Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Surgery

Background: Selection and application of suture materials, has gained more importance especially with the increasing number of patients seeking oral surgeries. Since lying in a bacterial-filled environment, sutures make the tissue prone to infection. Suture material plays an important role in the reduction of the risk of infection. This study aimed to assess the success rate of an antibacterial suture named Vicryl Plus in preventing bacterial growth in the surgical site of the mandibular third molar. Methods: 27 patients were included in this double-blinded randomized clinical trial study. Surgical Extraction of the mandibular wisdom tooth was done and the incision was managed by randomly using Vicryl Plus and Vicryl sutures. After 7 days, sutures were removed and assessed microbiologically. Predominant species of Streptococcus mutans and Lactobacillus were assessed as well as the total number of colonies on each suture. Results: There was a significant difference between two suture materials in colony number-length ratio of lactobacillus (p-value= 0.031) and total bacterial colonies (p-value=0.016); but not for S. mutans species (p-value=0.201). Conclusion: Antibacterial Vicryl suture can be a useful tool for the reduction in the rate of surgical site infection in high-risk cases and situations.

Download Full-text

Comparison of Post-Operative Symptom Severity (PoSSe) Scores in patients undergoing Mandibular Third Molar surgery in Ile-Ife, Nigeria

Annals of Health Research ◽

10.30442/ahr.0501-4-34 ◽

2019 ◽

Vol 5 (1) ◽

pp. 29-35

Author(s):

Olufemi Ogundipe ◽

Azuka Ralph Njokanma

Keyword(s):

Symptom Severity ◽

Third Molar ◽

Third Molar Surgery ◽

Surgical Removal ◽

Subjective Feeling ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Significant Difference ◽

The Mean ◽

A Prospective Study

Background: The Post-Operative Symptom Severity (Posse) score is useful in the assessment of patients after third molar surgery. Objective: To evaluate patients' perceptions of quality of life after surgical extraction of an impacted mandibular third molar by comparing their Post-operative Symptom Severity (PoSSe) scores at Post-operative Weeks (POW) 1 and 4. Methods: Seventy patients (age 18 to 35 years) at the Out-Patient Department were enrolled in a prospective study prior to surgical removal of third molars. Each patient was given a PoSSe questionnaire to be completed at POW 1 and POW 4. The scale assessed recovery in seven key domains on patients’ subjective feeling about pain, eating, speech, sensation, appearance, sickness and interference with daily activities. Results: All but one patient returned completely filled questionnaires. The mean age of the study population was 25.7 ± 4.5 years. The mean PoSSe score at POW 1 and POW 4 were 35.0 ± 7.2 and 33.2 ± 6.9 respectively with statistically significant difference (p = 0.010). The PoSSe score was higher among males compared to females at POW 1 (37.2 ± 7.6 vs 33.5 ± 6.6) and also higher among males at POW 4 (33.8 ± 9.4 vs 32.7 ± 4.6). Conclusion: The severity of symptoms was perceived to be worse at POW 1 when compared to POW4 but the symptoms were still severe at POW4. There is a need for surgeons need to pay more attention to management of symptoms in the post-operative intermediate period.

Download Full-text

Comparison of twin mix and revamped twin mix in mandibular third molar surgery - A randomised controlled double blinded study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3231 ◽

2020 ◽

Vol 11 (4) ◽

pp. 5821-5827

Author(s):

Dyna Albert ◽

Sudarssan Subramaniam Gouthaman ◽

Muthusekhar M R

Keyword(s):

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Mandibular Third Molar ◽

Significant Difference ◽

Facial Swelling ◽

Blinded Study ◽

Mandibular Third Molar Surgery ◽

Randomised Controlled ◽

Double Blinded

Mandibular third molar surgery is one of the most common minor oral surgical procedures performed by oral and maxillofacial surgeons. It is vital to provide the most comfortable postoperative phase to the patient and for this reason dexamethasone, a corticosteroid, is popularly used in various routes. The intraspace injection of dexamethasone mixed with 2% lignocaine and 4% articaine named, Twin Mix and Modified Twin Mix respectively is gaining increasing popularity. 0.5% Centbucridine is a safe alternative to 2% lignocaine with more cardio stable properties. In this study we aimed to evaluate the comparability of Twin Mix(TM) and Revamped Twin Mix(RTM) (mixture of dexamethasone and centbucridine) with respect to its anesthetic properties and its effectiveness in managing postoperative sequelae following mandibular third molar surgery. For this, a randomised controlled double blinded study was conducted among patients reporting to the Out Patient Department of a dental college. The sample size of the population studied was 32, 16 in Group A (RTM) and 16 in Group B (TM). The primary outcomes measured were facial swelling and mouth opening on postoperative day(POD) 1, 3 and 7. The secondary outcomes were VAS score during the surgical procedure, duration and latency of anesthesia. The data were analysed descriptively and using Student’s t Test. Representations were given in graphical and tabular forms. The mean postoperative mouth opening and facial swelling on POD 1, 3 and 7 were comparable and did not show any statistically significant difference. Similarly, the VAS score during procedure, latency and duration of anesthesia were comparable with no statistically significant difference. In conclusion, RTM can be used as an alternative to TM due to its comparable properties.

Download Full-text

A Comparative Study on Efficacy of Amoxicillin and Azithromycin in Prevention of Postoperative Sequelae Following Third Molar Surgery

Nepal Medical College Journal ◽

10.3126/nmcj.v21i3.26467 ◽

2019 ◽

Vol 21 (3) ◽

pp. 224-229

Author(s):

Rashmi Shakya Gurung ◽

K. Bimb ◽

D. Shrestha

Keyword(s):

Maxillofacial Surgery ◽

Third Molar ◽

Controlled Study ◽

Third Molar Surgery ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Operative Complications ◽

Alternative Drug ◽

Group B ◽

Post Operative Complications

Amoxicillin is the commonly prescribed antimicrobial for prevention of post-operative complications following surgical extraction of mandibular third molar. However recently, the use of macrolideantibiotics had been encouraged in dentistry. The aim of this study was to compare the efficacy of Amoxicillin and Azithromycin in preventing post-operative sequelae following third molar surgery. An open- labeled randomized controlled study was carried out in Department of Oraland Maxillofacial surgery, college of Dental Sciences and Hospital, Nepal Medical College (CODSHNMC), Attarkhel, Kathmandu, Nepal from May 2018 to June 2019. One hundred and twenty patients undergoing surgical extraction of impacted mandibular third molar were randomized by lottery method into two groups: Group A received Amoxicillin and Group B received Azithromycin. Both the groups were assessed postoperatively on 1st, 3rd and 7th days for post-operative complications- pain, swelling, trismus and pus discharge. The present study revealed no significant differences between the efficacy of Amoxicillin and Azithromycin in preventing postoperative sequelae following surgical extraction of impacted third molar. Amoxicillin and Azithromycin were therefore found to be equally effective. Thus, Azithromycin can be used as an alternative drug to Amoxicillin in case of resistance and intolerance to Amoxicillin.

Download Full-text

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.

Download Full-text

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

Download Full-text

Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery

Nepal Journal of Health Sciences ◽

10.3126/njhs.v1i2.42365 ◽

2021 ◽

Vol 1 (2) ◽

pp. 1-6

Author(s):

Pranay Ratna Sakya ◽

Dipti Shrestha ◽

Reena Shrestha ◽

Dhiraj Khadka Khadka ◽

Ratina Tamrakar ◽

...

Keyword(s):

Third Molar ◽

Third Molar Surgery ◽

P Value ◽

Third Molars ◽

Surgical Extraction ◽

Facial Swelling ◽

Degree Of Swelling ◽

Interincisal Distance ◽

Mandibular Third Molar Surgery ◽

Different Doses

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications. Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively. Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value >0.05) difference between the two doses. Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus. Keywords: Dexamethasone; impacted third molars; swelling; trismus.

Download Full-text

Flap design: Comparison of ward’s flap versus modified ward’s flap in surgical extraction of impacted mandibular third molar.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3877 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1323-1327

Author(s):

Ashook Kumar ◽

Anny Memon ◽

Suneel Kumar Panjabi ◽

Salman Shams

Keyword(s):

Postoperative Pain ◽

Third Molar ◽

P Value ◽

Full Thickness ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Flap Design ◽

Mucoperiosteal Flap ◽

Group A ◽

Group B

To compare the Ward’s Flap Versus Modified Ward’s flap in relation to access, healing & postoperative complications in surgical extraction of mandibular third molar impaction. Study Design: Comparative Cross Sectional. Setting: Department of Oral & Maxillofacial Surgery LUMHS Jamshoro/Hyderabad: Period: March 2017 to November 2017. Materials and Methods: The history, clinical examination and radiographs (OPG and periapical) had done by team of researchers and recorded on proforma. After selection of patient into either group (Group A=Wards Flap, Group B Modified Wards), the surgical extraction was carried out under local anesthesia. For group A, a standard full thickness mucoperiosteal flap (ward’s flap) was raised. The incision was given mesial to the impacted lower third molar. For group B, a standard full thickness mucoperiosteal flap (Modified ward’s flap) was given mesial to second molar. At the end of the surgery, the flap design used for the extraction of impacted lower third molar tooth and the duration of each operation (from the first extraction maneuver to the completion of the last suture), Pain, Swelling and Trismus13 were recorded on the proforma. Every patient was called for follow up on the 3rd day and 7th day. Results: Mean age was found 27.93 years, with range of minimum 20 years and maximum 35 years. Male were found in the majority 72.3%. Majority of the cases 51.5% were found with class B, in class A 37.5% and 10.9% were found with class C. According to the impaction position 50% cases were in class I, and 50% cases were in class II. Preoperative pain measurement was done according VAS, 71.9% patients were found with mild pain, 9.4% were with moderate pain while 18.8% patients were without pain. Modified Wards flap showed good efficacy regarding duration of third molar extraction as compare to Ward’s flap P-value 0.018. Modified ward’s flap had showed less postoperative pain as compare to ward’s flap p-value 0.022. No significant difference was found between both groups on 3rd and 7th postoperative day in Mouth opening. Conclusion: This study concluded that both ward’s flap and modified ward’s flaps showed good efficacy, while duration of surgery and postoperative pain were significantly less in the modified ward’s flaps as compare to ward’s flap. More large sample size studies are required to evaluate more accurate findings.

Download Full-text

The Effect of Platelet Rich Plasma on Tissue Healing after Mandibular Third Molar Surgery

Journal of Isfahan Dental School ◽

10.18502/ijds.v17i2.6880 ◽

2021 ◽

Author(s):

Negin Karimi ◽

Behnam Khorrami ◽

Reza Nezhadnasrollah ◽

Yamin Haghani

Keyword(s):

Soft Tissue ◽

Third Molar ◽

Test Group ◽

Third Molar Surgery ◽

P Value ◽

Soft Tissue Healing ◽

Tissue Healing ◽

Mandibular Third Molar ◽

The Mean ◽

Mandibular Third Molar Surgery

Introduction: This study aimed, effect of platelet-rich plasma (PRP) on soft tissue healing after mandibular third molar surgery. Materials & Methods: In this semi-blinded clinical trial study,30 selected patients requiring surgical extraction of soft tissue impacted mandibular third molar participated from cases referred to the Department of Surgery, Faculty of Dentistry, Isfahan Azad University 2017.Patients divided into both test and control groups. PRP was placed in the extracted socket of the test group, whereas the control group had no PRP. Arzhangian standard kit utilized for preparation of PRP. The outcome variables in this study were pain, swelling, inter incisal mouth opening, wound dehiscence, dry socket, bleeding, and tissue color. The collected data analyzed using statistical tests followed independent T-test, Mann-Whitney, and fisher (p value < 0.05). Results: The mean postoperative pain score (Visual Analog Scale) lowered for the test group after several wound dehiscence on the third and seventh days after surgery which was statistically significant (p value < 0.001). Although the mean bleeding time on the third day after surgery decreased in the test group, this difference was not statistically significant (p value = 0.59). There were no statistically significant between both groups for The dry socket incidence on the seventh day and the mean of inter incisal mouth opening in the third and seventh days after surgery as well. Conclusion: The usage of topical PRP has beneficial advantages on soft tissue healing after mandibular third molar surgery. Unlike the control group, The PRP group provided reduced pain and better soft tissue healing.

Download Full-text

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.

Download Full-text

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.

Download Full-text