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1.
Anchal Prajapati Aalap Prajapati Swati Sathaye 《Journal of maxillofacial and oral surgery》2016,15(2):217-220
Aim and Objective
The aim of the study is to reinstate the fact that antibiotics are not required as prophylaxis for third molar surgery. So the standard of care after extraction of mandibular third molar surgery for all healthy patients should be a good anti-inflammatory regimen rather than a antibiotic prophylaxis.Context
Surgical removal of impacted mandibular third molar is the most common procedure and many complications are usually encountered in this procedure like—pain, trismus, infection, swelling, inflammation and nerve damage. Now, the question that arises is does the age old practice of prescribing postoperative antibiotics solve these problems or adds on some new. The data collected and analysed in our observational study, however, reinstates that instead, it is the proper aseptic precautions and good anti-inflammatory regimen that are more important than the prophylactic antibiotics (Pasupathy and Alexander in J Craniofac Surg, 2011). Moreover, giving antibiotics means opening up the loopholes to bacterial resistance.Settings and Design
A retrospective analysis of the data collected from 40 patients coming to the department of Dental and Implant Surgery, Karamsad, Anand between October 2014 and December 2014, operated for third molar surgery was carried out.Materials and Methods
Data from 40 patients requiring disimpaction of mandibular third molar was analysed. Postoperatively, only anti-inflammatory medication was prescribed to all the patients.Results
None of the patients showed any of the signs or symptoms of infection.2.
Objectives
Pre-operative radiographic evaluation of impacted mandibular third molar and inferior alveolar canal (IAC) is important in preventing a possible nerve exposure and damage during surgical removal. The present study analysed the relation of the mandibular third molar with inferior alveolar canal using panoramic radiography (PAN) and cone beam CT (CBCT) and evaluated the radiographic features suggestive of IAN exposure and post-operative paresthesia.Materials and Methods
PAN and CBCT findings of 53 impacted mandibular third molars having a close relation with IAC undergoing extraction were analysed. Further, all cases were evaluated for any sensory loss in relation to IAN 1 week post-operatively.Results
The most common PAN feature was combination of darkening of roots (DR) and interruption of white line (IWL), seen in 35.86% (19) cases. The most common CBCT feature was thinning of lingual cortex in 81.14% (43) cases. The most common location of IAC in CBCT was inferior in 47.16% (25) cases, followed by buccal 26.41% (14). On comparison of PAN and CBCT findings, DR and IWL both exclusively 92.86% (13); 80% (12) cases and in combination 75% (15) were most commonly associated with thinning of lingual cortex. IAN exposure was seen in 7.55% (4) cases, and 3.77% (2) cases reported with paresthesia. Absence of corticalisation and IWL was associated with all cases of nerve exposure, inter-radicular location of IAC seen in three out of the four cases. Cases with paresthesia had DR and deflection of roots (DEFR) with thinning of lingual cortex by roots.Conclusion
DR with DEFR or IWL in PAN as combination and inter-radicular location of IAC with thinning of lingual cortex by root tips in CBCT are highly predictive of nerve exposure and subsequent paresthesia.3.
Khalid E. El-Kholey 《Journal of maxillofacial and oral surgery》2017,16(1):90-95
Introduction
The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth.Methods
This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale.Results
Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.15).Conclusions
Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.4.
J. Venkat Narayanan Prashanthi Gurram Radhika Krishnan Veerabahu Muthusubramanian V. Sadesh Kannan 《Oral and maxillofacial surgery》2017,21(3):295-299
Aim
The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline.Materials and methods
A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias.Results
The pain scores in both groups were analyzed using the Mann–Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted.Conclusion
From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.5.
Background
Angle fractures are quite common considering that the angle of the mandible forms an area of lower resistance which contains a thicker upper border, a thin basilar bone, and the presence of an impacted mandibular third molar. Common complications of mandibular third molar surgery include alveolar osteitis (dry socket), secondary infection, nerve dysfunction, and hemorrhage. Reports of mandibular fracture during and after third molar removal are uncommon.Purpose
The purpose of this paper is to discuss the risk and predisposing factors that should be analyzed regarding the possibility of immediate and late mandibular angle fractures and their need for surgical treatment as a means through which to remove impacted molars. This study is based on a thorough review of the literature as well as on one immediate and one late mandibular angle fracture as described by the authors’ own personal experience.Conclusions
The danger of an immediate jaw fracture can be avoided by means of proper instrumentation and by refraining from excessive force on the bone. The tooth should be sectioned in such a way as to minimize the extent of bone removal and force caused by instrumentation. The danger of a late jaw fracture can be avoided by precise diagnosis in cases of patients over 25 years of age, particularly men, whose tooth roots are superimposed on or adjacent to the inferior alveolar canal on a panoramic image, any local pathology and systemic disease or medications which may impair bone strength, and patients who present bruxism and are active athletes.6.
Srimathy S. Arora Tanvi Phull Ish Kumar Arun Kumar Nilesh Kumar Hem Singh 《Oral and maxillofacial surgery》2018,22(2):225-230
Introduction
The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery.Methodology
A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day.Result
As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups.Conclusion
It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.7.
G. D. Nandini 《Journal of maxillofacial and oral surgery》2016,15(4):456-460
Objective
The objective of the study was to compare the efficacy of dexamethasone given intra-massetrically via intra buccal approach on postoperative sequele after surgical extraction of impacted mandibular third molars.Methodology
Twenty patients, each of who required surgical extraction of a single impacted mandibular third molar under local anesthesia, were randomly set apart to one of the two groups of ten each. The experimental group received dexamethasone 8 mg injected to the masseter muscle intra buccally and the control group did not receive any steroid. Facial swelling and maximal inter-incisal distance were measured by an independent examiner preoperatively, and at 4th h, on the day of surgery, 2 and 7 postoperative days. Pain was measured from the patient’s response to a visual analogue scale.Results
Patients were of the age range 18–40 years. Dexamethasone group showed significant reduction in swelling and pain compared with the control group at all intervals. Dexamethasone injected into the masseter muscle via intra buccal approach resulted in significantly less trismus than control on day one postoperatively.Conclusion
Dexamethasone 8 mg given intra-massetrically through intra buccal approach is an effective way of minimizing swelling, trismus, and pain following surgical extraction of impacted mandibular third molars. It offers a simple, safe, painless, non-invasive and cost-effective treatment.8.
Shital Patel Saloni Mansuri Faizan Shaikh Taksh Shah 《Journal of maxillofacial and oral surgery》2017,16(1):79-84
Aim
To study the incidence of mandibular third molar impaction in relation to type and side of impaction, age and sex of patients and indications for its surgical removal through data collected from a single institute over a period of 3 and half years.Methods
The records of 1198 patients who underwent the surgical removal of impacted mandibular third molars were reviewed retrospectively. Records were divided into groups according to sex, age, type and side of impaction. Radiographs were studied to determine angular position of impacted mandible third molar.Results
We found that there was a high incidence of mesioangular lower third molar impaction (33.97 %), highest number of patients were found in 15–30 years of age group (48.33 %), a left side (56.93 %) was more commonly involved, female predominance (63.44 %) was observed and recurrent pericoronitis (33.81 %) was the most common indication.Conclusion
Awareness of the indications for surgical removal of impacted mandibular third molar to the patients will help to avoid future risk of complications and morbidity associated with the same. This will not only help in saving time and money but also prevents the psychological trauma associated with delayed treatment. Removal of only symptomatic IMTM seems to be the logical choice in view of financial constraint in developing countries like India but at the same time early removal offers freedom from future complications in selected cases. So surgeons should apply a meticulous approach in selecting the patients for SRIMTM.9.
Marcelo Bonifácio da Silva Sampieri Francisca Lívia Parente Viana Camila Lopes Cardoso Márcia Ferreira Vasconcelos Maria Helena Ferreira Vasconcelos Eduardo Sanches Gonçales 《Oral and maxillofacial surgery》2018,22(2):163-168
Objectives
The root anatomy and position of mandibular third molars are important factors in assessing the level of difficulty of surgical removal procedures. In this light, this study aims to identify the most frequent position and the root anatomy of mandibular third molars.Methods
The study sample comprised 1205 mandibular third molars from 710 panoramic radiographs evaluated. Regarding the position, all of them were based on Pell and Gregory’s and Winter’s classifications. The root anatomy was classified according to the type and number of roots, as well as the presence of laceration, fusion, or divergence. Gender and the quadrant were also considered. Following an interexaminer analysis, a statistical analysis was performed using the Kappa test.Results
The results showed that the IA (40.3%) and mesioangular (53.8%) position was predominant in mandibular third molars. Regarding the anatomy, the most common were two roots (98.3%), of the conical simple type (88.9%), with absence of laceration (89.2%), divergence (84%), and fusion (80%).Conclusion
The present study showed that the most prevalent mandibular third molar type in Brazilian patients was the IA and mesioangular position, with simple root anatomy. The result of this study can assist oral surgeons to better plan and assess the level of difficulty of surgical removal procedures.10.
Objective
Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery.Materials and methods
Retrospective case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation. Statistics are as follows: logistic and correlation analyses (P < 0.05).Results
Sixty-five patients with lingual nerve damage were included in the study. Improved two-point discrimination was associated with small size of resected tissue (P = 0.0275). No normal appearing distal nerve tissue was associated with improved sum score of perception (P = 0.0185), higher final sum score of perception value (P = 0.0475) and final pain perception (P = 0.0324). Foreign body reaction was associated with no final pain perception (P = 0.0492).Conclusions
Small size, absence of distal nerve tissue, and no foreign body reaction were associated with improvement of the neurosensory functions.Clinical relevance
Histological parameters of the traumatic neuromas in routine preparation appeared to have some prognostic value for neurosensory functions as improvement of the neurosensory functions was associated with small size of resected tissue, no distal normal appearing nerve tissue, and no foreign body reaction.11.
Joseph Edward Mubarak A. Aziz Arjun Madhu Usha Jyothi K. Narayanan 《Journal of maxillofacial and oral surgery》2017,16(4):424-429
Introduction
Extractions are routine procedures in dental surgery. Traditional extraction techniques use a combination of severing the periodontal attachment, luxation with an elevator, and removal with forceps. A new technique of extraction of maxillary third molar is introduced in this study—Joedds technique, which is compared with the conventional technique.Methods and Material
One hundred people were included in the study, the people were divided into two groups by means of simple random sampling. In one group conventional technique of maxillary third molar extraction was used and on second Joedds technique was used. Statistical analysis was carried out with student’s t test.Results
Analysis of 100 patients based on parameters showed that the novel joedds technique had minimal trauma to surrounding tissues, less tuberosity and root fractures and the time taken for extraction was <2 min while compared to other group of patients.Conclusion
This novel technique has proved to be better than conventional third molar extraction technique, with minimal complications. If Proper selection of cases and right technique are used.12.
M. Shyamala C. Ramesh V. Yuvaraj V. Suresh R. SathyaNarayanan T. S. Balaji M. Neil Dominic B. Nithin Joseph Jude 《Journal of maxillofacial and oral surgery》2016,15(1):99-105
Objectives
To compare the effectiveness of bupivacaine with adrenaline with that of carbonated bupivacaine with adrenaline on pain, onset of anesthesia and duration of anesthesia following surgical removal of impacted mandibular third molar.Study design
All the patients who underwent surgical removal of impacted mandibular third molar and who fulfilled our inclusion and exclusion criteria from 1st June 2013 to 30th June 2014 were included in our study. Patients who were diagnosed as having impacted mandibular third molar were randomly allocated to two groups namely group A (bupivacaine with adrenaline), group B (carbonated bupivacaine with adrenaline). Pain during deposition of local anesthetic, onset of anesthesia and duration of anesthesia were compared between the two groups. The collected data were subjected to statistical analysis by Chi Square test, Mann–Whitney U test.Results and conclusion
The efficacy of carbonated bupivacaine with adrenaline is more compared with bupivacaine with adrenaline in decreasing pain on deposition of local anesthetic solution and in rapid onset of anesthesia. The duration of anesthesia for carbonated bupivacaine with adrenaline and bupivacaine with adrenaline had no significant difference. The use of carbonated bupivacaine with adrenaline will reduce the patient discomfort both intra-operatively and post-operatively.13.
Amith Hadhimane Manjunath Shankariah Kiran V. Neswi 《Journal of maxillofacial and oral surgery》2016,15(2):156-163
Purpose
In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars.Methods
Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision.Results
The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p < .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p > .05) on the 1st, 3rd and 7th post-operative days.Conclusion
The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.14.
Mounzer Assad Maysaa Alkhaled Mohammed N. Alhajj 《Journal of maxillofacial and oral surgery》2018,17(1):84-88
Background
Oroantral fistula (OAF) is considered a frequent complication in dental practice. Many surgical techniques/methods have been proposed to close it. The aim of this study was to evaluate the auto-transplantation of upper third molar for closing OAF.Materials and Methods
Twenty patients participated in this study aged between 20 and 40 years old. The OAF was closed by auto-transplantation of upper third molar placed directly in the socket of the extracted tooth. Results were evaluated clinically and radiographically through the period of observation which lasted for 1 year.Results
Final results showed that the success rate of closing OAF was 95% while the success rate of upper third molar auto-transplantation was 90%.Conclusion
This technique is simple, applicable, provides immediate replacement of the missing tooth, and does not require complicated instruments or procedures.15.
Ritesh Rajan Dinesh Kumar Verma R. M. Borle Abhilasha Yadav 《Oral and maxillofacial surgery》2016,20(2):191-194
Purpose
The purpose of the present study was to find, if there exists, a co-relation between presence of unerupted mandibular third molar and fracture of mandibular condyle.Methods
A retrospective, multicenter study was done collecting the data of all mandibular condyle fractures treated from November 2006 till August 2015. Data was collected from the patient’s records and radiographs for the following information: age, sex, etiology of fracture, presence and state of lower third molars, and associated fracture. The results were subjected to statistical analysis.Results
Out of 180 patients of condylar fracture, unerupted third molars were present in 35 (19.44 %) cases compared to 145 (80.55 %) cases of condylar fracture where the unerupted third molars were not present. The difference was statistically significant (p < 0.05). In the unerupted third molar present group, isolated bilateral condylar fracture was seen in 4 (11.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 9 (25.7 %) cases, isolated unilateral condylar fracture in 0 (0.0 %) cases, and unilateral condylar fracture associated with other mandibular fractures in 17 (48.5 %) cases and condylar fracture associated with mid face fractures in 5 (14.2 %) cases. In the unerupted third molar absent group, isolated bilateral condylar fracture was seen in 5 (3.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 30 (20.6 %) cases, isolated unilateral condylar fracture in 24 (16.5 %) cases, unilateral condylar fracture associated with other mandibular fractures in 73 (50.34 %) cases, and condylar fracture associated with mid face fractures in 13(8.96 %) cases. The difference between the groups was statistically significant (p = 0.032).Conclusion
This study suggests that the fractures of mandibular condylar region have a significantly higher incidence in patients without an unerupted mandibular third molar.16.
Purpose
Different patterns of facial nerve branching within the parotid gland were detected, and these anatomical variations may affect the treatment approaches and outcomes of surgery. The aim of this study was to identify the patterns of facial nerve branching with the parotid gland and their importance in surgical procedures.Materials and methods
A total of 43 patients undergoing surgical treatments of parotid lesions were included in this study. Each patient’s demographic data and type of operation were recorded. In addition, the courses of the facial nerve within the gland were classified into six types according to their branching patterns and communication.Results
In all of the patients, the facial nerve consisted of one trunk separated into two divisions. Branching type III was the most common variety found (30.2 %) followed by type II (23.2 %), while type V represented the least frequent pattern (4.6 %).Conclusion
It is essential for surgeons to become familiar with the different types of nerve morphologies in order to avoid morbidity and preserve the facial nerve during surgery. Variations and anastomosis can explain the different consequences of facial nerve injury that may occur after parotid surgery.17.
Nanjappa Madan Kateel Shashidhara Kamath A. L. Gopinath A. Yashvanth Nagaraj Vaibhav G. Praveen 《Journal of maxillofacial and oral surgery》2017,16(2):186-191
Introduction
Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. The Gow-Gates technique is an useful alternative to the classical inferior alveolar nerve block and the incidence of unsuccessful anesthesia may be as high as classical technique. The aim of this study is to compare the clinical efficacy, degree of patient acceptability, advantages, disadvantages and limitations of the classical and Gow-Gates techniques for providing anesthesia in patients undergoing bilateral symmetrical surgical removal of impacted mandibular third molar under local anesthesia.Material and Methods
The split mouth design study was conducted on 100 patients aged between 20 to 40 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar performed by the same maxillofacial surgeon. 2 ml of 2 % lignocaine hydrochloride with 1:80,000 adrenaline was used as a standard local anesthetic solution in all the cases. By using four-digit numbers from a random number table, either Gow-Gates or classical inferior alveolar nerve block were randomly assigned to either left or right sides in each patient. The injections were administered by another surgeon who was blinded to the experiment. The patient was assessed for Pain experienced during injection, frequency of positive aspirations, Onset and duration of anesthesia and Nerves anesthetized.Results
Results were statistically analyzed by Mann–Whitney and chi square test. A ‘P’ value of less than 0.05 was considered for statistical significance. Higher mean pain during injection was recorded in classical group, was found to be statistically significant. No significant association was observed between aspiration and the groups. Higher mean onset of anesthesia was recorded in Gow-gates group, was found to be statistically significant. Higher mean duration of anesthesia was recorded in Gow-gates group, was not statistically significant. Higher success rate was recorded in Gow-gates group and was statistically significant.Conclusion
If we ignore delayed onset of anesthesia of Gow gates technique, it is found to be more reliable, beneficial and have higher success rate than classical inferior alveolar nerve block technique.18.
Satishkumar G. Patil Bindu S. Patil Udupikrishna Joshi B. M. Rudagi Aafreen Aftab 《Journal of maxillofacial and oral surgery》2017,16(2):212-218
Background and Purpose
The dislocation of mandibular condyle is a clinical condition in which the head of condyle has been displaced out of the glenoid fossa. Complete dislocation of the mandibular condyle can occur in anterior, posterior, lateral and superior direction. Among these dislocations, bilateral superolateral dislocation of mandibular condyles is quite rare and often misdiagnosed. Because of its rare occurrence and unusual clinical course, the best treatment is debatable.Patients and Method
We present the first case series of true bilateral superolateral dislocation of intact mandibular condyles (Type 2B) without fracturing the Zygomatic arch, associated with symphysis fracture.Conclusion
This article intends to provide information regarding the possible biomechanics and management of bilateral superolateral dislocation of mandibular condyles associated with symphysis fracture.19.
Mario Alberto Isiordia-Espinoza Othoniel H. Aragon-Martinez Ronell E. Bollogna-Molina Ángel J. Alonso-Castro 《Journal of maxillofacial and oral surgery》2018,17(2):142-149
Purpose
The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.Materials and Methods
The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.Results
Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.Conclusion
The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.20.