Preoperative intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery

The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative intravenous tramadol versus ketorolac in preventing pain after third molar surgery. Sixty-four patients undergoing elective third molar surgery were randomly assigned into one of the two groups (32 in each group): Group I received tramadol 50 mg, and Group 2 received ketorolac 30 mg intravenously preoperatively before the surgery. After injection of the study drugs, a standard intravenous sedation technique was administered and the impacted third molars were removed under local anaesthetic. The difference in postoperative pain was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, median time to rescue analgesic, postoperative acetaminophen consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac versus tramadol group (P = 0.05, Mann-Whitney U-test). Patients also reported significantly longer median time to rescue analgesic (9.0 h versus 7.0 h, P = 0.007, log rank test), lesser postoperative acetaminophen consumption (P = 0.02, Mann-Whitney U-test) and better global assessment (P = 0.01, chi2 test) for the ketorolac versus tramadol group. Preoperative intravenous ketorolac 30 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain.     

The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery

Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.     

Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study

We compared the effects of dexamethasone sodium phosphate given submucosally and intramuscularly on postoperative complications after removal of impacted lower third molars in a preliminary randomised prospective clinical trial. Thirty patients, each of whom required removal of a single impacted mandibular third molar under local anaesthesia, were randomly allocated to one of 3 groups of 10 each. The 2 experimental groups were given dexamethasone 4 mg submucosally or intramuscularly, and the control group had no steroid. Facial swelling and maximal interincisal distance were measured by an independent examiner at baseline (preoperatively), and at 1, 3, and 7 days postoperatively. Pain was measured by counting the number of rescue analgesic tablets taken, and from the patients’ response to a visual analogue scale (VAS). The mean age of the 16 men and 14 women was 27 years (range 20–48). Both dexamethasone groups showed significant reductions in swelling (p < 0.001) and in pain (p < 0.05) compared with the control group at all intervals. Submucosal dexamethasone resulted in significantly less trismus than controls on day 1 postoperatively (p = 0.04), but there were no significant differences among the groups at the other times. The effects of the two routes of dexamethasone were comparable for all variables. There were no cases of alveolar osteitis or wound infection. Dexamethasone 4 mg given submucosally is an effective way of minimising swelling, trismus, and pain after removal of impacted lower third molars, and is comparable with the intramuscular route. It offers a simple, safe, painless, non-invasive, and cost-effective treatment in moderate and severe cases.     

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.     

Pre-emptive analgesia with the combination of tramadol plus meloxicam for third molar surgery: a pilot study

The aim of this pilot study was to evaluate pre-emptive analgesia using the combination tramadol plus meloxicam compared with each individual drug alone for the reduction of pain after extraction of third molars. Fifty-one patients were randomised into three groups (n=17 in each), using a series of random numbers: the first group was given tramadol 25mg and meloxicam 7.5mg; the second tramadol 50mg, and the third meloxicam 15mg, all intramuscularly. Treatments were prepared in identical syringes by an independent investigator and were given immediately. The teeth were removed 50min after the analgesics had been given. Intensity of pain, consumption of analgesics, and adverse effects were evaluated. The intensity of pain was evaluated using a visual analogue scale (VAS) and the area under the curve of the VAS showed significant differences amongst the groups. In conclusion, the study showed that the combination of tramadol 25mg and meloxicam 7.5mg had an analgesic effect similar to that of meloxicam 15mg, but both were better than tramadol 50mg for relief of pain after the extraction of mandibular third molars.     

Mandibular third molar and inferior alveolar canal

Purpose

The purpose of this study was to determine the incidence of Inferior Alveolar Nerve (IAN) damage after surgical removal of lower third molars, to identify the cause and to construct a predictive model to assess the risk of IAN injury.

Materials and methods

Patients were selected from the out patient department after proper clinical and radiological evaluation of mandibular third molars. 50 mandibular third molars of 50 different patients were removed under local anaesthesia. Standardized data collection including the patient’s name, age, gender, proximity of inferior alveolar nerve were recorded.

Results

A total 6% of the operated sides demonstrated impairment of labial sensation and vast majority of these disturbances subsided completely within six weeks.

Conclusion

For IAN we found Patient’s age, the development of roots, the degree of impaction and the radiographic position of the nerve canal to be significantly correlated to sensory deficit.     

拔除第二恒磨牙后第三磨牙自行迁移的临床研究

目的 :探讨第二恒磨牙拔除后第三磨牙自行迁移在水平方向、垂直方向距离变化以及近中倾斜角的改变。方法 :将 2 6例患者分为实验组和对照组 ,实验组拔除第二恒磨牙的患者 15例 ,对照组未拔第二恒磨牙的患者 11例。 2组均拍摄侧位X线头影测量片 ,治疗前和治疗 9个月后测量第三磨牙在水平方向、垂直方向移动距离和近中倾斜度的变化并进行比较。结果 :实验组第三磨牙较对照组在水平方向 ( 7.0 8mm ,2 .0 9mm)移动较快 ,有显著差异 ;在垂直方向 ( 5 .75mm ,1.96mm)移动较快 ,有显著差异 ;其近中倾斜角变化 ( 11.2° ,3 .97°)也有显著意义。结论 :拔除第二恒磨牙加速了第三磨牙的萌出 ,减少了第三磨牙的阻生 ,并使第三磨牙尽快直立 ,并向近中迁移。     

Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi‐square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non‐steriodal anti‐inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.     

Relationship of third molar development and root angulation

Angled roots are seen in mandibular third molars, which have a high frequency of incomplete impaction. We examined the relationship between incomplete impaction and angled roots. We enrolled orthopantomographs to determine the prevalence of angled roots in 239 men and 222 women aged 21--35 years with bilateral mandibular third molars. Angled roots were more frequent in subjects in whom the third molars had a different status on each side than in those with the same status on both sides (men: P<0.05; women: P<0.01). The incidence of women with angled roots in those with bilateral incomplete impactions was higher than that in those with bilateral eruption (P<0.01). Angled roots among mandibular third molars are related to environmental factors. Angled roots occur more frequently in women with incomplete impaction than in those with full eruption.     

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.     

Patient-reported outcome measures in third molar surgery: a scoping review

Despite a surge of interest in patient-centred outcomes (PROMs) in healthcare settings, they remain an underutilised resource in third molar surgery. Clinicians and researchers in the field of oral surgery who are interested in incorporating PROMs into their clinical practice may face challenges in instrument selection with as yet no consensus registry available. PROMs have undoubtedly transcended their original brief as research instruments, with the collection of PROMs data now a routine undertaking in many healthcare systems. Quality improvement, appropriate resource allocation, and measurement of effectiveness of interventions are but a few of their advantages. This review article presents a scoping overview of the instruments most relevant to the third molar surgery population.     

正畸拔除下颌前磨牙对第三磨牙萌出影响的测量研究

目的:评价正畸拔除下颌前磨牙对下颌第三磨牙萌出角度和间隙的影响.方法:选取23 例正畸非拔牙矫治病例(男性12 例,女性11 例,平均年龄13.5 岁),23 例拔除下颌第一前磨牙矫治病例(男性12 例,女性11 例,平均年龄13 岁),21 例拔除下颌第二前磨牙矫治病例(男性11 例,女性10 例,平均年龄14.07 岁),在治疗前和治疗后拍摄全颌曲面断层片,测量下颌第三磨牙的轴倾角度和萌出间隙,使用SPSS 17.0软件对3 组病例的数据进行配对t检验.结果:拔除下颌第一前磨牙组患者RS,LS,Rratio,Lratio在治疗后显著增大(P<0.01);拔除下颌第二前磨牙组患者RM3,LM3等指标在治疗后增大(P<0.05),RS,LS,Rratio,Lratio等指标在治疗后显著增大(P<0.01).结论:正畸拔除下颌前磨牙较非拔牙矫治可以增加下颌第三磨牙的萌出间隙;拔除下颌第二前磨牙可以改善第三磨牙的萌出角度.     

Bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy: a long-term analysis

A residual bone defect at the distal aspect of the adjacent second molar may occur after total removal of the lower third molar. Lower third molar coronectomy has been proved to be a safe alternative to total removal, but the extent of bone regeneration at the adjacent tooth after coronectomy is not well reported. The aim of this prospective study was to investigate the long-term bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy. Preoperative and postoperative cone beam computed tomography scans were measured to assess bone regeneration at the distobuccal (DB), mid-distal (MD), and distolingual (DL) aspects of the lower second molar. Forty-eight coronectomies in 37 patients (23 female) with a mean ± standard deviation age of 29.1 ± 7.2 years were assessed. The mean follow-up was 93.2 ± 8.7 months. The mean bone level increase at DB, MD, and DL aspects was 3.2 ± 1.6 mm, 3.5 ± 1.5 mm, and 3.2 ± 1.6 mm, respectively; the bone levels were significantly higher than the preoperative measurements (P < 0.001). Age and impaction patterns were not factors affecting bone regeneration. Based on this study, it appears that coronectomy of the lower third molar brings favourable bone regeneration at the distal aspect of the adjacent second molar.     

Ibuprofen as a pre-emptive analgesic is as effective as rofecoxib for mandibular third molar surgery

The objective of this study was to compare the pre-emptive analgesic effect of rofecoxib, a cyclooxygenase (COX)-2 inhibitor, with a more traditional and commonly used analgesic, ibuprofen, for mandibular third molar surgery, utilizing a prospective, randomized, double-blind, placebo-controlled clinical trial. Fifty-five healthy patients who were scheduled to undergo surgical removal of an impacted mandibular third molar as outpatients at one of two government dental clinics in Fiji were enrolled. The patients were divided randomly into three groups to receive 50 mg rofecoxib or 400 mg ibuprofen, or a placebo 1 h prior to surgery. A dose of 1000 mg paracetamol was offered as rescue medication. Participants recorded their pain intensity on a 10-cm visual analogue scale 1 h before and just prior to surgery and every 30 min for 6 h following surgery. There were no significant analgesic differences between rofecoxib and ibuprofen at any time intervals postoperatively. Ibuprofen was significantly better at reducing pain at all time intervals by comparison with the placebo. Rofecoxib provided significantly better pain relief compared with the placebo, except at 60, 180, and 240 min postoperatively. Rescue medication use was significantly lower in the rofecoxib and ibuprofen groups by comparison with the placebo group; however, there was no significant difference between the two therapeutic groups. Rescue medication was used by 50%, 25%, and 94% of patients receiving rofecoxib, ibuprofen, and placebo, respectively. Ibuprofen, a commonly used over-the-counter analgesic, is as effective as rofecoxib for the relief of acute postoperative pain following third molar surgery when used pre-emptively.     

成人下颌磨牙后间隙与第三磨牙关系的三维研究

目的 测量成人下颌磨牙后区大小并分析其与第三磨牙状态的关系.方法 采用CBCT对86例成年骨性Ⅰ类均角患者根据第三磨牙状态进行分组,从三维方向对右侧下颌磨牙后间隙进行测量.在水平面上沿POL线(第一磨牙与第二磨牙颊尖连线)测量下颌平面(以及从下颌平面向根方2 mm的平面)处第二磨牙牙冠到升支前缘的最短距离.牙根层面...     

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.     

Analgesic efficacy of lysine clonixinate plus tramadol versus tramadol in multiple doses following impacted third molar surgery

This study compared the analgesic and anti-inflammatory efficacy, trismus control, and tolerability of the combination of lysine clonixinate and tramadol (LCT) versus tramadol (T) alone after surgical removal of impacted mandibular third molars. This study was a double-blind, randomized clinical trial, including two study groups of 20 patients each, who exhibited acute pain subsequent to surgical extraction of two mandibular third molars. Pain intensity was quantified over a 96-h period using a visual analogue scale and a 5-point verbal rating scale. Secondary indicators of analgesic and anti-inflammatory efficacy, trismus control, and tolerability were determined. Patients administered LCT exhibited better therapeutic effects that those administered T. Fifty percent of patients in the LCT group rated this therapy as ‘excellent analgesia’ compared with only 10% in the T group. The onset of the analgesic effect of LCT was significantly faster, without any therapeutic failures. There were no significant differences between the groups with regard to anti-inflammatory effect or trismus. The results of this study suggest that the postsurgical analgesic efficacy of LCT in combination (LC 125 mg + T 25 mg) is superior to that obtained with T alone, administered at the standard dose of 50 mg, for up to 96 h after the extraction of both impacted mandibular third molars.     

曲断片(牙合)平面对下颌第三磨牙间隙测量的影响

目的 在曲断片上分析(牙合)平面作为参考平面对测量下颌第三磨牙间隙的影响.方法 选择65例错(牙合)患者正畸前的曲断片(男28人,女37人),年龄19.5岁～26.8岁.下第三磨牙完全萌出组44侧,阻生组69侧.用配对t检验分析(牙合)平面定点误差对下颌第三磨牙间隙测量的影响.用随机区组分析比较各(牙合)平面测量第三磨牙间隙的差异.结果 (牙合)平面的定点误差较小(P≥0.05);下第三磨牙萌出组和阻生组以不同(牙合)平面测量第三磨牙间隙都有显著差异(P＜0.05).结论 尽管(牙合)平面的定点误差小,但不同(牙合)平面对下颌第三磨牙间隙测量值有明显影响.

Abstract：

Objective The purpose of this study was to investigate the influence of occlusal plane (OP) on the lower third molar space measurement on panoramic radiographs. Methods Subjects in the study consisted of 65 adult (28 males, 37 females) and were divided into two groups:third molar fully erupted group and third molar impacted group. 44 erupted mandible quadrants and 69impacted mandible quadrants on panoramic radiographs were used to compare the difference OP as the reference planes on the third molar space measurement on panoramic radiographs by block designs.Results Significant difference was noted among different occlusal planes (p＜0. 05) on the third molar space measurement both in fully erupted group and in impacted group. Conclusions Lower third molar space measurement was sensitive to various inclination of OP on panoramic radiographs.     

Comparative Evaluation of Pre-Emptive Analgesic Efficacy of Intramuscular Ketorolac Versus Tramadol Following Third Molar Surgery

Pre-emptive analgesia aims at preventing the central nervous system from reaching a hyper-excitable state known as central sensitization, in which it responds excessively to afferent inputs. The clinical implication would be more effective pain management, thereby reducing post-operative pain and analgesic requirements. This study aimed at investigating the existence of pre-emptive analgesia and to compare the pre-emptive analgesic efficacy of im ketorolac [NSAID] versus tramadol [SYNTHETIC OPIOD] for post-operative pain management following third molar surgery. Fifty patients under the age group of 16–25 years with asymptomatic, symmetrically impacted mandibular third molars were equally divided into 2 groups and underwent third molar surgery under local anesthesia. Ketorolac 30 mg and tramadol 50 mg were used in the study group, while sodium chloride 0.9 % was used in the control group. Study parameters included pain intensity scores for 12 post-operative hours, time to 1st rescue analgesia, total number of analgesics consumed during the 5 post-operative days and patients’ self assessment of efficacy of the surgery with regardsto no pain. Statistically, the data are presented as the mean values with their standard deviations and a 95 % confidence interval [p is significant, if p < 0.05] for the mean are applicable. Incidences of adverse events like pain on injection of the study drug, local reactions, nausea and vomiting were noted. Patients in the study group significantly performed better than the control group in terms of all the parameters; while among the study group, ketorolac fared better than tramadol. All the drug related complications were mild and did not require any intervention. Pre-operative ketorolac or tramadol in comparison to placebo resulted in a significantly better post-operative pain management. However as against tramadol, ketorolac is a better choice as a pre-emptive analgesic agent for the post-operative pain management following third molar surgery.     

Effect of premolar extraction on mandibular third molar impaction in young adults

Objective:To test the null hypothesis that orthodontic therapy with or without premolar extraction does not result in any difference in third molar impaction.Materials and Methods:Two groups were formed: 22 patients in one group with first premolar extractions and 22 patients in the other group without extractions. All patients were nongrowing subjects who had normal gonial angles and were skeletal Class I at the beginning of treatment. The available space for third molars, inclination of second and third molars, and angle between the second and third molars were evaluated. Also, the correlation of measured parameters and type of orthodontic therapy with the eruption of third molars was evaluated.Results:Of the third molars, 81.8% were impacted in the nonextraction group and 63.6% were impacted in the extraction group. Impaction of mandibular third molars was significantly correlated to the pretreatment and posttreatment inclination of third molars and the angle between the second and third molars. In the extraction therapy group, the retromolar distance increased significantly with a mean of 1.30 ± 1.25 mm.Conclusions:When the inclination of the third molar is inconvenient, the tooth may remain impacted even if there is enough retromolar space.