S180-S186. [PMID: 29284960 PMCID: PMC5731009 DOI: 10.4103/jpbs.jpbs_176_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Alveolar bone resorption is a significant clinical problem. Bone loss in third molar region following extraction or surgical removal not only leads to periodontal problems in second molar region but also it may lead to some serious problems like increased incidence of angle fractures. In order to reduce the risks following third molar surgery, the socket should be augmented with bone grafts. In recent days guided tissue regeneration is the most accepted and successful technique followed many authors and its efficacy has been proved. Materials and Methods: Based upon our clinical experience, the use of bio absorbable collagen wound dressing such as CollaPlugTN has achieved quick healing and more primary wound coverage. Amongst the graft materials collagen is preferable due to its high biocompatibility and hemostatic ability. This study was done to assess the regeneration of bone in the extracted third molar sockets using xenograft (CollaPlugTN-Zimmer) which was compared with the normal healing on the contra lateral side. The assessment was done to analyze post-operative healing complications and to compare the bone density formed between control site and implant site radiologically. Conclusion: On this basis of this study, the use of collaplugTN appears to be beneficial to the patient in postoperative wound healing and also for better bone formation. The use of this material was advantageous because of its simplicity of application cost effectiveness and availability. There is enhanced wound healing and early bone formation.
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Affiliation(s)
- Murugan Ranganathan
- Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College, Chidambaram, Tamil Nadu, India
| | - M Balaji
- Department of Dental Surgery, Dhanalakshmi Srinivasan Medical College, Perambalur, Tamil Nadu, India
| | - R Krishnaraj
- Prosthodontics, Rajah Muthiah Dental College, Chidambaram, Tamil Nadu, India
| | | | - Annamalai Thangavelu
- Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College, Chidambaram, Tamil Nadu, India
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Ge J, Yang C, Zheng J, Hu Y. Autogenous bone grafting for treatment of osseous defect after impacted mandibular third molar extraction: A randomized controlled trial. Clin Implant Dent Relat Res 2016; 19:572-580. [PMID: 27933720 DOI: 10.1111/cid.12466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 09/17/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extraction of impacted mandibular third molar (M3) has been cited as causing osseous defect at the distal aspect of the adjacent second molar (M2). PURPOSE This randomized controlled trial was aimed to evaluate the effect of autogenous bone grafting in situ for regeneration of periodontal osseous defect distal to the M2 compared with non-grafting after impacted M3 removal. MATERIALS AND METHODS A total of 60 sites in 51 adult patients were enrolled and randomly assigned to the control group or the test group. In both groups, the M3 was extracted using a piezosurgical device, and the distal root surface of M2 was scaled and root planned. In addition, the removed alveolar bone was grinded to particles and grafted to the distal osseous defect of M2 in the test group. The primary outcome variable was the osseous defect depth (ODD), the secondary outcome variables were probing pocket depth (PD) and clinical attachment level (CAL) on the disto-buccal aspect of the M2 during a 12-month follow-up period. Postoperative symptom at 7-day postoperatively and adverse events were also recorded and analyzed. RESULTS The patient characteristics were homogeneous between the 2 groups. Six and 12 months after surgery, there were statistically significant bone fill in both groups (P < .01). Moreover, the ODD and CAL in the test group were significantly lower than the control group at every postoperative re-entry (P < .01). The postoperative symptom was more severe in the test group than the control group, but the difference was not significant (P > .05). CONCLUSIONS The result of this study demonstrated that scaling and root planning was beneficial to periodontal healing of M2 after impacted M3 extraction. Addition of autogenous bone grafting for the treatment of osseous defects distal to M2 was safe and more effective than periodontal treatment alone. (Registry Number: ChiCTR-IOC-15006561).
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Affiliation(s)
- Jing Ge
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Jiawei Zheng
- Department of Oral-maxillofacial Head and Neck Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Yingkai Hu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
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Chen YW, Lee CT, Hum L, Chuang SK. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 46:363-372. [PMID: 27600798 DOI: 10.1016/j.ijom.2016.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/04/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
The extraction of an impacted third molar violates the surrounding soft and bony tissues. The surgeon's access to the tooth, for which there are various surgical approaches, has an important impact on the periodontium of the adjacent second molar. The aim of this review was to analyze the relationships between the different flap techniques and postoperative periodontal outcomes for the mandibular second molars (LM2) adjacent to the impacted mandibular third molars (LM3). An electronic search of MEDLINE and other databases was conducted to identify randomized controlled trials fulfilling the eligibility criteria. To assess the impact of flap design on the periodontal condition, the weighted mean difference of the probing depth reduction (WDPDR) and the weighted mean difference of the clinical attachment level gain (WDCAG) at the distal surface of LM2 were used as the primary outcomes. The results showed that, overall, the different flap techniques had no significant impact on the probing depth reduction (WDPDR -0.14mm, 95% confidence interval -0.44 to 0.17), or on the clinical attachment level gain (WDCAG 0.05mm, 95% confidence interval -0.84 to 0.94). However, a subgroup analysis revealed that the Szmyd and paramarginal flap designs may be the most effective in reducing the probing depth in impacted LM3 extraction, and the envelope flap may be the least effective.
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Affiliation(s)
- Y-W Chen
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard University, School of Dental Medicine, Boston, MA, USA; Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital and School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - C-T Lee
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Hum
- Harvard University, School of Dental Medicine, Boston, MA, USA
| | - S-K Chuang
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard University, School of Dental Medicine, Boston, MA, USA.
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Lee CT, Hum L, Chen YW. The effect of regenerative periodontal therapy in preventing periodontal defects after the extraction of third molars. J Am Dent Assoc 2016; 147:709-719.e4. [DOI: 10.1016/j.adaj.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
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Petsos H, Korte J, Eickholz P, Hoffmann T, Borchard R. Surgical removal of third molars and periodontal tissues of adjacent second molars. J Clin Periodontol 2016; 43:453-60. [PMID: 26847845 DOI: 10.1111/jcpe.12527] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the effect of mandibular third-molar (M3) removal on periodontal health of adjacent second molars (M2). Probing pocket depths (PPD) and probing attachment levels (PAL) have been described for primary outcome. As cofactors involved, gender, complications, two suture materials and two types of impaction were chosen as secondary outcomes. MATERIALS AND METHODS Seventy-eight patients (49 female; mean age: 16.0 ± 2.0 years) with 78 asymptomatic impacted mandibular M3 were included in this study. Plaque and gingival indices, PPD and PAL were recorded prior and 6 months after surgery. Impacted teeth were classified as either fully impacted (completely within in the bone) or submucosal (fully covered by oral mucosa). RESULTS Average baseline PPD was reduced from 3.3 mm to 2.6 mm after 6 months (p < 0.05). Average PAL was reduced from 3.0 to 2.5 mm (p < 0.05). Preoperative PPD ≥ 4 mm at the distolingual and distobuccal sites was positively correlated with clinical improvement (PPD: p < 0.05; PAL: p < 0.05). The impaction class was also identified as positive cofactor for PPD (p = 0.039), but not for PAL. CONCLUSIONS Young patients may benefit from an early removal of mandibular M3, especially in the presence of certain cofactors.
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Affiliation(s)
- Hari Petsos
- Department of Periodontology, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.,Private Practice, Soest, Germany
| | | | - Peter Eickholz
- Department of Periodontology, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Thomas Hoffmann
- Department of Periodontology, Centre for Dental, Oral, and Maxillofacial Medicine, TU Dresden, Dresden, Germany
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A New Multi-Ingredient Recipe for the Treatment of Localized Advanced Periodontal Disease following the Surgical Removal of Impacted Wisdom Teeth. Case Rep Dent 2016; 2016:3847615. [PMID: 27217960 PMCID: PMC4863088 DOI: 10.1155/2016/3847615] [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: 02/28/2016] [Accepted: 03/30/2016] [Indexed: 11/29/2022] Open
Abstract
Periodontal disease is a chronic inflammation of the tooth supporting structures. It leads to bone and attachment loss which is irreversible. Extraction of horizontally impacted lower third molar (L3M) teeth may result in localized periodontal pockets at the distal aspect of the adjacent lower second molars (L2M). We present a case of a 21-year-old male who suffered from a swelling and pain around his lower right second molar following surgical removal of a mesioangular impacted lower right third molar. We showed that oral hygiene measures, surgical access, mixture of autogenous and synthetic bone graft, and guided tissue regeneration (GTR) were enough to control the problem.
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Effects of Collagen Resorbable Membrane Placement After the Surgical Extraction of Impacted Lower Third Molars. J Oral Maxillofac Surg 2015; 73:1457-64. [DOI: 10.1016/j.joms.2015.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/20/2022]
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The association between orthodontic treatment and third molar position, inferior alveolar nerve involvement, and prediction of wisdom tooth eruption. Surg Radiol Anat 2014; 37:333-9. [PMID: 25107322 DOI: 10.1007/s00276-014-1357-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The present study aims to compare mandibular third molar position in relation to the mandibular ramus, mandibular third molar angulation, potential impaction and nerve involvement in orthodontic treated versus untreated subjects. METHODS The sample consisted of 300 panoramic radiographs 119 males (mean age 16.9 years); 181 females (mean age 16.8 years), contrasting an orthodontically treated (n = 150) to an untreated group (n = 150). Only patients with a full mandibular dentition were included. Pell and Gregory (Dent Digest 39: 330-338, 1933), Winter (Principles of exodontia as applied to the impacted third molars, 1926) and Félez-Gutierrez modified by Gomes (Study of nerve lesion following mandibular third molar surgery, 2011) classifications were used. Radiological information was used to predict eruption. Data was analyzed using frequency analysis and Chi-square testing. RESULTS 220 lower wisdom teeth (73.3%) were impacted in the treated group, opposed to 236 impacted lower wisdom teeth (78.7%) in the untreated group. A close relation with the mandibular nerve was observed 125 times (41.7%) in the treated group, opposed to an incidence of 112 (37.3%) in the untreated group. The differences were not statistically significant. A partial eruption was predicted for 153 (51%) lower wisdom teeth in the treated group, opposed to 106 (35%) in the untreated group and an impossible eruption in 67 (22%) in the treated group, opposed to 130 (43%). These differences were statistically significant (p < 0.05). CONCLUSIONS The significant outcomes indicate that orthodontically treated patients may develop a higher likeliness to partially erupted third molars, which potentially leads to local clinical morbidities, such as pericoronitis and caries on adjacent teeth. In this context, it may support third molar extractions at an earlier stage in particular cases.
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Montevecchi M, Incerti Parenti S, Checchi V, Palumbo B, Checchi L, Alessandri Bonetti G. Periodontal healing after 'orthodontic extraction' of mandibular third molars: a retrospective cohort study. Int J Oral Maxillofac Surg 2014; 43:1137-41. [PMID: 24774723 DOI: 10.1016/j.ijom.2014.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/16/2022]
Abstract
In this study we investigated periodontal healing of mandibular second molars following 'orthodontic extraction' of adjacent impacted third molars, under the null hypothesis that there would be no difference in probing pocket depths (PPD) and clinical attachment levels (CAL) at the distal aspect of second molars before and after treatment. A retrospective survey was conducted of 64 patients who consecutively underwent 'orthodontic extraction' of mandibular third molars in close anatomical relationship with the mandibular canal from January 1997 to January 2011. Age, smoking habit, and PPD and CAL at the distal aspect of second molars before and after treatment were recorded. A statistically significant difference was found in PPD and CAL before and after treatment for the overall sample and for the sample classified by age (>25 or ≤25 years), smoking habit (smoker or non-smoker), and type of third molar impaction (horizontal, mesioangular, or vertical). Median PPD and CAL reductions amounted to 6mm and 5mm, respectively. The null hypothesis was rejected and orthodontic extraction proved to be indicated for those impacted mandibular third molars at high risk of a postoperative periodontal defect at the distal aspect of the adjacent second molar.
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Affiliation(s)
- M Montevecchi
- Department of Periodontology, University of Bologna, Bologna, Italy
| | | | - V Checchi
- Department of Periodontology, University of Bologna, Bologna, Italy
| | - B Palumbo
- Department of Periodontology, University of Bologna, Bologna, Italy
| | - L Checchi
- Department of Periodontology, University of Bologna, Bologna, Italy
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Inocêncio Faria A, Gallas-Torreira M, López-Ratón M, Crespo-Vázquez E, Rodríguez-Núñez I, López-Castro G. Radiological infrabony defects after impacted mandibular third molar extractions in young adults. J Oral Maxillofac Surg 2013; 71:2020-8. [PMID: 24071377 DOI: 10.1016/j.joms.2013.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 05/29/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To estimate the prevalence of infrabony defects and their healing at the distal aspect of mandibular second molars (M2s) after extraction of impacted mandibular third molars (M3s). MATERIALS AND METHODS This prospective clinical study included 22 young healthy patients (21.03 ± 4.51 yr old). Thirty-seven surgical extractions of high-risk periodontal and mesioangular impacted M3s in close contact with adjacent M2s were performed. Radiographic bone height (RBH), radiographic infrabony defects (RIDs), and bone loss (BL) were recorded at baseline and 3, 6, and 12 months after surgery. RBH and RIDs were measured from the tip of a periodontal gauge to the root apex and to the cementoenamel junction of the M2, respectively; BL was calculated by dividing the length of the M2 root into thirds and categorized as slight, moderate, or severe. RESULTS Only 26 extracted teeth were included in all radiographic assessments. Mean RID size at baseline was 4.54 ± 1.87 mm. At 12 months, an average recovery of 2.80 ± 2.36 mm (P < .001) was recorded, for a mean RID size of 1.78 ± 1.65 mm. Statistically significant differences in RBH and RIDs were found at all assessments (P < .05). Improved bone healing was registered during the postoperative period, with higher values during the first 3 months (1.3 mm; P < .01). Most RIDs of at least 4 mm associated with moderate or slight BL decreased to no larger than 3 mm without BL. For moderate BL, the bone gain pattern was gradual and continuous, whereas for slight BL, the pattern was variable. CONCLUSIONS In young healthy patients, a high-risk periodontal impacted M3 leads to an RID of at least 4 mm associated with slight or moderate BL at the distal aspect of the M2, which decreases to no larger than 3 mm 12 months after surgery. Bone healing is clinically and statistically significant at 12 months, with the most notable changes at the first 3-month follow-up.
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Affiliation(s)
- Ana Inocêncio Faria
- PhD Student, Department of Stomatology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, A Coruña, Spain
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Mandibular second molar periodontal healing after impacted third molar extraction in young adults. J Oral Maxillofac Surg 2012; 70:2732-41. [PMID: 22989512 DOI: 10.1016/j.joms.2012.07.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/29/2012] [Accepted: 07/21/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To estimate the prevalence of preoperative periodontal defects and analyze 12-month spontaneous healing on the distal aspect of the mandibular second molar (M2) after impacted mandibular third molar (M3) extraction. MATERIALS AND METHODS This prospective clinical study was conducted in 25 healthy young patients (21.03 ± 4.38 yr old) with 40 extractions of higher-risk periodontal impacted M3s. Plaque and gingival indexes, recession, bleeding on probing, probing depth (PD), and attachment level were recorded before surgery and at 3, 6, and 12 months after surgery at 5 sites on the distal aspect of the M2. RESULTS The initial mean PD was 5.70 ± 3.80 mm, with the deepest mean PD at the lingual side. At 12 months, a mean PD average of 3.77 ± 2.86 mm was recorded, with a total average recovery of 1.93 ± 2.46 mm (P < .001), that was higher at 3 months (-1.62 mm, P < .001). The PD and attachment level improvements were statistically significant (P < .001) and nearly clinically significant from baseline to 12-month follow-up and from the buccal to the lingual side of the distal aspect of the M2. CONCLUSIONS Impacted M3s adjacent to M2s lead to periodontal defects that are deepest at the lingual side and almost recover at 12 months after extraction. The first 3 months is considered the cutoff for periodontal healing. Young adults with high-risk periodontal M3 impactions may benefit from early extraction, which increases spontaneous periodontal healing.
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Tsai SJ, Chen YL, Chang HH, Shyu YC, Lin CP. Effect of piezoelectric instruments on healing propensity of alveolar sockets following mandibular third molar extraction. J Dent Sci 2012. [DOI: 10.1016/j.jds.2012.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Inocêncio Faria A, Gallas Torreira M, López Ratón M. Repeatability and accuracy of a paralleling technique for radiographic evaluation of distal bone healing after impacted third molar surgery. Dentomaxillofac Radiol 2012; 42:78022535. [PMID: 22752321 PMCID: PMC3729189 DOI: 10.1259/dmfr/78022535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/12/2012] [Accepted: 01/14/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the repeatability and radiographic accuracy of an intraoral paralleling technique to evaluate periodontal bone healing on the distal surface of the second mandibular molar (2 Mm) after impacted third mandibular molar (3 Mm) surgical extraction. METHODS In order to estimate the variation in different radiographs, three replicas were made, each from 2 Mm, totalling 69 radiographic radicular longitude (RRL) recordings. One operator performed the periapical radiographs in a standard manner, utilizing a modified posterior film holder for the radiographic technique of parallelism, applied on the posterior region with the X-ray beam focused on the centre of 2 Mm. These radiographic recordings of the same region were obtained on three different and separate occasions, over a 12 month evaluation period after surgical extraction of the impacted 3 Mm. The RRL variable was measured and recorded three times by the same operator, with side-by-side comparison of three posterior periapical radiographs, irrespective of when the assessments were performed. RESULTS There were no statistically significant differences between the three replica recordings (p = 0.969). The correlations between the three sets of measurements were evaluated and found to be highly associated (intraclass correlation reliability coefficient = 0.90) and statistically significant (p≤0.05). The median and mean error of the radiographic technique evaluated was ±0.257 mm and ±0.347 mm, respectively. CONCLUSIONS The radiographic technique described permits standardization in periapical radiographs with a high repeatability and accuracy in posterior radiographic records (distal surface of 2 Mm) over a postoperative evaluation period of 12 months.
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Affiliation(s)
- A Inocêncio Faria
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Gallas Torreira
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M López Ratón
- Biostatistics Unit, Department of Statistics and Operations Research, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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Kaul RP, Godhi SS, Singh A. Autologous platelet rich plasma after third molar surgery: a comparative study. J Maxillofac Oral Surg 2012; 11:200-5. [PMID: 23730070 PMCID: PMC3386415 DOI: 10.1007/s12663-011-0311-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/05/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE This study is an attempt to evaluate the use of autologous platelet rich plasma (PRP) to promote wound healing and osseous regeneration in human third molar extraction sockets. MATERIALS AND METHOD PRP was prepared after two centrifugation and the gelling agent used was freshly prepared 10% calcium chloride.PRP gel was placed in one of the extracted sockets of bilateral impacted mandibular third molars. IOPA Xrays were used to evaluate the wound dehiscence, probing depth, bone density & alveolar bone level after 1st, 2nd and 7th day and 3rd & 6th month respectively. RESULTS On evaluation, it was found that PRP grafted sockets showed dehiscence in 8% cases. The decrease in alveolar bone level was highly significant in PRP grafted sockets in 3rd and 6th month post operatively. There was significant difference between pre-operative density of adjacent bone and bone formed in extraction sockets at 3rd and 6th month in PRP grafted sockets. There was significant reduction in probing depth from initial period to 3 and 6 months in both the groups, but PRP grafted sockets showed greater decrease in probing depth. CONCLUSION PRP is an inexpensive and widely available modality to minimize postoperative complication and enhance both hard and soft tissue healing potentials. This autologous product eliminates concern about immunogenic reaction and disease transmission. Its beneficial outcomes in dental clinic, including decrease in bleeding and rapid wound healing hold promise for further procedures.PRP is thus a new application in tissue engineering and developing area for clinician and researchers.
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Affiliation(s)
- Ruchi Pathak Kaul
- Department of Oral& Maxillofacial Surgery, ITS-CDSR, Muradnagar, Ghaziabad, India
| | - Suhas S. Godhi
- Department of Oral& Maxillofacial Surgery, ITS-CDSR, Muradnagar, Ghaziabad, India
| | - Anurag Singh
- Department of Oral& Maxillofacial Surgery, ITS-CDSR, Muradnagar, Ghaziabad, India
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Ramírez V, Marró P, López R. Effect of Mechanical Debridement on Distal Periodontal Aspects of Second Molars After the Extraction of Third Molars: A Systematic Review. J Periodontol 2012; 83:595-601. [DOI: 10.1902/jop.2011.110462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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