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Kim JY, Han MD, Lee H, Ko JH, Park YL, Huh JK. Are There Differences in the Causes and Complications of Mandibular Third Molar Extraction in Older Patients Compared to Younger Patients? J Oral Maxillofac Surg 2024:S0278-2391(24)00592-5. [PMID: 39038596 DOI: 10.1016/j.joms.2024.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Although most impacted third molars (ITMs) are extracted in the teens and early 20s, some undergo extractions after their 40s. It is unclear whether the reasons for extraction, the degree of impaction, and complications differ in patients in an older age group compared with a younger age group. PURPOSE The purpose of this study was to measure the association between age and 1) reason for extraction and 2) postoperative complications. STUDY DESIGN, SETTING, SAMPLE This was a retrospective cohort study of patients who had undergone surgical extraction of at least one mandibular ITM at a single institution. We excluded 1) age under 20 years, 2) follow-up period of less than 1 week, and 3) tooth extraction under general anesthesia. PREDICTOR VARIABLE The primary predictor variable was age, classified into 3 groups (20s:20-29; 30s:30-39; over 40s: 40 and greater). MAIN OUTCOME VARIABLE(S) The primary outcome variables were the reason for extraction (prophylactic or symptomatic) and the presence of complications. The secondary outcome variable was type of complication (postoperative infection, dry socket, neurosensory disturbance, presenting pain over 1 month, retained root requiring secondary treatment). COVARIATES The covariates were sex, laterality of ITM, and difficulty of extraction as measured by the difficulty index, a measure based on depth, orientation, and ramus relationship/space available, with a higher score indicating greater difficulty. ANALYSES χ2 test was performed to analyze the association of categorical outcome variables and covariates. Level of statistical significance was set at P < .05. RESULTS Of a total of 831 eligible subjects, there were 555 (66.8%), 159 (19.1%), and 117 (14.1%) in the 20s, 30s, and over 40s age groups, respectively. The percentage of symptomatic extraction of ITM was significantly higher in the over-40 age group compared with the 20s group (92.3 vs 69.4%, (P < .001). Complication rate also significantly differed between over 40s group and the 20s group (7.7 vs 1.8%, P < .001). Difficulty index and indications for ITM extraction were significantly different between groups (P < .001). CONCLUSION AND RELEVANCE Symptoms, difficulty, and complications related to ITM increase at over 40 years of age. This should be taken into consideration during the joint clinical decision-making process with patients with ITM.
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Affiliation(s)
- Jae-Young Kim
- Associate Professor, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Michael D Han
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago College of Dentistry, Chicago, IL
| | - Haneul Lee
- Resident, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Ko
- Former Resident, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Young Long Park
- Fellow, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Professor, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Gangnam Severance Hospital, Seoul, Republic of Korea.
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Lee DM, Ryu J, Kim H, Lee JY. Characteristics of impacted mandibular third molar-related lesions. J Korean Assoc Oral Maxillofac Surg 2024; 50:153-160. [PMID: 38940652 PMCID: PMC11217694 DOI: 10.5125/jkaoms.2024.50.3.153] [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: 04/24/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Objectives This study identifies factors for differential diagnosis among lesions by retrospectively comparing panoramic and cone-beam computed tomography images and analyzing the characteristics of lesions associated with impacted mandibular third molars (IMTs). Materials and Methods A retrospective cohort study was conducted in patients who simultaneously underwent IMT extraction surgery and related benign tumor resection or cyst enucleation at our institution from 2017 to 2021. To compare the characteristics of each group, two comparative analyses were conducted. The first comparison considered the most frequently observed lesions associated with IMTs: dentigerous cysts, odontogenic keratocysts (OKCs), and ameloblastoma. The second comparison involved placing dentigerous cysts, which have a relatively low recurrence rate, into group A and placing OKC, ameloblastoma, and odontogenic myxoma, which have high recurrence rates, into group B. Results Significant differences in the size of the lesion were found in the order of ameloblastoma, OKC, and dentigerous cyst (P <0.05). The buccolingual width of ameloblastoma differed significantly from that of the other groups, with no significant difference observed between the OKCs and dentigerous cysts (P=0.083). Conclusion Patient age and lesion size differed significantly among lesion types associated with IMTs, with younger age and larger lesions for OKCs and odontogenic tumors. OKCs are likely to have a larger mesiodistal width than dentigerous cysts. The buccolingual width of ameloblastomas was larger than those of dentigerous cysts and OKCs.
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Affiliation(s)
- Dong-Min Lee
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan, Korea
| | - Jihye Ryu
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan, Korea
| | - Hyeonjin Kim
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan, Korea
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan, Korea
- Department of Oral and Maxillofacial Surgery, Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan, Korea
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Otonari-Yamamoto M, Nakajima K, Sato H, Wada H, Matsumoto H, Nishiyama A, Hoshino T, Matsuzaka K, Katakura A, Goto TK. Dentigerous cysts suspected the other odontogenic lesions on panoramic radiography and CT. Oral Radiol 2024; 40:319-326. [PMID: 38165531 DOI: 10.1007/s11282-023-00732-4] [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: 05/25/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
Dentigerous cysts are known as the second most common type of cyst in the jaws. The cyst is one of the lesions occurred frequently in the posterior body of the mandible and is often related to the unerupted third molar and forms around the crown of the unerupted tooth attaching at the cementoenamel junction. Such characteristic appearances are the diagnostic points differentiating from ameloblastoma or odontogenic keratocyst. However, it would be hard for us to diagnose it as a dentigerous cyst if the lesion does not show its typical appearance. We experienced two cases of dentigerous cysts which did not form around the crown of the unerupted tooth on radiologically. Both cysts were relatively large and resorbed adjacent teeth roots. Therefore, an ameloblastoma or an odontogenic keratocyst was suspected rather than a dentigerous cyst as the imaging diagnosis. The biopsy revealed that the lesion was a "dentigerous cyst" in one of the cases and "developmental cyst with inflammation" in another case. After the excision, the histopathological diagnosis was a dentigerous cyst with inflammation in both cases. This report shows the two cases of dentigerous cysts focusing on panoramic radiography and CT images. Also, we discuss the differential diagnosis by reconsidering those diagnostic points.
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Affiliation(s)
- Mika Otonari-Yamamoto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kanda Misaki-Cho, Chiyoda-Ku, Tokyo, 101-0061, Japan.
| | - Kei Nakajima
- Department of Pathology, Tokyo Dental College, Tokyo, Japan
| | - Hitomi Sato
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kanda Misaki-Cho, Chiyoda-Ku, Tokyo, 101-0061, Japan
| | - Hirotaka Wada
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kanda Misaki-Cho, Chiyoda-Ku, Tokyo, 101-0061, Japan
| | - Hideki Matsumoto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kanda Misaki-Cho, Chiyoda-Ku, Tokyo, 101-0061, Japan
| | - Akihiro Nishiyama
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Teruhide Hoshino
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | | | - Akira Katakura
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Tazuko K Goto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kanda Misaki-Cho, Chiyoda-Ku, Tokyo, 101-0061, Japan
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Murugesan I, Kumar Vadivel J, Ramalingam K. Bone Trabecular Pattern Analysis in Odontogenic Cysts Using Cone Beam Computed Tomography: A Clinical Retrospective Study. Cureus 2024; 16:e54452. [PMID: 38510904 PMCID: PMC10951676 DOI: 10.7759/cureus.54452] [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: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction The cysts of the maxillofacial region account for one of the most common pathologies of the head and neck region after the mucosal pathologies. Radiography provides an essential clue in early diagnosis and triaging, but it continues further as it is used to evaluate the post-treatment outcome. However, manual analysis is prone to errors. In this scenario, fractal analysis (FA) in radiographs uses mathematical methods to analyse the changes in grey scales in a given radiographic image. FA in odontogenic cysts is used to characterise their complexity, uncover hidden patterns, monitor treatment response, and potentially provide prognostic information. This paper aimed to assess the fractal characteristics of the radicular cyst (RC), dentigerous cyst (DC), and odontogenic keratocyst (OKC) using cone beam computed tomography (CBCT). The objective was to calculate fractal dimension (FD) values expressed in each of these cysts, which could prove to be a radiological adjunct in diagnosing the above cysts. Materials and methods As this is a retrospective study, the archives of CBCT images from June 2021 to December 2023 were obtained from patients diagnosed and confirmed with a histopathological diagnosis with RC, DC, and OKC. The FA was performed using Image J Software (Ver 1.51, National Institute of Health Bethesda, Fiji). The cortical and cancellous bones were segmented using thresholding techniques and converted to binary images. The mean FD of the three planes was then compared to establish the distinctive fractal characteristic for the specific odontogenic cysts. A one-way ANOVA was performed using the Statistical Product and Service Solutions (SPSS) (version 23.0; IBM SPSS Statistics for Windows, Armonk, NY) to determine the difference between FD values of RC, DC, and OKC with a significance level less than 0.05. Results The FD values of DC, RC, and OKC were 1.33 ± 0.17, 1.08 ± 0.16, and 1.65 ± 0.12, respectively. The results indicated that OKC had higher FD values than DC and RC, which means that OKC had lesser bone destruction compared to DC and RC. Inferential statistics showed that the one-way ANOVA was used to compare the means of the three groups of FD data. When calculated for the three groups, the F-statistic value was at 7.29, which yielded a P value of 0.03, making it statistically significant for a 95% confidence interval (p<0.05). Conclusion Our CBCT study on bone trabecular pattern analysis using FD and FA in odontogenic cysts reveals distinct alterations in bone parameters among different cyst types. The probability of higher FD values in OKC is because of lesser cortical bone destruction in OKC compared to the other cyst types. These findings have potential implications for diagnosing, treating, and prognosticating odontogenic cysts.
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Affiliation(s)
- Induja Murugesan
- Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Jayanth Kumar Vadivel
- Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Kuang Q, Zhou H, Hong H, Lin D, You M, Lai W, Long H. Radiographic Features of Mandibular Second Molars with Eruption Disturbances: A Retrospective Study. J Clin Med 2023; 12:jcm12082798. [PMID: 37109135 PMCID: PMC10146564 DOI: 10.3390/jcm12082798] [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: 01/16/2023] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
We aimed to establish the characteristics and potential etiological risk factors of eruption disturbances in mandibular second molars (MM2). We retrospectively enrolled patients with eruption disturbances in MM2. A total of 143 MM2 with eruption disturbances from 112 patients (mean age 17.45 ± 6.35) were included in this study. Panoramic radiographs were employed to determine the risk factor, angulation type, impaction depth, tooth development stage, and associated pathology. The novel classification method of MM2 was based on impaction depth and angulation. Of 143 MM2, 137 and 6 were diagnosed with impaction and retention, respectively. Insufficient space was the most frequent risk factor for eruption disturbances. There were no significant differences between retention and impaction regarding sex, age, or side. The most frequent impaction type was Type I. The most frequent angulation of impacted MM2 was mesioangular. Impacted MM2 with shallower depth were more frequently associated with the presence of first molar undercut. Impaction types did not differ according to age, side, development stage, or distance from the MM1 distal surface to the anterior border of the ramus. Dentigerous cysts were associated with earlier MM2 development stages and greater MM2 depth. In conclusion, MM2 impaction types differed according to the risk factor, angulation type, MM1 undercut, and presence of cysts. Early MM2 development stage and greater MM2 depth were risk factors for MM2 eruption disturbances with cysts.
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Affiliation(s)
- Qianyun Kuang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Huiyi Hong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Donger Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wenli Lai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hu Long
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Perez A, Lenoir V, Lombardi T. Dentigerous Cysts with Diverse Radiological Presentation Highlighting Diagnostic Challenges. Diagnostics (Basel) 2022; 12:diagnostics12082006. [PMID: 36010356 PMCID: PMC9407358 DOI: 10.3390/diagnostics12082006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Dentigerous cyst is an odontogenic developmental cyst arising from the pericoronal tissue of an impacted tooth, and that may exhibit various radiological aspects. The aim of this article is to present four cases of histologically confirmed mandibular dentigerous cysts to highlight diverse radiological presentations: one of classical appearance (well-limited unilocular radiolucent lesion surrounding the crown) and three which have shown radiological peculiarities (one cyst displacing the adjacent tooth, with bone but no root resorption, one cyst presenting hallmarks of infection and one multilocular cyst with thin septa). Such radiologic diversity may, on occasion, suggest a clinical aggressive lesion such as an odontogenic keratocyst or ameloblastoma. The diagnosis of dentigerous cyst requires a thorough evaluation of the clinical presentation and accurate radiological studies.
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Affiliation(s)
- Alexandre Perez
- Unit of Oral Surgery and Implantology, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva & University Hospitals of Geneva, 1205 Geneva, Switzerland
- Correspondence:
| | - Vincent Lenoir
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Tommaso Lombardi
- Unit of Oral Medicine and Oral Maxillofacial Pathology, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva & University Hospitals of Geneva, 1205 Geneva, Switzerland
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Kim JY. Third molar extraction in middle-aged and elderly patient. J Korean Assoc Oral Maxillofac Surg 2021; 47:407-408. [PMID: 34713818 PMCID: PMC8564089 DOI: 10.5125/jkaoms.2021.47.5.407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
Extraction of impacted third molars is a routine procedure performed by oral and maxillofacial surgeons. However, extractions in middle-aged or elderly individuals are not easy, and there are several factors that need to be considered. These factors include decreased healing potential and the risk of complications increasing with age. In addition, third molars can often be fully or deeply impacted in middle-aged individuals, and pathologic changes, such as cysts, caries, or periodontitis of the adjacent second molar, can develop. Furthermore, the rate of ankylosis and systemic disease increases after middle age. It is considered that these factors acting alone or in combination increase the difficulty of extraction.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
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OLİVEİRA BC, FİSCHBORN A, PEDROSO C, ANDREİS J, SİLVEİRA C, GUZZONİ LF, BORTOLUZZİ M, FRANCO GC. Multiple Dentigerous Cysts in a Child: A Case Report and Radiographic Follow-up. CUMHURIYET DENTAL JOURNAL 2020. [DOI: 10.7126/cumudj.705978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Martinelli-Kläy CP, Martinelli CR, Martinelli C, Macedo HR, Lombardi T. Unusual Imaging Features of Dentigerous Cyst: A Case Report. Dent J (Basel) 2019; 7:dj7030076. [PMID: 31374841 PMCID: PMC6784467 DOI: 10.3390/dj7030076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 12/14/2022] Open
Abstract
Dentigerous cysts (DC) are cystic lesions radiographically represented by a well-defined unilocular radiolucent area involving an impacted tooth crown. We present an unusual radiographic feature of dentigerous cyst related to the impacted mandibular right second molar, in a 16-year-old patient, which suggested an ameloblastoma or odontogenic keratocyst (OKC) because of its multilocular appearance seen on the panoramic radiography. A multi-slice computed tomography (MSCT), however, revealed a unilocular lesion without septations, with an attenuation coefficient from 3.9 to 22.9 HU suggesting a cystic lesion. Due to its extension, a marsupialization was performed together with the histopathological analysis of the fragment removed which suggested a dentigerous cyst. Nine months later, the lesion was reduced in size and then totally excised. The impacted mandibular right second molar was also extracted. Histopathological examination confirmed the diagnosis of a dentigerous cyst. One year later, the panoramic radiography showed a complete mandible bone healing. Large dentigerous cysts can sometimes suggest other more aggressive pathologies. Precise diagnosis is important to avoid mistakes since DC, OKC and ameloblastoma require different treatments. Histological examination is, therefore, essential to establish a definitive diagnosis. In our case, MSCT and the tissue attenuation coefficient analysis contributed to guide the diagnosis and management of the dentigerous cyst.
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Affiliation(s)
- Carla Patrícia Martinelli-Kläy
- Laboratory of Oral & Maxillofacial Pathology, Oral Medicine and Oral and Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland.
- Centre for Diagnosis and Treatment of Oral Diseases, Ribeirão Preto 14025-250, Brazil.
| | | | - Celso Martinelli
- Centre for Diagnosis and Treatment of Oral Diseases, Ribeirão Preto 14025-250, Brazil
| | | | - Tommaso Lombardi
- Laboratory of Oral & Maxillofacial Pathology, Oral Medicine and Oral and Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland
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Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data. Antibiotics (Basel) 2019; 8:antibiotics8020053. [PMID: 31052566 PMCID: PMC6627726 DOI: 10.3390/antibiotics8020053] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of this paper was to highlight the most widely antibiotic protocols applied to the dental field, especially in the surgical treatment of impacted wisdom teeth. Once these protocols were screened, all the possible advantages or disadvantages for each drug and each posology were recorded in this review. In recent years, the need to use these protocols has been debated in the literature. The data obtained by this review underlined how antibiotic protocols applied to oral surgery treatments only included surgeries performed on patients who did not present other systemic pathologies. The first literature review obtained 140 results, and then after the application of the inclusion criteria, 12 papers were selected. The results showed that the most commonly used protocol involved the use of penicillin and clavulanate, obtaining safe clinical and prophylactic results in the management of infections. This widely used protocol seems to guarantee high predictability and safety. The presented review highlights the current possibility of antibiotic resistance affecting patients due to drug misuse. Further clinical studies are required to state specific guidelines; however, oral surgeons involved in third molar surgery should evaluate the local and general health conditions of the patients before suggesting any drug measures for patients.
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