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.     

Effect of preoperative prednisolone on clinical postoperative symptoms after surgical extractions of mandibular third molars

Background: This study compared postoperative symptoms in patients treated preoperatively with a single dose of ≤20 mg oral steroid during third molar surgery. Methods: A total of 450 patients were categorized randomly into three groups containing 150 patients each. Patients were in their second or third decade and had no specific medical history and findings involving infections of the mandibular third molar area. Two groups received preoperative steroids orally one hour before the operation; one group received 10 mg prednisolone and the other received 20 mg. No steroids were administered to the control group. Patients were asked to report by questionnaire any changes in postoperative symptoms, such as pain, facial oedema, or gastrointestinal disorders, and in masticatory disorders, trismus, or swallowing discomfort. They reported daily from days 1 to 6 post‐extraction by evaluating their experience over the preceding 24 hours. Results: A single preoperative oral administration of ≤20 mg prednisolone had no significant effect on postoperative symptoms of pain, facial oedema, or gastrointestinal upset, or on masticatory symptoms, trismus, or swallowing discomfort in mandibular third molar surgery. Conclusions: A single oral dose of ≤20 mg prednisolone before third molar extraction may not be helpful for the relief of postoperative symptoms.     

减数磨牙矫治设计中第三磨牙相关问题的考量

正畸治疗时常会选择拔除无法保留或保留预后较差的第一或第二磨牙,或者主动减数健康的磨牙以利于纠正颌骨不调的问题.此时第三磨牙的牙根发育状况,能否顺利萌出并成功代替第二磨牙行使功能,以及如何正畸牵引阻生的第三磨牙,均是正畸治疗的难点.本文就减数磨牙矫治设计中影响第三磨牙发育及萌出的相关因素作一综述.     

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。     

拔除病变第一磨牙后上、下颌第三磨牙正畸近移疗效比较

目的探讨拔除病变第一磨牙后上、下颌第三磨牙近移进行正畸治疗的效果。方法收集20例第一磨牙病变同时需要进行正畸治疗的患者,平均年龄18.6岁。根据患者口内情况将患者分为2组,每组10例。第一组上颌无明显拥挤,仅拔除病变的上颌第一磨牙,下颌拔牙或非拔牙矫治;第二组下颌无明显拥挤,仅拔除病变的下颌第一磨牙,上颌牙列拔牙或非拔牙治疗。全部病例均采用方丝弓矫治器,排齐整平牙列,关闭拔牙间隙,精细调整咬合关系。结果 20例患者都达到良好的矫治效果,双侧的磨牙、尖牙均达到良好的咬合关系。上颌第三磨牙前移平均8.8个月,平均近移7.94mm;下颌第三磨牙前移平均9.7个月,平均近移7.12mm。结论上、下颌由于存在骨质结构的差异,拔除无法保存的第一磨牙后,上颌第三磨牙近移比下颌磨牙较快。扶正簧的使用使倾斜的下颌磨牙得以直立。     

Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: a randomised controlled trial

We randomised 119 patients who had been referred for removal of partially impacted mandibular third molars to be given either metronidazole 1600 mg or placebo as a single dose 45 min before operation. Ten of the fifty-nine patients who were given metronidazole and 13 of the 60 given placebo developed dry sockets. Two variables were significantly associated with the development of a dry socket: pericoronitis and oral contraceptives.     

Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial

To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p < 0.01). Pain scores had also reduced significantly at seven days (p < 0.01), but not at 48 hours, and patients had lower levels of food impaction (p < 0.01) and less severe symptoms (p = 0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.     

Bad splits in bilateral sagittal split osteotomy: A retrospective comparative analysis of the use of different tools

This study aims to analyse the relationship between the incidence of bad splits and the surgical tools adopteded to perform bilateral sagittal split ramus osteotomy (BSSRO).BSSROs performed by the same experienced surgeon period were reviewed, retrospectively. The patients were divided into three groups according to the surgical instrument used to perform the osteotomy: a Lindemann burr, reciprocating saw or piezosurgery. Among the 1120 BSSROs performed, 5 bad fractures were detected during the observation period: 3 among patients operated with the Lindemann burr (0.8%) and 2 among those operated with a reciprocating saw (0.5%). There was no significant correlation between the bad split rate and age and gender of the patients, the type of malocclusion or the type of instrument used to perform the osteotomy.Within the limitations of the study it seems that the the choice of the osteotomy tool for BSSRO does not influence the rate of bad fractures and, therefore, the selection of the osteotmy tool should be left to the discretion of the surgeon.     

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.     

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.     

Dental age assessment based on the radiographic visibility of the periodontal ligament in lower third molars in a Thai sample

The objective of the present study was to analyze the radiographic visibility of the periodontal ligament in completed root formation lower third molars in a sample of lower northern Thai population. Digital panoramic images from 800 patients with ages ranging from 16 to 26 years were used in this study. The visibility status of the periodontal ligament of lower third molars with completed root formation including apical closure was assessed. For each stage, the minimum age, maximum age, median, mean, and standard deviation were calculated. The minimum age found in stage 0 was 16.17 years in males and 17.00 years in females. Stage 1 was first achieved at the age of 16.17 years in males and 17.08 years in females. The earliest onset of stage 2 was 17.00 years in males and 18.17 years in females. The incidence of stage 3 was first observed at 19.17 years in males and 18.83 years in females. It may be concluded that the radiographic visibility of the periodontal ligament in lower third molars may be a useful approach in the dental age assessment in a Thai population. In case the periodontal ligament visibility is found to be in stage 2, it may be confirmed that the individual is at least 18 years of age.     

A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars

Routine use of a palatal injection for the removal of maxillary third molars has never been validated. The purpose of this blinded, randomized, controlled trial was to assess the requirement of a separate palatal injection for the extraction of maxillary third molars. Fifty-one patients requiring the removal of bilateral maxillary third molars were enrolled. Each patient acting as their own control received buccal infiltrations of lignocaine bilaterally, then 0.2 mL of lignocaine without vasoconstrictor was administered to one side of the palate and the same amount of normal saline administered to the other side. Sides were randomized as to the active ingredient and both the patient and operator were blinded. All extractions were performed by a single operator using a consistent technique and no additional sedative or anaesthetic agents were utilized. Data relating to the pain of the extractions and of the palatal injection were obtained on a Visual Analogue Scale (VAS). Verbal Response Scale (VRS) data were obtained additionally for a subset of 21 patients. Statistical analysis confirmed clinical equivalence between saline and lignocaine to the palate (95% CI -1.7 to 6.2mm, equivalence range -6.75 to 6.75 mm). No patients requested additional lignocaine to the palate in order to ensure comfortable extraction. This study provides evidence that the poorly tolerated palatal injection of local anaesthetic for the removal of maxillary third molars may not be required.     

Influence of BSSO surgical technique on postoperative inferior alveolar nerve hypoesthesia: A systematic review of the literature

ObjectiveThe aim of this study was to evaluate the influence of different splitting techniques, namely, “mallet and chisel” versus “spreading and prying”, used during bilateral sagittal split osteotomy (BSSO) on postoperative hypoesthesia outcomes.Study designWe systematically searched the PubMed and Cochrane databases (from January 1957 to November 2012) for studies that examined postoperative neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) after BSSO.ResultsOur initial PubMed search identified 673 studies, of which, 14 met our inclusion criteria. From these 14 studies, 3 groups were defined: (1) no chisel use (4.1% NSD/site), (2) undefined chisel use (18.4% NSD/site), and (3) explicit chisel use along the buccal cortex (37.3% NSD/site).ConclusionStudy heterogeneity and a frequent lack of surgical detail impeded our ability to make precise comparisons between studies. However, the group of studies explicitly describing chisel use along the buccal cortex showed the highest incidence of NSD. Moreover, comparison of the study that did not use chisels with the 2 studies that explicitly described chisel use revealed a possible disadvantage of the “mallet and chisel” group (4.1% versus 37.3% NSD/site). These results suggest that chisel use increases NSD risk after BSSO.     

Palatal anaesthesia for the removal of maxillary third molars as practised by oral and maxillofacial surgeons in Australia and New Zealand

BACKGROUND: Injections of local anaesthetic to the palate are well known to be poorly tolerated. The absolute requirement of a palatal injection for the removal of maxillary third molars has never been investigated. The aim of this study was to document the current practice of palatal anaesthesia for extraction of these teeth with local anaesthesia as practised by oral and maxillofacial surgeons. METHODS: A postal survey was sent via the ANZAOMS office to all oral and maxillofacial surgeons who were members of the Australian and New Zealand Association, a total of 131. A response rate of 64 per cent (n = 84) was achieved. The frequency of administration and the factors that determined the decision to administer a palatal injection were assessed, as well as the methods employed for reducing the injection discomfort. RESULTS: The majority (77 of the 84) "always" gave a palatal injection for the removal of maxillary third molars, four respondents administered an injection "most of the time", and two respondents "occasionally". Significantly, one respondent "never" gave a palatal injection. The majority (76 per cent) utilized at least one adjunct in order to reduce the discomfort of the injection. CONCLUSIONS: The results of this survey suggest that for removal of maxillary third molars the requirement of the poorly tolerated palatal injection may not be absolute as conventionally taught and demonstrates the need for further investigation.     

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。     

2种方法在下颌水平阻生第三磨牙拔除中的比较

目的比较舌侧骨板劈开法与高速手机裂钻去骨法拔除下颌低位水平阻生第三磨牙的效果。方法将150颗下颌低位水平阻生第三磨牙随机分成2组, 每组75颗,分别采用舌侧骨板劈开法和高速手机裂钻去骨法拔除,记录手术时间及并发症情况并进行统计学分析。结果舌侧骨板劈开法和高速手机裂钻去骨法拔除下颌阻生第三磨牙的手术时间分别为（35.85±6.05）min和（43.52±7.70）min（P<0.05）。2种手术方法在骨折片去除、面部肿胀方面有统计学差异（P<0.05）,在牙龈撕裂、术后疼痛、张口受限、术后出血方面无统计学差异（P>0.05）。2种手术方法术后均未出现舌神经损伤及下唇麻木,高速手机裂钻去骨法发生干槽症1例。结论采用舌侧骨板劈开法拔除下颌低位水平阻生第三磨牙的手术时间短,且术中、术后并发症较少。     

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain,swelling, and mouth opening after surgical removal of impacted third molars: a randomized,controlled clinical trial

The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 32), ibuprofen (n = 33), or celecoxib (n = 33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6 h (P < 0.001), 12 h (P = 0.011), and 24 h (P = 0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.     

埋伏阻生第三磨牙致第二磨牙牙根外吸收临床处理策略分析及病例报告

目的探讨对于埋伏阻生的第三磨牙导致第二磨牙牙根外吸收的治疗方案选择及预后分析。 方法纳入2019年1月至2021年12月期间于南方医科大学口腔医院因埋伏阻生第三磨牙导致相邻第二磨牙牙根外吸收而就诊的35例病例为观察对象,通过临床及锥形束CT（CBCT）检查,根据Ericson分类将吸收程度分为以下三类予以处理：（1）轻度吸收：16例。拔除阻生第三磨牙并在第二磨牙远中同期行骨移植术;（2）中度吸收：11例。拔除阻生第三磨牙同时保护其近中牙囊;（3）重度吸收：8例。拔除阻生第二磨牙,择期修复或行正畸治疗。于术后7 d、1个月及6个月对病例进行临床及影像学检查,随访术区及第二磨牙预后情况。 结果15例第二磨牙牙根轻度吸收及10例中度吸收病例术后6个月随访,CBCT显示牙根外吸收程度较术前无加重,第二磨牙牙髓活力正常;1例轻度吸收病例失访,1例中度吸收病例出现第二磨牙牙髓坏死;8例重度吸收病例在拔除第二磨牙后进行种植或正畸治疗。 结论通过术前CBCT检查可准确判断埋伏阻生第三磨牙导致第二磨牙牙根外吸收程度。对于牙根外吸收轻度及中度病例采用不同的干预方法可有效地阻断第二磨牙的牙根外吸收进程,且尽可能保留第二磨牙的牙髓活力。