冠周局部注射地塞米松预防下颌第三磨牙拔除术后并发症

目的评价拔牙术前或术后行地塞米松冠周局部注射（下颌第三磨牙颊侧组织,磨牙后三角区以及咀嚼肌区）在下颌第三磨牙拔除术后肿胀,疼痛及张口受限的预防效果。 方法对240例患者的下颌第三磨牙依照阻生类型进行三种方法拔除,对三组牙拔除方式的患者分别列为实验组（拔牙术前冠周局部注射地塞米松组和拔牙术后注射地塞米松组）和对照组（拔牙术前术后均未注射地塞米松）,对患者术后第1、3、7天进行随访分析,对患者肿胀指数,疼痛程度和张口受限程度进行统计,并作统计学分析。实验组之间,以及实验组与对照组之间的比较采用卡方检验,以P<0.05为差异有统计学意义。 结果在拔牙术后第1天和第7天,术前或术后冠周局部注射地塞米松组与未注射地塞米松组在肿胀指数,疼痛程度和张口受限程度差异无统计学意义（P>0.05）;术后第3天,术前或术后冠周局部注射地塞米松组较对照组在肿胀反应中具有更好的疗效（P<0.05）,在疼痛和张口受限程度中具有一定的预防、治疗效果（P>0.05）。术前或术后冠周局部注射地塞米松对拔牙后肿痛反应及张口受限程度差异无统计学意义。 结论拔牙术前或术后冠周局部注射地塞米松可有效的预防下颌第三磨牙拔除术后肿胀、疼痛反应以及张口受限的发生。     

类固醇类药物对下颌阻生智齿拔除术后肿痛及张口受限的影响

目的 探讨类固醇类药物对下颌阻生智齿拔除术后反应的影响。方法 39例病例随机分为无药组、术后口服地塞米松（DXM）组和术后局部注射强的松龙封闭组,观察三组术后反应。结果 三组术后张口受限度及疼痛分级差异无统计学意义。术后第2日DXM组较另两组肿胀分级程度低,但第7日时DXM组与封闭组间无差异。结论 类固醇药物对下颌阻生智齿拔除术后的张口受限及疼痛没有作用,术后口服DXM可减少水肿反应。     

Randomized clinical study comparing Piezoelectric Surgery with conventional rotatory osteotomy in mandibular third molars surgeries

PurposeThe aim of this study was to evaluate the performance and to assess the postoperative sequel and quality of life after removal of impacted mandibular third molars using piezoelectric surgery compared with conventional rotatory osteotomy.Patients and methodsA single blinded, randomized, control clinical study was performed. Sixty-three patients (44 males, 19 females) who presented with bilaterally asymptomatic impacted mandibular third molars were included in this analysis. Each patient was treated, at two separate sessions approximately 4 weeks apart, with a conventional rotatory hand piece on one side of the mandible and a piezoelectric device on the contralateral side. Patients were followed up on postoperative days 1, 3, 5, 7, and 15 to rate the pain, swelling and trismus. Inferior alveolar nerve paresthesia was evaluated up to 12 months postoperatively.ResultsThe severity of the pain, trismus and swelling using the piezosurgery were significantly different from the rotary group. In both groups, pain was most intense and peaked during the first post-operative day, while swelling and trismus reached peak levels on the third postoperative day. The piezoelectric procedure resulted in a significantly longer procedural duration compared to the rotatory surgery (P < 0.001).ConclusionPiezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems and can improve a patient’s quality of life. Thus, piezoelectric surgery might be a preferred modality for patients undergoing complicated surgical extraction of impacted lower third molars.     

Comparison of postoperative morbidity between piezoelectric surgery and conventional rotary instruments in mandibular third molar surgery: a split-mouth clinical study

Background The extraction of impacted third molar teeth is a common procedure in maxillofacial surgery. The aim of this study was to compare of piezoelectric surgical technique with the one with conventional rotary instruments in terms of edema, trismus and pain, in mandibular third molar surgery. Material and Methods 20 individuals with symmetrically impacted lower mandibular third molars and 40 teeth were included in the study. Third molars on the left side of each patient were removed with piezosurgery, while the counterparts on the right side were removed with conventional rotary instruments. Postoperatively, the same antibiotic, analgesic, and mouthwash were recommended to both groups. Ultrasound, edema, trismus measurements were performed before surgery, postoperative, postoperative day 2 and postoperative day 7. VAS scale was used to evaluate the pain. Results The average age of 20 individuals included in the study was found to be 21.85 ± 3.08 years. The operation time of the individuals who underwent the surgery with conventional rotary instruments was found to be 12 minutes 31.70 ± 167.03 seconds, and the operation time in the Piezosurgery group was 19 minutes 10.60 ± 306.59 seconds. There was no significant difference between the two groups in terms of trismus, edema, and pain. Conclusions Piezosurgery is a safe method that can be used in molar removal, but in this split-mouth study, it is not found advantageous in terms of postoperative morbidity due to the longer working time compared to the one performed with conventional rotary instruments. Key words:Edema, impacted third molar, pain, piezosurgery, trismus.     

A comparative study of the effect of using a rubber drain on postoperative discomfort following lower third molar surgery

The aim of this prospective randomized study was to evaluate the effect of using a rubber drain on postoperative pain, swelling and trismus after lower third molar surgery. Of 100 patients with impacted lower third molars referred for surgical extraction, there were 40 males and 60 females, aged 18-40 years (mean=26+/-6.2SD). The patients were randomly divided into two equal groups. In the experimental group, a Penrose rubber drain was inserted into the extraction socket near the buccal fold after surgery and left for 72 h. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, but without use of a rubber drain. Pain, swelling and trismus were evaluated at 24h, 72 h and 5 days postoperatively in both groups. The results of the study indicate that the use of a rubber drain reduces postoperative discomfort in the form of swelling and trismus after lower third molar surgery, but seems to have no effect on pain.     

The Effect of a Single Dose Prednisolone With and Without Diclofenac on Pain, Trismus, and Swelling After Removal of Mandibular Third Molars

PURPOSE: The purpose of this study was to evaluate the effect of a single intramuscular dose of prednisolone and the prednisolone-diclofenac combination on postoperative pain, trismus, and edema after the removal of third molars. PATIENTS AND METHODS: Forty-five patients who were to undergo surgical removal of lower third molars were studied. Patients were divided into 3 groups. In the first group, each patient was given 25 mg prednisolone intramuscularly immediately after surgery. In the second group, each patient was given 25 mg prednisolone and diclofenac intramuscularly immediately after surgery, and in the third group, each patient was given sterile saline solution as control group. Postoperative pain was evaluated by visual analogue scale on the day of surgery. Facial swelling and trismus were evaluated on postoperative days 2 and 7. ANOVA was used to analyze these data. RESULTS: Statistical analysis of the data indicated the prednisolone-diclofenac combination suppressed pain intensity in comparison with control (P < .05) at the 6-hour observation. Both the prednisolone and prednisolone-diclofenac combinations suppressed pain at the seventh postoperative hour in comparison with the control (P < .05). The prednisolone-diclofenac combination group also had a smaller loss of opening at postoperative days 2 and 7 in comparison with both the prednisolone and control groups (P < .05). Postoperative swelling was less in both the prednisolone and prednisolone-diclofenac combination groups, as compared with the control group (P < .05) at postoperative day 2. The prednisolone-diclofenac combination group also had a smaller swelling at postoperative day 7 in comparison with both the prednisolone and control groups (P < .05). CONCLUSION: It was determined that the combination of a single dose of prednisolone and diclofenac is well-suited to the treatment of postoperative pain, trismus, and swelling after dental surgical procedures and should be used when extensive postoperative swelling of soft tissue is anticipated.     

Efficacy of hyaluronic acid spray on swelling,pain, and trismus after surgical extraction of impacted mandibular third molars

The aim of this study was compare the efficacies of two oral sprays in reducing swelling, pain, and trismus after the extraction of impacted mandibular third molars. This prospective double-blind, randomized, crossover clinical trial included 34 patients with bilateral symmetrically impacted mandibular third molars of similar surgical difficulty. Hyaluronic acid or benzydamine hydrochloride spray was applied (two pumps) to the extraction area, three times daily for 7 days. Swelling was evaluated using a tape measure method, pain with a visual analogue scale (VAS), and trismus by measuring the maximum inter-incisal opening. Assessments were made on the day of surgery and on days 2 and 7 after surgery. Statistically significant differences were detected for the swelling and trismus values between the two treatment groups on the second postoperative day (P = 0.002 and P = 0.03, respectively). However, there was no statistically significant difference in VAS scores between the two groups. The administration of hyaluronic acid spray was more effective than benzydamine hydrochloride spray in reducing swelling and trismus. Although no evidence of a reduction in pain levels was detected, hyaluronic acid appears to offer a beneficial effect in the management of swelling and trismus during the immediate postoperative period following impacted third molar surgery.     

电动式微动力系统与气动式手机拔除下颌阻生第三磨牙的临床效果比较

目的 比较电动式微动力系统和气动式手机在下颌阻生第三磨牙拔除术中的临床效果。方法 对106例患者的212颗下颌双侧第三磨牙分2次拔除,采用随机、交叉、自身对照方法,分别采用电动式微动力系统和气动式手机进行阻生牙拔除术。记录并比较患者手术时间及术中、术后并发症发生情况。采用SPSS 21.0 软件包对数据进行统计学分析。结果 电动式微动力组手术时间较短,术后第1天肿胀、疼痛程度均轻于气动式手机组（P<0.05）。结论 电动式微动力系统拔除下颌阻生第三磨牙优于气动式手机,值得临床应用。     

臭氧油在下颌阻生第三磨牙拔除术后应用效果研究

目的    观察下颌阻生第三磨牙拔除术后局部涂抹臭氧油的临床效果。方法    选取2019年1-9月就诊于南京大学医学院附属口腔医院并拟拔除双侧下颌阻生第三磨牙患者45例,共计患牙90颗。采用随机自身对照的方法,将所有患牙分为臭氧油组和对照组。所有患者均采用微创牙拔除术,术后连续3 d,臭氧油组在手术创面及创面周围涂抹臭氧油,对照组给予抗生素口服。于术后1、3、7 d评估患者疼痛、肿胀、张口受限程度等舒适度相关指标。结果   术后1、3、7 d,臭氧油组患者的疼痛及肿胀程度明显低于对照组,臭氧油组患者的张口度明显优于对照组,差异均有统计学意义（均P < 0.05）。结论    局部涂抹臭氧油能够有效缓解下颌阻生第三磨牙拔除术后的疼痛、肿胀和张口受限程度。     

The efficacy of etodolac and ibuprofen,regarding gender,on pain,edema and trismus after impacted lower third molar surgery: A randomized prospective clinical split-mouth study

Background This study aimed to conduct a randomized prospective study about the efficacy of etodolac and ibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teeth extraction. Material and Methods Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of impacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac (300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during three days. Patients were evaluated regarding pain, trismus and edema. Results Sixteen men and fourteen women participated of the study. No statistical difference was established regarding gender according to the evaluated parameters. However, etodolac use showed better results regarding pain, trismus and edema. Conclusions Pain, edema and trismus after impacted third molars extraction were not influenced by gender. Key words:Molar, third; sex, tooth extraction.     

下颌阻生第三磨牙拔除术后疼痛、张口受限及肿胀之分析

目的：探讨下颌阻生第三磨牙拔除术后的疼痛，张口受限及肿胀与手术难度的关系。方法：收集124例下颌阻生第三磨牙拔除术的病例，按手术难度分为三组，分别于术后第二日及第七日分析三者之间的疼痛，张口受限及肿胀差异。结果：三组的大部分病例均发生了张口受限，疼痛及肿胀反应，术后第二日及第七日三组间张口受限差异无统计学意义，术后第二日，挺出组疼痛分级程度较其它两组轻，而切开组与去骨组疼痛的分级无差异；术后第七日，去骨组仍有疼痛的比例较高，而切开组与挺出组间则无差异，术后第二日及第七日，去骨组及切开组之肿胀分级均较挺出组为高，在去骨组与切开组间则均无差异。结论：下颌阻生第三磨牙拔除术后均有可能发生张口受限，疼痛及肿胀反应，张口受限与手术难度无关，软组织损伤小者。术后疼痛较轻，去骨无加重疼痛，但疼痛缓解较慢，软组织的损伤程度与肿胀的发生及缓解有关联，肿胀与是否去骨并无密切关系。     

下颌第三磨牙阻生两种拔除术的并发症比较

目的:对比两种方法拔除下颌阻生的第三磨牙在术中或术后出现并发症的情况,分析其可能原因及预防方法。方法:回顾分析我科分别用涡轮机钻法和凿劈法拔除的524例下颌第三磨牙阻生病例中,出现术中或术后并发症的131例病例。结果:采用涡轮机钻法拔除的298例病例中,出现术中或术后并发症的有53例,占17.8%;而采用凿劈法拔除的226例病例,出现术中或术后并发症的有78例,占34.5%。手术创伤大、保护措施不到位和术中产热量大,是造成手术并发症的重要原因。结论:涡轮机钻法拔除阻生的下颌第三磨牙可减少拔牙手术并发症,术中并发症的出现会导致和加重术后并发症的发生。     

Effect of the suture technique on postoperative pain,swelling and trismus after removal of lower third molars: A randomized clinical trial

Background

To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision.

Material and Methods

A prospective, randomized, crossover clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days post operatively.

Results

No statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group.

Conclusions

Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound. Key words: Third molar, surgical flaps, suture techniques, postoperative pain, swelling, trismus.     

A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery

The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18-38years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24h, 48h and 1week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p<0.05). There was significantly less pain, swelling and trismus at 24h and 48h, respectively, in the suture-less group (p<0.05). There was no significant difference between the two treatment groups in terms of pain, swelling and trismus, at 1week postoperatively (p>0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.     

Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

OBJECTIVE: This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars. PATIENTS AND METHOD: Two hundred and sixty seven women, aged 17 - 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis). RESULTS: Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017). CONCLUSIONS: The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.     

Comparison of the effect of naproxen,etodolac and diclofenac on postoperative sequels following third molar surgery: A randomised,double-blind,crossover study

Objectives: To compare the three non-steroidal anti-inflammatory agents (NSAIDs) diclofenac potassium, etodolac and naproxen sodium in relation to pain, swelling and trismus following impacted third molar surgery. Study Design: The study was a randomized and a double-blinded study which included 42 healthy young individuals with impacted third molars and bone retention. Patients were randomly assigned to 3 groups (n: 14) to which diclofenac potassium, naproxen sodium and etodolac were administered orally an hour before the operation. Impacted third molars were surgically extracted with local anaesthesia. Visual analog scales (VAS) were used to assess the pain in the 6th, 12th hours and on the 1st, 2nd, 3rd, 5th, and 7th days postoperatively. Swelling was evaluated using ultrasound (US) and mouth opening (trismus) was measured with a composing stick pre and post operatively on the 2nd and 7th days respectively. Results: Regarding pain alleviation, diclofenac potassium was better than naproxen sodium and naproxen sodium was better than etodolac but these differences were not statistically significant. US measurements showed that the swelling on postoperative 2nd day was significantly lowest with diclofenac potassium as compared to others (p= 0.027) while naproxen sodium and etodolac acted similarly (p=0.747). No difference was noted regarding trismus in any of the groups. Conclusions: NSAIDs (diclofenac, naproxen and etodolac) are somehow similarly effective for controlling pain and trismus following extraction of mandibular third molars but diclofenac potassium surpasses others in reduction of swelling. Key words:Diclofenac potassium, naproxen sodium, etodolac, impacted third molar surgery, pain, swelling, trismus.     

Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial

The aim of this study was to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars. A triple-blind, randomized, placebo-controlled clinical trial of 120 patients requiring the surgical removal of lower third molars was performed. The subjects were randomized into the experimental group (patients were administered 600 mg of ibuprofen (p.o.) 1h before the surgical procedure, followed by placebo just after the end of the operation) or into the control group (subjects received the same medication but the administration sequence was reversed). Pain was assessed using visual analogue scales, and consumption of rescue analgesic. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus. There was a slightly higher need for rescue analgesics in the experimental group. The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.     

Treatment with soft laser. The effect on complaints after the removal of wisdom teeth in the mandible

In a placebo controlled double-blind randomized study the effect of low level laser therapy on postoperative complaints after removal of lower third molars was examined. Several parameters were investigated in two groups of patients; in one group low level laser was applied during and following third molar removal, in the other no active additional laser treatment was given. The results of this study show that therapeutic low level laser treatment could not statistically reduce the postoperative pain, swelling, trismus and function impairment after extraction of lower third molars.     

Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial

The effect of endo-alveolar and sub-mucosal administration of dexamethasone sodium phosphate to prevent inflammatory sequelae after surgical removal of lower third molars was studied. Forty-three patients underwent bilateral extractions of lower third molars and were randomly assigned to receive either dexamethasone 4 mg (group A) or 10 mg (group B) as endo-alveolar powder or 10 mg as sub-mucosal injection (group C) unilaterally. The controlateral site served as control and did not receive any steroid administration. Facial edema, trismus and pain perception were evaluated at the 2nd and 7th postoperative day. A multivariate analysis revealed that treatment and ostectomy time were both significantly positively associated with the degree of postoperative trismus and edema. Other baseline classification variables (e.g., molar classification) were also predictive of the degree of change in all clinical parameters. Test sites treated (any steroid application) showed greater reductions in all clinical parameters recorded compared to control. No statistically significant differences were observed between the three test groups. Both sub-mucosal and endo-alveolar administration of dexamethasone are effective in reducing postoperative sequelae of surgical removal of lower wisdom teeth.     

Efficacy of secondary closure technique after extraction of third molars: a meta-analysis

The purpose of this study was to assess the influence of two suture methods on the postoperative complications of extraction of mandibular third molars (M3M). We searched the MEDLINE (PubMed), Cochrane Library, and Web of Science databases until 18 May 2018 for randomised controlled trials (RCT) that evaluated the influence of any suture techniques on postoperative complications after the removal of impacted M3M. Pain, facial swelling, and trismus were measured for both the early stage (2–3 days) and late stage (5–7 days) after extraction. We identified 655 records, of which five were assessed for eligibility. All trials included had a moderate risk of bias. The analysis showed that the patients whose wounds had been closed primarily had significantly more pain than those whose wounds were closed secondarily (a wedge of mucosa) during the early stage (standardised mean difference (SMD), ?0.49; 95% CI ?0.71 to ?0.27; P < 0.0001) and the late stage (SMD ?0.36; 95% CI ?0.54 to ?0.19; P < 0.0001) after the removal of impacted M3M. Patients whose wounds were closed secondarily had less swelling (mm) at the postoperative early stage (SMD ?1.12; 95% CI ?1.57 to ?0.66; P < 0.00001) and late stage (SMD ?0.51; 95% CI ?0.68 to ?0.33; P < 0.00001). There was more trismus in the primary closure group than in the secondary group during both stages. Our findings suggest that secondary closure causes less pain, facial swelling, and trismus in both early and late stages of surgical removal of impacted M3M, and therefore it improves the quality of life by reducing postoperative discomfort.