Influence of Lidocaine including Buprenorphine for Postoperative Analgesia after the Extraction of Mandibular Third Molars: A Randomized Controlled, Double-Blind, Split-Mouth Study

Background. The presence of opioid receptors around the peripheral nerves offers the possibility of providing postoperative analgesia, thereby encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the efficacy of peripherally administered opioids in achieving adequate analgesia in regions with inflammation. Applying the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in managing postoperative pain. The split-mouth study was carried out to evaluate the efficacy of buprenorphine added to lidocaine 2% in providing postoperative analgesia after the surgical extraction of the impacted mandibular third molar. Materials and Methods. We conducted a randomized, double-blinded, split-mouth trial among 21 patients with impacted mandibular third molars bilaterally. In all patients, bilateral impacted mandibular third molars were extracted at different periods. The primary outcomes assessed were postoperative analgesia by the VAS score and the number of rescue analgesics consumed by patients at 24, 48, and 72 hours of interval via a questionnaire. Results. There was a statistical significant difference in postoperative analgesia duration at 24 (P = 0.012) and 48 hours (P = 0.024), respectively, between the test and control group. Even though the mean number of rescue analgesics consumed by the test group was less than that of the control group, no significant difference was seen. Conclusion. Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.

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Comparing the Effect of Facial Compression Bandage to That of Systemic Dexamethasone on Postsurgical Sequels after Extraction of Impacted Mandibular Third Molars: A Split-mouth Randomized Clinical Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6659 ◽

2021 ◽

Vol 9 (D) ◽

pp. 160-165

Author(s):

Ibraheem Hamadi ◽

Nuraldeen Maher Al-Khanati ◽

Zafin Kara Beit

Keyword(s):

Third Molar ◽

Study Groups ◽

Third Molars ◽

Dexamethasone Group ◽

Surgical Extraction ◽

Significant Difference ◽

Impacted Mandibular Third Molars ◽

The Mean ◽

Mandibular Third Molars ◽

Present Trial

AIM: The present study aimed to compare the clinical efficiency of facial pressure bandage, to that of intramuscular injection of dexamethasone (8 mg) on postsurgical sequels (swelling, pain, and trismus) of extraction of impacted mandibular third molar. METHODS: The study implemented a randomized split-mouth design. Patients with symmetrical bilateral impacted molars were eligible for the present trial. Sides were randomly assigned to two groups: pressure bandage group and dexamethasone group. The evaluated postsurgical sequels were extraoral swelling, trismus, and pain after 48 h and 7 days. RESULTS: The study included 42 impacted third molars (n = 42) in 21 patients with a mean age of 23.4 years. Most participants were females (66.7%). The mean postoperative swelling rates after 48 h and 7 days in pressure bandage group were found to be comparable to those of dexamethasone group. No significant difference was found in the mean rates of postoperative trismus between study groups after 48 h and 7 days. Differences in mean pain level scores between the pressure bandage group and dexamethasone group were statistically insignificant after 48 h and 7 days. CONCLUSION: The study findings showed that the effect of the pressure bandage was comparable to dexamethasone effect on the postsurgical sequels after surgical extraction of impacted mandibular third molars.

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Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial

International Journal of Dentistry ◽

10.1155/2016/8169356 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Hani Arakji ◽

Mohamed Shokry ◽

Nayer Aboelsaad

Keyword(s):

Statistical Significance ◽

Third Molar ◽

Test Site ◽

Surgical Removal ◽

Third Molars ◽

Randomized Controlled ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars ◽

Bone Quantity

The purpose of this study was to test the effect of the surgical removal of impacted mandibular third molars using piezosurgery versus the conventional surgical technique on postoperative sequelae and bone healing.Material and Methods.This study was carried out as a randomized controlled clinical trial: split mouth design. Twenty patients with bilateral mandibular third molar mesioangular impaction class II position B indicated for surgical extraction were treated randomly using either the piezosurgery or the conventional bur technique on each site. Duration of the procedure, postoperative edema, trismus, pain, healing, and bone density and quantity were evaluated up to 6 months postoperatively.Results.Test and control sites were compared using pairedt-test. There was statistical significance in reduction of pain and swelling in test sites, where the time of the procedure was statistically increased in test site. For bone quantity and quality, statistical difference was found where test site showed better results.Conclusion.Piezosurgery technique improves quality of patient’s life in form of decrease of postoperative pain, trismus, and swelling. Furthermore, it enhances bone quality within the extraction socket and bone quantity along the distal aspect of the mandibular second molar.

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Clinical assessment of impacted lower third molars at Ekpan, Delta State in Nigeria

Nepalese Medical Journal ◽

10.3126/nmj.v3i2.29486 ◽

2020 ◽

Vol 3 (2) ◽

pp. 352-355

Author(s):

Mabel Okiemute Etetafia ◽

Ese Anibor ◽

Martins Obaroefe

Keyword(s):

Third Molar ◽

Third Molars ◽

Impacted Tooth ◽

Female Ratio ◽

Impacted Teeth ◽

Pull Out ◽

Carious Lesions ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Introduction: Diagnosis and management of impacted mandibular third molars call for a cogent appraisal and treatment choice both for the sick person and the dental practitioner. This academic work scrutinized the pattern as well as treatment of impacted mandibular third molars at the Teem Clinic and Dental Centre, Ekpan, Delta State, in Nigeria.Materials and Methods: This cross-sectional survey involved 131 cases who reported impacted mandibular third molars. The age, gender, impacted tooth, type of impaction, pathological conditions, and treatment proffered were recorded.Results: The male to female ratio was 0.8:1, with an age range of 10 to 40 years. Of the lower third molar impactions 58 (42.0%) were mesioangular, 5 (3.6%) horizontal, 18 (13.0%) vertical and 57 (41.3%) were distoangular. A total of 47 (34.1%) quested for dental attention following varying degrees of pain induced by pericoronitis. Teeth removal was accomplished for 76 (55.0%) owing to carious lesions on the impacted teeth, proximate tooth, or both. Surgical extraction was the option taken in 69 (50.0 %) with caries on the impacted teeth while 3 (2.2%) had to pull out of their teeth done owing to carious lesions on the bordering second molars. In 3 (2.2%) both the impacted third molar and the proximate second molar were decayed. Conclusions: The prevailing indication for pulling out impacted mandibular third molars was acute pericoronitis. Mesioangular sort of impaction was most recurrent and ought to be considered for theplausibility of frequentness of complications.

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Vertical eruption patterns of impacted mandibular third molars after the mesialization of second molars using miniscrews

The Angle Orthodontist ◽

10.2319/061415-399.1 ◽

2014 ◽

Vol 86 (4) ◽

pp. 565-570 ◽

Cited By ~ 9

Author(s):

Un-Bong Baik ◽

Yoon-Ah Kook ◽

Mohamed Bayome ◽

Je-Uk Park ◽

Jae Hyun Park

Keyword(s):

Third Molar ◽

Control Group ◽

Third Molars ◽

Panoramic Radiographs ◽

Second Molar ◽

Space Closure ◽

Impacted Mandibular Third Molars ◽

Group 2 ◽

Mandibular Third Molars ◽

Group 1

ABSTRACT Objective: To investigate (1) whether vertical eruption of impacted third molars improves after mesialization of second molars and (2) what factors affect the vertical eruption of impacted third molars when space caused by missing molars is successfully closed by mesialization of the second molar using miniscrews. Materials and Methods: The treatment group (Group 1) included 52 patients who had (1) missing mandibular first molars (ML-6) or missing deciduous mandibular second molars (ML-E), (2) initially impacted mandibular third molars, and (3) successful space closure of the edentulous area with orthodontics. Panoramic radiographs at start of treatment (T1) and at time of space closure (T2) were collected. The control group (Group 2) included 46 nonedentulous patients with impacted mandibular third molars without molar protraction treatment. Panoramic radiographs with similar T1/T2 treatment times were selected. Nine measurements were obtained regarding horizontal available space, vertical eruption, and third molar angulation. Results: Third molars erupted vertically an average of 2.54 mm in Group 1 compared with 0.41 mm in Group 2. Age, gender, Nolla stage, and angle of the third molars did not show significant correlations with the vertical change of the impacted third molars, whereas the depth of third molar impaction and available space showed significant correlations. Conclusions: Impacted mandibular third molars vertically erupt as a result of uprighting with mesialization of the second molar, and vertical eruption is affected by the initial vertical location of impacted third molars and available space.

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Comparative evaluation of effectiveness of 2% lignocaine hydrochloride with 1.5% potassium chloride versus 2% lignocaine hydrochloride with adrenaline bitartrate versus 2% lignocaine hydrochloride as local anaesthetic for adult patients undergoing surgical extraction of impacted mandibular third molars: a randomized controlled clinical study

Journal of Oral Medicine and Oral Surgery ◽

10.1051/mbcb/2021017 ◽

2021 ◽

Vol 27 (4) ◽

pp. 55

Author(s):

Rinku Kalra ◽

Shreyas Gupte ◽

Thomson D'Cruz ◽

Nidhi Pandey ◽

Drishti Shah ◽

...

Keyword(s):

Potassium Chloride ◽

Controlled Study ◽

Depth Of Anesthesia ◽

Third Molars ◽

Randomized Controlled ◽

Surgical Extraction ◽

Significant Difference ◽

Duration Of Surgery ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Background and objective: Administration of some additives with local anesthetics can prolong pain free period post-operatively, thereby reducing need for post-operative analgesics and improving patient comfort. Potassium chloride was found to increase duration and quality of anesthesia in various studies on brachial plexus blockade. This study was designed to evaluate and compare the effect of 2% lignocaine with 1.5% potassium chloride, 2% lignocaine with adrenaline and 2% lignocaine (plain) in pterygomandibular nerve blocks. Materials and methods: A triple blind randomized controlled study was conducted on 120 adults, aged 18–45 years in ASA-I category, requiring surgical extraction of impacted mandibular third molars. The subjects were divided equally into 3 groups randomly by computer generated sequence; Group 1: 2% lignocaine plus 1.5% solution of potassium chloride, group 2: 2% lignocaine with 1:80,000 adrenaline and group 3: 2% plain lignocaine. Onset, duration, depth (pain) of anesthesia, patient satisfaction, systolic and diastolic blood pressures, heart rate and oxygen saturation, were evaluated and compared. Results: Onset was shortest for group1 and longest for grp3, statistically highly significant difference between the 3 groups (p < 0.01). Statistically significant difference (p < 0.05) was found in duration of surgery, duration of analgesia and VAS scores between groups 1 & 3. Duration and depth of anesthesia were comparable for groups 1 & 2. There was no statistically significant difference seen for total amount of dose used, SBP, DBP, HR and SpO2 between the 3 groups (p > 0.05). Conclusion: Potassium chloride, a physiological salt is inert and causes no local/systemic adverse effects when injected with lignocaine in physiologically permissible amounts. The combination achieves satisfactory onset, duration, depth of anesthesia without altering hemodynamic variables. Hence, it may be considered as a safe and effective additive.

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Effect of light-emitting diode phototherapy on pain and trismus following surgical extraction of impacted mandibular third molars

Journal of Craniomaxillofacial Research ◽

10.18502/jcr.v8i2.7645 ◽

2021 ◽

Author(s):

Gholamreza Shirani ◽

Mohammad Reza Reshadi

Keyword(s):

Continuous Wave ◽

Light Emitting Diode ◽

Control Group ◽

Third Molars ◽

Light Emitting ◽

Led Phototherapy ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars ◽

Effect Of Light

Purpose: This study aimed to assess the effect of light-emitting diode (LED) phototherapy on pain and trismus following surgical extraction of impacted mandibular third molars. Materials and Methods: This double-blind randomized controlled clinical trial evaluated 50 patients between 20 to 35 years requiring extraction of their impacted mandibular third molars. The patients were randomized into two groups of LED phototherapy and control by flipping a coin. Patients in the LED group underwent LED phototherapy immediately after surgery with red light at 618nm wavelength, 20 mW/cm2 power density and 4 J/cm2 energy density in continuous-wave mode (irradiated area: 3.15cm×1.5cm=4.725cm2). The LED device was used in off mode in the control group (as placebo). The level of postoperative pain was measured by the numerical rating scale, and trismus of patients was evaluated by measuring the maximum mouth opening (MMO). The two groups were compared by the Mann-Whitney and NPar tests. Results: The mean difference in MMO postoperatively, compared with baseline, was lower in the LED group than the placebo group but not significantly (P=0.465). The two groups were not significantly different regarding the level of pain. Conclusion: LED phototherapy with the parameters applied in this study failed to significantly decrease the level of pain and trismus following surgical extraction of impacted mandibular third molars.

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Retrospective analysis of malpositioned mandibular third molars in elderly patients

Iraqi Dental Journal ◽

10.46466/idj.v41i2.193 ◽

2019 ◽

Vol 41 (2) ◽

pp. 1-7

Author(s):

Charles E. Anyanechi ◽

Birch D Saheeb

Keyword(s):

Elderly Patients ◽

Third Molar ◽

Third Molars ◽

Hospital Records ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Alveolar Osteitis ◽

Impacted Mandibular Third Molars ◽

The Common ◽

Mandibular Third Molars

Objective: To determine the frequency of symptomatic malpositioned mandibular third molars in elderly patients. Method: An analytic study of hospital records of elderly patients with symptomatic impacted mandibular third molars over 17 years was undertaken. Information on demographics, types of impaction, reasons for surgical extraction, and complications after treatment were obtained. Those who were asymptomatic would be excluded from analysis. Results: Altogether, 6214 impacted mandibular third molars were isolated in 5, 431 patients. However, 436 (7.0%) symptomatic impacted teeth were recorded in 436 (8.0%) patients and these were extracted, while the rest, 5778 (93.0%) were asymptomatic. Males were greater than females in the ratio of 1.1:1. The frequency of occurrence of mesio-angular and vertical impactions were significant (P= 0.001) compared with disto-angular and horizontal. Periodontal disease was 211 (48.4%) of the case in addition to dental caries and its clinical sequelae 203 (46.6%) were significant reasons for extractions (P=0.000). The common postoperative complications were alveolar osteitis and hypersensitivity of the adjacent molar 22(68.7%) which related to surgical extraction of disto-angular impactions (P= 0.001). Conclusions: This study showed the older the patient the less likely malpositioned mandibular third molar suggesting that majority of such impactions do not cause pathology after many years of their presence in the oral cavity. Prophylactic extraction of malpositioned mandibular third molars in all patients should be discouraged, but each case should be treated on merit or when symptomatic.

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Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar – A prospective study.

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2019.014 ◽

2019 ◽

Vol 6 (2) ◽

pp. 41-43

Author(s):

Manu Goel ◽

Milind Shringarpure ◽

Vasant Shewale ◽

Chandrashekhar Bande ◽

Ajit Joshi ◽

...

Keyword(s):

Risk Factors ◽

Third Molar ◽

Third Molars ◽

Surgical Time ◽

Impacted Mandibular Third Molar ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Surgical Difficulty ◽

Mandibular Third Molars

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, especially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complications in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon’s experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for ‘right side’ was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for ‘gagging reflex present’ was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon’s experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon’s time, surgeon’s experience, check flexibility, and inter incisal mouth opening.

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Effect of Platelet-Rich Fibrin Application on Non-Infectious Complications after Surgical Extraction of Impacted Mandibular Third Molars

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168249 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8249

Author(s):

Grzegorz Trybek ◽

Justyna Rydlińska ◽

Magda Aniko-Włodarczyk ◽

Aleksandra Jaroń

Keyword(s):

Treatment Process ◽

Infectious Complications ◽

Control Group ◽

Surgical Removal ◽

Study Group ◽

Impacted Tooth ◽

Platelet Rich Fibrin ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Due to the frequent development of non-infectious complications after surgical removal of the third lower impacted tooth, many techniques are used to reduce their severity. Among them is the technique of applying platelet-rich fibrin to the post-extraction alveolus. The study included 90 consecutively enrolled patients. Eligible patients were randomly assigned to two groups: patients with and without platelet-rich fibrin introduced into the postoperative alveolus. Pain, swelling, trismus, and temperature were evaluated after the procedure. Pain intensity was significantly higher in the control group than in the study group at 6 h, 1, and 3 days after surgery. PRF application did not significantly affect the intensity of swelling. Body temperature was significantly higher in the control group than the study group on day two after surgery. The trismus was significantly higher in the control group than in the study group at one, two, and seven days after surgery. Application of the PRF allows for a faster and less traumatic treatment process. It will enable for speedier recovery and return to active life and professional duties.

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