Retained Third Molars Removal in a Severely Resorbed Edentulous Mandible. A Case Report

The presence of asymptomatic third molars can represent a potential problem in the mandible when these teeth are retained and the patient has lost all normally erupted teeth. Once the mandibular first and second molars are removed, the mandibular body becomes weaker with time, increasing the complexity, morbidity and incidence of complication in the surgical procedure to remove the retained third molar. This paper reports a case where the mandibular third molars retained in a severely resorbed mandible were removed in a 54-year-old female patient. The treatment plan was based on the safe surgical removal of the teeth and prosthetic rehabilitation with an implant-supported milled bar overdenture and a bone-mucous-supported complete denture in the mandibular and maxillary arch, respectively. If the removal of a retained third molar is indicated in a severely resorbed edentulous mandible, the treatment plan must involve not only preventive measures in order to avoid mandible fracture during or after tooth removal, but also alternatives that allow an adequate mandibular rehabilitation.

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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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Lingual split bone technique – Revisited as a standard operating procedure for surgical removal of third molar during COVID pandemic

Journal of Academy of Dental Education ◽

10.25259/jade_3_2021 ◽

2021 ◽

Vol 7 ◽

pp. 18-22

Author(s):

Sushmitha Mohan ◽

Annamalai Thangavelu ◽

Aravindraj

Keyword(s):

Operating Procedure ◽

Third Molar ◽

Standard Operating Procedure ◽

Surgical Removal ◽

Third Molars ◽

Standard Operating ◽

Infectivity Rate ◽

Alveolar Osteitis ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Objectives: The objective of the study is to revisit the forgotten art of Lingual split bone technique during the COVID pandemic as a Standard Operating Procedure (SOP) for the surgical removal of impacted mandibular third molars. It was originally introduced in early 90’s by Sir William Kelsey Fry and also we have compared its advantages over the bone guttering technique. Materials and Methods: Twenty seven cases were operated during COVID pandemic in our institution using Davi’s modified lingual split technique under strict COVID protocol. Results: All impacted mandibular third molars were successfully removed. With regards to post-operative complication; 3 patients had nerve injury (11%), 2 patients had lingual paraesthesia (7.6%), 1 patient had alveolar osteitis (3.8%), 2 patients had postoperative infection (7.6%), 3 patients had trismus (19%). The overall success rate was 100%. Also the results of a comparison between bone guttering and chisel-mallet technique were stated. Conclusion: The use of lingual split bone technique deserves consideration during this COVID time as an alternate for bone guttering in surgical removal of third molar as it ensures minimal cross infectivity rate among both dentists and patients. Thus, patient care can be delivered with confidence even during pandemic.

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TO COMPARE THE EFFECT OF PRE-EMPTIVE DEXAMETHASONE AND METHYLPREDNISOLONE EITHER BY INTRAMUSCULAR OR BY SUBMUCOSAL ROUTE FOR THE POSTOPERATIVE CONTROL OF PAIN, SWELLING, AND LIMITED MOUTH OPENING FOLLOWING THE EXTRACTION OF IMPACTED THIRD MOLARS

10.36106/ijsr/1824575 ◽

2020 ◽

pp. 1-7

Author(s):

Kiran Shubha ◽

Ravi Narula ◽

Navneet Kaur

Keyword(s):

Intramuscular Injection ◽

Third Molar ◽

Mouth Opening ◽

Surgical Removal ◽

Third Molars ◽

Limited Mouth Opening ◽

Submucosal Injection ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars ◽

Better Than

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.

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Inferior alveolar nerve injury assessment after surgical removal of mandibular third molar.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3425 ◽

2020 ◽

Vol 27 (03) ◽

pp. 530-534

Author(s):

Abdul Wahid Bhangwar ◽

Muhammad Irfan Khan ◽

Hira Fatima ◽

Salman Shams

Keyword(s):

Nerve Injury ◽

Local Anesthesia ◽

Maxillofacial Surgery ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Surgical Removal ◽

Third Molars ◽

Mandibular Third Molar ◽

Mandibular Third Molars ◽

Inferior Alveolar Nerve Injury

To assess the nerve injury (inferior alveolar nerve) after surgical removal of mandibular third molars under local anesthesia. Study Design: Observational study. Setting: Oral & Maxillofacial Surgery Department LUMHS Jamshoro/Hyderabad. Period: From 11th November 2015 to 10th May 2016. Material & Methods: This study consisted of one hundred patients. Inclusion criteria’s were patients with impacted mandibular third molar, patient’s age from 18 to 45years and irrespective of gender. Exclusion criteria were patients younger than 18yrs of age of above 45 years, patients having neurological disorders, medically compromised patients, patients receiving radiotherapy or chemotherapy, patients with known allergy to local anesthesia, patients having pathology due to mandibular third molars, patients radiographicaly root is very near to inferior dental canal. Results: Out of 100 patients incorporated in this research 66 were male (66%) and 34 female (34%). The mean age was 29+3.20 years. Common indication of extraction were recurrent pericoronitis 52(52%) cases followed by deep caries/ pulpitis in 28(28%) cases, orthodontic reason in 11(11%) cases and caries to adjacent tooth in 9(9%) cases. Third molar impaction according to winter’s classification were Mesioangular in 54(54%) cases followed by Horizontal in 26(26%) cases and Vertical in 11(11%). Radiographic showed Narrowing of root in 21% cases and narrowing of inferior dental (ID) canal 20% cases, followed by diversion of ID canal in 16 % cases, deflection of root 14 % cases and darkening of root in 11% cases. After surgical removal of mandibular third molar, the inferior alveolar nerve injury was observed in 6(6%) cases. Conclusion: We conclude that inferior alveolar nerve paresthesia occurs in 6% after surgical removal of mandibular third molars.

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Removal of dental surgical bur from maxillary sinus: a case report

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v17i0.8653838 ◽

2018 ◽

Vol 17 ◽

pp. e18224

Author(s):

Yeon Jung Kim ◽

Ana Maria Barg da Silva ◽

Mirko Dennys Ayala Perez ◽

Heloisa F. Marão ◽

Debora Pallos

Keyword(s):

Maxillary Sinus ◽

Clinical Case ◽

Treatment Plan ◽

Correct Diagnosis ◽

Maxillofacial Surgery ◽

Third Molar ◽

Oral And Maxillofacial Surgery ◽

Surgical Removal ◽

Third Molars ◽

Third Molar Extraction

The most commonly performed surgical procedure in Oral and Maxillofacial Surgery practices are the removal of impacted third molars. Extensive training, skill and experience allow this procedure to be performed in an atraumatic approach. The aim of this study was to drawing attention to the importance of the correct management of the complications cases of foreign body inside maxillary sinus after surgical removal of maxillary third molars. This is an unusual clinical case of a dental surgical bur accidentally displacement into the maxillary sinus during an upper third molar extraction surgery. After removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

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Incidence of neurosensory deficits following surgical removal of mandibular third molars: a prospective clinical study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191633 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1546

Author(s):

Thaufiq Ahamed M. I. ◽

Naveen Jayakumar ◽

Neelakandan R. S.

Keyword(s):

Tamil Nadu ◽

Statistical Significance ◽

Maxillofacial Surgery ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Lingual Nerve ◽

Surgical Removal ◽

Third Molars ◽

Post Surgery ◽

Mandibular Third Molars

Background: The aim of this prospective study was to determine the incidences of inferior alveolar nerve and lingual nerve deficit following surgical removal of impacted mandibular third molars and to evaluate the risk factors responsible for these postoperative neurosensory deficits.Methods: A total of 80 patients who reported to department of oral and maxillofacial surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India requiring surgical removal of impacted mandibular third molar were included in this cross-sectional study. Standard surgical procedure was performed. All patients were reassessed one week post-surgery. Subjectively reported altered sensations were recorded and objective assessments were performed with light touch test, two-point discrimination threshold and pin-pick pain threshold. The collected data was analyzed using the chi square test to find out any clinical relevance.Results: There was no inferior alveolar nerve related neurosensory deficits and 6 (7.5%) resulted in lingual nerve related neurosensory deficits. The incidence of LN deficit for mesioangular, horizontal, distoangular was 1.3%, 3.8% and 2.5% respectively. Type of impaction assumed a mild statistical significance (p = 0.050).Conclusions: This study highlights the importance of careful preoperative clinical and radiographic assessment of patients where third molar surgery is planned. The surgical technique of third molar removal is also likely to have great impact on the outcome.

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Effect of Intraoral Drainage after Impacted Mandibular Third Molar Extraction on Non-Infectious Postoperative Complications

Journal of Clinical Medicine ◽

10.3390/jcm10204705 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4705

Author(s):

Grzegorz Trybek ◽

Joanna Jarzęcka ◽

Olga Preuss ◽

Aleksandra Jaroń

Keyword(s):

Postoperative Complications ◽

Sodium Alginate ◽

Third Molar ◽

Surgical Removal ◽

Third Molars ◽

Third Molar Extraction ◽

Mandibular Third Molar ◽

Wisdom Teeth ◽

Group B ◽

Mandibular Third Molars

Surgical removal of mandibular third molars is associated with non-infectious postoperative complications, including pain, swelling, trismus. Intraoral drains are noteworthy because of their ease of application, availability, and effectiveness. This study aimed to evaluate the use of latex and calcium–sodium alginate mouth flat drains on the severity of postoperative complications such as pain, trismus, and edema after surgical removal of mandibular third molars. Ninety patients who underwent surgical removal of wisdom teeth were studied. The patients were divided into three groups. Group A—with a latex flat drain, group B—with a sodium–calcium alginate (Kaltostat) flat drain, and group C—with a wound closed with knotted sutures. Patients were assessed for pain on a VAS scale every day from surgery to postoperative day 7. Before the procedure and on postoperative days 1, 2, and 7, the pain level, edema, and trismus were measured, respectively. Intraoral drainage with a flat drain after mandibular third molar removal does not significantly reduce pain, as measured by the VAS scale, or postoperative swelling, as measured by lines between craniometric points. Intraoral drainage with a latex drain after mandibular third molar removal does not significantly reduce trismus, while intraoral drainage with a calcium–sodium alginate drainage bag significantly increases trismus.

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The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413343 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13343

Author(s):

Anna Starzyńska ◽

Magdalena Kaczoruk-Wieremczuk ◽

Michele Antonio Lopez ◽

Pier Carmine Passarelli ◽

Paulina Adamska

Keyword(s):

Growth Factors ◽

Postoperative Complications ◽

Clinical Features ◽

Oral Surgery ◽

Third Molar ◽

Surgical Removal ◽

Third Molars ◽

Platelet Rich Fibrin ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Surgical removal of impacted mandibular third molars constitutes one of the most frequently performed procedures within oral surgery. This surgery procedure is associated with many post-operative complications. Advanced platelet-rich fibrin (A-PRF) belongs to the second generation of platelet concentrates and is rich in numerous growth factors. The aim of this study was to assess the influence of A-PRF on selected clinical features following the surgical removal of impacted mandibular third molars. The research was conducted on 100 generally healthy patients, who underwent a lower third molar odontectomy in Department of Oral Surgery, Medical University of Gdańsk, Poland, between 2018 and 2019. The research group consisted of 50 patients (immediate A-PRF socket filling) and control group (50 patients without A-PRF socket filling). During the study, the following clinical features were assessed: pain (visual analog scale), analgesics intake, the presence of trismus, edema, hematomas within the surrounding tissues (e.g., cheek), prevalence of pyrexia, dry socket, secondary bleeding, presence of hematomas, skin warmth in the post-operative area, and bleeding time observed by the patient were analyzed on the 3rd, 7th, and 14th day after the procedure. There was a significant association between A-PRF socket filling and pain intensity, the analgesics intake, trismus, and edema on the 3rd and the 7th day (p < 0.05). The presence of hematomas and skin warmth on the 3rd day after the surgery (p < 0.05) were also statistically associated with A-PRF use. The study showed that in reducing the incidence of postoperative complications, A-PRF was more important than the position of the tooth or the duration of the procedure. The growth factors in A-PRF reduce postoperative complications, such as pain, trismus, edema, analgesics intake, presence of hematomas, and skin warmth, after mandibular wisdom teeth odontectomy.

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The association between orthodontic treatment with removal of premolars and the angulation of developing mandibular third molars over time

The Angle Orthodontist ◽

10.2319/071112-573.1 ◽

2012 ◽

Vol 83 (3) ◽

pp. 376-380 ◽

Cited By ~ 13

Author(s):

Bradly Russell ◽

Mark Skvara ◽

Eric Draper ◽

William R. Proffit ◽

Ceib Philips ◽

...

Keyword(s):

Orthodontic Treatment ◽

Treatment Plan ◽

Third Molar ◽

Linear Mixed Effect Model ◽

Vertical Position ◽

Third Molars ◽

Mixed Effect ◽

Mandibular Third Molar ◽

Mandibular Third Molars ◽

Over Time

ABSTRACT Objective: To assess changes in mandibular third molar angulation during orthodontic treatment in subjects having either first or second premolars or neither removed. Materials and Methods: In a retrospective study approved by the institutional review board, right and left mandibular third molar angulations were compared to the vertical axis of adjacent second molars before and at the end of orthodontic treatment. The sample included 25 subjects with first premolars removed, 25 subjects with second premolars removed, and 24 subjects with no premolars removed. A decrease in angulation over time of at least 5°, so that the third molar became more vertical, was considered clinically favorable. Data were assessed by a linear mixed effect model and a proportional odds model with significance set at P < .05. Results: Prior to treatment, the average mandibular third molar angulation did not differ significantly among the three study groups (P = .97). The average change during treatment was not significantly affected by group (P = .59), but a higher proportion of mandibular third molars were more vertical by at least 5° in the second premolar extraction group compared to the other two groups at the completion of treatment. Conclusion: Although creating space for third molars to erupt and function has intuitive appeal, clinicians should not assume that third molars will move upright to a vertical position even if premolar removal is performed as part of an orthodontic treatment plan.

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Assessment of Lingual Nerve Paresthesia after Removal of Mandibular Third Molar

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2231177 ◽

2021 ◽

pp. 253-259

Author(s):

V. Usha ◽

G. Rajabackiyam ◽

K. Prabhu Sankar ◽

Varun Muthuraman ◽

Aravind Christo ◽

...

Keyword(s):

Root Resorption ◽

Third Molar ◽

Lingual Nerve ◽

Surgical Removal ◽

Third Molars ◽

Second Molar ◽

Mandibular Third Molar ◽

Impacted Mandibular Third Molars ◽

The Common ◽

Mandibular Third Molars

Surgical removal of impacted mandibular third molars are the most commonly performed minor surgical procedures by maxillofacial surgeon. If not treated can lead to few complications like pericoronitis, root resorption of second molar, caries of second molar, cyst and tumours can arise from them. The common complications include swelling, hematoma, trismus and lingual nerve injuries. In this article 1000 cases of various types impactions were surgically operated and assessment of lingual nerve injury was done.

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