Inability to work after surgical removal of mandibular third molars

Inability to work after mandibular third-molar surgery was studied in 201 patients operated on in a specialist clinic. Mean indicated inability to work was 1.07 days; 95% confidence intend, 0.91-1.23 days; range, 0-6 days. Eighty-six (43%) patients did not indicate any reduction in working ability. Duration of operation more than 14 min, heavy smoking (> 19 cigarettes/day), and female sex were associated with prolonged inability to work Self-administered analgesic consumption and pain scores over the first postoperative week showed positive correlations with inability to work r = 0.44 and 0.41, respectively. Other indicators of the normal postoperative reaction were to a lesser extent associated with reduced ability to work Total sick-leave cost in Norway associated with surgical third-molar removals, adjusted for age-related income, employment rate, treatment rate, and provider of treatment, was 46.4 million NOK per year.     

Changes in quality of life after surgical removal of impacted mandibular third molar teeth

Background  

The decision to get impacted teeth removed is not straightforward because of the concerns about its possible outcome. Assessment of quality of life is now regarded as an essential component for assessing outcomes of dental health care. The purpose of this paper is to assess the effect of impacted third molar teeth surgery on a number of health related outcomes.     

Periodontal dressing after surgical crown lengthening: A randomized clinical trial

Objective. The aim of the present study was to evaluate the effect of periodontal dressing on post-operative pain and swelling after surgical crown lengthening. Materials and methods. A blind, randomized, clinical trial was carried out with 36 patients. Following surgical crown lengthening, the individuals were randomly allocated to the periodontal dressing group (PDG) and control group (CG, non-placement of periodontal dressing). Pain and discomfort were analyzed using a visual analog scale (VAS), verbal scale (VS) and the number of analgesics consumed in 7 days post-operatively. Post-operative infection, stability of the gingival margin and type of healing were also evaluated. Results. The PDG had a significantly higher percentage of responses of ‘strong pain’ on the VS in the first day post-operatively (33.3% vs 5.3%, p = 0.03) and greater pain on the first and second days post-operatively based on the VAS. Moreover, a significant difference between groups was found regarding gingival swelling after 7 days. However, gingival recession was found in 57.8% of the sites in the CG and only 5.5% of sites in the PDG. No change in condition was found among individuals with conjunctive tissue/bone exposure in the CG in the immediate post-operative period and 80% of the patients in the PDG had healing by first intention after 7 days. Conclusion. The use of periodontal dressing seems to be preferable following surgical crown lengthening with connective tissue/bone exposure. However, adequate post-operative analgesic strategies should be employed due to the possibility of intense pain in the first 24 hours.     

Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans

Aim: The aim of the present study was to evaluate the outcome of a surgical procedure based on pocket elimination and bone re‐contouring for the treatment of peri‐implantitis. Material and methods: The 31 subjects involved in this study presented clinical signs of peri‐implantitis at one or more dental implants (i.e. ≥6 mm pockets, bleeding on probing and/or suppuration and radiographic evidence of ≥2 mm bone loss). The patients were treated with a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following the surgery. At the time of surgery, the amount of bone loss at implants was recorded. Results: Two years following treatment, 15 (48%) subjects had no signs of peri‐implant disease; 24 patients (77%) had no implants with a probing pocket depth of ≥6 mm associated with bleeding and/or suppuration following probing. A total of 36 implants (42%) out of the 86 with initial diagnosis of peri‐implantitis presented peri‐implant disease despite treatment. The proportion of implants that became healthy following treatment was higher for those with minor initial bone loss (2–4 mm bone loss as assessed during surgery) compared with the implants with a bone loss of ≥5 mm (74% vs. 40%). Among the 18 implants with bone loss of ≥7 mm, seven were extracted. Between the 6‐month and the 2‐year examination, healthy implants following treatment tended to remain stable, while deepening of pockets was observed for those implants with residual pockets. Conclusion: The results of this study indicated that a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following surgery was an effective therapy for treatment of peri‐implantitis for the majority of subjects and implants. However, complete disease resolution at the site level seems to depend on the initial bone loss at implants. Implants with no signs of peri‐implantitis following treatment tended to remain healthy during the 2‐year period, while a tendency for disease progression was observed for the implants that still showed signs of peri‐implant disease following treatment. To cite this article:
Serino G, Turri A. Outcome of surgical treatment of peri‐implantitis: results from a 2‐year prospective clinical study in humans.
Clin. Oral Impl. Res. 22 , 2011; 1214–1220.
doi: 10.1111/j.1600‐0501.2010.02098.x     

A comparative clinical study of three periodontal surgical techniques

Abstract A comparative 4-month trial was performed after initial preparation. The procedures used were curettage, replaced flap and apically repositioned flap procedures with osseous recontouring respectively in a split-mouth technique in 17 male and 23 female patients, 22 to 65 years old. Changes were assessed with plaque and gingival indices, and measurements of pocket depths, attachment levels and tissue contours. All procedures reduced pocket depths. Apically repositioned flaps were the most successful, reducing overall mean pockets from 3.5 to 1.9 mm. Changes in attachment levels post-operatively showed only a small degree of variation among the three surgical procedures, and would not affect the choice of the apically repositioned flap as the most effective method for pocket reduction. A marked improvement in tissue contour was obtained in those areas treated by apically repositioned flap procedures and osseous recontouring. Despite failure to improve tissue contour, replaced flap procedures showed an equal degree of success in maintaining plaque control when compared to apically repositioned flaps, as evidenced by static plaque indices. Replaced flap procedures were also the only group to show improved gingival health over the 4-month post-operative period with lower gingival indexes. It would seem that good healing, followed by a high standard of oral hygiene, may overcome the presence of gingival and marginal osseous deformities.     

Complications of computer-aided-design/computer-aided-machining-guided (NobelGuide) surgical implant placement: an evaluation of early clinical results

Purpose: The aim of this study was to evaluate early clinical results of computer-aided design (CAD)/computer-aided machining (CAM)-guided surgical implant placement (NobelGuide™, Nobel Biocare, Yorba Linda, CA, USA) with focus on surgical and/or prosthetic complications, management, and prevention.
Materials and Methods: Thirteen patients rehabilitated between March 2003 and October 2006 with CAD/CAM-guided dental implants and immediate loading (NobelGuide, Nobel Biocare) were evaluated. The treatment planning and procedures were carried out in accordance to the system protocol. The complications encountered in this case series were classified and assessed according to early (planning and procedural – surgical; prosthetic) and late complications (surgical; prosthetic).
Results: The prosthetic complications outnumbered surgical complications both in the early and late treatment phases. The main early surgical complication was bony interference that prevented complete seating of the prostheses. Most of the late surgical complications were implant failures with an overall failure rate of 9%. Fracture of the carbon fiber framework prosthesis was the main late prosthetic complication.
Conclusions: The NobelGuide system is a reliable treatment modality, but not without its complications. Strict adherence to the system protocol is the key prevention of complications.     

Assessment of clinical ability in the removal of teeth among undergraduate dental students: a longitudinal comparative study

To evaluate the clinical ability of undergraduate students to remove teeth, we have developed a new, structured, and objective assessment scale including 11 items that measure the various skills required on a visual analogue scale (VAS). We did a pilot study to validate the new format and included 10 students, each one of whom was rated by three examiners. The assessment form was then used to evaluate the ability of students taking teeth out throughout the academic year 2017–2018. Results showed high inter-examiner reliability, significant correlation of mean scores (p < 0.001), and high internal validity of the assessment form (Cronbach’s α from 0.8257 to 0.9191). A total of 340 extractions were assessed (228 by fifth-year, and 112 by fourth-year, students). In addition, 73 students (47 fifth-year, and 26 fourth-year) were assessed halfway through the year and at their final examinations. The fail/pass rate was (64/164) for the fifth-year students, and (43/69) for the fourth year students, with no significant difference between them (chi squared 3.719; p = 0.054). Fifth-year students had significantly higher mean scores than fourth-year students in the subscales “use of the elevator” and “confidence” (p = 0.004 and 0.003 respectively). Both groups showed significant improvement in their mean scores between the mid-term and final examinations (p = 0.001 and 0.010, respectively). The newly developed VAS-based format for assessing the removal of teeth offered an objective, standardised, and feasible method for assessment of clinical skills of undergraduate students for both formative and summative purposes.     

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.     

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.     

Assessment of the referral system for surgical removal of third molars at the Dental Faculty,King Saud University

Introduction: There is compelling evidence that prophylactic extraction of third molars is a health problem that needs to be addressed. In particular, the vast amount of evidence demonstrating complications after removal of third molars, rather than supporting the necessity of removal or the negative effects of retention, raise this concern. Objective: The aim of this study was to investigate the referral system for third molar extraction at our institution by assessing patient opinions and the experience of the oral surgeons and the referring dentists. The main outcome measures of concern were the reasons for third molar extraction, patient awareness about the surgery and the comorbidities that may accompany the surgery. Methods: Pilot cross-sectional survey questionnaires were distributed at the Dental Faculty Clinic at King Saud University, from 15 March 2015 to 30 June 2016 by the staff in charge of the patient waiting area, oral surgery clinic, primary care clinic and specialist clinic. Results: Of 400 potential respondents, 226 completed the survey (response rate: 54%). Of these patients, 91% knew why they had been referred to the oral surgery department, but 73.5% did not understand the surgical extraction procedure or its complications. In total, 45.2% of the patients referred had no signs or symptoms, and 36% were referred for prophylactic reasons. In conclusion, our system needs reassessment. To combat the subjective health practice of routinely referring patients for prophylactic extraction, the role of primary care should be emphasised by implementing a system for regular patient check-ups, and public awareness should be increased.Key words: Wisdom tooth, removal, retention, surgery     

Effects of surgical removal of mandibular third molar on the periodontium of the second molar

Abstract: Objective: The effects on periodontal tissues of adjacent second molars after semi‐impacted mandibular third molar surgery were evaluated. The influence of flap design was studied. Methods: Twenty volunteers randomly underwent the three‐cornered flap technique (group A) or the distal wedge flap technique (group B). The periodontal probing depth was measured by using a ‘Williams’‐type probe just prior to surgery and three months post‐operatively. Six sites, mesio‐buccal, buccal, disto‐buccal, disto‐lingual, lingual and mesio‐lingual, around the second molar were selected for measurement. Kruskal–Wallis test and Dunn test (post hoc) were used. Significance level was set at 5%. Results: There were no complications (oedema, alveolitis, etc.) in any of the patients of the study. The results showed that both methods caused shallow pocket depth (P > 0.05) and there were no statistically significant differences between the flap techniques (P > 0.05). Flap design was not an important factor affecting the periodontal status of the second molar. Conclusion: The decision to use any of the various flap designs for access to mandibular third molars should be based on operator preference rather than on the assumption that periodontal health of the adjacent second molar will be improved.     

Registration methods for surgical navigation of the mandible: a systematic review

Image-to-patient registration in navigated mandibular surgery is complex due to the mobile nature of the mandible compared with other craniofacial bones. As a result, surgical navigation is rarely employed in the mandibular region. This systematic review provides an overview of the different registration methods that are used for surgical navigation of the mandible. A systematic search was performed in the MEDLINE Ovid, Scopus, and Embase databases on March 25, 2021. Search terms included synonyms for mandibular surgery, surgical navigation, and registration methods. Articles about navigated mandibular surgery, where the registration method was explicitly mentioned, were included. The database search yielded a total of 2952 articles, from which 81 articles remained for analysis. Four main registration methods were identified: point registration, surface registration, hybrid registration, and computer vision-based registration. The mobility of the mandible is accounted for by either keeping the mandible in a fixed position during preoperative imaging and surgery, or by tracking the mandibular movements. Although different registration methods are available for navigated mandibular surgery, there is always a trade-off between accuracy, registration time, usability, and invasiveness. Future studies should focus on testing the different methods in larger patient studies and should report the registration accuracy.     

Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study

The aim of this study was to assess the changes in occlusal patterns during combined surgical and orthodontic therapy in patients with vertical jaw malformations. Twenty-six orthognathic patients (18 female, eight male; median age 25 years, interquartile range 11.5 years) and 10 control patients (five female, five male; median age 29.8 years, interquartile range 13.5 years) recruited from neutral configured patients attending the Department of Orthodontics, were investigated. Based on cephalometry, the patients were grouped into vertical skeletal configurations of either open, deep, or natural bite cases. Registrations of the occlusal contacts were taken using a digital occlusal sensor immediately before surgery and at 9 months after the surgical intervention. Before the intervention, open and deep bite patients showed significantly less efficient occlusal patterns than the untreated controls regarding total tooth contact (P < 0.001), time of occlusion (P = 0.002), occlusal asymmetry (P = 0.001), anterior tooth contact (P < 0.001), and posterior tooth contact (P < 0.001). After surgery, the parameters in the deep bite patients were similar to those in the controls; however, in open bite patients, total tooth contact (P = 0.003), occlusal asymmetry (P = 0.011), and posterior tooth contact (P = 0.035) differed significantly. In conclusion, combined orthodontic and surgical correction of vertical malocclusions was found to improve occlusal function in patients with deep bite to the level of controls.     

The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: a pilot study

This prospective study evaluated the role of cone beam computed tomography (CBCT) in the treatment of patients with impacted mandibular third molars at increased risk of inferior alveolar nerve (IAN) injury. Subjects with an increased risk of IAN injury, as diagnosed on panoramic radiographs, were enrolled in this study and underwent additional CBCT imaging. Two oral maxillofacial surgeons independently planned the surgical technique and estimated the risk of IAN injury on panoramic radiographs and on CBCT images. A test of symmetry and the McNemar test were executed to calculate the differences between the two imaging modalities. The study sample comprised 40 patients (mean age 27.6 years) presenting 53 mandibular third molars. Risk assessment for IAN injury based on panoramic radiography compared with CBCT imaging differed significantly (P < 0.005). After reviewing the CBCT images, significantly more subjects were reclassified to a lower risk for IAN injury compared with the panoramic radiograph assessments. This change in risk assessment also resulted in a significantly different surgical approach (P < 0.03). The results of this study show that CBCT contributes to optimal risk assessment and, as a consequence, to more adequate surgical planning, compared with panoramic radiography.     

Ingestion of a quadhelix appliance requiring surgical removal: a case report

Abstract

This report presents an unusual case, whereby a 13-year-old Down’s syndrome boy accidentally swallowed a removable quadhelix appliance that subsequently required surgical removal. The paper discusses management strategies for patients who have accidentally swallowed components of their orthodontic appliance. It also highlights the need for orthodontists to consider limited objective treatment options for certain patient groups.     

Anatomical recovery of the duct of the submandibular gland after transoral removal of a hilar stone without sialodochoplasty: evaluation of a phase II clinical trial

Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10 mm in diameter, but patients had no recurrent symptoms. By the 12 months’ follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow.