Are sterile gloves necessary in nonsurgical dental extractions?

PURPOSE: The aim of the study was to compare the incidence of healing complications of extraction socket with the use of sterile or clean nonsterile gloves during nonsurgical dental extractions. MATERIAL AND METHODS: This was a randomized prospective study conducted at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (Nigeria), between October 2002 and January 2003. Patients who were referred for nonsurgical extractions of permanent teeth and who satisfied the inclusion criteria into the study were randomly allocated into 2 groups. One group had their extractions performed with the surgeon wearing a pair of sterile gloves and the second group had their extractions performed with the surgeon wearing a pair of clean nonsterile gloves. Two hundred sixty-nine patients who had 301 teeth extracted and satisfied the inclusion criteria for socket healing assessment were assessed for postoperative socket healing. RESULTS: Three different types of socket healing complications were identified (dry socket, acutely inflamed socket, and acutely infected socket). A total of 32 patients (11.9%) developed socket healing complications. Nineteen of 122 patients in the sterile glove group and 13 of 147 patients in the clean nonsterile glove group developed socket healing complications (P = .09). CONCLUSION: The study confirmed that the use of sterile surgical gloves offers no advantage over clean nonsterile gloves in minimizing extraction socket healing complications following dental extraction. Therefore, nonsurgical dental extraction can be safely performed with the surgeon wearing clean nonsterile gloves.     

A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves

This randomised prospective study aimed at evaluating possible differences in the post-operative complication rate following lower wisdom tooth surgery performed with either sterile or clean surgical gloves. The microbiological profiles of the tooth sockets and glove surfaces were also evaluated and compared. A total of 275 ASA I, non-smoking and non-drinking patients consented to be randomly assigned into two groups for lower wisdom tooth surgery, performed by operators wearing either sterile or clean gloves. All the patients returned for a post-operative assessment visit one week later. An additional 40 patients were recruited and randomised into the sterile glove group (n = 20) or the clean glove group (n = 20) for the microbiology study. Specimens were taken from the glove surfaces and the post-operative socket wounds during wisdom tooth surgery. This clinical trial showed no significant difference between the sterile and clean glove groups in the incidence of acute inflammation, acute infection and dry sockets in the wounds. No single peri-operative factor had a statistically significant effect on post-operative pain intensity. Most of the bacterial isolates from the clean gloves were Gram-positive cocci or spore-forming bacilli. The total number of colony forming units and the variety of bacterial isolates from the socket wounds in the sterile and clean glove groups were similar. The study concluded that there was no advantage in using sterile surgical gloves rather than clean gloves to minimize post-operative complications in wisdom tooth surgery. There was also no apparent relationship between the bacteria contaminating the clean glove surfaces and those isolated from the socket wounds.     

Clinical evaluation of post-extraction site wound healing

AIM: The aim of this prospective study was to evaluate the clinical pattern of post-extraction wound healing with a view to identify the types, incidence, and pattern of healing complications following non-surgical tooth extraction. STUDY DESIGN: A total of 311 patients, who were referred for non-surgical (intra-alveolar) extractions, were included in the study. The relevant pre-operative information recorded for each patient included age and gender of the patient, indications for extraction, and tooth/teeth removed. Extractions were performed under local anesthesia with dental forceps, elevators, or both. Patients were evaluated on the third and seventh postoperative days for alveolus healing assessment. Data recorded were: biodata, day of presentation for alveolus healing assessment, day of onset of any symptoms, body temperature (degrees C) in cases of alveolus infection, and presence or absence of pain. RESULTS: Two hundred eighty-two patients (282) with 318 extraction sites were evaluated for alveolus healing. Healing was uneventful in 283 alveoli (89%), while 35 alveoli (11%) developed healing complications. These complications were: localized osteitis 26 (8.2%); acutely infected alveolus 5 (1.6%); and an acutely inflamed alveolus 4 (1.2%). Females developed more complications than males (p=0.003). Most complications were found in molars (60%) and premolars (37.1%). Localized osteitis caused severe pain in all cases, while infected and inflamed alveolus caused mild or no pain. Thirty patients (12%) among those without healing complications experienced mild pain. CONCLUSIONS: Most of the post-extraction alveoli healed uneventfully. Apart from alveolar osteitis (AO), post-extraction alveolus healing was also complicated by acutely infected alveoli and acutely inflamed alveoli. This study also demonstrated a painful alveolus is not necessarily a disturbance of post-extraction site wound healing; a thorough clinical examination must, therefore, be made to exclude any of the complications.     

Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center

AIMS: The aims of this study were to determine the prevalence, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST). METHODS AND MATERIALS: Two specially designed questionnaires were completed over a four-month period. One questionnaire was completed for every patient who had one or more permanent teeth extracted in the Oral Surgery Clinic. The other questionnaire was completed for every patient who returned for a post-operative visit and was diagnosed with dry socket during the study period. RESULTS: There were 838 dental extractions carried out in 469 patients. The overall prevalence of dry socket was 4.8%. There was no statistically significant association between the development of dry socket and age, sex, medical history, medications taken by the patient, indications for the extraction, extraction site, operator experience, or the amount of local anesthesia and administration technique used. The prevalence of dry socket following non-surgical extractions was 3.2%, while the prevalence following surgical extractions was 20.1% (P< 0.002). The prevalence of dry socket following surgical and non-surgical extractions was significantly higher in smokers (9.1%) than in non-smokers (3%) (P = 0.001), and a direct linear trend was observed between the amount of smoking and the prevalence of dry socket (P = 0.034). The prevalence of dry socket was significantly higher in the single extraction cases (7.3%) than in the multiple extraction cases (3.4%) (P = 0.018). The clinical picture and management of dry socket at DTC/JUST were similar to previous reports in the literature. The prevalence of dry socket, its clinical picture, and management at DTC/JUST are similar to those reported in the literature. CONCLUSION: Smoking and surgical trauma are associated with an increased incidence of dry socket. Moreover, patients who had single extractions were more likely to develop dry socket than those who had multiple extractions in the same visit.     

Update on dry socket: a review of the literature

Dry socket is a postoperative complication that occurs after a dental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1% until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, ten times more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the risk factors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and criticize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket.     

两种微创法拔除下颌阻生第三磨牙的临床效果比较研究

目的　比较研究两种微创法拔除下颌阻生第三磨牙的临床效果。方法　选取2017年8月至2018年6月于上海交通大学医学院附属第九人民医院口腔综合科就诊的需拔除双侧下颌阻生第三磨牙患者50例。采用随机、单盲、自身牙弓左右侧交叉对照的研究方法,一侧患牙使用45°冲击式气动手机法（联合使用加长球钻去骨、加长裂钻分牙）拔除,对侧患牙使用超声骨刀法（超声骨刀去骨、45°冲击式气动手机配合加长裂钻分牙）拔除。比较两种方法术中去骨时间、阻生牙完全脱位时间、患者术后48 h疼痛视觉模拟评分法（visual analog scale,VAS）评分及患侧面部肿胀百分率等。结果　50例患者的100颗患牙均顺利拔除,所有患者均未出现术后出血、创口感染、干槽症等并发症。45°冲击式气动手机法术中平均去骨时间和阻生牙完全脱位时间均短于超声骨刀法,差异均有统计学意义（均P < 0.05）。45°冲击式气动手机法术后48 h疼痛VAS评分和患侧面部肿胀百分率均略高于超声骨刀法,但差异均无统计学意义（均P > 0.05）。结论　45°冲击式气动手机法和超声骨刀法均为安全性较高、术后反应较小的下颌阻生第三磨牙微创拔除方法,两者在拔除相同阻生类型的患牙时产生的手术创伤基本相当,但前者具有手术时间更短、设备成本更低的优势,适合在临床中推广应用。     

两种微创法拔除下颌阻生第三磨牙的临床效果比较研究

 目的　比较研究两种微创法拔除下颌阻生第三磨牙的临床效果。方法　选取2017年8月至2018年6月于上海交通大学医学院附属第九人民医院口腔综合科就诊的需拔除双侧下颌阻生第三磨牙患者50例。采用随机、单盲、自身牙弓左右侧交叉对照的研究方法,一侧患牙使用45°冲击式气动手机法（联合使用加长球钻去骨、加长裂钻分牙）拔除,对侧患牙使用超声骨刀法（超声骨刀去骨、45°冲击式气动手机配合加长裂钻分牙）拔除。比较两种方法术中去骨时间、阻生牙完全脱位时间、患者术后48 h疼痛视觉模拟评分法（visual analog scale,VAS）评分及患侧面部肿胀百分率等。结果　50例患者的100颗患牙均顺利拔除,所有患者均未出现术后出血、创口感染、干槽症等并发症。45°冲击式气动手机法术中平均去骨时间和阻生牙完全脱位时间均短于超声骨刀法,差异均有统计学意义（均P < 0.05）。45°冲击式气动手机法术后48 h疼痛VAS评分和患侧面部肿胀百分率均略高于超声骨刀法,但差异均无统计学意义（均P > 0.05）。结论　45°冲击式气动手机法和超声骨刀法均为安全性较高、术后反应较小的下颌阻生第三磨牙微创拔除方法,两者在拔除相同阻生类型的患牙时产生的手术创伤基本相当,但前者具有手术时间更短、设备成本更低的优势,适合在临床中推广应用。     

Effect of manuka honey socket dressing on postoperative sequelae and complications following third molar extraction: A randomized controlled study

To evaluate the effect of manuka honey on the healing of mandibular third molar extraction sockets.This was a prospective randomized study at a tertiary health institution in Lagos, Nigeria. All extractions were transalveolar, using the distobuccal bone guttering technique. Participants were randomized into two study groups. Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap, while participants in group B underwent mucosal flap closure of the socket without application of manuka honey. The primary outcome was healing of the extraction socket at 7 days postoperatively. The secondary outcomes measured were postoperative sequelae, namely pain, swelling, and trismus on postoperative days 1, 3, and 7, and socket healing complications — specifically inflamed socket, infected socket, and alveolar osteitis.In total, 112 participants completed the study, with 56 participants per group. There were no significant differences in demographic variables between both groups. On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029).A significant difference was observed between pre- and postoperative pain scores in both study groups (p = 0.001). A comparison of postoperative mean facial swelling between the two groups showed no statistically significant differences on all the review days (p = 0.66). The difference in postoperative socket healing complication rate between both groups was statistically significant (χ² = 4.747, p = 0.029).Within the limitations of the study it seems that the application of manuka honey appears to aid earlier healing of the third molar extraction socket, with a significantly lower frequency of complications. Therefore, the application of manuka honey is recommended whenever appropriate.     

A clinical investigation into the incidence of dry socket

A clinical investigation was undertaken to find the incidence of dry socket as a post-operative complication of dental extraction on an out-patient basis. Two thousand three hundred and sixty three extractions were carried out under local anaesthesia by clinical staff and students over a four month period. The results are presented and their significance discussed, the incidence of dry socket being found to be dependent upon the site of the tooth extracted, the relative difficulty of the extraction and upon the integrity and size of the blood clot in the extraction socket.     

微创法与劈冠法在下颌低位阻生智齿拔除中的比较研究

目的:在下颌低位阻生智齿拔除中,比较微创拔牙法与锤凿劈冠法的效果。方法 :研究对象为我院收治的134例下颌低位阻生智齿患者,将其分为研究组和对照组,分别为69、65例。研究组患者采用微创拔牙法,而对照组患者采用锤凿劈冠法。比较2组患者的以下指标:术中并发症、拔牙时间、术后并发症。结果:研究组和对照组的拔牙时间分别为(16.28±1.01)、(32.25±1.09)min,2组相比,P<0.01,前者明显比后者短(t=124.72)。研究组和对照组患者的邻牙松动、术中根折、舌侧骨板骨折等术中并发症的发生率比较,P<0.05,前者明显低于后者;而2组患者的牙龈撕裂术中并发症的发生率比较,P>0.05,差异无统计学意义。研究组和对照组患者的干槽症、张口受限、术后疼痛等术后并发症的发生率比较,P<0.01,前者明显低于后者。结论:对于下颌低位阻生智齿的拔除,采用微创拔牙法减轻了患者的恐惧和不适感,创伤小,拔牙时间缩短,术中及术后并发症少,拔牙创口愈合快,非常值得在临床上推广和应用。     

A clinical evaluation of dry socket in a Nigerian teaching hospital.

PURPOSE: We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients' demographic pattern, predisposing factors, the treatment given, and treatment outcome. Patients and Methods: A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome. RESULTS: Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients' mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth (P =.00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed. CONCLUSION: The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.     

Atraumatic removal of teeth and root fragments in dental implantology

A technique that facilitates the removal of teeth or retained root fragments without traumatizing the alveolar bone of the socket is described. This technique may be employed whenever such extractions are envisaged, but it is particularly important when the subsequent placement of dental implants is planned.     

Disturbed healing of extraction wounds.

Disturbed healing of a dental extraction wound can cause severe pain and can jeopardize attempts at dental implants or other treatments. The pathogenesis of disturbed healing was studied by histological examination of 221 postoperative biopsies taken for diagnostic purposes from human extraction wounds at different stages of healing. A relationship was observed between the healing stages and different disturbances such as dry socket, suppurative osteitis, necrotizing osteitis, and fibrous healing.     

Comparative study of the effect of warm saline mouth rinse on complications after dental extractions

The aim of the present study was to determine the effect of saline mouth rinse on postoperative complications following routine dental extractions. Patients aged ≥16 years, who were referred to the oral surgery clinic with an indication for non-surgical extraction of pathologic teeth, were prospectively and uniformly randomized into three groups. Group A (n = 40) were instructed to gargle six times daily with warm saline and group B (n = 40) twice daily; group C (n = 40) were not instructed to gargle with warm saline and served as controls. Information on demographic characteristics, indications for extraction, and the development of complications, such as alveolar osteitis, acute inflamed socket, and acute infected socket, was obtained and analyzed. There were no significant differences between patients who gargled six times daily with warm saline and those who gargled twice daily with reference to either alveolar osteitis or acute inflamed socket (P > 0.05). However saline mouth rinses at either frequency were beneficial in the prevention of alveolar osteitis in comparison with those who did not rinse. A twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with a six times daily rinse regimen.     

Evaluation of post-extraction healing after atraumatic axial tooth extraction using Benex system II versus conventional extraction: Randomized control trial

Background and PurposeTooth extraction is critical for dental treatment complications. One of the most discussed topics is socket healing after extraction. The Benex system allows extraction without causing unnecessary socket expansion by removing the tooth vertically, preserving both bone and soft tissue.AimTo assess postoperative healing signs, symptoms, and complications using the Benex extraction system and compare it with conventional extraction among patients at Umm Al-Qura University.MethodsThirty-eight patients with hopeless single-rooted teeth were included. They were divided into two equal groups: one in which teeth were extracted using the conventional method and one in which extractions were performed by Benex. The Benex system for tooth extraction was performed by drilling into the root canal, followed by screw insertion. Once the extractor was properly positioned, extraction was accomplished by turning the hand screw clockwise. At baseline, the wound size was evaluated. On days 1, 3, and 7 after extraction, telephone interviews were conducted to evaluate pain and post-extraction complications using a pain scale and questionnaire. Socket healing and wound size were evaluated after 2 and 4 weeks of extraction using the healing index and H₂O₂ epithelization test.ResultsThe Benex extraction system accelerated early soft-tissue healing and decreased pain and wound size compared with the control group. Conclusion. The Benex system is relatively safe and easy to use, but this does not eliminate the need for a degree of education and training. Proper selection of the case, knowledge of using the device, and implementation of that knowledge in the treatment planning are important factors in ensuring success with this system.     

3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars

Objectives

This prospective study introduced a digitally designed sectioning guide and evaluated its feasibility for the extraction of horizontally impacted lower third molars.

Materials and methods

This study included 38 horizontally impacted lower third molars, randomly divided into experimental and control groups. The teeth were extracted using a 3D-printed titanium surgical guide in the experimental group; free-hand extractions were performed in the control group. The surgical duration, tooth sectioning duration, cortical bone perforation, and postoperative complications, including pain, swelling, trismus, dry socket, infection, and hemorrhage, were evaluated.

Results

Although not statistically significant, guided surgery tended to reduce the number of tooth sectioning steps compared to free-hand extractions. There were no cases of cortical bone perforation in the experimental group. Although the surgical duration was greater in the experimental group (p < 0.05), there were no differences in postoperative pain, swelling, and trismus. There were no cases of postoperative infection and hemorrhage in either group.

Conclusions

3D-printed titanium surgical guides had superior accuracy and safety compared to free-hand surgery. Further studies with larger sample sizes are required to verify these findings.

Clinical relevance

The template improved the safety of tooth sectioning during impacted lower third molar surgery and resulted in a more predictable extraction. The narrow sectioning groove could fit comfortably with hypertrophic soft tissues in the posterior mandible.

     

A randomized clinical trial compared the effect of intra-alveolar 0.2 % Chlorohexidine bio-adhesive gel versus 0.12% Chlorohexidine rinse in reducing alveolar osteitis following molar teeth extractions

Objectives: To evaluate socket healing, incidence of acute alveolar ostieitis (AO) and associated pain following single molar tooth extraction in patients who receive intra-alveolar 0.2% chlorhexidine (CHX) gel, and those who rinsed with 0.12 % CHX rinse. Study Design: A prospective randomized clinical trial was conducted on two parallel groups of patients. Group1 (141 patients): Rinsed with 0.12 % CHX rinse from the second postoperative day, two times daily for a week. Group2 (160 patients): Who had direct intra-alveolar application of 0.2% CHX gel and day 3 post-operatively. The socket was evaluated 3 and 7 day post operatively for the presence of AO by checking probing tenderness in the socket, empty socket, food debris, halitosis and pain assessment by VAS. Results: Forty-eight AO cases were diagnosed out of 301 extractions (15.9%). In Group1, 25 cases were found (17.7%) while 23 cases were found in Group2 (14.4%). The difference was not statistically significant (p=0.428). Presence of empty socket and food debris in Group1 were higher than in Group2 but the difference was not statistically significant (p= 0.390 & p = 0.415). Occurrence of halitosis in Group2 was more than Group1, but the difference was not significant (p= 0.440). Statistical significance was found between AO in extraction done by root separation (29%) and those routinely extracted (12.3 %) (p=0.001). Conclusions: Postoperative evaluation of molar extraction sockets that received direct intra-alveolar application of 0.2% CHX gel showed insignificant less occurrence of AO when compared with 0.12 % CHX rinse. Key words:Chlorhexidine rinse, bio adhesive gel, alveolarosteitis, dry socket, molar teeth extraction, post-extraction socket.     

Influence of trans-operative complications on socket healing following dental extractions

AIM: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation. METHODS AND MATERIALS: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients. RESULTS: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01). CONCLUSIONS: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.     

������ֹ������ϵ�ѡ��Ӧ��

??Pain is a common complication after tooth extraction. It can be divided into reactive pain after extraction??pain caused by local infection and dry socket. The pain caused by dry socket is the most severe one. And pain relief is the main treatment. The mild pain can be relieved by oral analgesic drugs??while for the severe pain??filling pain-relieving materials in extraction sockets can significantly reduce pain and improve the quality of life. To provide guidance for clinical practice??treatments and preventions of the pain after tooth extraction were introduced according to different causes. Furthermore??the advantages and shortcomings of different kinds of pain-relieving materials filling in extraction sockets were compared.     

Relationships between surgical difficulty and postoperative pain in lower third molar extractions.

PURPOSE: To investigate the influence of surgical difficulty on postoperative pain after extraction of mandibular third molars. MATERIALS AND METHODS: A prospective study was performed of 139 patients who underwent a total of 157 mandibular third molar extractions. For evaluation of surgical difficulty, a 4-class scale was completed after surgery: I, extraction with forceps only; II, extraction requiring osteotomy; III, extraction requiring osteotomy and coronal section; IV, complex extraction (root section). The duration of surgery was also recorded. Postoperative pain was evaluated using a visual analog scale that each patient completed daily until day 6 postsurgery, at which time the sutures were removed. RESULTS: A statistically significant relationship was observed between surgical difficulty (as rated on the scale) and postoperative pain. Longer interventions generally produced more pain. CONCLUSIONS: Pain after extraction of a mandibular third molar increases with increased surgical difficulty and duration of the intervention.