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.     

下颌阻生牙拔除后两种镇痛方法效果的观察

目的 探讨下颌阻生牙拔除后两种镇痛方法的效果.方法 将62例患者分为两组,试验组(32例)拔牙后用甲哌卡因局部封闭,对照组(30例)术后2h服用布洛芬缓释胶囊0.3g,此后每隔6h口服一次,至术后48 h结束.比较两种方法术后镇痛效果.结果 试验组术后2h平均疼痛评分(2.5±1.1)低于对照组(2.8±1.1),但两组患者术后2～48 h疼痛程度差异无统计学意义(P＞0.05),疼痛评分与年龄、性别、分组均无关,仅与术后时间有关(P＜0.05).结论 下颌阻生牙拔除术后局部封闭可取得与服用布洛芬缓释胶囊相同的镇痛效果.     

The effect of surgical drain together with a secondary closure technique on postoperative trismus, swelling and pain after mandibular third molar surgery

This investigation compared the results of 2 types of wound closure after mandibular third molar removal. In both the test group and the control group, the molars were removed using a mucoperiosteal flap as described by Szmyd; a wedge of tissue distal to the second molar was removed before closure to secure self-irrigation of the empty socket. The test group received a gauze drain partially submerged into the socket to secure more drainage and to prevent primary wound healing. Examinations were performed 2 days and 7 days after surgery, and pain, swelling, trismus and wound condition were recorded. Analyses of variance indicated that there was no significant difference between the 2 types of wound closure.     

Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain

There is uncertainty regarding the role of preemptive analgesia in preventing postoperative pain. Most previous studies were of parallel design completed under general anesthesia with many confounding inter-patient's variables. The present study evaluated the efficacy of preemptive ketorolac in a crossover design in patients undergoing bilateral mandibular third molar surgery. This was a double blind, randomized, placebo-controlled study where 34 patients had each of their identical impacted mandibular third molars removed under local anesthesia on two occasions. Each patients acted as their own control; one side was pretreated with intravenous ketorolac 30 mg before surgery followed by placebo injection after surgery, and for the other side, the patient was given placebo injection before surgery and post-treated with intravenous ketorolac 30 mg after surgery. The difference in postoperative pain between pretreated and post-treated side in each patient was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, time to rescue analgesic, postoperative analgesic consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac pretreated sides when compared with the post-treated sides (P = 0.003). Patients also reported a significantly longer time to rescue analgesic (8.9 h versus 6.9 h, P = 0.005), lesser postoperative analgesic consumption (P = 0.007) and better global assessment for the ketorolac pretreated sides (P = 0.01). Pretreatment with intravenous ketorolac has a preemptive effect for postoperative third molar surgery and extended the analgesia by approximately 2 h.     

下颌第三磨牙拔除患者疼痛、焦虑情况与人格特点的相关性分析

目的: 探讨下颌第三磨牙拔除患者疼痛、焦虑情况及其与人格特点之间的关系。方法: 选择85例下颌第三磨牙拔除患者,术前采用改良牙科焦虑量表(modified dental anxiety scale, MDAS)及艾森克人格问卷(Eysenck personality questionnaire, EPQ-RSC)进行调查评分,术后第2天采用视觉模拟疼痛量表(visual analogue scale, VAS)进行评分,分析VAS 评分、MDAS评分与人格特点的相关性。采用SPSS 19.0软件包对数据进行统计学分析。结果: 85例患者中,轻度疼痛、中度疼痛分别占52.94%与47.06%,轻度焦虑、中度焦虑与重度焦虑分别占61.18%、28.23%、10.59%;轻、中度疼痛患者L、P、E评分比较无显著差异(P>0.05),轻度疼痛患者N评分显著低于中度疼痛患者(P<0.05);不同焦虑程度患者L、P评分比较无显著差异(P>0.05),N评分为轻度<中度<重度(P<0.05),E评分为轻度>中度>重度(P<0.05);相关性分析显示,患者疼痛与神经质之间呈正相关性(r=0.198,P=0.001);焦虑与神经质之间呈正相关性(r=0.205,P<0.001),与内外向之间呈负相关(r=-0.312,P<0.001)。结论: 下颌第三磨牙拔除患者均存在一定程度焦虑及术后疼痛,且焦虑情绪与神经质、内外向人格存在显著相关性,疼痛程度与神经质人格特点紧密相关。     

下颌阻生第三磨牙的研究进展

第三磨牙是发育和萌出最晚的牙齿,临床上以第三磨牙的阻生最为常见,尤其是下颌第三磨牙。下颌第三磨牙的阻生容易引发冠周炎、龋齿、间隙感染和骨髓炎等病症,通常需要外科拔除或者进行正畸矫治。而在拔除或者保留第三磨牙的选择上,临床医生各持不同的看法。在正畸治疗中,常遇到需拔除下颌第二磨牙或第一磨牙。因此,保留第三磨牙以替代缺失的磨牙就有很重要的意义。本文通过对相关文献的分析,以期为临床上拔除或保留第三磨牙的选择提供参考。     

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.     

Oral hygiene and postoperative pain after mandibular third molar surgery

OBJECTIVE: The purpose of this study was to evaluate the association between oral hygiene before surgery and pain, inflammation, and trismus after the surgical removal of 190 impacted lower third molars. STUDY DESIGN: Patient hygiene was assessed by the simplified oral hygiene index. The maximum active interincisal oral opening was determined before surgery by using a millimeter scale, from the upper incisive edge to the lower incisive edge. Pain and inflammation were in turn recorded in written form by each patient 2, 6, and 12 hours after the operation and every day thereafter for 7 days. RESULTS: Maximum postoperative pain was recorded 6 hours after extraction, with peak inflammation after 24 hours. The patients with the poorest oral hygiene reported higher pain levels throughout the postoperative period and more analgesic consumption in the first 48 hours. In contrast, oral hygiene appeared to exert no influence on either trismus or inflammation. CONCLUSIONS: Poor oral hygiene before the surgical removal of 190 impacted lower third molars is correlated with greater postoperative pain.     

两种局部麻醉方法应用于下颌阻生第三磨牙拔除术的比较

目的 比较下颌高、中位阻生第三磨牙拔除的患者应用无痛口腔局麻仪行牙周膜注射与卡局芯式注射器行下牙槽神经阻滞麻醉注射的麻醉效果.方法 随机选择50例行双侧下颌高、中使阻生第三磨牙拔除术的成人患者,同一患者左右侧随机归入试验组和对照组.试验组应用无痛口腔局麻仪行阻生牙牙周膜局部浸润麻醉,对照组应用卡局芯式注射器行下牙槽神经阻滞麻醉,患者本人对两种麻醉方式的注射疼痛程度及效果进行评价.结果 两组比较,试验组麻醉注射时疼痛的视觉模拟评分法(visual analogue scale,VAS)值为2.48±0.98,对照组为6.12±0.44,差异有统计学意义(=3.501,P＜0.01).麻醉效果试验组患者自评为“优”者44例,对照组为35例,两组差异无统计学意义(H=2.833,P=0.812).结论 应用无痛口腔局麻仪行牙周膜局部浸润麻醉更有利于下颌高、中位阻生牙拔除术中的无痛操作.     

Kinesio taping use to reduce pain and edema after third molar extraction surgery: A randomized controlled split-mouth study

ObjectiveEvaluating Kinesio Taping (KT) use to reduce pain and edema in individuals subjected to surgical extraction of impacted mandibular third molars.Materials and methodsThirteen individuals (5 men and 8 women, mean age: 23.25 years) were subjected to mutual extraction of two mandibular third molars based on the same surgical protocol and pharmacological approach. All individuals were subjected to kinesio taping application on one side of patients' face (test group - KT), in the immediate postoperative period. The other side of the face was not subjected to KT application, and it was used as control (No KT). An examiner assessed individuals’ pain and edema based on the visual analog scale (VAS) and on the Todorović-Marković method, respectively, at the preoperative, immediate postoperative, and second and fifth postoperative days. Statistical analysis was based on the Scheirer–Ray–Hare test.ResultsEdema (48 h and 120 h after surgery) and pain intensity (24 h, 48 h and 120 h after surgery) were lower on the KT side (p < 0.05). Moreover, edema and pain intensity fully reduced on the KT side 120 h after surgery (p < 0.05).ConclusionKinesio taping adopted in the current study was effective in reducing edema and postoperative pain in patients subjected to oral surgery.Clinical relevanceKT enables patients to experience a more comfortable postoperative period and helps improving their quality of life.     

近中水平阻生下颌第三磨牙的矫治探索

目的探索保存和利用近中水平阻生下颌第三磨牙的矫治方法,以期保留更多的近中水平阻生的下颌第三磨牙。方法利用自行研制的磨牙胎面正轴装置及磨牙远中正轴装置,配合下颌固定矫治器,对近中水平阻生的下颌第三磨牙进行矫治。结果利用本研究方法对10例11颗近中水平阻生的下颌第三磨牙进行17．26个月矫治,均取得第三磨牙直立、稳定、覆胎覆盖关系正常的预期目标。结论利用磨牙殆面正轴装置及磨牙远中正轴装置,可快速、安全、高效地完成对近中水平阻生下颌第三磨牙的矫治。     

下颌阻生第三磨牙拔除术后邻牙远中骨缺损的CBCT评价

目的: 分析成人下颌阻生第三磨牙（impacted mandibular third molar, impacted M3M）拔除术后6个月的第二磨牙（mandibular second molar, M2M）远中骨缺损变化及其影响因素。方法: 回顾性分析已拔除阻生M3M的25例患者（37颗M3M）的术前及术后6个月CBCT资料。采用SPSS 25软件包进行数据统计,采用重复测量方差分析比较手术前、后M2M远中骨缺损深度变化,采用独立样本t检验分析其影响因素。结果: M2M术后6个月远中骨缺损深度减少,骨高度相比术前改善;年龄、阻生类型是影响M2M术后6个月骨缺损的因素。结论: 年轻患者高风险M3M拔除后,M2M远端的骨高度有所恢复;年龄、阻生类型是其影响因素。当M3M需要拔除时,早期拔除可能对M2M的牙周健康产生有益影响;如M3M为低位阻生,应同期植入骨移植材料,以期获得更好的远中骨愈合。     

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.     

引导再生术用于下颌第三磨牙拔除后牙槽骨再生的疗效评估

目的观察联合应用Bio-oss骨代材料和Bio-gide胶原膜的引导骨再生术(guided bone regeneration,GBR)治疗下颌阻生第三磨牙拔除后邻牙远中牙槽骨缺损的疗效。方法将24例下颌阻生第三磨牙拔除患者随机分为GBR组和对照组,GBR组12例,对照组12例。GBR组拔牙后行Bio-oss、Bio-gide引导骨再生术。对照组拔牙后常规处理拔牙创。分别记录术前、术后3个月拔牙区域牙槽骨再生情况,邻牙远中牙周探诊深度(probing depth,PD)、牙槽嵴顶到釉牙骨质界的距离、松动度及敏感度。结果与术前相比两组术后拔牙区域均存在牙槽骨再生,X线片显示,GBR组疗效优于对照组,且有显著性差异。GBR组新骨形成量较多,牙周探诊深度减小,邻牙远中牙槽嵴顶到釉牙骨质界的距离减小。无邻牙松动和敏感病例,对照组新骨形成量较少,牙周探诊深度和邻牙远中牙槽嵴顶到釉牙骨质界的距离变化不明显,存在部分邻牙松动和敏感病例。结论联合应用Bio-oss骨代材料和Bio-gide胶原膜行引导骨再生术可促进拔牙区域牙槽骨再生和邻牙远中牙槽骨高度的改善。     

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.     

电动式微动力系统与气动式手机拔除下颌阻生第三磨牙的临床效果比较

目的 比较电动式微动力系统和气动式手机在下颌阻生第三磨牙拔除术中的临床效果。方法 对106例患者的212颗下颌双侧第三磨牙分2次拔除,采用随机、交叉、自身对照方法,分别采用电动式微动力系统和气动式手机进行阻生牙拔除术。记录并比较患者手术时间及术中、术后并发症发生情况。采用SPSS 21.0 软件包对数据进行统计学分析。结果 电动式微动力组手术时间较短,术后第1天肿胀、疼痛程度均轻于气动式手机组（P<0.05）。结论 电动式微动力系统拔除下颌阻生第三磨牙优于气动式手机,值得临床应用。     

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.     

臭氧油在下颌阻生第三磨牙拔除术后应用效果研究

目的    观察下颌阻生第三磨牙拔除术后局部涂抹臭氧油的临床效果。方法    选取2019年1-9月就诊于南京大学医学院附属口腔医院并拟拔除双侧下颌阻生第三磨牙患者45例,共计患牙90颗。采用随机自身对照的方法,将所有患牙分为臭氧油组和对照组。所有患者均采用微创牙拔除术,术后连续3 d,臭氧油组在手术创面及创面周围涂抹臭氧油,对照组给予抗生素口服。于术后1、3、7 d评估患者疼痛、肿胀、张口受限程度等舒适度相关指标。结果   术后1、3、7 d,臭氧油组患者的疼痛及肿胀程度明显低于对照组,臭氧油组患者的张口度明显优于对照组,差异均有统计学意义（均P < 0.05）。结论    局部涂抹臭氧油能够有效缓解下颌阻生第三磨牙拔除术后的疼痛、肿胀和张口受限程度。     

Intrasocket interventions to prevent alveolar osteitis after mandibular third molar surgery: A systematic review and network meta-analysis

A systematic review and network meta-analysis was carried out to assess the efficacy of different intrasocket interventions immediately after mandibular third molar surgery to prevent alveolar osteitis (AO). An electronic search was undertaken using EMBASE, Cochrane Library, MEDLINE/PubMed, Web of Science, Scopus, LILACS, and grey literature. We reviewed studies published up to September 2019 and included 37 randomized controlled trials (6175 mandibular third molar surgeries in 4716 patients). The pairwise meta-analysis showed that the incidence of AO decreased significantly when an intrasocket intervention was performed (risk ratio 0.39 [0.30, 0.52]; p < 0.0001). Platelet-rich fibrin (odds ratio 0.28; 95% CI [0.10, 0.71]), chlorhexidine gel 0.2% (0.52 [0.32, 0.95]), eugenol paste (0.06 [0.00, 0.77]), recombinant bovine growth factor (0.07 [0.00, 0.97]), colloidal silver gelatin sponge (0.05 [0.00, 0.74]), and acellular dermal matrix (0.04 [0.00, 0.74]) were significantly more effective than the placebo. Platelet-rich fibrin and chlorhexidine 0.2% gel had a large number of included studies and patients per comparison. Overall, there was moderate evidence to support the use of platelet-rich fibrin or chlorhexidine 0.2% gel in the socket for the prevention of AO after mandibular third molar surgery.