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

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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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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Flap vs flapless technique for impacted third molar removal: A split mouth prospective randomized control study

Journal of Oral Medicine Oral Surgery Oral Pathology and Oral Radiology ◽

10.18231/j.jooo.2021.051 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167-171

Author(s):

Neeraj ◽

Banshilal Beniwal ◽

Padmanidhi Agarwal ◽

Vikas Berwal ◽

Richa Malik

Keyword(s):

Healing Process ◽

Third Molar ◽

Mouth Opening ◽

Third Molars ◽

Pocket Depth ◽

Second Molar ◽

Group I ◽

Flap Design ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.

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Computer-Aided Design/Computer-Aided Manufacturing Cutting Guides for Odontectomy of Deeply Impacted Mandibular Third Molars

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.371 ◽

2018 ◽

Vol 6 (12) ◽

pp. 2395-2401

Author(s):

Mamdouhh Ahmed ◽

Mariam Kamel Salah ◽

Nesrine Khairy

Keyword(s):

Accurate Determination ◽

Inferior Alveolar Nerve ◽

Mouth Opening ◽

Surgical Removal ◽

Third Molars ◽

Cutting Guide ◽

Facial Swelling ◽

Computer Aided ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

AIM: To evaluate a new technique for surgical removal of deeply impacted mandibular third molars (DIMTM), using computer-guided cutting guide to maintain inferior alveolar nerve (IAN) integrity and the covering buccal bone. PATIENTS AND METHODS: Eighteen cases indicated for removal of DIMTM. Cone-beam Computed Tomography (CBCTs) used to determine the tooth’s relation to the IAN. Computer-guided software used for fabrication of surgical cutting guide stent to expose the impacted tooth and repositioning of bone after odontectomy without fixation. Clinical assessment included a neurosensory deficit of IAN, pain using a visual analogue scale (VAS), facial swelling, and maximal mouth opening (MMO). CBCTs were taken immediately and six months postoperatively to evaluate position and healing of bone. RESULTS: None of the patients showed a permanent neurological deficit of IAN while all patients showed normal parameters of pain, facial swelling and MMO. CONCLUSION: this technique has shown the accurate determination of the bony window cuts with subsequent preservation of IAN and external oblique ridge.

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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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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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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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Incidence of impacted mandibular third molars in population of Bosnia and Herzegovina: a retrospective radiographic study

Journal of Health Sciences ◽

10.17532/jhsci.2013.80 ◽

2013 ◽

Vol 3 (2) ◽

pp. 151-158 ◽

Cited By ~ 4

Author(s):

Sadeta Šečić ◽

Samir Prohić ◽

Sanja Komšić ◽

Amra Vuković

Keyword(s):

Bosnia And Herzegovina ◽

Statistical Difference ◽

Oral Surgery ◽

Third Molar ◽

Dental Arch ◽

Surgical Removal ◽

Third Molars ◽

Dentigerous Cysts ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Introduction: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction byanother tooth or development in an abnormal position. The mandibular third molar is the most frequently impacted tooth. The incidence varies from 9.5% to 68% in different populations.Methods: The study was conducted in Department of Oral Surgery, Faculty of Dentistry, University in Sarajevo. Study represents retrospective analysis of panoramic radiographs (orthopantomograms) of patientsreferred to Department of Oral Surgery from January 2010 to February 2013 with indication for surgical removal of impacted third molars.Results: Of the 2000 radiographs, 761 presented with at least one impacted third molar (38%). A total of 1034 impacted mandibular third molars were present (51.7%). The most common age group was thirddecade (61.2%). Signifi cant statistical difference in incidence of third molar impaction was found between females and males (p<0.05), but there was no statistical difference in incidence in urban and suburbanpopulation (p=0.374). Vertical angulation was the most common pattern of impaction (65%). Frequency of third molars erupted into their normal position (class IA) was 42%. Impacted mandibular molars wereassociated with periodontal pockets in 134 (6.5%) cases and with dentigerous cysts in 5 cases (0.2%).Conclusion: The present study provides useful data regarding the clinical status of third molars in population of Bosnia and Herzegovina.

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