Evaluating the Relationship between Mandibular Third Molar and Mandibular Canal with Semiautomatic Segmentation: A Pilot Study on CBCT Datasets

Inferior alveolar nerve injury is the main complication in mandibular third molar surgery. In this context, cone-beam computed tomography (CBCT) has become of crucial importance in evaluating the relationship between mandibular third molar and inferior alveolar nerve. Due to the growing interest in preoperative planning in oral surgery, several post-processing techniques have been implemented to obtain three-dimensional reconstructions of a volume of interest. In the present study, segmentation techniques were retrospectively applied to CBCT images in order to evaluate whether post-processing could offer better visualization of the structures of interest. Forty CBCT examinations performed for inferior third molar impaction were analyzed. Segmentation and volumetric reconstructions were performed. A dataset composed of multiplanar reconstructions for each study case, including segmented images, was submitted for evaluation to two oral surgeons, two general practitioners and four residents in oral surgery. The visualization of root morphology, canal course, and the relationship with mandibular cortical bone on both native CBCT and segmented images were assessed. Inter-rater agreement showed values of intraclass correlation coefficient (ICC) above 0.8 for all the examined parameters. Oral surgeons presented higher ICC values (p < 0.05). Segmented images can improve preoperative evaluation of the third molar and its relationship with the surrounding anatomical structures compared to native CBCT images. Further evaluation is needed to validate these preliminary results.

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

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.

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

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.

Efficacy of Submucosal Dexamethasone Injection on Postoperative Adverse Outcomes Following Third Molar Surgery

Introduction: The most common dento-alveolar procedure is surgical removal of an impacted third molar, which is associated with post-operative pain, swelling, and trismus. Objective: To determine the effect of submucosal dexamethasone injection on the post-operative outcomes in third molar surgeries. Materials and Methods: It was a descriptive study conducted in Department of Oral & Maxillofacial Surgery, Liaquat College of Medicine & Dentistry, Karachi between November 7, 2019 to May 6, 2020. All patients who fulfilled the inclusion criteria and visited to LCMD, Karachi were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. In our study, all the patients (n=65) received 4mg submucosal dexamethasone injection. The duration of surgery was recorded with postoperative outcomes in terms of pain, trismus and swelling were measured on 3rd and 7th day. All the collected data were entered into the proforma and used electronically for research purpose. Results: The mean SD of age was 25.9 ± 7.2 years. Right side surgery was documented in 39 (60%) patients, while left side surgery was documented in 26 (40%) patients. On the third and seventh day, the mean SD of VAS pain score was (5.9 ± 3.2), (3.8 ± 4.4), swelling was (2.5 ± 1.1), (0.9 ± 0.6) mm, and trismus was (16.9 ± 9.7), (11.8 ± 9.1) mm, respectively. Conclusion: It is to be concluded that a significant difference in outcomes was observed between the third and seventh post-operative days in patients who had submucosal dexamethasone injections in third molar surgeries.

Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups ( n = 15 ). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student’s t -test and Mann–Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 ( p < 0.05 ), groups 1 and 2 ( p < 0.01 ), and group 4 ( p < 0.001 ) in ascending order. For analgesic intake, there was no significant difference for group 1 ( p > 0.05 ). However, there were statistical differences between the control group and groups 2 and 3 ( p < 0.01 ) and group 4 ( p < 0.001 ). Trismus and swelling did not differ among the groups ( p > 0.05 ). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions

The aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries. The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 h before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 h. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48 h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 h, and 7 days. Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 h after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05). The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET) in the pre-operative time, only a few rescue analgesics are necessary.

Third Molar Surgery: Risk Factors and Complications after Removal of Third Molars

Objective: There is a need for this research because it aims to identify characteristics that increase the likelihood of negative outcomes following the removal of third molars. Study Design: Observational/transversal study Place and Duration: Dental College HITEC-IMS Taxilla/ Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Nov 2020-June 2021 Methods: A total of 180 male and female participants were included in this study. The patients ranged in age from 20 to 50. Pericoronitis and tooth impaction were among the complaints of the patients included in the study. The oral and maxillofacial department operated on all of the patients who requested the removal of their third molars. All patients provided written consent before having their personal data collected, including their age, gender, BMI, kind of impaction, and location of their third molar. Various operative variables were employed. In our research, we looked at post-operative complications and risk variables. The whole data was analyzed with SPSS 23.0. Results: 110 (61.1%) patients were males and 70 (38.9%) cases were females. 28.17±9.47 years were the mean age with mean BMI 24.11±3.65 kg/m2. Most of the teeth impacted in left side found in 102 (56.7%) patients. Most common type of impaction was mesioangular among 90 (50%) cases followed by distoangular 45 (23.7%) cases. Majority of the third molars were fully impacted 120 (66.7%), 38 (21.1%) were partially impacted and frequency of erupted tooth was 22 (12.2%). All the third molars were removed by buccal guttering technique under local anesthesia. Post-operative infection was the most common complication found in 80 (44.4%) cases followed by gingival defect in 27 (15%) radicular fractures in 24 (13.3%) cases. Location of the third molar and bone removal was the most common factor found. Conclusion: There was an increased risk of problems with tooth sectioning, bone removal, and/or tooth localization in patients above the age of 22. Both the evaluation of the indications for the removal of third molars and the process of informed consent should reflect this information. Keywords: Third Molars, Surgery, Anesthesia, Complications, Impactions

Non-conventional therapies for analgesia

Purpose: Third molar surgery is a quite common procedure. Some patients experience pain associated with this situation. The aim of this article aims to discuss non-conventional therapies for the management of postoperative pain associated with third molar surgery. Methods: An extensive literature search was conducted with the keywords “third molar” + “pain” and all articles that excluded already established drugs as analgesics, anti-inflammatories, or therapies such as laser therapy and ozone therapy whereas non-conventional drugs and therapies were retained. Results: The article rated bromelain, honey, hyaluronic acid, nicotine patches, Kinesio tape, TENS, anticonvulsants, curcumin, and melatonin. Some therapies are efficient and safe, while others have not shown promising results. Conclusions: Bromelain and Kinesio tape are considered the most effective non-conventional therapies for controlling postoperative pain, and even with few studies on them, they are therapies with promising results.