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Miyamoto I, Tanaka R, Kogi S, Yamaya G, Kawai T, Ohashi Y, Takahashi N, Izumisawa M, Yamada H. Clinical Diagnostic Imaging Study of Osteoradionecrosis of the Jaw: A Retrospective Study. J Clin Med 2021; 10:jcm10204704. [PMID: 34682827 PMCID: PMC8538245 DOI: 10.3390/jcm10204704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Radiation therapy (RT) plays a significant role in the management of head and neck malignancies. This study aimed to review the clinical symptoms and various imaging findings of osteoradionecrosis (ORN) and provide a clinical perspective on the development of ORN. The retrospective cohort was composed of 57 sites in 54 patients who had a history of RT and suspected ORN and 48 sites in 45 patients who were confirmed to have ORN. Image analyses included computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, bone scintigraphy, and single-photon emission CT (SPECT). The irradiated tissue was damaged by RT, and the extent of damage was correlated with clinical symptoms. The bone marrow showed sclerotic changes and the devitalized bone showed bone resorption after invasive stimulation. Chronic trismus and pathological fracture are considered severe conditions, typically occurring in the last stage of ORN. Furthermore, neurological symptoms were an important sign of tumor recurrence, since diagnostic imaging was difficult. The possible treatment options vary depending on the stage of ORN. We speculate that bone sclerosis reactions and bone resorption are sequential reactions that seem to be protective measures of the bone to radiation injury.
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Affiliation(s)
- Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
- Correspondence: ; Tel.: +81-19-651-5111
| | - Ryoichi Tanaka
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Shintaro Kogi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Genki Yamaya
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Tadashi Kawai
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Yu Ohashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Noriaki Takahashi
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Mitsuru Izumisawa
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Hiroyuki Yamada
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
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Libdy MR, Rabello NM, Marques LS, Normando D. The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs. Dental Press J Orthod 2020; 25:68-74. [PMID: 32965389 PMCID: PMC7510487 DOI: 10.1590/2177-6709.25.4.068-074.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/25/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. METHODS 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). RESULTS The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). CONCLUSIONS Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.
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Affiliation(s)
| | | | - Leandro Silva Marques
- Universidade Federal dos Vales do Jequitinhonha e Mucuri,
Departamento de Ortodontia (Diamantina/MG, Brazil)
| | - David Normando
- Universidade Federal do Pará, Departamento de Ortodontia (Belém/PA,
Brazil)
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Miyamoto I, Takahashi T, Tanaka T, Hirayama B, Tanaka K, Yamazaki T, Morimoto Y, Yoshioka I. Dense cancellous bone as evidenced by a high HU value is predictive of late implant failure: a preliminary study. Oral Radiol 2018; 34:199-207. [PMID: 30484029 DOI: 10.1007/s11282-017-0299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/10/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The mechanism of late implant failure is unclear. This study examined the association between sclerosing cancellous bone images and the risk of late implant failures using multi-detector row computed tomography (CT) imaging data. METHODS We performed a case-control study. The study group consisted of consecutive patients with implant failures treated at Kyushu Dental University between 2001 and 2016. CT data for late failure of 36 implants in 16 patients were available. The study cohort consisted of 16 patients with 36 late failed implants and 28 patients with 113 successful implants. RESULTS The mean survival rate was 6.9 months for early implant failure, 76.6 months for late failure with marginal bone resorption, inflammation symptoms, and so-called peri-implantitis, and 95.0 months for late failure caused by implant fracture. The mean HU value for cases in the control group was 507 compared with 1231 for cases with late failure implants. Logistic regression was used for analysis. There were signs of high radiodensity of peri-implant cancellous bone when comparing adjusted radiodensity per 100 HU using CT data (OR 2.35; 95% CI 1.73-3.20; p < 0.001). CONCLUSIONS Within the limits of our study, the presence of high radiodensity and cancellous bone consolidation on imaging may be related to risk factors for late implant failure. Therefore, CT images of the host cancellous bone status for observation of visible sclerosis could be a useful diagnostic indicator for late implant failure.
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Affiliation(s)
- Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Tatsurou Tanaka
- Division of Oral Radiology, Kyushu Dental University, 2-6-1 Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Bunichi Hirayama
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Kenko Tanaka
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Toru Yamazaki
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yasuhiro Morimoto
- Division of Oral Radiology, Kyushu Dental University, 2-6-1 Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, 2-6-1 Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
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Uto Y, Kuroshima S, Nakano T, Ishimoto T, Inaba N, Uchida Y, Sawase T. Effects of mechanical repetitive load on bone quality around implants in rat maxillae. PLoS One 2017; 12:e0189893. [PMID: 29244883 PMCID: PMC5731745 DOI: 10.1371/journal.pone.0189893] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/04/2017] [Indexed: 12/04/2022] Open
Abstract
Greater understanding and acceptance of the new concept "bone quality", which was proposed by the National Institutes of Health and is based on bone cells and collagen fibers, are required. The novel protein Semaphorin3A (Sema3A) is associated with osteoprotection by regulating bone cells. The aims of this study were to investigate the effects of mechanical loads on Sema3A production and bone quality based on bone cells and collagen fibers around implants in rat maxillae. Grade IV-titanium threaded implants were placed at 4 weeks post-extraction in maxillary first molars. Implants received mechanical loads (10 N, 3 Hz for 1800 cycles, 2 days/week) for 5 weeks from 3 weeks post-implant placement to minimize the effects of wound healing processes by implant placement. Bone structures, bone mineral density (BMD), Sema3A production and bone quality based on bone cells and collagen fibers were analyzed using microcomputed tomography, histomorphometry, immunohistomorphometry, polarized light microscopy and birefringence measurement system inside of the first and second thread (designated as thread A and B, respectively), as mechanical stresses are concentrated and differently distributed on the first two threads from the implant neck. Mechanical load significantly increased BMD, but not bone volume around implants. Inside thread B, but not thread A, mechanical load significantly accelerated Sema3A production with increased number of osteoblasts and osteocytes, and enhanced production of both type I and III collagen. Moreover, mechanical load also significantly induced preferential alignment of collagen fibers in the lower flank of thread B. These data demonstrate that mechanical load has different effects on Sema3A production and bone quality based on bone cells and collagen fibers between the inside threads of A and B. Mechanical load-induced Sema3A production may be differentially regulated by the type of bone structure or distinct stress distribution, resulting in control of bone quality around implants in jaw bones.
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Affiliation(s)
- Yusuke Uto
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shinichiro Kuroshima
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Yamadaoka, Suita-city, Osaka, Japan
| | - Takuya Ishimoto
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Yamadaoka, Suita-city, Osaka, Japan
| | - Nao Inaba
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yusuke Uchida
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takashi Sawase
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Sun R, Cai Y, Yuan Y, Zhao JH. The characteristics of adjacent anatomy of mandibular third molar germs: a CBCT study to assess the risk of extraction. Sci Rep 2017; 7:14154. [PMID: 29074859 PMCID: PMC5658424 DOI: 10.1038/s41598-017-14144-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
This study aims to investigate the characteristics of adjacent anatomy of mandibular third molar germs (MTMGs). Three hundred Chinese patients aged 12 to 17 years old who received cone-beam computed tomography (CBCT) were enrolled. The continuity of cortical outline of inferior alveolar canals (IACs) in the region of MTMGs, the integrity of lingual bone cortex and the relationship between hard tissue part of MTMGs and IACs were investigated by observing CBCT data via the NNT viewer software. The age, degree of dental development, gender and location were recorded as variables. The associations between different variables and the observed data were analysed. The possibilities of disrupted cortical outline of IACs or the hard tissue part of MTMGs contacting IACs were significantly lower in 12 or 13 age groups, lower in Nolla stage ≤ 6. Males were significantly less than females in the incidence of disrupted cortical outline of IACs. As to the perforation of lingual bone cortex, no significant differences were observed in gender, ages, location or development stages. According to the CBCT images, anatomical factors contributed the lest to the risk of inferior alveolar nerve and lingual nerve injury in the 12 to 13 age group during removing the MTMG removal.
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Affiliation(s)
- Rui Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedical Engineering of Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Yu Cai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedical Engineering of Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Yi Yuan
- Department of Oral Radiology, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Ji-Hong Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedical Engineering of Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, P.R. China.
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China.
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Akashi M, Hashikawa K, Wanifuchi S, Kusumoto J, Shigeoka M, Furudoi S, Terashi H, Komori T. Heterogeneity of Necrotic Changes between Cortical and Cancellous Bone in Mandibular Osteoradionecrosis: A Histopathological Analysis of Resection Margin after Segmental Mandibulectomy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3125842. [PMID: 28951870 PMCID: PMC5603110 DOI: 10.1155/2017/3125842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aimed to analyze differences in necrotic changes between cortical and cancellous bone in resection margins after segmental mandibulectomy for advanced mandibular osteoradionecrosis. METHODS Anteroposterior bone specimens from eleven patients who underwent segmental mandibulectomy with simultaneous free fibula flap reconstruction for advanced osteoradionecrosis were analyzed histopathologically for the presence of necrotic bone based on the presence of blood vessels within Haversian canals. RESULTS Ten of eleven (91%) cortices near the inferior border of the mandible at the anterior margins were necrotic. All cancellous bones at the anterior margins were viable. Seven of eleven (64%) cortices near the inferior border of the mandible at the posterior margins were necrotic. Three of eleven (27%) cancellous bones at the posterior margins were necrotic. CONCLUSION Necrotic changes are more prevalent in cortices than in cancellous bones in mandibular osteoradionecrosis, probably due to a decrease of periosteal blood supply caused by radiotherapy.
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Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Manabu Shigeoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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IWATA EIJI, AKASHI MASAYA, KISHIMOTO MEGUMI, KUSUMOTO JUNYA, HASEGAWA TAKUMI, FURUDOI SHUNGO, KOMORI TAKAHIDE. Meaning and Limitation of Cortical Bone Width Measurement with DentaScan in Medication-Related Osteonecrosis of the Jaws. THE KOBE JOURNAL OF MEDICAL SCIENCES 2017; 62:E114-E119. [PMID: 28289268 PMCID: PMC5436531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
Mandibular cortical bone measurement with x-ray imaging is known to be a potentially useful tool in the detection of dimensional changes caused by bisphosphonate. The primary purpose of this study was to assess the meaning and limitation of cortical bone measurement with computed tomography (CT) in patients with medication-related osteonecrosis of the jaw (MRONJ). The investigators obtained DentaScan images of the mandible from 15 patients with MRONJ, 15 patients with a history of antiresorptive agent administration without symptoms of MRONJ (non-MRONJ), and 15 control subjects. The cortical bone width measured on DentaScan images was compared between the three groups (ANOVA and Tukey's test). Interobserver reliability between two observers was also assessed. The values of interclass correlation coefficient were 0.48 in the MRONJ group, 0.29 in the Non-MRONJ group, and 0.34 in control group. The cortical bone widths calculated both by observer 1 and observer 2 were thicker in patients with MRONJ than in the non-MRONJ group and controls. There were significant differences in cortical bone width among the MRONJ, non-MRONJ, and control groups in observer 1 (P < 0.001) and observer 2 (P < 0.001), specifically comparing the MRONJ group with the non-MRONJ group and the control group. Cortical bone width measurement is useful for the distinction between medication-related osteonecrosis of the jaw and normal bone, in spite of the low interobserver reliability.
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Affiliation(s)
| | - MASAYA AKASHI
- Corresponding author: Phone: +81-8-382-6213, Fax: +81-8-382-6229, E-mail:
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Ghaeminia H, Hoppenreijs TJM, Xi T, Fennis JP, Maal TJ, Bergé SJ, Meijer GJ. Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial. Clin Oral Investig 2016; 21:71-83. [PMID: 26922634 PMCID: PMC5203820 DOI: 10.1007/s00784-016-1751-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Objectives The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. Material and methods A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher’s exact test. Results A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. Conclusion Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. Clinical relevance Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Th J M Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J P Fennis
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - T J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Oral and Maxillofacial Surgery, ZBC Private Clinic Nijmegen, Groenewoudseweg 315, 6524 TX, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Implantology & Periodontology, Radboud University Medical Center, Phillips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands
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Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol 2014; 6:417-423. [PMID: 25071882 PMCID: PMC4109093 DOI: 10.4329/wjr.v6.i7.417] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/27/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery.
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