Patients' satisfaction and prevalence of complications on surgical extraction of third molar

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis

OBJECTIVE

Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery.

MATERIALS AND METHODS

Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023.

RESULTS

Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively.

CONCLUSIONS

The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports.

CLINICAL RELEVANCE

The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

A novel simplified approach for endodontic retrograde surgery in short single-rooted teeth

BACKGROUND

High technical thresholds, long operative times, and the need for expensive and specialized equipment impede the widespread adoption of endodontic microsurgery in many developing countries. This study aimed to compare the effects of a simplified, cost-effective, and time-efficient surgical approach involving orthograde obturation using biological ceramic material greater than 6 mm combined with apicoectomy for single-rooted teeth with short lengths with those of the conventional and current standard methods.

MATERIALS AND METHODS

Forty-five premolars equally categorized into three groups: conventional surgery group, standard surgery group, and modified surgery group. A µCT scan was used to calculate the volume of voids. A micro-leakage test and scanning electron microscope (SEM) were performed to assess the sealing effect. Additionally, four cases of chronic periapical periodontitis in the anterior region were selected, and the patients received either the modified approach or the standard surgery for endodontic microsurgery.

RESULTS

The volumes of voids in the apical 0-3 mm of the modified group and the standard group were comparable. The micro-leakage test and SEM examination demonstrated closely bonded fillings in the dentinal walls in both the modified surgery group and standard surgery group. The outcomes of the preliminary application of this modified procedure on patients were successful at the time of the follow-up cutoff.

CONCLUSIONS

The modified surgery group exhibited similar root canal filling and apical sealing abilities with the standard procedure for single-rooted teeth with short lengths (< 20 mm). The preliminary application of this modified surgical procedure achieved favorable results.

Prophylactic therapy for prevention of surgical site infection after extraction of third molar: An overview of reviews

BACKGROUND

To compare the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars with different degree of impaction.

MATERIAL AND METHODS

Systematic reviews and meta-analyses evaluating the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars were included. An electronic search was performed in PubMed, EMBASE, and the Cochrane Database of Systematic reviews. AMSTAR 2 tool was used to evaluate the confidence in results from the included reviews. Descriptive analyses were performed.

RESULTS

Six reviews were included. A significant benefit of different antibiotics to the prevention of site infection after extraction of third molars was reported. Amoxicillin/amoxicillin clavulanic acid could significantly reduce the rate of surgical site infection versus placebo. Chlorhexidine gel could significantly reduce the frequency of alveolar osteitis versus placebo.

CONCLUSIONS

Based on the limited evidence, there is a significant benefit of prophylactic therapy while the comparative effect of different types of prophylactic regimes are controversial.

What do we know about uncommon complications associated with third molar extractions? A scoping review of case reports and case series

The current study aimed to explore the types and frequencies of uncommon complications associated with third molar extractions based on a scoping review of case reports and case series. The study used an electronic literature search based on PubMed and Embase up to March 31, 2020, with an update performed on October 22, 2021. Any case reports and case series that reported complications associated with third molar extractions were included. The types of complications were grouped and the main symptoms of each type of complication were summarized. A total of 51 types of uncommon complications were identified in 248 patients from 186 studies. Most types of complications were post-operative. In the craniofacial and cervical regions, the most frequent complications included iatrogenic displacement of the molars or root fragments in the craniofacial area, late mandibular fracture, and subcutaneous emphysema. In other regions, the most frequent complications include pneumomediastinum, pneumorrhachis, pneumothorax, and pneumopericardium. Of the patients, 37 patients had life-threatening uncommon complications and 20 patients had long-term/irreversible uncommon complications associated with third molar extractions. In conclusion, a variety of uncommon complications associated with third molar extractions were identified. Most complications occurred in the craniofacial and cervical regions and were mild and transient.

Single blind, randomized study comparing clinical equivalence of Trusilk® and Mersilk® silk sutures for mucosal closure following surgical removal of mesioangular impacted mandibular third molar

Background: Mesioangular impacted mandibular third molar is a common dental anomaly, for which surgical extraction is required. Post-surgery closure of mucosa reduces the prevalence of pain and other surgery-associated complications. We compared tissue reaction/inflammation after 3 and 7 days of mucosal closure with Trusilk® and Mersilk® silk sutures, following impacted mandibular third molar removal. Methods: This multicenter, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (July 2020-November 2021) included subjects (Trusilk®, n=65 and Mersilk®, n=64), requiring mucosal suturing following impacted mandibular third molar removal. The primary endpoint, incidence of pain, swelling and trismus at the extraction area on post-surgery day 3 and 7 was evaluated. The secondary endpoints, incidence of tissue reaction, wound infection, suture loosening, other complications, operative time, amount of anesthesia, intraoperative suture handling, time needed for complete wound healing and suture removal, and adverse events were also recorded. Results: Socio-demographic and intra-oral characteristics were comparable between the groups. In Trusilk® and Mersilk® groups, a gradually decreasing pain score, starting from day 0 post-surgery (42.17±22.38 vs. 45.97±22.20) to day 7 (8.40±11.93 vs. 8.28±12.13) to day 30 (1.98±0.89 vs. 1.75±0.76) was witnessed. After the surgery, 21.54% and 17.19% subjects in Trusilk® and Mersilk® groups, respectively, had no post-operative swelling, while at the last two visits none of the subjects had swelling. Non-significant difference in wound infection, suture loosening, wound healing, bleeding, taste changes, operative time, amount of anesthesia, intraoperative suture handling, and time needed for complete wound healing and suture removal was noted among the groups. No suture-related adverse events were recorded. Conclusions: The results indicated that the Trusilk® and Mersilk® silk sutures are clinically equivalent and can be used for mucosal closure after removal of an impacted mandibular third molar with a minimal rate of pain, swelling and trismus. Clinical Trial Registry of India Registration: CTRI/2020/03/024100 (20/03/2020)

Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis

OBJECTIVES

This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.

METHODS

Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.

RESULTS

Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), P=0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), P=0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), P<0.000 1]. PRF significantly reduced trismus and alveolar osteitis (P<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (P>0.05).

CONCLUSIONS

Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.

Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study

Introduction:

The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems.

Aims and Objectives:

This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications.

Material and Methods:

The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months.

Results:

This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal.

Conclusion:

Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.

Revisit incidence of complications after impacted mandibular third molar extraction: A nationwide population-based cohort study

Most of complications after impacted mandibular third molar (iLM3) extraction surgeries are transient and resolved spontaneously within one or two weeks, but some of them are more complicated and required further treatments to alleviate the symptoms. The aim of study is to revisit incidence and predictors of complications after iLM3 surgery by reviewing previous literature and investigating a population-based data. From Taiwan National Health Insurance Research Database, records of 16,609 patients who had received iLM3 extraction under ambulatory settings were retrieved for analysis. Outcomes of interest included dry socket (DS), prolonged temporomandibular joint symptoms (TMD), and surgical site infection (SSI), which necessitated additional appointments to manage. Odds ratios of having those complications between different variables were analyzed. The incidence rates of DS, TMD, and SSI were 3.6%, 0.41%, 0.17%, respectively; while they ranged from 0.33–19.14% (DS), 0–4.17% (TMD), and 0.2–5.17% (SSI) in previous studies. Logistic regression revealed DS significantly correlated with complexity of odontectomy (2.5-fold of risk) and history of gingivitis or pericoronitis (1.3-fold of risk). More TMD was found in female than male patients (0.5% versus 0.3%). However, no factors associated with SSI was found; neither did we find aging as a risk in association with any of above complications. Compared to previous studies, our data supports that surgical intervention should be considered in iLM3 with risk of gingivitis or pericoronitis to reduce the occurrence of DS. The original information in this article, which provides a “real-world” evidence, along with the organizing data we summarized from previous article, can serve as a reference for clinicians in assessing the complication risks before treatment of iLM3.

Pre-Operative Oral Health-Related Quality of Life in Patients Attending Surgical Removal of Mandibular Third Molar Teeth

The study aimed to measure the pre-operative oral health-related quality of life (OHRQoL) and to identify patient and teeth pathologies associated with worse OHRQoL among patients attending mandibular third molar tooth extraction. Data were collected preoperatively from 199 patients attending surgical removal of their mandibular third molar. To that end, we measured the Oral Health Impact Profile-14 (OHIP-14) and analyzed its association with: (1) demographics; (2) health-related behaviors such as smoking, alcohol consumption, physical activity, and dietary habits; (3) Plaque Index (PI); (4) Decay, Missing, and Filled Teeth (DMFT); and (5) clinical characteristics related to third molar extraction, such as the indication for extraction, tooth angulations, and radiographic pathology. The mean age of the study population was 21.5 ± 3.2 years and the mean OHIP-14 global score was 22.5 ± 8.3. The present study identified patient and teeth profiles that are associated with worse pre-operative OHRQoL in patients attending mandibular third molar extraction. The “vulnerable patient” profile includes poor health-related behaviors, particularly the performance of physical activity less than once a week (p = 0.028). The “disturbing teeth” profile includes higher plaque scores (p = 0.023) and specific characteristics of the third molar teeth, such as pericoronitis (p = 0.027) and radiolucency around third molars in panoramic radiography (p < 0.001). These findings support the hypothesis that OHRQoL is a complex phenomenon which is associated with the patient’s health-related behaviors as well as with specific tooth pathologies.

Efficacy of a topical gel containing chitosan, chlorhexidine, allantoin and dexpanthenol for pain and inflammation control after third molar surgery: A randomized and placebo-controlled clinical trial

BACKGROUND

The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery.

MATERIAL AND METHODS

A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n=72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product.

RESULTS

Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p=0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered 'good' in 22.2% for the CG and 97.2% for the EG (p<0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56±1,19) compared to the placebo group (3.25±1.6) (p=0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26±0.51) in comparison to the CG (0.56±0.67) (p=0.003).

CONCLUSIONS

The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal.

Postoperative effects of intra-alveolar application of 0.2% chlorhexidine or 1% hyaluronic acid bioadhesive gels after mandibular third molar extraction: a double-blind randomized controlled clinical trial

OBJECTIVE

The aim of this study was to analyze the postoperative effects of intra-alveolar applications of 0.2% chlorhexidine (CHL) or 1% hyaluronic (HA) acid bioadhesive gels following the extraction of mandibular impacted third molars (MITMs).

MATERIALS AND METHODS

In this double-blind randomized controlled clinical trial, 90 patients with one asymptomatic MITM were randomized into three group (n = 30 per group): group 1 (0.2% CHL), group 2 (1% HA), and group 3 (control). Visual analogue scales (VAS) were used to assess postoperative pain 24, 48, and 72 h and 7 days after surgery. Postsurgical complications were recorded: trismus, alveolitis osteitis, infection, or hematoma.

RESULTS

In order from least to greatest, postoperative pain at all evaluation times was 0.2% CHL < 1% HA < control. At 24 h, statistically significant differences were found between both study groups and the control groups (0.2% CHL/control: P = 0.001; 1% HA/control: P = 0.010). At 48 and 72 h, significant differences were only found between 0.2% CHL and the control group (P = 0.229 and P = 0.046, respectively). At 7 days, no significant differences were found between any groups. Comparing the incidence of postoperative trismus, alveolitis osteitis, infection, or hematoma, although complications were more frequent in the control group, no statistical differences between groups were found (P > 0.050).

CONCLUSIONS

Both 0.2% CHL and 1% HA bioadhesive gels applied intra-alveolarly minimize the postoperative complications after MITM extraction. Further research is necessary to confirm the present results.

CLINICAL RELEVANCE

This study might help to reduce the postsurgical complications in patients after MITM extraction.

Comparative Evaluation of Preemptive Analgesia of Dextromethorphan and Ibuprofen in Third Molar Surgeries

Introduction:

Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective.

Objective:

The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries.

Material and Methods:

Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively.

Results:

The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1^st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients.

Conclusion:

DM premedication is a viable preemptive analgesic in reducing postoperative pain.

Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink

Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.

An Insight into Acute Pericoronitis and the Need for an Evidence-Based Standard of Care

Background: Pericoronitis is inflammation of the operculum associated with a partially erupted third molar. It is a highly prevalent infection of the oral cavity and presents as a painful sensation of the soft tissue encompassing the crown of the involved tooth. Though pericoronitis is common, there is no evidence-based standard-of-care for treatment of emergency patients with acute pericoronitis. Study Design: In this study, anonymous clinicians were asked to participate in an online survey with questions formulated to identify professional clinical background, emergency treatment preferred for acute pericoronitis, number of associated complications, frequency of third molar extraction, and patient satisfaction. Results and Conclusion: A statistical analysis of the collected data regarding the variance among different treatment plans and associated complications revealed little consensus in the treatment of pericoronitis. The lack of consistency of the responses focusing on the preferred treatment for emergency patients with acute pericoronitis reinforces the need for developing a standard-of-care to train future dental professionals based on well-designed randomized controlled clinical trials and meta-analyses. Practical Implications: The ultimate goal is developing a treatment option with the fewest complications to provide the best health care for patients with pericoronitis. This issue is seen not only as an acute infection but also has the potential to impact overall health.

Impact of platelet-rich fibrin on mandibular third molar surgery recovery: a systematic review and meta-analysis

Background

The present study investigated and evaluated the efficacy and safety of platelet-rich fibrin (PRF) in patients during bilateral mandibular third molars extraction by systematic review and meta-analysis.

Methods

The PubMed, Embase, and Cochrane library databases were retrieved, and the effect of PRF on the healing process of the alveolar socket after surgical extraction of the mandibular third molars was evaluated by meta-analysis. The postoperative pain, swelling, trismus, osteoblastic activity, and soft tissue healing were assessed, and the incidence of alveolar osteitis, weighted mean difference (WMD)/standard mean difference (SMD), the risk ratio (RR), and the 95% confidence interval (CI) were calculated.

Results

The current results showed that the local application of PRF during lower third molar extraction prevented postoperative complications. Subsequently, the pain (SMD = − 0.53, 95% CI: − 1.02–-0.05, P_{heterogeneity} = 0.001, I² = 75.7%) and swelling (WMD = − 0.55, 95% CI: − 1.08–-0.01, P_{heterogeneity} = 0.573, I² = 0) were relieved and the incidence of alveolar osteitis was reduced (RR = 0.35, 95% CI: 0.16–0.75, P_{heterogeneity} = 0.597, I² = 0%). However, no significant difference was observed in trismus, osteoblastic activity, and soft tissue healing between the PRF and non-PRF groups.

Conclusion

The current study confirms that PRF only reduces some of the postoperative complications but does not prevent all the postoperative complications. PRF significantly relieved the pain and swelling and reduced the incidence of alveolar osteitis after the extraction of an impacted lower third molar.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0824-3) contains supplementary material, which is available to authorized users.

Satisfaction analysis of patients with single implant treatments based on a questionnaire survey

Background: The factors influencing satisfaction of the patients with implant treatments are still unclear. This study aims to evaluate the patients' satisfaction and to identify influencing factors, which will improve the medical quality of oral implantology. Materials and methods: Patients who lost single teeth and received implant treatments were enrolled in Nanjing Stomatological Hospital between February 2016 and March 2018. A questionnaire survey was performed to assess patient satisfaction and data were collected at four time points. Information included gender, age, educational level, application of bone augmentation, type of prosthetic restoration, period of teeth loss, dentist qualification, and tooth position. Meanwhile, the satisfaction of the patients was evaluated by visual analog scale. Results: A total of 373 patients completed the questionnaires. The mean of overall satisfaction score was 69.05±7.10. Lower overall satisfaction score was found in patients who received bone augmentation (P<0.001) and those with a longer period of teeth loss (P<0.05). In the bone augmentation group, the elements of pain and complication were significantly associated with a decrease in the median satisfaction score (P<0.001), and a similar result was obtained form the duration of operative time and healing response (P<0.001). On the other hand, the satisfaction scores for elements including the duration of operative time and healing response (P<0.05), aesthetics and psychology (P<0.05), and chewing function (P<0.05) decreased with an extended period of teeth loss. Meanwhile, over half of respondents were more concerned about the survival time (40.70%) and success rate (20.49%) of implants. Conclusion: Bone augmentation and the period of teeth loss are negative factors affecting patient satisfaction, and the success rate and survival time of implants are considerable aspects for patients. It is essential to raise general awareness of oral hygiene and optimize the dental implant therapeutic process.

Postoperative effects on lower third molars of using mouthwashes with super-oxidized solution versus 0.2% chlorhexidine gel: A randomized double-blind trial

BACKGROUND

The main objective of the present study is to evaluate the effects and possible benefits with regard to the postoperative period of lower third molar extractions, comparing the intraalveolar application of a bioadhesive gel of 0.2% chlorhexidine (CHX) to the use of a mouthwash with a super-oxidized solution, (SOS) Dermacyn® Wound Care (Oculus Innovative Sciences lnc., California, USA).

MATERIAL AND METHODS

A randomized double-blind study was carried out in 20 patients with a split-mouth design, with a total of 40 extractions of symmetrically impacted bilateral lower third molars. Patients were divided into two groups, a control group (C = 20) and an experimental group (D = 20). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated using the distance between different facial points, at three, eight, and fifteen days after extraction. Pain, swelling, and amount of analgesics taken were evaluated using the VAS scale throughout the 15 days following extraction. Tolerance to treatment was evaluated using a verbal scale. Results were statistically compared using the Student's t- and chi-squared tests.

RESULTS

No statistically significant differences were found between the two groups with regard to infectious complications, swelling, or wound healing. Use of analgesics and self-reported pain levels were slightly lower in the experimental group than in the control group during days 6 and 7 of the study (p < 0.05). The global treatment tolerance was satisfactory and similar in both groups.

CONCLUSIONS

Both CHX and SOS are effective at improving the postoperative period after extraction of lower third molars.

Third Molar and Their Relationship with Caries on the Distal Surface of Second Molar: A Meta-analysis

PURPOSE

The aim of this meta-analysis was to determine which characteristics of mandibular third molars (MTMs) are more often associated with an increase in the prevalence/incidence of caries on the distal surface of mandibular second molars (MSMs).

METHODS

Three electronic databases were analyzed: PubMed; OVID and the Virtual Health Library. Observational studies were included, and the risk of bias was assessed using The Newcastle-Ottawa Scale. The Comprehensive Meta-Analysis software program was used for meta-analysis.

RESULTS

Fifteen studies were included in this systematic review, and five were included in the meta-analysis. The distal surface of MSMs were more likely to exhibit caries in the following scenarios: when MTMs were found in the A position, rather than the C position (OR: 3.45, 95% CI: 2.28-5.22, p<0.001); when the horizontal position was compared with the vertical (OR: 8.12, 95% CI: 3.75-17.58, p<0.001) and distoangular (OR: 9.75, 95% CI: 3.49 - 27.25, p<0.001) positions; and when the mesioangular position was compared with the vertical (OR: 7.25, 95% CI: 3.48-15.10, p<0.001) and distoangular (OR: 9.54, 95% CI: 3.47 - 26.21, p<0.001) positions.

CONCLUSION

The results of this study suggest that the presence of MTMs increases the incidence of caries on the distal surface of MSMs. Furthermore, caries on the distal surface of MSMs is more commonly associated with position A and horizontal and mesioangular mandibular molars.

Radiographic study of mandibular third molars: evaluation of the position and root anatomy in Brazilian population

OBJECTIVES

The root anatomy and position of mandibular third molars are important factors in assessing the level of difficulty of surgical removal procedures. In this light, this study aims to identify the most frequent position and the root anatomy of mandibular third molars.

METHODS

The study sample comprised 1205 mandibular third molars from 710 panoramic radiographs evaluated. Regarding the position, all of them were based on Pell and Gregory's and Winter's classifications. The root anatomy was classified according to the type and number of roots, as well as the presence of laceration, fusion, or divergence. Gender and the quadrant were also considered. Following an interexaminer analysis, a statistical analysis was performed using the Kappa test.

RESULTS

The results showed that the IA (40.3%) and mesioangular (53.8%) position was predominant in mandibular third molars. Regarding the anatomy, the most common were two roots (98.3%), of the conical simple type (88.9%), with absence of laceration (89.2%), divergence (84%), and fusion (80%).

CONCLUSION

The present study showed that the most prevalent mandibular third molar type in Brazilian patients was the IA and mesioangular position, with simple root anatomy. The result of this study can assist oral surgeons to better plan and assess the level of difficulty of surgical removal procedures.

Clinical studies on core-carrier obturation: a systematic review and meta-analysis

BACKGROUND

This systematic review aimed to evaluate the clinical performance of core-carrier obturation in endodontic treatment.

METHODS

Keywords of "(core carrier OR Thermafil) OR (cold lateral condensation OR lateral condensation) OR (warm vertical condensation OR vertical condensation) AND (obturation OR root canal filling) AND clinical study" were searched for all obtainable publications up to year 2017 in the databases of PubMed, ScienceDirect, EMBASE, Scopus and Web of Science. The success rate, short-term postoperative pain, overfilling and adaptation of core-carrier obturation from clinical studies were selected. Reviews, laboratory studies, animal studies and irrelevant reports were excluded.

RESULTS

1349 relevant articles were identified with 149 duplicated articles removed and 1173 irrelevant articles were excluded after screening. The titles and abstracts of the 19 identified articles were screened in the systematic review. The full texts of remaining articles were retrieved with data extracted for meta-analysis on the success rate, postoperative pain, overfilling and adaptation of obturation. The pooled success rate of core-carrier obturation was 83% (95% CI: 69%-91%). The pooled incidence of 1-day and 7-day short-term postoperative pain were 35% (95% CI: 15%-62%) and 6% (95% CI: 1-35%). The pooled proportion of teeth with overfilling and adequate adaptation of the obturation material were 31% (95% CI: 18%-50%) and 85% (95% CI: 75%-91%), respectively.

CONCLUSIONS

The success rate of endodontic treatment using core-carrier obturation was 83%. Short-term postoperative pain was not uncommon (24%). Most teeth (85%) had adequate adaptation using core-carrier obturation material, but a considerable amount of teeth (31%) had overfilling.

Is The Late Mandibular Fracture From Third Molar Extraction a Risk Towards Malpractice? Case Report with the Analysis of Ethical and Legal Aspects

Objectives

The present study reports a case of late mandibular fracture due to third molar extraction and highlights the inherent clinical, ethical and legal aspects related to this surgical complication.

Material and Methods

A female patient underwent surgical procedure for the extraction of the mandibular right third molar. Two days after the surgery the patient reported pain and altered occlusion in the right side of the mandible. After clinical and radiographic re-examination, the diagnosis of late mandibular fracture was established. A second surgery, under general anaesthesia, was performed for the fixation of the mandibular bone.

Results

The fractured parts were reduced and fixed with locking plate systems and 2 mm screws following load-sharing principles. The masticatory function showed optimal performance within 7 and 21 days after the surgery. Complete bone healing was observed within 1 year of follow-up.

Conclusions

For satisfactory surgical outcomes, adequate surgical planning and techniques must be performed. Signed informed consents explaining the risks and benefits of the treatment must be used to avoid ethical and legal disputes in dentistry.

Comparative Evaluation of Immediate Post-Operative Sequelae after Surgical Removal of Impacted Mandibular Third Molar with or without Tube Drain - Split-Mouth Study

INTRODUCTION

Third molar surgery is one of the most common surgical procedures performed in general dentistry. Post-operative variables such as pain, swelling and trismus are major concerns after impacted mandibular third molar surgery. Use of passive tube drain is supposed to help reduce these immediate post-operative sequelae. The current study was designed to compare the effect of tube drain on immediate post-operative sequelae following impacted mandibular third molar surgery.

AIM

To compare the post-operative sequelae after surgical removal of impacted mandibular third molar surgery with or without tube drain.

MATERIALS AND METHODS

Thirty patients with bilateral impacted mandibular third molars were divided into two groups: Test (with tube drain) and control (without tube drain) group. In the test group, a tube drain was inserted through the releasing incision, and kept in place for three days. The control group was left without a tube drain. The post-operative variables like, pain, swelling, and trismus were calculated after 24 hours, 72 hours, 7 days, and 15 days in both the groups and analyzed statistically using chi-square and t-test analysis.

RESULTS

The test group showed lesser swelling as compared to control group, with the swelling variable showing statistically significant difference at post-operative day 3 and 7 (p≤ 0.05) in both groups. There were no statistically significant differences in pain and trismus variables in both the groups.

CONCLUSION

The use of tube drain helps to control swelling following impacted mandibular third molar surgery. However, it does not have much effect on pain or trismus.

The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction

BACKGROUND

Despite efforts to prevent postoperative discomfort, there are still many immediate side effects associated with the surgical extraction of impacted lower third molars. Cicatrization is a physiological process through which the loss of integrity of oral mucosa is recovered and damaged tissues are repaired. Bexident Post (ISDIN, Spain) is a topical gel that contains chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol. While this gel has many clinical indications, there are no published clinical trials evaluating its use in impacted mandibular third molar surgery. This study aims to clinically evaluate the efficacy of a gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on wound healing and reduction of postoperative side effects and complications after extraction of an impacted mandibular third molar.

MATERIAL AND METHODS

A split-mouth design study was carried out on a total of 50 bilaterally and symmetrically impacted third molar extractions, which were randomly placed into either a control group (CG=25) or an experimental group (EG=25). Patients were all informed of the purpose of the study and provided written consent. All procedures were carried out by the same dental practitioner, in accordance with standard surgical protocol. A different dental practitioner, unaware of which treatment had been applied, provided follow-up care. The EG applied 10 ml of topical gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol to the surgical wound three times a day for 10 days, patients in the CG did not apply any gel.

RESULTS

The groups were homogeneous insofar as potentially confounding variables. No significant findings were found regarding postoperative swelling and pain. Neither of the groups displayed poor healing or infectious complications of the wound during the postoperative period. In all the recorded follow-ups (Day 7 p=0.001, and Day 14 p=0.01), the wound's aesthetic appearance was better in the EG. Overall treatment tolerance was satisfactory and similar in both groups.

CONCLUSIONS

The gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol did not aid in patients' postoperative comfort; however, improved wound healing was observed.

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

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.

Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes

Introduction

The aim of this study was the comparision of postoperative outcomes in impacted mandibular third molars that were treated using either platelet-rich fibrin (PRF), a combination of PRF and piezosurgery, or conventional rotatory osteotomy.

Patient and methods

The study included 20 patients; 40 extractions of impacted mandibular third molars were performed. Patients were divided into two main groups. In group A (n = 20), traditional surgery was performed on one side (Group 1, n = 10); traditional surgery was performed, and PRF was administered to the extracted socket on the other side of same patient (Group 2, n = 10). In group B (n = 20), on one side, piezosurgery was used for osteotomy, and PRF was administered (Group 3, n = 10); on the other side of same patient, traditional surgery was performed (Group 4, n = 10). Parameters assessed at baseline for each patient included pain, the number of analgesics taken, trismus, and cheek swelling. These variables were also assessed on postoperative days 1, 2, 3, and 7.

Results

Statistical analysis revealed a significant reduction in postoperative pain (sum of 1^st, 2^nd, 3^rd and 7^th days) and trismus (on postoperative day 1) in group 2 (traditional surgery + PRF group), and in postoperative pain, the number of analgesics taken (sum of 1^st, 2^nd,3^rd and 7^th days) and trismus (on postoperative day 1) in group 3 (piezosurgery + PRF group) compared to groups 1 and 4 (traditional surgery groups), (p ≤ 0.05). However, swelling on postoperative days 1, 3, and 7 did not differ among the groups (p > 0.05). Only difference was on second day between groups 1–4 and 2–4 (p ≤ 0.05).

Conclusions

The results of our study have shown that the use of PRF with traditional surgery and PRF combined with piezosurgery significantly reduced pain during the postoperative period. In addition, PRF in combination with piezosurgery significantly decreased the number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery. As a result of this study, PRF and combination use of PRF and piezosurgery have positive effects in reducing postoperative outcomes after impacted third molar surgery.

What do patients take into account when they choose their dentist? Implications for quality improvement

BACKGROUND

From dental care providers' perspective, it is vital to put efforts into improving the quality of services delivered. Therefore, the exploration of patients' satisfaction with dental services and their preferences with regard to the factors involved in their dental care choices should be one of the main areas of focus in a dental care office, by focusing on the quality management.

AIMS

The aim of this research was to determine the factors that patients consider important when choosing a dentist, and bring evidence on the importance of implementing a quality management system for dental care.

METHODS AND PARTICIPANTS

The data analysis was conducted on a national representative sample of patients who had visited a dentist at least once in the last 12 months, in Romania. Using a survey which explored patients' satisfaction with their dental care visits, data were collected between October and November 2012 with the help of computer-assisted telephone interviews. Information about socio-demographics, frequency of accessing dental care, factors associated with choosing a dentist, and the level of patients' satisfaction were collected.

RESULTS

Out of the 1,650 people who agreed to participate in the study, 724 respondents (43.8%) represented the sample who visited a dentist at least once in the last 12 months and whose responses were analyzed in this article. The majority of the respondents were satisfied with the quality of dental services received, with 85.91% of them rating their satisfaction with 5, on a scale from 1 to 5. According to a high majority of the patients (n=680, 93.92%), the communication with their dentist was extremely easy. The most frequently mentioned factors that respondents took into account when choosing a dentist were the dentist's competence (22.22%), the recommendation from someone known (20.56%), and the overall quality of the service provided (19.72%). Among the other factors mentioned were patience and respect.

CONCLUSION

The factors patients consider important when choosing a dentist are the dentist's competence, the recommendation from someone known, and the overall quality of the service provided, but interpersonal factors such as patience and respect are also valued. Our results are relevant for dental education providers, who should consider shaping their curricula as to ensure they train future dentists in a manner that will meet patients' expectations and increase patient satisfaction levels.