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He H, Ruan N. Factors influencing inferior alveolar nerve injury after extraction of mandibular third molar. Med Oral Patol Oral Cir Bucal 2024; 29:e613-e619. [PMID: 39088718 PMCID: PMC11365058 DOI: 10.4317/medoral.26576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/17/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND This study sought toexplore the manifestations of clinical symptoms and identify the risk factors linked to inferior alveolar nerve injury (IANI) in the context of mandibular third molar extraction. MATERIAL AND METHODS In this study, 172 patients admitted to our hospital for mandibular third molar extraction from June 2021 to December 2022 were selected for the study, and the clinical data of the participants were retrospectively analyzed, and the risk factors of IANI associated with mandibular third molar extraction were analyzed by uni/multi-factor logisitic regression. RESULTS Noticeable distinctions were noted between the groups with and without injuries in relation to age, time of surgery, number of broken roots, angle of blockage, CEJ (cementoenamel junction) distance, curved roots of the molar, clarity of the upper and lower walls of the nerve canal, and Pell & Gregory classification. Logistic regression analysis showed that age, time of surgery, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar were independent risk factors for IANI. Multi-factor logistic regression analysis further confirmed that age, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar were associated with IANI. CONCLUSIONS Alveolar nerve injury manifests as hyperalgesia or absence of sensation, numbness and abnormal pain in the lower lip. Factors influencing IANI associated with mandibular third molar extraction were age, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar.
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Affiliation(s)
- H He
- No.237 Luoyu Road Hongshan District, Wuhan Hubei, 430079, China
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Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101810. [PMID: 38432484 DOI: 10.1016/j.jormas.2024.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6-9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece.
| | - Georgia Kostare
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Michael Kostares
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
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Kostares E, Kostare G, Kostares M, Tsakris A, Kantzanou M. Prevalence of surgical site infections following extraction of impacted mandibular third molars: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101995. [PMID: 39084557 DOI: 10.1016/j.jormas.2024.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/20/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024]
Abstract
Our research aims to assess the prevalence of surgical site infections (SSI) following impacted mandibular third molar extractions. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus and Cochrane Central databases. The pooled prevalence, accompanied by 95% confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Our meta-analysis included seventeen eligible studies, encompassing a total of 37,585 impacted mandibular third molar extractions. The overall prevalence of SSI following impacted mandibular third molar extractions was estimated at 1.7% (95% CI 1%-2.6%), indicating considerable heterogeneity among the studies. No study was identified as critically influential. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Georgia Kostare
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Michael Kostares
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
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de Souza Santos S, Bonatto MS, Mendes PGJ, Martins AVB, Pereira DA, de Oliveira GJPL. Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A split-mouth, randomized, controlled trial. Oral Maxillofac Surg 2024; 28:919-924. [PMID: 38355872 DOI: 10.1007/s10006-024-01223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. METHODS Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. RESULTS It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90 s vs. 144.5 ± 68.85 s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. CONCLUSION It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).
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Affiliation(s)
- Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Ana Vitória Borges Martins
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
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Luo GM, Yao ZS, Huang WX, Zou LY, Yang Y. Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve. World J Clin Cases 2024; 12:1728-1732. [PMID: 38660071 PMCID: PMC11036467 DOI: 10.12998/wjcc.v12.i10.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/15/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). AIM To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. METHODS Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. RESULTS All IMM3s were extracted easily without symptoms of IAN injury after extraction. CONCLUSION Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.
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Affiliation(s)
- Guang-Ming Luo
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Zhang-Shun Yao
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Wei-Xiang Huang
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Lei-Yan Zou
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Yan Yang
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
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Albanese M, Zangani A, Manfrin F, Bertossi D, De Manzoni R, Tomizioli N, Faccioni P, Pardo A. Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study. Dent J (Basel) 2023; 11:238. [PMID: 37886923 PMCID: PMC10605236 DOI: 10.3390/dj11100238] [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: 08/18/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.
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Affiliation(s)
| | | | | | | | | | - Nicolò Tomizioli
- Dentistry and Maxillofacial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A, Scuro 10, 37134 Verona, Italy; (M.A.); (A.Z.); (D.B.); (R.D.M.); (P.F.); (A.P.)
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Qu H, Yang Y, Tian Y, Li Z, Sun L, Chen F, Tian B. Third molar-related knowledge, attitudes, behaviors, and medical history of 904 Chinese adults: a cross-sectional survey. J Zhejiang Univ Sci B 2023; 24:896-904. [PMID: 37752091 PMCID: PMC10522566 DOI: 10.1631/jzus.b2200617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/07/2023] [Indexed: 09/28/2023]
Abstract
This study investigated the perceptions and medical history of third molars (M3s) and assessed the prevalence of visible M3s (V-M3s) among 904 Chinese adults. The enrolled participants were interviewed to complete a structural questionnaire focused on sociodemographic information and their understanding of, attitudes toward, behaviors regarding, and medical history with respect to M3s. In addition, the number of V-M3s in the cohort was determined by oral examination. Logistic regression analysis was performed to explore the association between individuals' sociodemographic characteristics and their perception of M3s or the presence of V-M3s. The Chi-square test was used to compare the actions taken against symptomatic M3s and the corresponding outcomes among different groups divided according to respondents' sociodemographic factors. In total, 904 completed questionnaires were gathered and analyzed. Nearly half (43.9%) of the respondents knew nothing about M3s, and only 12.7% provided correct answers to all the questions asked. Male sex, older age, occupation involving physical labor, and no previous dental experience were active factors in unawareness of M3s. Male sex was also significantly associated with the presence of at least one V-M3 and negative behavior about symptomatic M3s. In terms of medical history, 192 participants reported having had at least one M3 extracted (438 in total), and 72.6% of the M3s were removed due to the presence of related symptoms or pathologies. In conclusion, the population investigated had a shortage of knowledge about M3s and adopted negative attitudes and actions about M3-related problems.
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Affiliation(s)
- Honglei Qu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China
| | - Yang Yang
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou 730050, China
| | - Yi Tian
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China
| | - Zhibang Li
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China
| | - Lijuan Sun
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China
| | - Faming Chen
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China.
| | - Beimin Tian
- Department of Periodontology, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China.
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Al-Haj Husain A, Schönegg D, Valdec S, Stadlinger B, Gander T, Essig H, Piccirelli M, Winklhofer S. Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review. J Imaging 2022; 8:jimaging8030075. [PMID: 35324630 PMCID: PMC8954741 DOI: 10.3390/jimaging8030075] [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: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (S.V.); (B.S.)
| | - Daphne Schönegg
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (D.S.); (T.G.); (H.E.)
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (S.V.); (B.S.)
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (S.V.); (B.S.)
| | - Thomas Gander
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (D.S.); (T.G.); (H.E.)
| | - Harald Essig
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (D.S.); (T.G.); (H.E.)
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland;
- Correspondence: ; Tel.: +41-44-253-83-96
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