Periodontal healing after impacted lower third molar surgery. A retrospective study

The effect on periodontal tissues of lower third molar surgery, due to impaction or semi-impaction, has been investigated in a retrospective study comprising 215 cases. The post-operative examination took place 2 years after the surgical treatment and included both clinical and radiographic variables. Clinical registrations included the amount of plaque, and presence of gingivitis and periodontal pockets. The results showed a higher incidence of plaque, gingivitis and pockets on the distal surface of the second molar than on other surfaces of the first and second molars. The alveolar bone level distal to the second molar was registered by radiographic examination with a periodontal probe as indicator. 2 years post-operatively, 43.3% of the cases exhibited pocket depths exceeding 7 mm and 32.1% showed intrabony defects exceeding 4 mm. Some factors affecting the periodontal healing after lower third molar surgery are discussed.     

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.     

Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery

The aim of this study was to compare the effect of intramuscular (IM) injection and consumption of 8 mg dexamethasone in patients after lower third molar (LTM) surgery. 20 healthy Thai patients, average age 20 years, with bilateral LTM removal were recruited for this study, a double blinded, paired sample clinical trial. The washout period was 1 month after the first operation. Clinical assessment of facial swelling, pain and maximum mouth opening were measured before and after operation for 7 days. No significant difference was found in facial swelling between IM injection and consumption of 8 mg dexamethasone after LTM surgery (paired t test P>0.05). The visual analogue scale scores for pain assessment showed no significant difference between IM injection and consumption of dexamethasone (paired t test P>0.05). The results conclude that IM injection or consumption of dexamethasone after LTM surgery can be used to control facial swelling, pain and trismus.     

Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study

The effects of impacted lower 3rd molar surgery on periodontal tissues in the adjacent 2nd molar area have been investigated in a prospective study comprising 176 cases from 2 age groups: less than or equal to 20 years (n = 93) and greater than or equal to 30 years (n = 83), respectively. The preoperative and 1-year postoperative examinations included both clinical and radiographic variables. All patients were subjected to a standardized surgical procedure and optimal plaque control pre-, intra- and postoperatively. Early removal of impacted lower 3rd molars with large angulation and close positional relationship to the adjacent 2nd molar proved to have a beneficial effect on periodontal health.     

Antibiotic therapy in impacted third molar surgery

The use of routine antibiotic therapy in patients undergoing surgical third molar extraction is controversial. The efficacy of antibiotic therapy in preventing postoperative complications following surgical third molar extractions was evaluated in 141 patients. In the test group (66 patients), the protocol utilized a regimen of 2 g of amoxicillin orally daily for 5 d postoperatively, starting at the completion of surgery. In the control group (75 patients), no antibiotic therapy was given. No significant difference was found between the test group and the control group in the incidence of postoperative sequelae, i.e. fever, pain, swelling and alveolar osteitis. A statistically significant association between smoking, habitual drinking and increased postoperative pain and fever was found. Patient age > or = 18 yr was positively correlated with an increased incidence of alveolar osteitis. Swelling was found to be gender-related, in that female patients experienced more swelling than male patients. No correlation was found between the time required for surgery or difficulty of extraction and post-operative pain. In conclusion, no difference was found between patients receiving postoperative amoxicillin and the control group in the incidence of postoperative sequelae.     

Periodontal healing two and four years after impacted lower third molar surgery. A comparative retrospective study

The long-term effects on periodontal tissues of impacted lower 3rd molar surgery have been investigated in a retrospective study comprising 51 cases. The postoperative examinations took place 2 and 4 years after the surgical treatment and included both clinical and radiographic variables. Assessments were made regarding the oral hygiene status, gingival condition and periodontal tissue breakdown in terms of increased probing depths and intrabony defects. Comparing the results of the two examinations, no significant changes of the incidence of plaque and gingivitis were seen on the distal surface of the 2nd molar, nor any significant change concerning the probing depth. The proximal bone level distal to the second molar was recorded by radiographic examination with a cut-off periodontal probe as indicator. Two years postoperatively, 16.7% of the cases aged less than or equal to 25 years showed intrabony defects exceeding 4 mm, compared with 40.7% in the age group greater than or equal to 26 years. At the 4-year re-examination, the corresponding figures were 4.2% and 44.4%, respectively. The improvement concerning the alveolar bone level was mainly seen in individuals under 25 years. Some factors affecting the periodontal healing after impacted lower 3rd molar surgery are discussed.     

Atypical migration of an impacted lower third molar

This report describes the atypical migration of an impacted lower third molar tooth in a 42-year-old woman. Serial radiographs showed that, over a period of 13 years, the tooth migrated from its original disto-angular position posterior to and beneath the roots of the adjacent second molar to a more horizontal position beneath the roots of the first permanent molar. The tooth was surgically removed under general anaesthesia, with biopsy and curettage of soft tissue found in the bone posterior to the tooth along the path of migration. This pattern of tooth movement is highly unusual in an adult patient.     

前倾阻生的下颌第三磨牙在下颌第一恒磨牙缺失时的矫正

目的　为代偿下颌第一恒磨牙的缺失 ,将下颌第二、三磨牙前移到原第一、二磨牙的位置后 ,再将前倾阻生的第三磨牙矫正到正常位置并发挥正常功能。方法　用方丝弓固定矫治器将第二、三磨牙前移到第一、二磨牙的位置 ,再后推第三磨牙 ,解除第二磨牙对其的阻生 ,最后 ,后倾竖直该牙。结果　 9例前倾阻生的下颌第三磨牙在第一恒磨牙缺失时 ,通过该方法矫治 ,均成功地使第三磨牙竖直到正常位置。结论　下颌第一恒磨牙缺失后 ,可用矫正的方法使第二、三磨牙前移 ,分别代替原第一、二磨牙 ,前倾阻生的第三磨牙可以矫正     

Orthodontic techniques for uprighting the mesio-angularly impacted lower third molar

An impacted lower third molar can sometimes be uprighted orthodontically to provide a functional tooth. Many such cases can be managed by the interested GDP, although more complex mechanics are probably best left to the specialist. This article reviews the indications for treatment, and describes appropriate techniques.     

Marginal flap versus paramarginal flap in impacted third molar surgery: a prospective study

OBJECTIVE: A clinical prospective study was carried out to compare 2 flap designs-marginal and paramarginal-that are used during impacted third molar surgery. MATERIALS AND METHODS: Twenty-seven healthy patients (ages 17 to 31 years) who underwent surgical removal of 4 impacted third molars, including 54 lower and 54 upper, were included. A marginal flap was used in 1 randomly chosen half of the jaw, and a paramarginal flap was used in the other half. The influence of these flaps on wound healing, periodontal pocket depth of the adjacent second molar, pain, trismus, and swelling was studied. RESULTS: Wound dehiscences developed in 8 paramarginal flap cases, whereas none occurred with the use of a marginal flap. The buccal and distal probing depths of the adjacent second molar were significantly bigger in marginal flaps at 5 and 10 days after surgery. However, the probing depth was similar with the use of both techniques at 3 months. Pain, trismus, and swelling were similar with both techniques. CONCLUSIONS: We found no advantages to the use of a paramarginal flap instead of a traditional marginal flap for removing impacted third molars.     

Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery

This study aimed to investigate the effects of dexamethasone intramuscular injection 1h preoperatively, in reducing facial swelling, pain and trismus after lower impacted third molar (LITM) surgery. Twenty healthy Thai patients with both LITM surgical extraction were enrolled in the study. The washout period was 1 month after the first operation. Clinical assessment of the facial swelling, pain and trismus were measured before and after operation for 7 days and the patient's total analgesic consumption was recorded. The level of significance used in the statistical decisions was P<0.05. Preoperative intramuscular injection of single-dose 8mg dexamethasone reduced postoperative swelling after LITM surgical extraction significantly on the second postoperative day, but immediately after surgery and on day 7 after the surgical extraction, no significant difference was found between the dexamethasone and control groups. Dexamethasone also reduced postoperative pain after LITM surgical extraction significantly on postoperative days 2 and 7. Additionally, the amount of paracetamol decreased significantly. There were no significant differences in trismus in the study and control groups 7 days after LITM operation. Single-dose intramuscular injection of dexamethasone can reduce postoperative facial swelling and pain, without affecting trismus after LITM surgical extraction.