Dexmedetomidine Sedation With and Without Midazolam for Third Molar Surgery

Abstract Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.

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TOMOGRAFIA COMPUTADORIZADA: VANTAGENS SOBRE A RADIOGRAFIA PANORÂMICA NA AVALIAÇÃO DE TERCEIROS MOLARES INFERIORES INCLUSOS

DENS ◽

10.5380/rd.v15i2.9202 ◽

2007 ◽

Vol 15 (2) ◽

Author(s):

Carolina LAZAROTTO ◽

Grasielle KARPSTEIN ◽

Wilson Kenji SHIROMA

Keyword(s):

Oral Surgery ◽

Third Molar ◽

Oral Pathology ◽

Conventional Radiography ◽

Mandibular Canal ◽

Radiographic Evaluation ◽

Third Molar Surgery ◽

Oral Radiology ◽

Conventional Tomography ◽

Macroscopic Findings

Tomografia Computadorizada: vantagens sobre a Radiografia Panorâmica na avaliação de terceiros molares inferiores inclusos. A cirurgia dos terceiros molares inferiores retidos pode levar a alterações sensoriais importantes, devido a trauma no nervo alveolar inferior, o qual no seu trajeto, apresenta relação intra-óssea importante com as raízes dos molares. A relação entre os ápices do terceiro molar e o canal mandibular deve ser previamente identificada à intervenção cirúrgica. O presente trabalho tem por objetivo a comparação das imagens, da relação dos terceiros molares inferiores retidos com o canal mandibular, fornecidas por radiografias panorâmicas (RP) e por tomografias computadorizadas (TC). Metodologia: Comparação de radiografias panorâmicas e suas respectivas TC, levando em consideração a relação de proximidade dos ápices dentários com o canal mandibular. Resultados: Das RP avaliadas, todas apresentaram imagem de sobreposição do canal mandibular, e uma delas, também sugeriu trajeto interradicular do mesmo. Na TC comprovou-se tridimensionalmente relação de proximidade dos mesmos e em um caso, descartou-se a possibilidade de um trajeto interradicular do canal mandibular. Conclusão: Pelo material analisado, sugere-se que a TC mostra-se superior no diagnóstico e planejamento cirúrgico de terceiros molares inclusos. Palavras-Chave: Tomografia; Radiografia Panorâmica; Nervo Mandibular Referências Bibliográficas 1. DÍAZ-TORRES, M. J. et al. Fatores clínicos y radiológicos de “verdadera relación” entre el nervio dentário y el tercer molar. Revista Española de Cirurgia Oral y Maxillofacial, v. XII, n. 2, p. 51-57, 1990.2. FREDERIKSEN, N.L.; Diagnostic imaging in dental implantology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. v.80, 540-554, 1995.3. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of Macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. v. 4, p. 327-332, 1989.4. LINDH, C.; PETERSON, A. Radiologic examination for location the mandibular canal: A comparision between panoramic radiography and conventional tomography. The International Journal of Oral & Maxillofacial Implants. V. 4, n. 3, p.249-253, 1989.5. SINN, D. P.; KARAS, N. D. Radiographic evaluation of facial injuries. In: FONSECA, R. J.; WALKER, R. V. Oral and Maxillofacial Trauma. 2. ed. Saunders Company, 1997. p. 391-418.6. GRAZIANI, Mario. Cirurgia bucomaxilofacial. 8. ed. Rio de Janeiro: Guanabara Koogan, c1995.7. GOMES, A. C. et al. Estudo das lesões nervosas após cirurgia dos terceiros molares inferiores retidos. Dissertação de Mestrado em odontologia – Faculdade de Odontologia de Pernambuco – Camaragibe-Pe, 2001. 123 p.8. FÉLEZ-GUTIÉRREZ, J. et al. Las lesiones Del nervio dentario inferior en el tratamiento quirúrgico del tercer molar inferior retenido: aspectos radiológicos, prognósticos y preventivos. Archivos de Odontoestomatología, v. 13, n. 2, p. 73-83, 1997.9. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computedtomography. Int J Oral Maxillofac Implants, v. 4, p. 327-332, 1989.10. RUD, J. Third molar surgery: relationship of root to mandibular canal and injuries to inferior dental nerve. Tandlaegebladet, v. 87, n. 18, p. 619-630, 1983.

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Oral surgery

Oxford Handbook of Clinical Dentistry ◽

10.1093/med/9780198832171.003.0010 ◽

2020 ◽

pp. 377-429

Keyword(s):

Soft Tissue ◽

Oral Surgery ◽

Third Molar ◽

Third Molar Surgery ◽

Dental Practice ◽

Comprehensive Overview ◽

General Dental Practice ◽

Dental Procedures ◽

Operative Assessment

This chapter provides a comprehensive overview of several aspects of oral surgery. It starts with some general principles that are applicable to all types of surgery and gradually includes details of common dental procedures. There is emphasis on suturing and dento-alveolar surgery including third molar surgery. More specialized procedures such as an apicectomy and a coronectomy are also described. The aim is to provide guidance that will help with the pre-operative assessment, as well as details of the specific oral surgery techniques. Clinicians in general dental practice and dental core trainees in hospitals often encounter patients with dento-alveolar infections as well as benign soft tissue or bone pathologies. This chapter provides the foundations of management of these conditions.

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Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data

Antibiotics ◽

10.3390/antibiotics8020053 ◽

2019 ◽

Vol 8 (2) ◽

pp. 53 ◽

Cited By ~ 23

Author(s):

Gabriele Cervino ◽

Marco Cicciù ◽

Antonio Biondi ◽

Salvatore Bocchieri ◽

Alan Scott Herford ◽

...

Keyword(s):

Systematic Review ◽

Oral Surgery ◽

Third Molar ◽

Health Conditions ◽

Drug Misuse ◽

Third Molar Surgery ◽

Inclusion Criteria ◽

Third Molar Extraction ◽

Wisdom Teeth ◽

High Predictability

The aim of this paper was to highlight the most widely antibiotic protocols applied to the dental field, especially in the surgical treatment of impacted wisdom teeth. Once these protocols were screened, all the possible advantages or disadvantages for each drug and each posology were recorded in this review. In recent years, the need to use these protocols has been debated in the literature. The data obtained by this review underlined how antibiotic protocols applied to oral surgery treatments only included surgeries performed on patients who did not present other systemic pathologies. The first literature review obtained 140 results, and then after the application of the inclusion criteria, 12 papers were selected. The results showed that the most commonly used protocol involved the use of penicillin and clavulanate, obtaining safe clinical and prophylactic results in the management of infections. This widely used protocol seems to guarantee high predictability and safety. The presented review highlights the current possibility of antibiotic resistance affecting patients due to drug misuse. Further clinical studies are required to state specific guidelines; however, oral surgeons involved in third molar surgery should evaluate the local and general health conditions of the patients before suggesting any drug measures for patients.

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Specialist practice for minor oral surgery: a comparative audit of third molar surgery

BDJ ◽

10.1038/sj.bdj.4808154 ◽

1993 ◽

Vol 174 (8) ◽

pp. 273-277 ◽

Cited By ~ 12

Author(s):

A Sadler ◽

M Davidson ◽

C Houpis ◽

S Watt-Smith

Keyword(s):

Oral Surgery ◽

Third Molar ◽

Third Molar Surgery ◽

Minor Oral Surgery ◽

Specialist Practice ◽

Comparative Audit

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Subcutaneous emphysema during third molar surgery: a case report

Brazilian Dental Journal ◽

10.1590/s0103-64402011000100015 ◽

2011 ◽

Vol 22 (1) ◽

pp. 83-86 ◽

Cited By ~ 14

Author(s):

Umberto Romeo ◽

Alexandros Galanakis ◽

Francesco Lerario ◽

Gabriele Maria Daniele ◽

Gianluca Tenore ◽

...

Keyword(s):

Subcutaneous Emphysema ◽

High Speed ◽

Soft Tissues ◽

Oral Surgery ◽

Surgical Complication ◽

Third Molar ◽

Daily Basis ◽

Third Molar Surgery ◽

Endodontically Treated Teeth ◽

Third Molar Extraction

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

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Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10215081 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5081

Author(s):

Francisco Javier Quesada-Bravo ◽

Ana Rocío García-Carricondo ◽

Fernando Espín-Gálvez ◽

Carmen Fernández-Sánchez ◽

Damaso Fernández-Ginés ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Oral Surgery ◽

Third Molar ◽

Third Molar Surgery ◽

Control Group ◽

Anaesthetic Block ◽

Standard Block ◽

And Control ◽

Experimental Group

Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine–epinephrine and submucosal reinforcement with 0.8 mg dexamethasone–5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine–epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients’ scores on the VAS as well as their consumption of analgesic drugs after surgery.

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Anestesia transcortical em exodontias simples e complexas

Research Society and Development ◽

10.33448/rsd-v9i10.8109 ◽

2020 ◽

Vol 9 (10) ◽

pp. e9039108109

Author(s):

Haline Alves da Silva ◽

Mirelle de Sousa Soares ◽

Paulo Ronaldo Sousa Texeira ◽

Marcelo Bruno Meneses Mendes ◽

Maria Cândida de Almeida Lopes

Keyword(s):

Tooth Extraction ◽

Oral Surgery ◽

Third Molar ◽

Third Molar Surgery ◽

Mandibular Third Molar ◽

Intraosseous Injection ◽

Mandibular Third Molar Surgery

Anestesia transcortical consiste no depósito da solução anestésica no osso esponjoso adjacente ao dente a ser anestesiado. O objetivo desse trabalho é apresentar um levantamento retrospectivo científico sobre a eficácia clínica da anestesia transcortical aplicada às exodontias simples e complexa através de revisão de literatura. Foi realizada uma pesquisa nas bases Pubmed, SciELO e Scopus, usando as combinações de palavras-chave “intraosseous injection AND oral surgery”, “tooth extraction AND intraosseous anesthesia”, “mandibular third molar surgery AND intraosseous injection” e “tooth extraction AND transcortical anesthesia”. Foram incluídos estudos clínicos publicados no período de 2000 a 2020, em inglês. Foram excluídos estudos laboratoriais, estudos em animais, casos clínicos e revisões de literatura. Quanto aos resultados, foram localizados 92 aplicando-se as palavras-chave, dos quais 7 foram incluídos após critérios de inclusão e exclusão, através de leitura dos títulos, resumos e textos completos. A maioria (n=6) era estudos clínicos, dos quais 5 eram randomizados. Todos os estudos avaliaram o sistema QuickSleeper, incluindo comparação a anestesia transcortical com a técnica de bloqueio do nervo alveolar inferior (n=3). A percepção dolorosa (n=3) e a eficácia (n=4) foram os fatores mais avaliados nos trabalhos. A anestesia transcortical é uma alternativa às técnicas convencionais e pode ser aplicada em casos de falhas ou insuficiências da anestesia convencional em exodontias simples e complexas.

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Impact of electro-neuro-feedback on postoperative outcome of impacted lower third molar surgery

European Journal of Dentistry ◽

10.4103/ejd.ejd_296_17 ◽

2018 ◽

Vol 12 (01) ◽

pp. 077-088

Author(s):

Giacomo Oteri ◽

Antonia Marcianò ◽

Gabriele Cervino ◽

Matteo Peditto

Keyword(s):

Clinical Outcome ◽

Biochemical Parameters ◽

Oral Surgery ◽

Third Molar ◽

Postoperative Outcome ◽

Third Molar Surgery ◽

Surgical Removal ◽

Third Molars ◽

School Of Dentistry ◽

The Impact

ABSTRACT Objective: The purpose of this study was to evaluate the impact of a treatment with electro-neuro-feedback (ENF), a portable transcutaneous electrical nerve stimulation (TENS) device, on the clinical outcome and inflammatory biochemical parameters related to the impacted lower third molar surgery. Materials and Methods: A randomized, split-mouth, and single-blind study was conducted on 32 patients requiring lower third molars extractions and referred to the Oral Surgery Unit of the School of Dentistry of the University of Messina. Every patient underwent surgical removal of both lower third molars. The first extraction included a placebo (electrodes placement with turned-off device) treatment following the surgery, while the second had the ENF used next to the avulsion and the following days. Clinical parameters were collected 4 days before, immediately after, 2, 4, and 7 days after the surgical procedure. Biochemical parameters were obtained 1 day before the surgical removal and 7 days after. Data were processed using Wilcoxon–Mann–Whitney test, with significance being set at P < 0.05. Results: Clinical outcome parameters showed a significant improvement after the ENF treatment, while considered inflammatory markers expressed different patterns. Conclusions: ENF, a reliable portable TENS device, has demonstrated to be a useful tool in the managing of the postsurgical phases, reducing edema, pain, and consequent pain-killers consumption.

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