Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study

Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.     

Randomized clinical study comparing piezosurgery and conventional rotatory surgery in mandibular cyst enucleation

PurposeThe aim of the present study is to compare piezoelectric surgery to the conventional rotatory surgery in mandibular cyst enucleation, and to determine the 2 method's suitability and the postoperative outcomes.Material and methodsEighty patients were included in the study. 35 male and 45 female, which showed cystic mandibular lesions, compared with the inferior alveolar nerve or the mental nerve. The patients were randomly divided into two groups. In the test group, cystectomy was performed using conventional rotatory instrumentation (rotatory-group), and in the other one piezoelectric surgery (piezo-group).The swelling was documented 24/48/72 h and 1 week post-surgery and the patients recorded their subjective postoperative pain daily for 7 days using a Visual Analog Scale (VAS).ResultsPatients treated with piezoelectric technique have presented a lower VAS, minor swelling and less recovery time compared to the rotatory-group. No lesions of the mandible nerve were detected with piezosurgery whereas surgery with rotary instruments resulted in 8% hypesthesia at least up to one week.ConclusionThe results of this study suggest that piezosurgery may be considered effective in cyst enucleation compared to traditional procedures with burs, since it grants the patients significantly less post-surgical pain and swelling.     

The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery

Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.     

4种超声骨刀去骨法在高难度下颌阻生第三磨牙拔除术中的应用

目的：探讨应用超声骨刀进行4种去骨拔牙法在高难度下颌阻生第三磨牙拔除术中的应用效果。方法：根据改良的纳入标准将55例患者的74颗牙定为高难度下颌阻生第三磨牙。以X线平片和锥形束CT（CBCT）为依据,按不同的阻生牙情况,设计4种超声骨刀去骨拔除方法：术式1为整体去骨拔除,术式2为分块去骨拔除,术式3为去骨分牙拔除,术式4为牙骨一并拔除。记录去骨方式、手术时间以及围术期并发症,评价应用效果。结果：所有阻生牙均顺利拔除,4种去骨拔除术中,术式1为38颗牙（51.4%）,术式2为18颗牙（24.3%）,术式3为12颗牙（16.2%）,术式4为6颗牙（8.1%）。平均用时为15 min（8-26 min）。所有病例随访1个月,仅2例（2.7%）出现术后局部感染,予以引流、抗感染治疗,1周内痊愈。结论：本研究创立的4种超声骨刀去骨拔牙方法能顺利拔除所有类型的高难度下颌阻生第三磨牙,且用时较短,并发症较少。     

微创法与锤凿法拔除下颌阻生智齿的临床研究

目的:评估微创拔牙技术在阻生牙拔除术中的应用价值。方法:选择342例需拔除下颌阻生智齿患者,随机分成2组,分别采用微创法和锤凿法拔除患牙,记录两种方法平均拔除时间、术后肿胀、疼痛、张口受限、颞颌关节痛、干槽症等并发症发生情况。结果:实验组与对照组相比,平均拔除时间明显缩短(P<0.001);术后疼痛、肿胀、张口受限、干槽症、颞颌关节痛等并发症发生率较对照组明显降低(P<0.005)。结论:随着微创医学的发展及新型拔牙器械的推出,微创拔牙理念和技术将逐渐取代传统的锤凿法。     

无痛微创法与凿骨劈冠法拔除下颌阻生智齿的临床观察

目的 观察无痛微创法和凿骨劈冠法拔除下颌阻生智齿的临床疗效。方法 306颗下颌阻生智齿随机分成2组,分别采用无痛微创法（实验组）和凿骨劈冠法（对照组）拔除患牙,记录2组平均拔除时间、术后肿胀、疼痛、张口受限、颞颌关节痛、干槽症等并发症发生情况及对拔牙的畏惧感。结果 实验组与对照组相比,平均拔除时间明显缩短（P<0.01）;术后疼痛、肿胀、张口受限、颞颌关节痛、干槽症等并发症发生率较对照组明显降低（P<0.01）;术前畏惧在术后的消失率和术前不畏惧在术后出现的畏惧率,均表明实验组优于对照组（P<0.001）。结论 随着社会-心理-生物医学模式的不断完善,拔牙手术正由传统的凿骨劈冠法向着无痛、微创、安全、规范、舒适、愉悦等人性化方向发展。     

Presence of mandibular third molars during bilateral sagittal split osteotomy increases the possibility of bad split but not the risk of other post-operative complications

Timing of third molar removal in relation to bilateral sagittal split osteotomy (BSSO) is controversial, especially with regard to post-operative complications. We investigated the influence of mandibular third molar presence on complications after BSSO with sagittal splitters and separators, by a retrospective record review of 251 patients (502 surgical sites). Mandibular third molars were present during surgery at 169 sites and removed at least 6 months preoperatively in 333 sites. Bad splits occurred at 3.0 % (5/169) and 1.5% (5/333) of the respective sites. Presence of mandibular third molars significantly increased the risk of bad splits (OR 1.08, CI 1.02–1.13, p < 0.01). The mean incidences of permanent neurosensory disturbances, post-operative infection, and symptomatic removal of the osteosynthesis material were 5.4% (OR, 0.89; 95% CI, 0.79–1.00; p = 0.06), 8.2% (OR, 1.09; 95% CI, 0.99–1.20; p = 0.63), and 3.4% (OR, 0.97; 95% CI, .92–1.03; p = 0.35) per site, respectively, without a significant influence of mandibular third molar status. In conclusion, the presence of mandibular third molars during surgery increases the possibility of bad split but does not affect the risk of other complications. Therefore, third molars can be removed concomitantly with BSSO using sagittal splitters and separators.     

末端磨牙区拥挤与下颌智齿牙根形态的关系

目的探讨磨牙区拥挤与下颌智齿牙根发育形态之间的关系。方法选择下颌第三磨牙牙根发育完成的22-35岁成年正畸患者的曲面断层片1056张,观察下颌第一、第二及第三磨牙牙根分叉和聚拢的分布情况,探讨下颌第三磨牙阻生与完全萌出与其牙根聚拢程度的关系。结果从下颌第一磨牙至第三磨牙,牙根聚拢程度有增加的趋势。下颌第三磨牙阻生与否对于牙根的分开与聚拢没有显著影响。结论下颌第三磨牙牙根形态变异较大,牙根的分开与聚拢与末端磨牙区拥挤与否无明显关联。     

A Randomized Clinical Trial to Compare the Efficacy of Submucosal Aprotinin Injection and Intravenous Dexamethasone in Reducing Pain and Swelling After Third Molar Surgery: A Prospective Study

Objective

The purpose of this study was to compare two different groups of drugs, aprotinin and dexamethasone for its efficacy in reducing post operative swelling and pain after third molar surgery.

Methods

Fifty consecutive patients requiring surgical removal of single mandibular third molar (class II position B) under local anesthesia were randomly divided into two groups, each group consisting of 25 patients. One group was administered 8 mg dexamethasone through intravenous route pre-operatively. The other group received 1 ml of Aprotinin through submucosal route in operating area after the onset of local anesthesia. Swelling was assessed by measuring facial contours at baseline and at 1st, 3rd and 7th post-operative days. Pain was measured on the 1st, 3rd and 7th post-operative days using visual analog scale. Based on statistical analysis (paired t test and Wilcoxon’s signed ranking test), the results showed statistically significant difference in post operative swelling and pain on 3rd postoperative day in dexamethasone group as compared to aprotinin group.

Results

The results of present study showed a similar reduction in the severity of pain and swelling at the aprotinin and dexamethasone sites on 1st and 7th postoperative day. It was also noticed that the aprotinin promoted a greater reduction of swelling and pain on 3rd postoperative day.

Conclusion

It appeared that, benefits of aprotinin against the risks of dexamethasone and its efficacy in controlling pain and swelling after third molar surgery makes aprotinin to be a valuable alternative to dexamethasone.     

低强度超声在下颌埋伏智牙拔除术中的应用

目的:观察埋伏阻生牙拔除术后应用低强度超声照射对缓解疼痛、肿胀、干槽症和促进骨愈合的效果。方法:在门诊患者中,依据曲面断层X线片选择两侧埋伏阻生程度相近者为研究对象,一侧创口术后照射低强度超声,另一侧进行常规处理。应用SPSS10.0软件对患者手术后疼痛、肿胀、干槽症和创口完全骨愈合的情况进行统计学分析。结果:实验组和对照组比较,实验组疼痛4例,对照组16例(P<0.05);实验组肿胀11例,对照组13例(P>0.05);实验组发生干槽症患者0例,对照组4例(P<0.05);实验组创口完全骨愈合35例,对照组21例(P<0.01)。结论:埋伏阻生牙拔除术后应用低强度超声,可以显著缓解术后疼痛,降低干槽症发生率,并促进创口骨愈合,但是对术后肿胀的治疗效果不明显。     

下颌骨埋伏阻生智牙2种方法拔除的交叉试验研究

目的:对2种拔除下颌骨埋伏阻生智牙方法的临床效果进行比较。方法:选取双侧阻生情况相似的下颌骨埋伏阻生智牙拔除患者15例,左右两侧手术相隔2周,分别采用侧入法(经下颌骨外斜线途径)和常规的上入法(经牙槽嵴顶途径)拔除两侧智牙,记录手术时间、术后反应及并发症情况,采用配对t检验进行统计学分析。结果:侧入法组手术时间(66.73±19.26)min,明显短于上入法组的(91.20±39.19)min,两者有显著性差异(P=0.0026);肿胀情况:侧入法组较上入法组明显(P=0.0233);术后疼痛及张口度情况两组之间差别不大。上入法拔除组术后有4例伤口延期愈合,4例发生一过性下唇麻木;侧入法组伤口均一期愈合,有2例发生一过性下唇麻木。结论:使用侧入法拔除下颌骨内埋伏阻生智牙特别适用于埋伏牙位置深、对保持术区牙槽嵴高度要求高的病例。     

超声骨刀与凿骨劈冠法拔除下颌阻生智齿的比较

目的 探讨超声骨刀拔除下颌阻生智齿的效果.方法 根据下颌阻生第三磨牙拔除难度判断方案选择拔牙难度判断为较难的228颗下颌阻生智齿,分成实验组和对照组,每组114颗,实验组应用超声骨刀法拔牙,对照组采用凿骨劈冠法拔牙.对2组的拔牙时间、术后疼痛、张口受限、面部肿胀情况进行分析比较.结果 实验组平均拔牙时间为(16+5.2...     

Efficacy of platelet rich plasma in bone regeneration after surgical removal of impacted bilateral mandibular third molars: pilot study

Purpose  

This study was done to assess the efficacy of platelet rich plasma (PRP) in bone regeneration.     

Changes in quality of life after surgical removal of impacted mandibular third molar teeth

Background  

The decision to get impacted teeth removed is not straightforward because of the concerns about its possible outcome. Assessment of quality of life is now regarded as an essential component for assessing outcomes of dental health care. The purpose of this paper is to assess the effect of impacted third molar teeth surgery on a number of health related outcomes.     

Acupuncture on anxiety and inflammatory events following surgery of mandibular third molars: a split-mouth,randomized, triple-blind clinical trial

The aim of this study was to compare the effects of acupuncture and placebo acupuncture on the control of pain, oedema, and trismus following the extraction of third molars and on the control of preoperative anxiety. Sixteen patients (mean age 22.5 ± 3.45 years) each underwent four acupuncture sessions, one prior to each surgery and the others at 24, 48, and 72 hours after each surgery (left and right tooth). Oedema was determined using measurements of the face and trismus was determined by maximum mouth opening at baseline and at 24, 48, 72 hours and 7 days following surgery. Postoperative pain was evaluated by the patients using a visual analogue scale (VAS) at 24, 48, and 72 hours following surgery. Anxiety was evaluated using the State–Trait Anxiety Inventory and a VAS at baseline and before and after acupuncture prior to surgery. The statistical analysis was performed using the paired t-test and Wilcoxon test. Acupuncture showed a better performance in the control of oedema at 48 hours (P = 0.026), 72 hours (P = 0.046), and 7 days (P = 0.040) when compared to placebo. There was no statistically significant difference between the acupuncture and placebo groups in the control of pain, trismus, or anxiety.     

Dentists' decisions on prophylactic removal of mandibular third molars: a 10-year follow-up study

OBJECTIVES: In recent years, several critical outcome studies concerning the prophylactic removal of mandibular third molars have been published. These would appear to motivate a more restrictive approach today as compared with 10 years ago. The aim of the present study was to examine dentists' decisions on the prophylactic removal of impacted mandibular third molars over a 10-year period. METHODS: Thirty-six cases were selected so as to represent an equal distribution of males and females, ages, angular position and degree of impaction of the molar. Twenty-six general dental practitioners (GDPs) and 10 oral surgeons judged the same cases on two occasions 10 years apart. RESULTS: Calculated for each category of dentists, there was no significant difference in the mean number of molars designated for removal between the two occasions. Two GDPs and three oral surgeons presented a higher removal rate, whereas five GDPs presented a lower removal rate on the second occasion as compared to the first one. The dentists presented a considerable interindividual variation in removal rate, between 0 and 22 molars on the first occasion and between 0 and 25 molars on the second occasion. CONCLUSION: In the decisions on prophylactic removal of mandibular third molars, there has been no change over the last 10 years towards a more noninterventionist attitude. Thus, the dentists seem not to have been influenced by the evidence that this intervention is not cost-effective.     

正畸影响下颌第三磨牙自发性近中移动的相关性分析

目的:探讨拔除下颌第一磨牙或第二前磨牙,下颌第三磨牙自发性近中移动的相关影响因素。方法:本研究用回顾性分析,纳入近中移动下颌第二磨牙以关闭第一磨牙或第二前磨牙缺牙间隙的患者38例,共51颗下颌第三磨牙。在正畸治疗前(T1)和已关闭拔牙间隙且第三磨牙被施力前(T2)拍摄曲面断层片,记录矫治前下颌第三磨牙的Nolla stage分期,对相关线距和角度的变化进行分析。线性回归分析探讨下颌第三磨牙自发性近中移动的影响因素。结果:下颌第二磨牙后间隙增加(5.84±2.03) mm ( P<0.001);下颌第三磨牙自发性近中移动(4.67±2.87) mm ( P<0.001);远中直立2.90°±10.58° ( P＝0.026),垂直向变化(-1.27±2.43) mm ( P<0.001)。多因素回归分析显示,矫治前的第三磨牙Nolla stage分期越大(B＝0.26, P＝0.025),矫治中获得的磨牙后间隙越多(B＝0.82, P<0.001),第三磨牙距离 平面越近(B＝-0.272, P＝0.021),其自发性近中移动越大。 结论:正畸近中牵引下颌第二磨牙关闭拔牙间隙时,下颌第三磨牙会自发近中移动。发育更成熟、距离 平面更近以及萌出间隙增加更多的下颌第三磨牙自发性近中移动更多。     

Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials

PurposeTo investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) for the relief of inflammatory events (pain, edema, and trismus) after surgical removal of third molars.Materials and methodsA two-phase PROSPERO-registered systematic review was conducted in accordance with the PRISMA statement. PubMed, Scopus, Web of Science, COCHRANE, LILACS, DOSS, and gray literature were searched using the following terms (MeSH) or their combinations: molar, third; anti-inflammatory agents, non-steroidal; analgesia; preoperative period; pain management.ResultsFrom a total of 2903 articles, 31 (n = 2184 subjects) were selected. All studies presented a low risk of bias but exhibited high heterogeneity in methodology. Ten studies were selected for the meta-analysis. Preemptive analgesia for removal of third molars reduced average pain scores, especially those 1 h and 6 h after surgery (n = 151, p < 0.001, 95% CI = −2.81 to −0.97), reduced the average consumption of medication, and decreased the number of patients requiring medication without affecting the average time for its first consumption.ConclusionIn summary, most NSAIDs showed good results for inflammatory events and reduced average pain scores and consumption of rescue medication. However, more homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs and the relief of inflammatory events.     

Effect of clinical guidelines on practice for extraction of lower third molars: study of referrals in 1997 and 2000

We made a retrospective study of patient records for 3-month periods during 1997 and 2000 to assess changes in referral patterns and decision-making for extraction of lower third molars after publication of national guidelines. A total of 277 patients were referred to the department for extraction of lower third molars in 1997 and 234 in 2000 while overall referrals increased from 884 to 979. The number having extractions dropped from 243/277 (88%) to 190/234 (81%) of those referred (P=0.05) and of those operated on, bilateral removal dropped from 120/243 (49%) to 65/190 (34%) (P=0.002). The number of patients operated on under general anaesthesia reduced from 161/243 (66%) to 103/190 (54%) (P=0.01). However, women remained more likely to get treatment under general anaesthesia than men.In conclusion, there was a reduction in referrals for extraction of third molars, the proportion of referred patients having extractions, the number of bilateral operations, and changes in the choice of anaesthesia over the period of introduction of national guidelines on operations for third molars.