Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report

Introduction: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening.Case report:The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders.Conclusion: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

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“RA.DI.CA.” Splint for the Management of the Mandibular Functional Limitation: A Retrospective Study on Patients with Anterior Disc Displacement without Reduction

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17239057 ◽

2020 ◽

Vol 17 (23) ◽

pp. 9057

Author(s):

Carlo Di Paolo ◽

Giovanni Falisi ◽

Fabrizio Panti ◽

Paola Di Giacomo ◽

Alessandro Rampello

Keyword(s):

Functional Limitation ◽

Mouth Opening ◽

Wilcoxon Test ◽

Disc Displacement ◽

Temporomandibular Joint Disc ◽

Functional Aspects ◽

Anterior Disc Displacement ◽

Retrospective Clinical Study ◽

Before And After ◽

Emotional Strain

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p < 0.05. Ninety-nine patients (70%) declared themselves “healed” from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p < 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.

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Efficacy of platelet rich plasma (PRP) on mouth opening and pain after surgical extraction of mandibular third molars

Journal of Oral Medicine and Oral Surgery ◽

10.1051/mbcb/2020045 ◽

2020 ◽

Vol 27 (1) ◽

pp. 9

Author(s):

Maidah Hanif ◽

Muhammad Azhar Sheikh

Keyword(s):

Platelet Rich Plasma ◽

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Oral And Maxillofacial Surgery ◽

Surgical Removal ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Molar Teeth

Introduction: Surgery of mandibular third molar teeth for removal is one of the most common procedures undertaken in oral and maxillofacial surgery departments. The complications created by the post extraction wound healing and physiological consecution of third molar surgery can affect patients' quality of life. Platelet rich plasma (PRP) is an autologous concentrate of platelets suspended in the Plasma that accelerates healing by concentration of growth factors which lessen the inflammation and as a result pain and trismus. Materials and methods: A Study was conducted on 130 patients at the department of Oral and Maxillofacial Surgery, FUCD Islamabad, for a period of 6 months after ethical approval. The patients with impacted mandibular wisdom teeth were selected and divided equally into two equal groups. The pain score was measured using the visual analogue scale (VAS) and trismus was measured using Vernier caliper before the surgery, immediately after surgery, on 3rd and 7th follow up visits. Results: The mean postoperative pain on 7th day was significantly lower in the PRP group with statistically significant P-value <0.0001. Trismus was also less reported in the PRP group with P-value <0.00065. Conclusion: Platelet Rich Plasma is effective to lessen trismus and pain after surgical removal of mandibular third molar teeth.

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Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

BMC Oral Health ◽

10.1186/s12903-021-01759-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wissam Nehme ◽

Youssef Fares ◽

Linda Abou-Abbas

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Third Molar ◽

Mouth Opening ◽

Mean Difference ◽

Third Molar Surgery ◽

Third Molars ◽

Dexamethasone Group ◽

Mandibular Third Molar ◽

Surgical Extraction

Abstract Background Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. Methods A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. Results The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). Conclusion The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

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Effect of age on immediate postoperative tissue reaction following surgical extraction of impacted mandibular third molar

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i2.29447 ◽

2016 ◽

Vol 7 (2) ◽

pp. 120 ◽

Cited By ~ 1

Author(s):

Chandan Kumar Paul ◽

Quazi Billur Rahman ◽

Shamiul Alam ◽

Gokul Chand Kundu ◽

Helal Uzzaman

Keyword(s):

Third Molar ◽

Mouth Opening ◽

Tissue Reaction ◽

Third Molar Surgery ◽

Aged Patient ◽

Impacted Mandibular Third Molar ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Tissue Reactions ◽

Effect Of Age

Background: Postoperative morbidity following third molar surgery is affected by a number of factors. The aim of this study was to determine the effect of age on immediate postoperative tissue reactions following mandibular impacted third molar surgery. Objectives: To assess the discomforts after impacted mandibular third molar extraction in different aged patient. Methods: 100 patients, 54 Female and 46 male, aged 18 to 42 years comprised the study materials. Tooth extraction was performed with buccal guttering technique after adequate elevation and reflection of full thickness mucoperiosteal flap. Pain, swelling and trismus were evaluated preoperatively and on 2nd POD and 7th POD. Data was processed and analyzed using SPSS and was compiled and test of significance was done using Chi square (x2) test and un-paired 't' test. Results: Statistical analysis of the data indicated that pain and swelling was significantly less and significant maximum mouth opening was achieved in early aged patient than late age when preoperative and postoperative results were compared. Conclusion: As postoperative immediate tissue reactions are more in late aged patient than younger so impacted mandibular third molar should extract in early age.

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The Effect of Oral Ketorolac Compared to Ibuprofen on Edema, Trismus, and Pain After Mandibular Third Molar Surgery

Avicenna Journal of Dental Research ◽

10.34172/ajdr.2021.25 ◽

2021 ◽

Vol 13 (4) ◽

pp. 130-134

Author(s):

Mostafa Govahi ◽

Hamidreza Ajami ◽

Vahid Khalili ◽

Ayda Paydar ◽

Gooya Kabir

Keyword(s):

Statistical Tests ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

P Value ◽

Third Molar Extraction ◽

Mandibular Third Molar ◽

Mandibular Third Molar Surgery ◽

The One ◽

Surgery Department

Background: Latent third molar extraction is the most common surgery in dentistry. Common complications of this surgery include pain, swelling, and trismus. To control these side effects, several drugs have been developed and evaluated in various studies. However, the present study is the first one to compare the effects of ibuprofen and ketorolac on pain, swelling, and trismus after molar surgery. Methods: This study was a split-mouth clinical trial. To conduct the trial, 20 candidates were selected from among patients referring to Surgery Department of the Dentistry School at Yazd Shahid Sadoughi University of Medical Sciences for mandibular third molar removal surgery. The patients were divided into two groups after the surgery: one group received ibuprofen, and the other one received ketorolac. Pain, swelling, and trismus were evaluated prior to the surgical procedure, 24 hours later, and one week after the surgery. Data were analyzed by SPSS software version 22 by using Wilcoxon statistical tests and paired t test. Results: Ibuprofen and ketorolac had similar effects on pain relief (P value>0.05). Studying the two groups produced similar results regarding improvement in mouth opening (P value>0.05). Improvement pace of the postoperative swelling was significantly faster in the group receiving ketorolac compared to the one receiving ibuprofen (P value <0.05). Conclusions: It was concluded that ibuprofen and ketorolac had positive and almost similar effects on pain control, edema, and trismus after molar surgery. However, ketorolac was more effective in controlling edema after surgery.

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Effects of estradiol hormone in menopausal women on anterior disc displacement of temporomandibular joint

BIO Web of Conferences ◽

10.1051/bioconf/20202802002 ◽

2020 ◽

Vol 28 ◽

pp. 02002

Author(s):

Yosaphat Bayu Rosanto ◽

Poerwati Soetji Rahajoe

Keyword(s):

Temporomandibular Joint ◽

Extracellular Matrix Remodeling ◽

Disc Displacement ◽

Matrix Remodeling ◽

Articular Disc ◽

Normal Position ◽

Sexual Hormones ◽

Joint Structure ◽

Anterior Disc Displacement ◽

Menopausal Women

Anterior disc displacement is a condition when the articular disc is in the anterior normal position. Epidemiological research shows that the prevalence of TMD is higher in women than in men. Women have a dominant hormone that is not owned by men, the hormone estradiol. Estrogen receptors and the hormone progesterone are found in articular joints in humans. Joint structure, extracellular matrix remodeling, and bone volume modification can be affected by sexual hormones. It was thought to cause changes in connective tissue in the TMJ structure. This study aims to determine the effect of the level of the hormone estradiol in menopausal women on anterior temporal disc displacement of the temporomandibular joint. Subjects were 40 postmenopausal women who were examined for temporomandary joints. The diagnosis of anterior disc displacement was made using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) method. Subjects were grouped into subjects with normal tempromandibular joints and subjects with anterior disc displacement. Estradiol hormone was examined by the immunoassay method. This study’s conclusion is estradiol hormone in menopausal women with anterior disc displacement is higher than menopausal women without anterior disc displacement.

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Use of chlorhexidine 0.2% gel to prevent alveolar osteitis in mandibular third molar surgical extraction.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.08.4264 ◽

2020 ◽

Vol 27 (08) ◽

pp. 1606-1611

Author(s):

Shuja Hamid ◽

Mahwish Memon ◽

Raza Ali ◽

Salman Shams

Keyword(s):

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Control Group ◽

Dry Socket ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Alveolar Osteitis ◽

Group A ◽

Group B

Objectives: To evaluate the efficacy of 0.2% chlorhexidine gel placed intra alveolar in the prevention of alveolar osteitis after the surgical extraction of mandibular third molar. Study Design: Randomized Control trial. Setting: Department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro/Hyderabad. Period: January 2016 to July 2016. Material & Methods: This study consisted of 40 patients in control group A and 40 patients of Chlorohexidine gel group B used after surgical extraction. A single dose of 0.2% bio-adhesive gel was introduced in group B while the control group A was left alone. Postoperative complications like pain, swelling, limited mouth opening, and dry socket were seen. Frequency and percentages were calculated. Mean +/- SD were calculated for quantitative variables. Results: On 3rd day patients reported with pain in group A were 24 and in group B were 15. Pain was seen in 4 patients (10%) on 15th day in group A while in group B no patient came with pain. 19 patients reported with dry socket on day 3 in group A and 4 patients in group B, While none of the patient encountered with Dry socket on 15th day in group in both groups. Conclusion: The data presented indicates that the bio-adhesive gel containing 0.2% chlorohexidine, applied post-extraction produced a better patient recovery.

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Comparative Evaluation of Two Different Flap Designs and Postoperative Outcome in the Surgical Removal of Impacted Mandibular Third Molar

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-2131 ◽

2017 ◽

Vol 18 (9) ◽

pp. 807-811 ◽

Cited By ~ 6

Author(s):

Shabeer Ahamed ◽

A Rabi ◽

PM Mohamed Haris ◽

Deepu M Panickal ◽

Venith J Pulikkottil ◽

...

Keyword(s):

Patient Satisfaction ◽

Third Molar ◽

Mouth Opening ◽

Postoperative Outcome ◽

Study Groups ◽

Surgical Removal ◽

Triangular Flap ◽

Impacted Mandibular Third Molar ◽

Mandibular Third Molar ◽

Significant Difference

ABSTRACT Aim The aim of this study is to compare triangular and envelope flap designs and the postoperative outcome in the surgical removal of impacted mandibular third molar. Materials and methods A total of 50 participants were assessed clinically and were divided randomly into two groups. Group I (participants operated by triangular flap) and group II (participants operated by envelope flap), with 25 participants each between the age group of 20 and 30 years. Patient satisfaction was assessed subjectively using a graded scale from very satisfied to very unsatisfied. The degree of pain was recorded for 7 days with reference to predefined values on visual analog scale (VAS). Trismus was evaluated on the day 3, day 5, and day 7 of the postoperative period in millimeters. Quantitative data were analyzed by unpaired t-test and qualitative data were by Fischer's exact test. Results The mean overall age is 25.5 years. There was no statistically significant difference between the study groups with respect to age. There was no significant association between the patient satisfaction and flap type (p = 0.684). A significant difference between the study groups on 4th, 5th, and 6th days with respect to pain was observed, wherein fewer subjects operated with triangular flap reported pain. A highly significant difference in mouth opening was observed, with triangular flap group participants having a higher mouth opening than envelope flap subjects on day 7. Conclusion The present study indicated that participants operated by triangular flap had a better mouth opening postoperatively compared with envelope flap participants, whereas there were no significant differences in patient satisfaction and pain scores at the end of the 7th day after third molar surgery. Clinical significance Flap design is a significant factor in the surgical removal of impacted third molar, and it influences the severity of complications. Furthermore, it is important for allowing optimal visibility and access to the impacted tooth and also for subsequent healing of the surgically created defect. How to cite this article Rabi A, Haris PMM, Panickal DM, Ahamed S, Pulikkottil VJ, Haris KTM. Comparative Evaluation of Two Different Flap Designs and Postoperative Outcome in the Surgical Removal of Impacted Mandibular Third Molar. J Contemp Dent Pract 2017;18(9):807-811.

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Evaluation of efficacy of submucosal tramadol after mandibular third molar surgery: a prospective pilot study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195009 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4320

Author(s):

Karan V. Panchal ◽

Navin S. Shah ◽

Pratik Agrawal ◽

Parshwa N. Shah

Keyword(s):

Pilot Study ◽

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Analgesic Efficacy ◽

Third Molar Surgery ◽

Oral And Maxillofacial Surgery ◽

Third Molar Extraction ◽

Mandibular Third Molar ◽

Surgical Extraction

Background: Surgical extraction of mandibular third molar is one of the most commonly performed procedure in oral and maxillofacial surgery. Its removal causes swelling, trismus, and moderate to severe pain which can be treated with various NSAID’s drugs, which have numerous side effects and gastric disturbances. In order to bypass such disturbances, Tramadol may be considered as an alternative for such patients. The aim of the study was to evaluate analgesic efficacy of submucosal tramadol and its implication over swelling and mouth opening after mandibular third molar surgery.Methods: This is a prospective study where in after post-surgical extraction of mandibular third molar, efficacy of submucosal injection of tramadol is evaluated in terms of pain and its implication over swelling and mouth opening.Results: The present study suggested there was statistically significant VAS score for pain after submucosally injecting tramadol post-surgical extraction of mandibular third molar in the following visits- 4hourly, 8hourly and 24hourly. In respect to swelling, statistically significant values was noted during 24hr and 72 h our post extraction. Also in case of mouth opening, statistically significant values were found 24 hourly.Conclusions: The present pilot study concluded that submucosal tramadol post mandibular third molar extraction has been effective in reducing pain, limiting post-extraction swelling and less impacting mouth opening by inducing less complications thereby bypassing gastric disturbances.

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Effect of Occlusal Splints on the Stress Distribution on the Temporomandibular Joint Disc

Brazilian Dental Journal ◽

10.1590/0103-6440201601459 ◽

2017 ◽

Vol 28 (3) ◽

pp. 324-329 ◽

Cited By ~ 2

Author(s):

Fabiane Maria Ferreira ◽

Paulo Cézar Simamoto-Júnior ◽

Carlos José Soares ◽

António Manuel de Amaral Monteiro Ramos ◽

Alfredo Júlio Fernandes-Neto

Keyword(s):

Stress Distribution ◽

Temporomandibular Joint ◽

Disc Displacement ◽

Fe Model ◽

Distribution Analysis ◽

Articular Disc ◽

Occlusal Splint ◽

Occlusal Splints ◽

Anterior Disc Displacement ◽

Disc Position

Abstract Conservative approach, including occlusal splint therapy, is the first option to treat temporomandibular disorders (TMD), because of its reversibility. The present study analyzed the effect of the articular disc position and occlusal splints use on the stress distribution on this disc. A two-dimensional (2D) finite element (FE) model of the temporomandibular joint with the articular disc at its physiologic position was constructed based on cone-beam computed tomography. Three other FE models were created changing the disc position, according to occlusal splint use and anterior disc displacement condition. Structural stress distribution analysis was performed using Marc-Mentat package. The equivalent von Mises stress was used to compare the study factor. Higher stress concentration was observed on the intermediate to anterior zone of the disc, with maximum values over 2MPa. No relevant difference was verified on the stress distribution and magnitude comparing disc positions and occlusal splint use. However, there was stress reduction arising from the use of the occlusal splints in cases of anterior disc displacement. In conclusion, based on the generated FE models and established boundary conditions, the stress increased at the intermediate zone of the TMJ disc during physiological mandible closure. The stress magnitude was similar in all tested situations

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