Bone regeneration after surgical repositioning of impacted mandibular second molars: a case report

Abstract  – A case is presented where the mesially impacted mandibular second molar teeth were surgically uprighted in an 11-year-old female patient. Bone regeneration is shown in the areas occupied by the impacted second molars with maturation of bone and cortication of the crest of the alveolar bone. The probing depths are also normal with no residual bony defects. This healing was achieved with no bone grafting procedure, emphasizing two important factors: to prevent/minimize any trauma to the tissues at the site of elevation and uprighting of the tooth (i.e. maintaining viable periodontal ligament cells and minimal cementum damage); and to obtain primary closure whilst allowing the tissue in the mesial defect to reorganize against the scaffold of bone. However, the procedure on the one side was complicated with necrosis and infection of the pulp space with external inflammatory root resorption. Endodontic therapy of this tooth proved to be successful with periradicular healing radiographically and re-establishment of the lamina dura. At the 3-year follow-up, the endodontically treated tooth showed no clinical and radiographic signs of pathology. The left second mandibular molar had no pulpal or periodontal postsurgical complications, which may be attributed to apparently more open apices allowing for pulp revascularization after manipulation at the time of surgery. This report illustrates unassisted wound healing that occurs in the area of uprighting with complete reconstitution of periodontal anatomy without additional regenerative procedures to augment bone.     

Healing following GTR treatment of bone defects distal to mandibular 2nd molars after surgical removal of impacted 3rd molars

AIM: The purpose of this study was to study the healing, following guided tissue regeneration (GTR) treatment, of bone defects distal to mandibular 2nd molars (M2s) after surgical removal of impacted mesioangularly or horizontally inclined third molars (M3s) in patients > or = 25 years. METHOD: 20 patients with bilateral soft tissue impacted M3s were included in the split-mouth study. The 2 sites to be treated in each patient were randomised before the 1st operation as to which would undergo the test procedure and which would be the control site. After surgical removal of M3 at test sites, a resorbable polylactic acid (PLA) barrier was attached to M2 to cover the post-surgical bone defect. The flap was then replaced and sutured to cover the barrier. Control sites underwent the same procedure, as did the test sites, with the exception that no barrier was placed. The clinical examinations performed were oral hygiene pre- and 12 months postoperatively and probing pocket depth 12 months postoperatively. The alveolar bone level (ABL) at the distal surface of the M2, as determined from radiographs taken at suture removal and 12 months postsurgery, was chosen to be the primary response variable. RESULTS: Most bone defects showed healing up to 10%-20% of the tooth length at both test and control sites. 2 test and 2 control sites showed no improvement in the bone level. The mean values of bone healing registered in mm from the cemento-enamel junction (CEJ) were 2.6 +/- 2.19 SD and 3.0 +/- 2.20 SD for test and control sites, respectively. Different factors affecting the healing result are discussed.     

Risks and benefits of removal of impacted third molars: critical review of the literature. 1]

Because of the ever-increasing enthusiasm that new graduates have demonstrated for practising minor oral surgery procedures, the authors believed that it would be useful to translate the results of a research project done in 1990 by Drs. David S. Precious and Paul Mercier, who are well-known oral and maxillofacial surgeons. This paper is about the risks and benefits associated with the removal of impacted third molars.     

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.     

Risks and benefits of removal of impacted third molars. A critical review of the literature.

A critical review of the literature about risks and benefits of the removal of impacted 3rd molar teeth is presented in 4 categories: risk of non-intervention, risk of intervention, benefit of non-intervention and benefit of intervention. There are well-defined criteria for removal of impacted 3rd molar teeth. Absolute indications and contra-indications for the removal of asymptomatic 3rd molar teeth cannot be established because no long-term studies exist which validate the benefit to the patient either of early removal or of deliberate retention of these teeth. The prudent course of action for the clinician to follow is based on rational clinical decision-making using traditional methods of evaluation to effect the optimal outcome, keeping the interests of the individual patient above all else.     

Interrelation of complaints after removal of impacted mandibular third molars

Swelling, pain and trismus were evaluated quantitatively after the removal of impacted mandibular third molars on 30 healthy individuals. Evaluation took place 48 h and 7 days after surgery. The mutual correlation between the complaints was determined as well as the correlation between the length of the operation and the degree of postoperative complaints. It is concluded from the study that the longer the operation takes, the more postoperative pain can be expected. However, neither swelling nor trismus is correlated with the length of time of the operation. The size of the swelling was not related to the degree of trismus or postoperative pain. A strong interrelation between postoperative pain and trismus indicates pain as the main reason for reduced mouth opening after removal of impacted mandibular third molars.     

Alveolitis sicca dolorosa after removal of impacted mandibular third molars

The aim of the investigation was to study the occurrence of alveolitis and other side effects in women taking oral contraceptives after surgical removal of impacted mandibular third molars. Reactions to surgical removal of 156 bilateral third molars were examined in 78 patients. The material was divided into 2 groups. In 1 group, the patients took oral contraceptives of the combined type and in the other group the patients took no contraceptives. Each group was further divided into 2 subgroups: (1) removal of a molar during menstruation; and (2) removal of the contralateral molar in the same patient at the middle of the menstrual cycle. The results showed significantly more alveolitis in the group taking oral contraceptives and in women who were operated on during menstruation. These findings would suggest that oral surgery involving fertile women should be undertaken during periods free from oral contraceptives and menstruation.     

Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study

Primary and secondary closure techniques after removal of impacted third molars were compared in terms of post-operative pain and swelling. Two hundred patients with impacted third molars were randomly divided into two groups of 100. Panoramic radiographs were taken to assess degree of eruption and angulation of third molars. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In Group 2 a 5-6 mm wedge of mucosa adjacent to the second molar was removed to obtain secondary healing. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. The statistical analysis (*analysis of variance for repeated measures, P < 0.05) showed that pain was greater in Group 1, although it decreased over time similarly in the two groups (P = 0.081, F(6,198) = 3.073*). Swelling was significantly worse in Group 1 (P < 0.001, F(6,198) = 44.30*). In Group 1, dehiscence of the mucosa was present in 33% of patients at day 7, and 2% showed signs of re-infection with suppurative alveolitis at 30 days. Pain and swelling were less severe with secondary healing than with primary healing.     

Efficacy of simvastatin in bone regeneration after surgical removal of mandibular third molars

Oral and Maxillofacial Surgery - The aim of this study was to assess the efficacy of simvastatin in bone regeneration in extraction sockets of mandibular third molars using cone beam computed...     

Comparative study of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars

Aim

Aim of the study is to compare the primary and secondary healing after surgical removal of impacted mandibular third molars, in terms of swelling, severity of pain, trismus, and periodontal healing between two types of closure.

Materials and methods

A total of 60 patients, divided into two groups randomly: group A, with 30 patients in which primary closure was done; group B, with 30 patients in which secondary closure was done. A comparison between two groups was done in terms of postoperative pain, swelling, trismus at first, third, and seventh postoperative days, and periodontal healing near adjacent second molar after 6 months.

Results

The swelling and pain in group A were greater than that in group B, with a statistically significant difference (p <?0.05). Mouth opening is greater in group B compared to group A. There is no significant difference in periodontal healing in between two groups after 6 months. Complication like alveolar osteitis was noted in 1 patient (3.3%) in group B.

Conclusion

We conclude that secondary closure was better than primary closure in terms of postoperative pain, swelling, and trismus. Irrespective of any closure technique, there is no difference in terms of periodontal healing.

     

完全埋伏阻生的下颌第三磨牙拔除术后第二磨牙远中骨缺损的修复

多数完全埋伏阻生的下颌第三磨牙由于紧邻第二磨牙,拔除术后常会出现相邻下颌第二磨牙远中骨质缺损,且多为拔除术前原有骨质缺损的进一步显现及加剧,故拔除术后可能出现第二磨牙远中牙周袋形成,甚至远中牙根吸收、龋坏等症状,严重时甚至会出现第二磨牙松动以致拔除的情况,故术后第二磨牙远中骨缺损的修复有重要意义。第二磨牙远中骨缺损量受多种因素影响,如年龄、拔除术前下颌第三磨牙阻生状态、手术方式等。目前针对第二磨牙远中骨缺损不同影响因素有多种预防方式及修复方式,主要为骨及骨替代材料移植、引导骨组织再生术、细胞活性成分移植等,不同修复方式均有不足之处,或经济成本高,或导致骨吸收影响新骨生成量,本文针对目前拔除完全埋伏阻生的下颌第三磨牙后,相邻第二磨牙远中骨缺损影响因素、预防及修复方法的研究进展作一综述。     

Vestibular bone window for the extraction of impacted lower third molars: four case reports

Four patients attending for the extraction of an impacted lower third molar are reported. The aim of this paper is was to describe a technical approach, which facilitates impacted lower third molar extraction, minimizing the ostectomy, thus reducing secondary postoperative manifestations and avoiding possible periodontal defects on the distal side of the second mandibular molar. To facilitate the extraction of the crown, roots or the complete molar, a small ostectomy in the form of a window can be made in the vestibular cortical, approaching the extraction through the resultant mesial space.