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Parrini S, Arzente G, Bartali E, Chisci G. The Role of Cyanoacrylate after Mandibular Third Molar Surgery: A Single Center Study. Bioengineering (Basel) 2024; 11:569. [PMID: 38927805 PMCID: PMC11200889 DOI: 10.3390/bioengineering11060569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The management of the surgical wound of partially impacted mandibular third molar surgery has a great impact on recovery as well as on food impact retention. The present study used clinical parameters and health-related quality of life (HRQL) to compare outcomes of cyanoacrylate application versus traditional suture of third molar impaction surgery. METHODS This was a retrospective observational study of subjects scheduled for outpatient third molar surgery. Each participant signed an informed consent agreement. Inclusion criteria were as follows: presence of at least one partially impacted mandibular third molar, confirmed with a preoperative panoramic radiograph. Exclusion criteria were the following: smoking, diagnosed diabetes mellitus. Between June 2020 and September 2023, a total of 78 patients of mean age 31.14 years old (range 21-40 years, standard deviation 9.14), were included in this study-38 patients were male, 40 patients were female. A group of patients received traditional silk suture (G1 = 41 patients), while the second group (G2 = 37 patients) received hemostasis performed with fibrin sponge and, after complete soaking of the sponge, the application of cyanoacrylate gel on the blood clot and suture with one 2/0 stitch in order for recovery for secondary closure. The following parameters were measured: HRQL, average pain (AP), maximum pain (MP), complication score (CS), facial swelling (FS), and erythema. RESULTS For HRQL parameters, oral disability was found to be significantly higher in G1 while AP was significantly higher in G2 (p < 0.05). AP was higher in G2 (p = 0.0098), as well as MP (p = 0.001). No differences were found with regards to CS (p = 0.0759). FS and erythema were higher in G1 (p < 0.0001 for facial swelling, and p = 0.0001 for erythema). CONCLUSIONS on the basis of this study, the use of cyanoacrylate after mandibular third molar surgery appears to be useful in order to reduce postoperative oral disability, facial swelling, and erythema after tooth extraction, with increased average and medium pain: clinicians may consider its use in selected cases.
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Affiliation(s)
| | | | | | - Glauco Chisci
- Oral Surgery Postgraduate School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
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Falci SGM, Guimarães MTBÁ, Canarim NM, Falci SE, Martins OBL, de Souza GM, Galvão EL. Comparison of suture and sutureless techniques on postoperative complications after third molar surgery: a systematic review. Clin Oral Investig 2024; 28:115. [PMID: 38267703 DOI: 10.1007/s00784-024-05518-4] [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: 08/14/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To compare, among patients undergoing third molar surgeries, whether the use or omission of sutures improves postoperative clinical parameters. METHOD A systematic literature review was conducted to identify randomized clinical trials in humans. The steps of this review were conducted following the PRISMA protocol. The risk of bias assessment was performed using the revised Cochrane tool (RoB 2). The RevMan software was employed for meta-analyses, and the quality of evidence was evaluated using GRADE. RESULT A total of seven articles were included in the systematic review; however, only one article quantitatively measured bleeding, rendering meta-analysis for this outcome unfeasible. The group of patients in whom sutures were not used presented lower pain and edema on the first day (respectively: MD - 1.08; 95% CI - 1.35 to - 0.81; MD - 1.23; 95% CI - 2.34 to - 0.11) and second day (respectively: MD - 0.50; 95% CI - 0.83 to - 0.17; MD - 10.66; 95% CI - 1.16 to - 0.16) postoperatively, compared to the group where sutures were employed. The group of patients who received sutures exhibited increased trismus on the first day postoperatively (MD 1.04; 95% CI 0.67 to 1.41). CONCLUSION The omission of postoperative sutures in third molar surgeries appears to favor pain and edema outcomes within the first 24 h after the procedure, as well as trismus within the same timeframe. CLINICAL RELEVANCE Despite the suture being the standard conduct in tooth extractions. The omission of sutures in third molar extractions may favor inflammatory outcomes of pain, edema, and trismus in the immediate postoperative period.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Marco Túllio Becheleni Ávila Guimarães
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Nathalia Moore Canarim
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Salomão Emanuel Falci
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Olga Beatriz Lopes Martins
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Glaciele Maria de Souza
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil.
| | - Endi Lanza Galvão
- Department of Physical Therapy, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Diamantina, MG, Brazil
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Scribante A, Ghizzoni M, Pellegrini M, Poli PP, Maiorana C, Spadari F. Microbiological and Clinical Assessments of Suture Materials and Cyanoacrylate Application in Impacted Third Molar Surgeries: A Scoping Review. J Funct Biomater 2023; 14:529. [PMID: 37888194 PMCID: PMC10607494 DOI: 10.3390/jfb14100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing complications. This scoping review aimed to assess the clinical and microbiological aspects of various suture materials and cyanoacrylates. Unlike existing studies, we included more articles and comprehensively compared suture materials. Articles published in languages other than English; duplicate studies; studies deemed irrelevant for the specific research questions, including those analyzing different supplementary treatments or not corresponding to the abstract's content; ex vivo or experimental animal studies; studies lacking approval from an ethics committee; and narrative reviews, systematic reviews, or systematic and meta-analysis reviews were excluded. Thus, only 17 studies, published between 2000 and 2023, were included in the search. Suture techniques varied among surgeons, with debates on primary and secondary closure methods. A comparison of different suture materials and their effects on wound healing, infection rates, and other factors was described. Cyanoacrylate has also been used as an alternative to traditional sutures. Microbiological analysis showed varying bacterial adhesion based on the suture material, with silk sutures retaining more microbes than PTFE sutures. Clinical assessments have revealed differing inflammatory responses that affect wound healing and complications. Cyanoacrylate has emerged as a promising alternative to traditional sutures, owing to its rapid polymerization and early healing. However, the choice of suture material in impacted third molar surgery remains controversial, considering microbiological factors and clinical outcomes. More extensive randomized clinical trials are required to better understand the effect of suture materials on surgical outcomes and potential improvements. This study could enhance the safety and effectiveness of this common oral surgical procedure.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Matteo Pellegrini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Pier Paolo Poli
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Carlo Maiorana
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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Javid K, Mourão CF, Mello-Machado RC, Sartoretto SC, Torres M, Stellet Lourenço E, Leite PEC, Granjeiro JM, Alves GG, Calasans-Maia MD. Clinical and Biochemical Evaluation of the Use of Alb-PRF versus L-PRF in Mandibular Third Molar Extractions: A Split-Mouth Randomized Clinical Trial. J Funct Biomater 2023; 14:505. [PMID: 37888172 PMCID: PMC10607814 DOI: 10.3390/jfb14100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
Bone tissue engineering seeks biomaterials that enable cell migration, angiogenesis, matrix deposition, and tissue regeneration. Blood concentrates like platelet-rich fibrin (L-PRF) offer a cost-effective source of cells and growth factors to enhance healing. The present study aimed to evaluate heated serum albumin with liquid PRF (Alb-PRF) and L-PRF clinically and biochemically after placement in dental sockets following mandibular third molar extraction. In a controlled, split-mouth study involving 10 volunteers, 20 extracted molars were treated with either Alb-PRF or L-PRF. Post-extraction, pain, trismus, infection presence, and swelling were measured. The concentrations of different analytes in the surgical sites were also examined. The data were statistically analyzed, with significance defined at p < 0.05 (t-test). No significant difference was noted between the groups for pain and trismus, but Alb-PRF showed a significant reduction in swelling on day seven. The Alb-PRF group showed lower levels of pro-inflammatory cytokines (GM-CSF, IL-1b, IL-6, IFNy, IL-8, IL-15, RANTES, and MIP-1a) after seven days, with only higher expressions of MIP-1b, IL-1b, and MCP-1 found in the L-PRF group. Differences were observed in the release of analytes between L-PRF and Alb-PRF, with Alb-PRF significantly reducing edema after seven days. Alb-PRF reduced edema, while L-PRF increased inflammatory cytokines. When compared to L-PRF, Alb-PRF reduced edema and the release of inflammatory cytokines, suggesting promising effects in socket healing while underscoring the role of growth factors and cytokines in potential applications of blood concentrates.
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Affiliation(s)
- Kayvon Javid
- Graduate Program in Dentistry, Fluminense Federal University, Niterói 24020-140, Brazil
| | - Carlos Fernando Mourão
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | | | | | - Madelaine Torres
- Graduate Program in Dentistry, Fluminense Federal University, Niterói 24020-140, Brazil
| | | | - Paulo Emilio Correa Leite
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niterói 24033-900, Brazil
| | - José Mauro Granjeiro
- Department of Oral Surgery, Fluminense Federal University, Niterói 24020-140, Brazil
| | - Gutemberg Gomes Alves
- Department of Biotechnology, Fluminense Federal University, Niterói 24033-900, Brazil
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Akhter J, Kalita S, Goyal R, Jaiswal P, Ramalingam K, Yadav D. A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study. Cureus 2023; 15:e41973. [PMID: 37593271 PMCID: PMC10427245 DOI: 10.7759/cureus.41973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Background In order to maintain the surgery site's shape, functionality, and aesthetics, closure of the wound is essential for intra-oral and general surgical procedures. Wound closure speeds up healing by reducing the buildup of inflammatory cells. For a wound to heal well, the incision must be precise, the tissue must be handled delicately, the wound must be precisely repositioned, and the closure material must have optimum functional properties and be sterile. Aim This study aims to conduct a clinical comparison of the effectiveness of silk suture versus isoamyl 2-cyanoacrylate (IAC) for intra-oral mucosal incisions. Methodology Fifty patients who needed a minor oral surgical operation under local anesthesia from the Department of Oral and Maxillofacial Surgery were recruited for this prospective clinical trial. Ethical clearance and informed consent were obtained for this study. Two groups were created from the sample of 50 patients in this investigation. An intra-oral mucosal incision was closed in one group using a 3-0 silk suture and in the second using two drops of IAC. An accurate approximation of the incised edges was used to avoid leaving any gaps between them. Parameters such as the time taken for closure, pain, bleeding, swelling, mouth opening, wound dehiscence, wound infection, and local ulceration were evaluated in this study. A visual analog scale (0-10) was used to assess the pain score. Facial swelling was evaluated by the tape method given by Gabka and Matsumura. The measurement was done from tragus to pogonion, tragus to oral commissure, and outer canthus to gonion. The sum of these measurements was calculated. By measuring the distance between the incisal edges of the upper and lower central incisors, the trismus was evaluated using a graduated metal scale. Assessment of bleeding (0-4) was done by asking the patient. Assessment of wound dehiscence and local ulceration was done based on visual inspection and palpation on the first, second, and seventh days postoperatively. All the recorded parameters were tabulated. The statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY). The Chi-square test was used to compare the categorical variables between the study groups. The independent t-test was used to compare the means between the study groups. The statistical significance was kept at a p-value less than 0.05. Results The results showed that there was no statistically significant difference between suture and IAC in terms of incidence of pain and wound dehiscence. But the time taken for wound closure was less with IAC, and the pain score on the seventh day was higher with IAC and statistically significant. Conclusion We observed that IAC was as effective as the gold standard silk suture. The advantages of IAC are its hemostatic and bacteriostatic qualities, and IAC also took less time to complete the procedure.
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Affiliation(s)
- Javed Akhter
- Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, IND
| | - Sangita Kalita
- Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, IND
| | - Rohit Goyal
- Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, IND
| | - Pooja Jaiswal
- Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Divya Yadav
- Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, IND
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Azab M, Ibrahim S, Li A, Khosravirad A, Carrasco-Labra A, Zeng L, Brignardello-Petersen R. Efficacy of secondary vs primary closure techniques for the prevention of postoperative complications after impacted mandibular third molar extractions: A systematic review update and meta-analysis. J Am Dent Assoc 2022; 153:943-956.e48. [PMID: 36030117 DOI: 10.1016/j.adaj.2022.04.007] [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: 12/20/2021] [Revised: 04/15/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this systematic review was to determine whether secondary closure (SC) or primary closure (PC) is better at preventing postoperative complications after impacted mandibular third-molar extraction. TYPES OF STUDIES REVIEWED The authors sought randomized controlled trials comparing the effects of PC and SC on pain, swelling, trismus, infection, and bleeding after impacted mandibular third-molar extraction. Screening, data extraction, and risk of bias assessments were conducted independently and in duplicate. The reviewers pooled results across studies using a random-effects meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS This review identified 785 unique citations and included 40 trials. Compared with PC, SC was found to have trivial benefits for pain at day 7 and trismus within 1 week (moderate certainty). The incidence of infection and bleeding did not differ importantly between techniques (moderate certainty). However, SC is probably associated with less swelling on day 1 (standardized mean difference, -0.98; 95% CI, -1.22 to -0.73; moderate certainty) and day 3 (standardized mean difference, -0.87; 95% CI, -1.16 to -0.59; moderate certainty). There was very low certainty evidence for pain on days 1 and 3 and low certainty evidence for swelling on day 7. CONCLUSIONS AND PRACTICAL IMPLICATIONS Clinicians choosing between closure techniques should be aware that SC probably imparts an important benefit only for swelling at days 1 and 3. There seems to be a trivial difference between the techniques in other outcomes.
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Chukwuma BC, Taiwo AO, Akinmoladun VI, Ibikunle AA, Bala M. Postoperative Sequelae Following Surgical Extraction of Impacted Mandibular Third-Molar Extraction Using the Complete Closure Versus the Sutureless Techniques. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:12-19. [PMID: 36590767 PMCID: PMC9802601 DOI: 10.4103/jwas.jwas_191_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 01/03/2023]
Abstract
Background Wound closure techniques affect the severity of inflammatory complications that ensue following surgical extraction of the impacted mandibular third molar (M3). The choice of the technique remains a topic for discussion because reports regarding their associated sequelae are split. This study therefore compares the pain, swelling and trismus in the complete closure and the sutureless/non-closure techniques. Materials and Methods This was a prospective, randomised clinical study carried out at the Dental and Maxillofacial Surgery department of a tertiary hospital. A total of 74 participants requiring impacted mandibular M3 extractions were randomised into a complete closure group and a sutureless technique group. They were subjected to the procedure under similar technique and conditions and followed up for a week to assess their experiences of pain, swelling and trismus. Variables were recorded and analysed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. The critical level of significance was set at P < 0.05. Results The sutureless group had statistically significantly higher postoperative pain on days 1, 3, 4 and 5 (P < 0.05) and lesser severity of trismus on day 7 (P < 0.05) than the complete closure group. There was no significant difference in swelling. Conclusion Compared with the complete closure group, the sutureless group had similar severity of swelling, less trismus but had higher pain severity in the week following M3 surgery.
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Affiliation(s)
| | | | | | | | - Mujtaba Bala
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Takadoum S, Douilly G, de Boutray M, Kabani S, Maladière E, Demattei C, Lapeyrie P. Sutureless socket technique after removal of third molars: a multicentric, open, randomized controlled trial. BMC Oral Health 2022; 22:256. [PMID: 35754043 PMCID: PMC9233809 DOI: 10.1186/s12903-022-02287-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although wisdom-tooth extraction is a routine intervention, the postoperative period remains marked by local inflammation classically manifesting as pain, edema and trismus. Furthermore, there is no consensus on the best operative techniques, particularly for the mucosal closure stage on impacted mandibular wisdom teeth. METHODS This parallel, randomized, non-blinded study compared pain following removal of impacted third molars, with and without sutures. Patients were electronically allocated 1:1 to extraction with versus without sutures. Patients ≥ 14 years' old scheduled for extraction of four impacted wisdom teeth under general anesthesia at three French hospitals were eligible for inclusion. Exclusion criteria included taking antiplatelet agents or anticoagulants, coagulation disorders or immunosuppression, and planned orofacial surgical procedures or emergency pain/infection. The primary objective was pain evaluated by Visual Analogue Scale on Day 3. Secondary outcomes were edema, trismus, healing, complications, painkiller consumption and quality of life on Day 3 and 31. RESULTS Between June 2016 and November 2018, 100 patients were randomized. Finally, 44 patients in the Suture group and 50 patients in the Without Suture group were analyzed. Mean age was 16.5 years and 66.6% of patients were female. After adjustment on center, age and smoking, no statistical difference was seen between groups for pain on Day 3 (p = 0.904). No differences were seen for swelling, trismus, consumption of painkillers, healing, complications or quality of life. Smokers had a 3.65 times higher complications rate (p = 0.0244). CONCLUSIONS Sutureless removal of third molars is thus a reliable technique without negative consequence on outcomes, and allows shorter operating time. Smoking is a risk factor for postoperative complications. Trial registration www. CLINICALTRIALS gov (NCT02583997), registered 22/10/2015.
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Affiliation(s)
- Sarah Takadoum
- Service de Chirurgie Orale, Department of Oral Surgery, CHU Nîmes, CHRU de Nîmes - Hôpital Universitaire Carémeau, University of Montpellier, Place du Professeur Debré, 30029, Nîmes Cedex 9, France.
| | - Grégory Douilly
- Pôle de Chirurgie Orale, 320 rue René Cassin, 84000, Avignon, France
| | - Marie de Boutray
- Department of Maxillofacial Surgery, Montpellier Regional University Hospital - Gui de Chauliac Hospital, Montpellier, France
| | - Sarah Kabani
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Maladière
- Department of Maxillofacial Surgery, Perpignan Hospital Perpignan, Perpignan, France
| | - Christophe Demattei
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nîmes, France
| | - Philippe Lapeyrie
- Service de Chirurgie Orale, Department of Oral Surgery, CHU Nîmes, CHRU de Nîmes - Hôpital Universitaire Carémeau, University of Montpellier, Place du Professeur Debré, 30029, Nîmes Cedex 9, France
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