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

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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Comparison of postoperative complications after impacted mandibular third molar extraction with conventional suturing versus tube drainage.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.4011 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1408-1413

Author(s):

Wajid Ali Rajper ◽

Kashif Ali Channar ◽

Munawar Din Larik ◽

Sajid Ali Majeedano ◽

Aftab Ahmed Soomro ◽

...

Keyword(s):

Postoperative Complications ◽

Third Molar ◽

Mouth Opening ◽

P Value ◽

Third Molars ◽

Mandibular Third Molar ◽

Group A ◽

Impacted Mandibular Third Molars ◽

Group B ◽

Mandibular Third Molars

Objectives: To determine the effectiveness of tube drain compared with conventional suturing on postoperative complications after extraction of impacted mandibular third molars. Study Design: Cross Sectional study (Comparative). Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, LUMHS Jamshoro/Hyderabad. Period: Six months duration from 12-11-2015 to 13-05-2016. Material & Methods: All the patient age from 18 to 45 years irrespective of gender, having mesioangular impacted mandibular third molar were included in the study. Patients were divided into two groups, Group-A and group-B. The severity of pain was recorded by using Visual Analog Scale from 0 no pain to 10 worst pain, degree of swelling was measured by facial size through Amin and Laskin criteria and mouth opening was measured by interincisal distance through ruler. All data was recorded on the 3rd and 7th day by the clinician. Results: Mean age of group A was 31.22+7.21 years, and mean age of group B was 28.34+5.33 years. Male were found slightly more as compared to female. On 3rd day the post-operative pain assessment was almost equal in both groups p-value 0.06 and assessment of post-operative swelling on 3rd day was found with insignificant difference p-value 0.22. Assessment of pain on 7th post-operative day was that the severe pain was found significantly reduced in group B as compared to group A p-value 0.01, swelling was significantly reduced in group B p-value 0.04. While mouth opening was also found significantly more in group B as compared to group A p-value 0.022. Conclusion: After removal of impacted mandibular third molars, incorporating tube drain is very effective as compared to conventional suturing in reducing the facial swelling, trismus and postoperative pain.

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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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Correlation between mandibular third molar and mandibular incisor crowding: A retrospective CBCT-based study

Journal of Dental Research Dental Clinics Dental Prospects ◽

10.34172/joddd.2021.040 ◽

2021 ◽

Vol 15 (4) ◽

pp. 247-250

Author(s):

Seerab Husain ◽

Sri Rengalakshmi

Keyword(s):

Third Molar ◽

Third Molars ◽

Mandibular Incisor ◽

Positive Correlation ◽

Irregularity Index ◽

Mandibular Third Molar ◽

Group A ◽

The Mean ◽

Group B ◽

Mandibular Third Molars

Background. Late mandibular incisor crowding is a fairly common phenomenon experienced by growing adults. The etiology of late mandibular incisor crowding, however, is controversial and inconclusive. Hence, this study aimed to investigate the correlation between mandibular third molar and mandibular incisor crowding using Cone-beam computed tomography (CBCT) data. Methods. The study consisted of 40 samples of CBCT images divided into two groups (n=20). Group A comprised CBCT images without third molars, and group B included CBCT images with third molars. The images were observed in the axial view and manually marked to calculate the amount of crowding using Little’s irregularity index. The obtained values were statistically analyzed using Pearson’s correlation test. SPSS 23 was used for statistical analysis. Results. The results showed a positive correlation between the mandibular third molars and mandibular incisor crowding, which was significant (P=0.033). The mean Little’s irregularity index score for groups A and B were 4.26 and 6.799, respectively (P=0.033). Conclusion. The positive correlation between the two groups suggests an association between the mandibular third molars and mandibular incisor crowding.

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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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Efficacy of ibuprofen gargle for postoperative pain after mandibular third molar extraction: a phase II, placebo-controlled, double-blind, randomized crossover trial (Preprint)

10.2196/preprints.35533 ◽

2021 ◽

Author(s):

Yasumasa Kakei ◽

Takeshi Ioroi ◽

Takahiro Ito ◽

Yutaro Okazaki ◽

Takumi Hasegawa ◽

...

Keyword(s):

Postoperative Pain ◽

Crossover Trial ◽

Third Molar ◽

Third Molars ◽

Double Blind ◽

Third Molar Extraction ◽

Randomized Crossover Trial ◽

Mandibular Third Molar ◽

Mandibular Third Molars ◽

Subject Difference

BACKGROUND Extraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral administration of NSAIDs can produce various adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical use of analgesics has been proposed as an alternative to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars in comparison with a placebo gargle. OBJECTIVE This will be the first clinical study to evaluate the efficacy of ibuprofen gargle for relieving postoperative pain after extraction of mandibular third molars. METHODS This study will be performed at Kobe University Hospital. Participants (n = 40) will be randomized equally to one of two groups. The IP group will receive ibuprofen gargle on postoperative day (POD) 1 and placebo gargle on POD 2. The PI group will receive placebo gargle on POD 1 and ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargle on PODs 3 to 5 at least once daily. The primary objective is to estimate the within-subject difference in a visual analogue scale (VAS) before and 5 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject difference in ΔVAS before and 15 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2, the ΔVAS before and after 5 or 15 minutes of use of ibuprofen gargle on PODs 3 to 5, the overall effectiveness (self-completion, five scales) on PODs 1 to 5, the daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1 to 7, and the occurrence of adverse events. RESULTS The Kobe university Certified Review Board approved the study. The intervention was implemented in May 2021. CONCLUSIONS This trial will provide exploratory evidence of the efficacy and safety of ibuprofen gargle for pain reduction after mandibular third molar extraction. CLINICALTRIAL Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210022. Registered on 10 May 2021.

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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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The use of piezosurgery for mandibular third molar extraction

Stomatoloski glasnik Srbije ◽

10.2298/sgs1404203t ◽

2014 ◽

Vol 61 (4) ◽

pp. 203-209 ◽

Cited By ~ 2

Author(s):

Nenad Tanaskovic ◽

Miroslav Lucic

Keyword(s):

Postoperative Complications ◽

Surgical Techniques ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Mouth Opening ◽

Standard Group ◽

Third Molars ◽

Wisdom Teeth ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Introduction. Extraction of impacted mandibular third molars is often accompanied by intraoperative and postoperative complications such as damage of the inferior alveolar nerve, prolonged difficulty in mouth opening, alveolitis, pain and swelling in the region of surgery. The aim of this study was to compare two surgical techniques (standard and piezo) in the extraction of mandibular third molars and to assess their postoperative complications. Material and Methods. Study included 16 patients (8 male and 8 female) age 17 to 32 years treated in the period from 2012 to 2014. All patients had both mandibular molars impacted. One third molar was extracted using classical technique while the other one using a piezo device. Preoperative preparation was the same for all patients and included radiological analysis and verification of teeth by ortopan tomography (OPG) and CT. Patients were assessed one, seven and 14 days after the procedure. Results. After the extraction, all patients were followed for postoperative symptoms: pain, swelling and paresthesia of the inferior alveolar nerve. The results confirmed advantages of piezosurgery in the removal of impacted mandibular third molars. Average duration of the intervention was 18 minutes with standard technique while the duration with piezo technique was 23 minutes. According to the visual-analog scale (VAS) the average pain in the standard group was 9 whereas in the piezo group it was 6. Postoperative swelling was 10 mm (pronounced) the first day after the procedure in the standard group while in the piezo group it was 6 mm (moderate). Conclusion. The use of piezo technology for the extraction of impacted wisdom teeth is reliable method which reduces the risk of the most common postoperative complications following mandibular wisdom teeth removal.

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Evaluation of Demographic, Radiological and Intraoperative Factors For Assessment of Postoperative Pain And Complications In Surgical Removal Of Impacted Mandibular Third Molar – A Prospective Study

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v7i2.531 ◽

2020 ◽

pp. 42-52

Author(s):

Manu R. Goel ◽

Milind D. Shringarpure ◽

Vasant V. Shewale ◽

Tejasvini Dehankar ◽

Chandrashekhar R. Bande ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Third Molar ◽

Surgical Removal ◽

Third Molars ◽

Impacted Tooth ◽

Mandibular Third Molar ◽

Surgical Difficulty ◽

A Prospective Study ◽

Root Contact

Third molars usually erupt within the age of 17 – 21years. Usually, due to the evolution of human jaws, the size is decreasing leading to the impacted tooth. An impacted tooth may lead to external resorption of the adjacent tooth, trismus, infection, etc. Many studies have been reported in the literature for evaluating the surgical difficulty and postoperative complications secondary to impacted third molars. This study includes a sample of 100 subjects evaluated for the surgical difficulty and postoperative complications. Various demographic, radiological, and intraoperative factors were evaluated which may lead to postoperative complications. Factors responsible for postoperative sequelae were also evaluated with complications. Postoperative pain after 4 hours and 7 days was assessed to mark the factors commonly responsible. Pain at 7th postoperative day was significant involving factors like fully impacted, horizontal impaction, level C, no/very little retromolar space, and root contact. Postoperative complications were not reported in this study.

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Use of Collagen Membrane in the Treatment of Periodontal Defects Distal to Mandibular Second Molars Following Surgical Removal of Impacted Mandibular Third Molars: A Comparative Clinical Study

Biology ◽

10.3390/biology10121348 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1348

Author(s):

C. Burnice Nalina Kumari ◽

Thiagarajan Ramakrishnan ◽

Pradeep Devadoss ◽

Rajaram Vijayalakshmi ◽

Khalid J. Alzahrani ◽

...

Keyword(s):

Alveolar Bone ◽

Third Molar ◽

Collagen Membrane ◽

Surgical Removal ◽

Third Molars ◽

Membrane Barrier ◽

Group A ◽

Impacted Mandibular Third Molars ◽

Group B ◽

Mandibular Third Molars

The study aims to assess the efficacy of using collagen membrane in the treatment of distal periodontal defects of mandibular second molars following the removal of mesioangularly or horizontally impacted mandibular third molars surgically. Forty sites in twenty patients with bilaterally impacted mandibular third molars (mesioangular or horizontal) were considered for the study. In 20 test sites (Group A), after surgical removal of the mandibular third molar, a resorbable collagen membrane barrier was placed on the distal aspect of the mandibular second molar to cover the post-surgical bone defect. In the other control 20 sites (Group B), the same surgical procedure was repeated without placing any membrane barrier. The clinical parameters recorded were Oral Hygiene Index Simplified (OHI-S), Probing pocket depth (PPD), Clinical attachment level (CAL), and radiographic assessment of alveolar bone level (ABL). OHI-S score of most of the patients was observed to be satisfactory. Group A was observed to achieve a statistically significant reduction in PPD, CAL, and ABL gain compared to Group B. The improvements indicated that the use of collagen membrane facilitates early wound stabilization and promotes primary closure of the defect. This recovery is achieved through its unique property to assist fibrinogenesis over osteoconduction. Further longitudinal studies are needed to confirm the present findings.

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Evaluasi Ekstraksi Molar Ketiga Rahang Bawah Berdasarkan Angulasi Mesial pada Radiografi Panoramik

e-GIGI ◽

10.35790/eg.8.1.2020.28743 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Rosalina I. Saputri ◽

Rizky M. Boedi

Keyword(s):

Predictive Factor ◽

Third Molar ◽

Third Molars ◽

Panoramic Radiographs ◽

Second Molar ◽

Stomatognathic System ◽

Third Molar Extraction ◽

Irregular Pattern ◽

Mandibular Third Molar ◽

Mandibular Third Molars

Abstract: Third molar development is a concern in dental care because of its influence on stomatognathic system. Due to third molar irregular pattern of eruption, different clinical and radiographic considerations on how to decide an extraction were studied. This study was aimed to evaluate the effect of mandibular third molar mesial angulation (MA) towards the extractions on panoramic radiographs. This was a retrospective study. A longitudinal study of mandibular third molars (n=192) of 102 individuals (50 Female and 52 Male) was conducted. Development of the mandibular third molar was staged according to modified Köhler et al. staging technique. Mesial angulation was measured from the intersection between axes of third molar and adjacent second molar of the most developed stage for extraction cases or before root completion for non-extraction cases. Of 102 subjects, 107 mandibular third molars were extracted. The increase of 1° of MA would increase the odds ratio (OR) of extraction by 1.113 (95% CI 1.070-1.158, p<0.01). The ROC curve showed the MA of 18.5o as the threshold of extraction with 76% of sensitivity and 68% of specificity. In conclusion, MA has the possibility as a predictive factor of mandibular third molar extraction. Future studies using bigger sample sizes and variations of third molar development are suggestedKeywords: third molar, angulation, extraction, predictive factor, panoramic radiographs Abstrak: Pertumbuhan molar ketiga menjadi perhatian pada perawatan dental karena pengaruh-nya pada sistem stomatognasi. Terdapat banyak penelitian tentang berbagai pertimbangan klinis dan radiografis untuk melakukan ekstraksi molar ketiga karena pola erupsinya yang tidak menentu. Penelitian ini bertujuan untuk mengevaluasi efek angulasi mesial (AM) dari molar ketiga rahang bawah terhadap tindakan ekstraksi pada radiografi panoramik. Jenis penelitian ialah retrospektif. Pengamatan molar ketiga rahang bawah (n=192) secara longitudinal dilakukan pada 102 individu (50 perempuan dan 52 laki-laki). Pertumbuhan molar ketiga diukur berdasarkan tahap pertumbuhan dari teknik modifikasi Köhler et al. AM diukur dari pertemuan aksis molar ketiga dan molar kedua di sebelahnya, pada tahap pertumbuhan paling akhir pada kasus ekstraksi, atau sebelum akar gigi terbentuk sempurna pada kasus non-ekstraksi. Pada sampel penelitian, ekstraksi dilakukan pada 104 molar ketiga rahang bawah. Peningkatan 1o dari AM akan meningkatkan rasio peluang dari ekstraksi sebesar 1,113 (95% CI 1,070-1,158, p<0,01). Pada kurva ROC, AM sebesar 18,5o menunjukan 76% sensitivitas dan 68% spesifisitas. Simpulan penelitian ini ialah AM dapat digunakan sebagai faktor prediksi terhadap ekstraksi molar ketiga rahang bawah. Perkembangan penelitian selajutnya dapat dilakukan dengan jumlah sampel yang lebih besar dan dengan memperhatikan pertimbahan klinis serta parameter radiografik lainnya.Kata kunci: molar ketiga, angulasi, ekstraksi, faktor prediksi, radiografi panoramik

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