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Wang Q, Zhang T. Application of an ultrasonic bone knife combined with a dental electric motor in the extraction of mandibular middle and low impacted teeth. BMC Oral Health 2024; 24:18. [PMID: 38178077 PMCID: PMC10768189 DOI: 10.1186/s12903-023-03788-0] [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: 05/20/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE To investigate the clinical application of an ultrasonic bone knife (UBK) combined with a dental electric motor (DEM) in the extraction of mandibular middle and low impacted teeth. METHODS From January 2022 to May 2023,200 patients with wisdom teeth were randomly divided into three groups: experimental group A (UBK combined with DEM), experimental group B (UBK combined with high-speed turbine mobile phone (HSTMP)), and the control group (bone chisel split crown (BCSC)). The operation time, psychological state during operation, pain, swelling, limitation of mouth opening and other complications on the first, second and third days after operation were recorded. RESULTS The operation time of experimental group A (EAG) (12.95 ± 2.12) minutes was shorter than that of experimental group B (EBG) (17.06 ± 2.25) minutes and the control group (CG) (23.43 ± 2.18) minutes, and the difference was statistically significant (P < 0.05). The psychological state of the EAG was significantly lower than that of the EBG and CG (P < 0.05). The postoperative pain, swelling, limitation of mouth opening and complications in the EAG were significantly lower than those in the EBG and CG (P < 0.05). CONCLUSION UBK combined with DEM in the extraction of mandibular middle and low obstructed teeth has good results, good prognosis, high safety, short operation time, better psychological status of patients, low postoperative pain, swelling, mouth opening restriction and complication rate, and is currently the preferred extraction method.
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Affiliation(s)
- Qian Wang
- School of Stomatology, Jinan University, Guangzhou, 510000, China
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Zhongshan City, Zhongshan, 528400, China
| | - Tonghan Zhang
- School of Stomatology, Jinan University, Guangzhou, 510000, China.
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Zhongshan City, Zhongshan, 528400, China.
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Gülnahar Y, Alpan AL, Gülnahar E. Articaine versus lidocaine inferior alveolar nerve block in posterior mandible implant surgeries: a randomized controlled trial. Med Oral Patol Oral Cir Bucal 2023; 28:e108-e115. [PMID: 36806026 PMCID: PMC9985933 DOI: 10.4317/medoral.25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/16/2022] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the effects of %4 articaine and %2 lidocaine on inferior alveolar nerve block (IANB) for implant surgery in the posterior mandible. MATERIAL AND METHODS The patients who have inserted implants in the posterior mandible were divided into 2 groups for IANB: lidocaine and articaine. VAS = visual analog scale, pain during surgery and injection, lip numbness time, mandibular canal-implant apex distance, age, gender, bone density, implant number, release incision, adjacent teeth, and duration of surgery were analyzed using t-test, Mann-Whitney U test, Spearman's coefficient, and, Pearson's chi-squared test. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials. RESULTS 577 patients were included and 1185 dental implants were analyzed. There was no significant difference between the two groups in terms of injection and surgery VAS values (p>0.05). The lip numbness time of lidocaine was 3.06±3.22min while articaine was found to be 2.96±3.09min (p>0.05). Mandibular canal-implant apex distance was found to be 2.28±0.75mm in the articaine and 2.45±0.86mm in the lidocaine group (p<0.05). Release incision was made more in the articaine group (51/252) than in the lidocaine group (40/325) (p<0.05). CONCLUSIONS There was no difference between the %4 articaine and %2 lidocaine in terms of pain perception in posterior mandible implant applications. Both anesthetics provided adequate anesthesia for implant application.
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Affiliation(s)
- Y Gülnahar
- Pamukkale University Faculty of Dentistry Department of Periodontology Kınıklı Campus 20160 Denizli, Turkey
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Todaro C, Cerri M, Isola G, Manazza A, Storelli S, Rodriguez y Baena R, Lupi SM. Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report. PROSTHESIS 2023; 5:221-233. [DOI: 10.3390/prosthesis5010017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.
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Affiliation(s)
- Claudia Todaro
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Medical and Surgical Specialties, University of Catania, 95124 Catania, Italy
| | | | - Stefano Storelli
- School of Dentistry, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20142 Milan, Italy
| | - Ruggero Rodriguez y Baena
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Saturnino Marco Lupi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars. Clin Oral Investig 2022; 27:1499-1507. [PMID: 36374352 DOI: 10.1007/s00784-022-04769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This prospective study introduced a digitally designed sectioning guide and evaluated its feasibility for the extraction of horizontally impacted lower third molars. MATERIALS AND METHODS This study included 38 horizontally impacted lower third molars, randomly divided into experimental and control groups. The teeth were extracted using a 3D-printed titanium surgical guide in the experimental group; free-hand extractions were performed in the control group. The surgical duration, tooth sectioning duration, cortical bone perforation, and postoperative complications, including pain, swelling, trismus, dry socket, infection, and hemorrhage, were evaluated. RESULTS Although not statistically significant, guided surgery tended to reduce the number of tooth sectioning steps compared to free-hand extractions. There were no cases of cortical bone perforation in the experimental group. Although the surgical duration was greater in the experimental group (p < 0.05), there were no differences in postoperative pain, swelling, and trismus. There were no cases of postoperative infection and hemorrhage in either group. CONCLUSIONS 3D-printed titanium surgical guides had superior accuracy and safety compared to free-hand surgery. Further studies with larger sample sizes are required to verify these findings. CLINICAL RELEVANCE The template improved the safety of tooth sectioning during impacted lower third molar surgery and resulted in a more predictable extraction. The narrow sectioning groove could fit comfortably with hypertrophic soft tissues in the posterior mandible.
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Nogueira DGDM, Leão JC, Sales PHDH, Silva PGDB, Gomes ACA. Piezoelectric Surgery Is Effective in Reducing Pain, Swelling, and Trismus After Removal of Impacted Lower Third Molars: A Meta-Analysis. J Oral Maxillofac Surg 2022; 81:483-498. [PMID: 36442532 DOI: 10.1016/j.joms.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Surgery of impacted lower third molars may be associated with postoperative complications. The aim of this study is to determine whether piezoelectric surgery is effective in reducing pain, swelling, and trismus compared to conventional rotary instruments during extraction of impacted lower third molars. METHODS For this systematic review, the searches were performed independently by 2 researchers. Randomized clinical trials that used the piezoelectric instrument for the removal of impacted lower third molars in humans were included. The predictor variable was the study group (piezo surgery vs rotary instruments). The main outcome was the analysis of postoperative pain, swelling, and trismus. Data analysis included risk of bias assessment (RoB 2 Cochrane) and meta-analysis with heterogeneity based on random effects I2 and 95% confidence interval. RESULTS In the initial results, 956 articles were revised and after applying inclusion/exclusion criteria, the final sample was composed of 18 publications, all being randomized clinical trials. The results of this meta-analysis demonstrated a significant reduction in pain scores with a Cohen's d of -0.95 [CI 95% = -1.23 to -0.67] of high clinical impact (P < .001). In the piezo group there was a significant increase in mouth opening of 4.29 [CI 95% = 2.33 to 6.25] mm (P < .001). Regarding swelling, Tragus-Ang and Go-eye, both showed a significant reduction in the piezo group (P < .001). There was a significant increase of 7.32 [CI 95% = 4.40 to 10.24] minutes in the piezo group (P < .00001), and none of the studies showed a significant risk of bias. CONCLUSIONS Piezo proved to be effective in reducing pain, swelling, and trismus in third molar surgeries even with longer surgical time, but due to the lack of standardization in primary studies regarding swelling, new, controlled and standardized studies should be carried out with the objective of proving the effectiveness of this therapeutic modality in the reduction of postoperative swelling.
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Affiliation(s)
- Daniela Guimarães de Melo Nogueira
- PhD Student in Dentistry, Department of Prosthetics and Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Jair Carneiro Leão
- Full Professor, Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil
| | - Pedro Henrique da Hora Sales
- PhD Student in Dentistry, Department of Prosthetics and Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil
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Saraiva Amaral J, Marto CM, Farias J, Alves Pereira D, Ermida J, Banaco Á, Campos Felino A, Caramelo F, Matos S. A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars. Bioengineering (Basel) 2022; 9:bioengineering9070276. [PMID: 35877327 PMCID: PMC9311873 DOI: 10.3390/bioengineering9070276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients’ quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. Methods: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. Results: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. Conclusions: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.
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Affiliation(s)
- Joana Saraiva Amaral
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
- Correspondence: (J.S.A.); (S.M.)
| | - Carlos Miguel Marto
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical and Academic Centre of Coimbra (CACC), 3004-561 Coimbra, Portugal
| | - João Farias
- Private Clinical Practice, CliFarias, 3810-157 Aveiro, Portugal;
| | - Daniela Alves Pereira
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
- Centre for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Jorge Ermida
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
| | - Álvaro Banaco
- Dentistry Department, Institute of Oral Medicine and Surgery, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (D.A.P.); (J.E.); (Á.B.)
| | - António Campos Felino
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-135 Porto, Portugal;
| | - Francisco Caramelo
- Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical and Academic Centre of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Sérgio Matos
- Centre for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Dentistry Department, Institute of Periodontology, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Correspondence: (J.S.A.); (S.M.)
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Nehme W, Fares Y, Abou-Abbas L. Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial. BMC Oral Health 2021; 21:393. [PMID: 34380473 PMCID: PMC8359387 DOI: 10.1186/s12903-021-01759-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. Methods A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. Results The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). Conclusion The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1
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Affiliation(s)
- Wissam Nehme
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
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