RESUMEN
BACKGROUND Surgical extraction of impacted mandibular third molars is the most commonly performed procedure in oral surgery; its associated complications include sensory nerve damage, swelling, and trismus. This study aimed to evaluate the effects of hyaluronic acid (HA) on healing of the socket following extraction of the lower impacted third molar tooth in 40 dental patients. MATERIAL AND METHODS This prospective, double-blind, randomized, controlled study was carried out on 40 adult healthy patients indicated for surgical removal of bilateral impacted mandibular third molars with equal surgical difficulty (moderate surgical difficulty according to the Koerner index. Patients with right mandibular third molars were included into the study (HA) group and those with left mandibular third molars were included into the control group. Surgical removal of impacted teeth was performed at different times for each patient for proper measurement of postoperative clinical variables, including pain, swelling, and mouth opening. RESULTS Postoperative pain evaluation results using the visual analog scale (VAS) showed reduced pain levels at all observation periods. Postoperative swelling peaked in intensity within 12-48 hours, resolving between the 5th and 7th days, and there was no significant difference in pre- and postoperative measurements of interincisal opening between both groups (P>0.05). CONCLUSIONS We found that intra-socket application of hyaluronic acid after surgical extraction of impacted mandibular third molars promoted normal wound healing, and there was a clinical benefit of reduced postoperative pain and swelling.
Asunto(s)
Ácido Hialurónico , Tercer Molar , Extracción Dental , Diente Impactado , Cicatrización de Heridas , Humanos , Ácido Hialurónico/farmacología , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Extracción Dental/métodos , Diente Impactado/cirugía , Femenino , Masculino , Adulto , Cicatrización de Heridas/efectos de los fármacos , Método Doble Ciego , Estudios Prospectivos , Alveolo Dental/efectos de los fármacos , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
Pericoronitis is a common dental condition involving the inflammation of soft tissues around a partially erupted wisdom tooth, typically the lower third molars. It is most frequently diagnosed in young adults aged 20-29, with a higher prevalence in women. The condition often results from the accumulation of bacteria and food debris under the operculum, leading to infection and inflammation. Common symptoms include localized pain, gum swelling, trismus, and sometimes pus discharge. This study aims to discuss the types of clinical management of pericoronitis of the lower third molar as described in the literatureTooth extraction eliminates the source of inflammation, providing long-term relief but carries a higher risk of inferior alveolar nerve damage and greater postoperative discomfort compared to other methods.This minimally invasive procedure removes the gingival cap to prevent food and bacteria accumulation. It is suitable for patients with good oral hygiene and proper tooth angulation. Electrosurgery and laser methods reduce bleeding and swelling but have contraindications. Coronectomy, an alternative to extraction, avoids nerve damage by leaving the roots in place. Suitable for non-carious, pathology-free teeth, it shows lower risk of sensory disturbances and postoperative complications, though root migration may occur. Pericoronitis requires personalized treatment based on patient condition and tooth positioning. Thorough diagnostics and tailored approaches are crucial for effective management and improved outcomes.
Asunto(s)
Tercer Molar , Pericoronitis , Extracción Dental , Humanos , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Femenino , Pericoronitis/cirugía , Adulto , Adulto Joven , MasculinoRESUMEN
BACKGROUND-OBJECTIVE(S): This randomized, split-mouth study aimed to compare postoperative complications following the surgical extraction of impacted lower third molars using piezosurgery versus conventional rotary instruments. MATERIALS AND METHODS: Twenty-one patients, aged 18-35 years, with bilaterally and symmetrically impacted lower third molars, were randomly assigned to undergo extraction using piezosurgery on one side and conventional rotary instruments on the other. RESULTS: The piezosurgery method required a longer operation time. However, it resulted in quicker resolution of postoperative swelling by the 7th day compared to the conventional method, where swelling persisted longer. Mandibular angle-tragus measurements were significantly higher with the conventional method on the 1st, 3rd, and 7th postoperative days. Although mouth opening decreased significantly after piezosurgery, it returned to preoperative levels by the 7th day, outperforming the conventional method. Postoperative pain was notably higher with the conventional method during the first four days but showed no significant difference from the 5th day onward. Alveolar bone healing was significantly better with piezosurgery at the 3rd and 6th months. Temporary paresthesia occurred in one patient from the conventional group, resolving within four weeks. Neither method resulted in alveolar osteitis. CONCLUSION(S): Within the study's limitations, piezosurgery demonstrated a reduction in postoperative discomfort, suggesting its advantage in enhancing patient recovery following lower third molar extractions. CLINICAL SIGNIFICANCE: Piezosurgery, when used appropriately, can reduce postoperative complications compared to conventional methods. Clinicians should be aware of its indications, benefits, and potential challenges. Trial registration This study was registered as a clinical trial to the ClinicalTrials.gov, and the registration ID is NCT06262841 ( https://clinicaltrials.gov/study/NCT06262841 ).
Asunto(s)
Regeneración Ósea , Tercer Molar , Piezocirugía , Complicaciones Posoperatorias , Extracción Dental , Humanos , Tercer Molar/cirugía , Extracción Dental/métodos , Extracción Dental/efectos adversos , Adulto , Femenino , Masculino , Adolescente , Piezocirugía/métodos , Adulto Joven , Complicaciones Posoperatorias/prevención & control , Diente Impactado/cirugía , Dolor Postoperatorio/etiología , Morbilidad , Mandíbula/cirugíaRESUMEN
BACKGROUND: The purpose of the study was to compare the efficacy of the use of 0.2% chlorhexidine irrigation and the oral antibiotics for the prevention of postoperative complication like pain, trismus, swelling and infection after the surgical extraction of IMTM. MATERIAL AND METHODS: A randomised, double blinded clinical trial was planned with two equal groups. Patients were randomly divided into two groups using computer-generated codes with an allocation ratio of 1:1. Group I (Control): Standard preoperative and postoperative systemic oral antibiotics and Group II (Study): No systemic antibiotics and Chlorhexidine irrigation local delivery. The primary outcomes evaluated were postoperative pain, mouth opening, swelling and infection. The secondary outcome variables were the number of analgesics and antibiotics taken by the patient in the postoperative period, the satisfaction of the patient and adverse events, were followed up regulary for 7 days postoperatively. RESULTS: A total of 84 patients, divided into two equal groups participated in the study. In intergroup comparison of swelling, the difference was non-significant on postoperative day (POD) 1 and 7, except for POD 3, where it showed significantly lower results in the antibiotic group (p = 0.012). However, there was no significant difference in pain found between both groups at any of the postoperative time points, and the study group had a lesser need for rescue analgesics than the control group. A statistically significant difference in incidence of dry socket was observed (p = 0.03) and gastrointestinal adverse symptoms, but it showed insignificant results for wound dehiscence and pus discharge. Also, patient satisfaction was higher in the study group. CONCLUSIONS: both antibiotics and localised delivery demonstrated comparable results in terms of swelling, pain and trismus. However, with lesser adverse events, the localised chlorhexidine delivery with curved tips outperformed the antibiotic group.
Asunto(s)
Antibacterianos , Clorhexidina , Tercer Molar , Complicaciones Posoperatorias , Irrigación Terapéutica , Extracción Dental , Diente Impactado , Humanos , Clorhexidina/administración & dosificación , Masculino , Femenino , Método Doble Ciego , Extracción Dental/efectos adversos , Adulto , Tercer Molar/cirugía , Antibacterianos/administración & dosificación , Diente Impactado/cirugía , Irrigación Terapéutica/métodos , Complicaciones Posoperatorias/prevención & control , Adulto Joven , Administración Oral , Mandíbula/cirugía , Antiinfecciosos Locales/administración & dosificación , Sistemas de Liberación de Medicamentos , AdolescenteRESUMEN
BACKGROUND: Limiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications. METHODS: In groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days. RESULTS: 60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate. CONCLUSIONS: Hyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost-effective option if postoperative pain control is merely targeted. TRIAL REGISTRATION: This trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.
Asunto(s)
Dexametasona , Edema , Hialuronoglucosaminidasa , Tercer Molar , Dolor Postoperatorio , Diente Impactado , Trismo , Humanos , Dexametasona/uso terapéutico , Hialuronoglucosaminidasa/uso terapéutico , Trismo/prevención & control , Edema/prevención & control , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Tercer Molar/cirugía , Diente Impactado/cirugía , Masculino , Femenino , Estudios Prospectivos , Adulto , Adulto Joven , Extracción Dental/efectos adversos , Antiinflamatorios/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Dimensión del Dolor , Adolescente , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Background and Objectives: The aim of this study was to investigate the efficacy of a single preoperative dose of deflazacort on pain, swelling, and trismus after impacted lower third molar surgery. Materials and Methods: This randomised, prospective, double-blind, split-mouth clinical study included 26 healthy individuals with bilaterally impacted lower third molars. Group 1 was given a placebo (single-dose vitamin C tablet), and group 2 was given a single 30 mg dose of deflazacort 1 h prior to surgery. Pain was evaluated using the visual analogue scale for 1 week postoperatively. Oedema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. The Mann-Whitney U test was applied for group analyses. p values < 0.05 were considered statistically significant. Results: Postoperative pain scores were significantly lower in the deflazacort group at the 6th and 12th hours after surgery (p < 0.05). There were no significant differences in trismus between the groups at any time point (p > 0.05). There was less oedema in the deflazacort group on postoperative days 2 and 7, without any statistically significant difference (p > 0.05). Conclusions: A single preoperative dose of 30 mg deflazacort was found to be clinically effective in reducing pain and oedema after extraction of impacted lower third molars.
Asunto(s)
Edema , Tercer Molar , Dolor Postoperatorio , Pregnenodionas , Diente Impactado , Trismo , Humanos , Trismo/prevención & control , Trismo/etiología , Tercer Molar/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Femenino , Masculino , Edema/prevención & control , Edema/etiología , Adulto , Método Doble Ciego , Diente Impactado/cirugía , Estudios Prospectivos , Pregnenodionas/uso terapéutico , Pregnenodionas/administración & dosificación , Extracción Dental/efectos adversos , Extracción Dental/métodos , Adulto Joven , Dimensión del Dolor/métodosRESUMEN
An urgent issue is the preservation or reconstruction of the volume of bone tissue in planning and surgical treatment in the fields of medicine, such as traumatology, orthopedics, maxillofacial surgery and dentistry. After tooth extraction, resorption of the bone tissue of the alveolar crest of the jaws occurs, which must either be further eliminated by performing additional operations or using osteoplastic material for socket preservation at the extraction stage. Background and Objectives: The aim of the study was a comparative analysis of various osteoplastic materials used to preserve the volume of bone tissue in the preimplantation period. Materials and Methods: As part of the study, 80 patients were treated, who underwent socket preservation using xenografts, plasma enriched with growth factors, an autologous dentin matrix (ADM) and hydroxyapatite. Results: The results of the treatment 16 weeks after removal were comprehensively analyzed using a morphometric analysis of the bone's volume, cone beam tomography and morphological examination of burr biopsy specimens, as well as by determining the stability of the installed implant at different stages of treatment. Conclusions: The lowest level of bone tissue resorption according to the CBCT data was noted in the ADM and xenograft groups. It should be noted that the use of osteoplastic material in jaw surgery when reconstructing alveolar defects is an essential procedure for preventing the atrophy of bone tissue.
Asunto(s)
Proceso Alveolar , Dentina , Humanos , Femenino , Masculino , Persona de Mediana Edad , Proceso Alveolar/cirugía , Proceso Alveolar/diagnóstico por imagen , Adulto , Extracción Dental/métodos , Extracción Dental/efectos adversos , Aumento de la Cresta Alveolar/métodos , Tomografía Computarizada de Haz Cónico/métodos , Anciano , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugíaRESUMEN
BACKGROUND: This study sought toexplore the manifestations of clinical symptoms and identify the risk factors linked to inferior alveolar nerve injury (IANI) in the context of mandibular third molar extraction. MATERIAL AND METHODS: In this study, 172 patients admitted to our hospital for mandibular third molar extraction from June 2021 to December 2022 were selected for the study, and the clinical data of the participants were retrospectively analyzed, and the risk factors of IANI associated with mandibular third molar extraction were analyzed by uni/multi-factor logisitic regression. RESULTS: Noticeable distinctions were noted between the groups with and without injuries in relation to age, time of surgery, number of broken roots, angle of blockage, CEJ (cementoenamel junction) distance, curved roots of the molar, clarity of the upper and lower walls of the nerve canal, and Pell & Gregory classification. Logistic regression analysis showed that age, time of surgery, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar were independent risk factors for IANI. Multi-factor logistic regression analysis further confirmed that age, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar were associated with IANI. CONCLUSIONS: Alveolar nerve injury manifests as hyperalgesia or absence of sensation, numbness and abnormal pain in the lower lip. Factors influencing IANI associated with mandibular third molar extraction were age, number of broken roots, angle of blockage (40°-70°), CEJ distance (10-12 mm, >12 mm), and curved roots of the molar.
Asunto(s)
Mandíbula , Lesiones del Nervio Mandibular , Tercer Molar , Extracción Dental , Humanos , Tercer Molar/cirugía , Femenino , Masculino , Extracción Dental/efectos adversos , Adulto , Estudios Retrospectivos , Factores de Riesgo , Lesiones del Nervio Mandibular/etiología , Persona de Mediana Edad , Adulto Joven , Complicaciones Posoperatorias/etiología , AdolescenteRESUMEN
BACKGROUND: Dental malpractice claims, which pertain to legal actions against dentists accused of clinical negligence that caused harm to patients, have increased in the past ten years in South Korea. The claims are caused by complications, particularly trigeminal nerve injuries, resulting from various dental procedures. Medicolegal issues related to trigeminal nerve injury have not been previously described in South Korea. Therefore, in this study, we aimed to identify the general, dental, and judicial characteristics of closed dental malpractice claims. METHODS: This study was designed as a descriptive study. We collected the data of 51 closed claims related to trigeminal nerve injury resulting from dental procedures such as dental implant emplacement, tooth extraction, and local anesthesia. The claims were decided by courts in South Korea between 2016 and 2023. The general, dental, and judicial characteristics of the claims were analyzed retrospectively. RESULTS: The average claim resolution period was 4.2 (range: 1.47-8.39) years post-adverse events that occurred more frequently in dental clinics (68.6 %) than in dental (25.5 %) or general hospitals (5.9 %). Inferior alveolar (66.7 %) and lingual (17.6 %) nerves were injured following dental procedures. The duty to inform was breached in 68.6 % of claims. The dental procedure performed (P < 0.001) and the injured nerve (P < 0.001) were associated with the violation of the duty to care. CONCLUSION: To improve the quality of dental care services, the analysis of the adverse events using various resources including judgments should be strongly addressed.
Asunto(s)
Mala Praxis , Traumatismos del Nervio Trigémino , Humanos , Mala Praxis/estadística & datos numéricos , Mala Praxis/legislación & jurisprudencia , República de Corea/epidemiología , Estudios Retrospectivos , Traumatismos del Nervio Trigémino/epidemiología , Traumatismos del Nervio Trigémino/etiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Orales/legislación & jurisprudencia , Extracción Dental/efectos adversosRESUMEN
We encountered a case involving a brain abscess in the right frontal lobe of a 12-year-old girl who was diagnosed with a chief complaint of headache and nausea. Left maxillary sinusitis, a dental infection related to dental caries and apical periodontitis, was observed in the left maxillary first molar in addition to left frontal sinusitis also being present. In addition to administering antibacterial agents, extraction of the left maxillary first molar and drainage of the paranasal sinuses and brain abscess were performed. Follow-up over the course of 1 year and 5 months indicated that the patient had progressed without any sequelae; therefore, the prognosis was good. In this case, although bone destruction was observed in the posterior wall of the frontal sinus, which could be a route for bacteria to enter the skull, we considered the possibility of direct invasion from the same site to be low because the brain abscess occurred on the opposite side. We believe that a route for hematogenous invasion from apical periodontitis, in addition to sinusitis, is also possible. Regardless of the route, the outset was an infection in the dental field; therefore, this case reaffirmed the importance of dental cavity treatment in childhood.
Asunto(s)
Antibacterianos , Absceso Encefálico , Sinusitis Frontal , Sinusitis Maxilar , Humanos , Femenino , Absceso Encefálico/etiología , Absceso Encefálico/microbiología , Niño , Sinusitis Maxilar/etiología , Sinusitis Maxilar/microbiología , Antibacterianos/administración & dosificación , Sinusitis Frontal/complicaciones , Sinusitis Frontal/microbiología , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/patología , Drenaje/métodos , Caries Dental/etiología , Caries Dental/microbiología , Caries Dental/terapia , Resultado del Tratamiento , Extracción Dental/efectos adversos , Tomografía Computarizada por Rayos X , Periodontitis Periapical/etiología , Periodontitis Periapical/microbiología , Periodontitis Periapical/terapia , Diente MolarAsunto(s)
Trastornos de la Articulación Temporomandibular , Extracción Dental , Humanos , Trastornos de la Articulación Temporomandibular/etiología , Trastornos de la Articulación Temporomandibular/cirugía , Extracción Dental/efectos adversos , Extracción Dental/métodos , Femenino , Masculino , Adulto , Persona de Mediana EdadRESUMEN
PURPOSE: Bone resorption inhibitors, such as bisphosphonates (BP) and denosumab, are frequently used for the management of osteoporosis. Although both drugs reduce the risk of osteoporotic fractures, they are associated with a serious side effect known as medication-related osteonecrosis of the jaw (MRONJ). Sclerostin antibodies (romosozumab) increase bone formation and decrease the risk of osteoporotic fractures: however, their anti-resorptive effect increases ONJ. Thus, this study aimed to elucidate the role of sclerostin deletion in the development of MRONJ. METHODS: Sclerostin knockout (SostΔ26/Δ26) mice were used to confirm the development of ONJ by performing tooth extractions. To confirm the role of sclerostin deficiency in a more ONJ-prone situation, we used the BP-induced ONJ model in combination with severe periodontitis to evaluate the development of ONJ and bone formation in wild-type (WT) and SostΔ26/Δ26 mice. Wound healing assay using gingival fibroblasts with or without sclerostin stimulation and tooth extraction socket healing were evaluated in the WT and SostΔ26/Δ26 mice. RESULTS: ONJ was not detected in the extraction socket of SostΔ26/Δ26 mice. Moreover, the incidence of ONJ was significantly lower in the SostΔ26/Δ26 mice treated with BP compared to that of the WT mice. Osteogenic proteins, osteocalcin, and runt-related transcription factor 2, were expressed in the bone surface in SostΔ26/Δ26 mice. Recombinant sclerostin inhibited gingival fibroblast migration. The wound healing rate of the extraction socket was faster in SostΔ26/Δ26 mice than in WT mice. CONCLUSION: Sclerostin deficiency did not cause ONJ and reduced the risk of developing BP-induced ONJ. Enhanced bone formation and wound healing were observed in the tooth extraction socket. The use of romosozumab (anti-sclerostin antibody) has proven to be safe for surgical procedures of the jaw.
Asunto(s)
Proteínas Adaptadoras Transductoras de Señales , Osteonecrosis de los Maxilares Asociada a Difosfonatos , Ratones Noqueados , Animales , Proteínas Adaptadoras Transductoras de Señales/genética , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Osteonecrosis de los Maxilares Asociada a Difosfonatos/patología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/genética , Ratones , Eliminación de Gen , Marcadores Genéticos , Cicatrización de Heridas/efectos de los fármacos , Ratones Endogámicos C57BL , Extracción Dental/efectos adversos , Difosfonatos/farmacología , Difosfonatos/efectos adversos , Osteogénesis/efectos de los fármacos , Péptidos y Proteínas de Señalización Intercelular/metabolismo , Péptidos y Proteínas de Señalización Intercelular/genéticaRESUMEN
Background and Objectives: In socket preservation, the goal is to minimize bone resorption after tooth extraction to maintain the volume and contour of the alveolar ridge. The use of PRF in post extraction sites may reduce ridge resorption by encouraging the growth of new bone and acting as a scaffold for tissue. In addition, PRF may enhance healing and minimize postoperative pain. The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in maintaining the ridges' dimensions at the extraction site, in the maxilla and mandible, as well as its impact on post-extraction discomfort. Methods: The study was conducted on 60 patients presenting for extraction of posterior teeth and was randomly divided into three groups: group I PRF (n = 20), group II PRF + collagen (n = 20), and group III control (n = 20). Sockets were filled with PRF (group I) and PRF + collagen (group II). At baseline and follow-up after 3 months, CBCT was used to assess the bone dimensions. The postoperative pain evaluations were performed at 24 h, 3 days, and 7 days after the tooth extraction. The pain rate was evaluated using a numerical rating scale from the British Pain Society. Results: The study examined the effects of platelet-rich fibrin (PRF) and PRF combined with collagen on the height and width of the ridges, as well as the pain experienced by the patients following alveolar ridge preservation surgery. ANOVA and t-tests were used to evaluate and compare the ridge dimensions. Comparing the results to the control group, there were no significant differences in the height or width of the ridges. However, both the PRF and PRF + Collaplug® treatments effectively reduced the short-term postoperative pain. Conclusions: The study findings suggest that platelet-rich fibrin (PRF) and PRF combined with collagen do not exert significant effects on ridge width and height compared to the standard treatment following alveolar ridge preservation. However, it is noteworthy that both the PRF and PRF + collagen treatments demonstrated efficacy in reducing postoperative pain in the short term, offering a potential advantage over standard treatment protocols.
Asunto(s)
Proceso Alveolar , Dolor Postoperatorio , Fibrina Rica en Plaquetas , Extracción Dental , Alveolo Dental , Humanos , Extracción Dental/métodos , Extracción Dental/efectos adversos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Masculino , Femenino , Adulto , Alveolo Dental/efectos de los fármacos , Persona de Mediana Edad , Proceso Alveolar/efectos de los fármacos , Resultado del TratamientoRESUMEN
This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.
Asunto(s)
Anestésicos Locales , Carticaína , Lidocaína , Nervio Mandibular , Tercer Molar , Bloqueo Nervioso , Extracción Dental , Humanos , Carticaína/efectos adversos , Carticaína/administración & dosificación , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Método Doble Ciego , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Adulto , Nervio Mandibular/efectos de los fármacos , Adolescente , Adulto Joven , Extracción Dental/efectos adversos , Masculino , Femenino , Tercer Molar/cirugía , Anestesia Dental/efectos adversos , Anestesia Dental/métodos , Estudios de SeguimientoRESUMEN
OBJECTIVES: Use of numerous medications such as tyrosine kinase inhibitors (sunitinib), monoclonal antibodies (bevacizumab), fusion proteins (aflibercept), mTOR inhibitors (everolimus), radiopharmaceuticals (radium 223), selective estrogen receptor modulators (raloxifene), and immunosuppressants (methotrexate and corticosteroids) has been reported to be a risk factor for development of medication-related osteonecrosis of the jaws till date. This study aimed to evaluate the preventive effect of low-level laser therapy (LLLT) and gaseous ozone on the onset of MRONJ following tooth extraction. MATERIALS AND METHODS: A total of 40 male Wistar rats were randomly allocated into 4 groups of 10 rats each. The groups laser (L), ozone (O), and control (C) received weekly intraperitoneal injections of zoledronic acid (0.06 mg/kg), while group sham (S) received saline solution for 4 weeks. After the 4th injection, all subjects underwent mandibular first molar extraction and adjunctive laser or ozone was applied according to the groups. All the rats were sacrificed at 4 postoperative weeks for comparative histomorphometric evaluation of bone healing in extraction sites. RESULTS: Laser and ozone groups demonstrated significantly higher bone formation compared to control group (p < 0.05), while no significant difference was found between laser and ozone groups (p = 1.00). Furthermore, the greatest bone formation was observed with the sham group (p < 0.05). CONCLUSIONS: Findings of the current study support that adjunctive LLLT and ozone therapy following tooth extraction may help prevent MRONJ and improve bone healing in subjects under zoledronic acid therapy. CLINICAL RELEVANCE: Since the introduction in 2003, great effort has been devoted to developing a certain management protocol for MRONJ. Several publications have appeared in recent years documenting promising results of adjunctive LLLT and ozone application in treatment of MRONJ. However, experimental data are limited on this regard and the present study, for the first time, aimed to evaluate and compare the effects of LLLT and ozone in prevention of MRONJ.
Asunto(s)
Terapia por Luz de Baja Intensidad , Ozono , Ratas Wistar , Extracción Dental , Animales , Terapia por Luz de Baja Intensidad/métodos , Extracción Dental/efectos adversos , Extracción Dental/métodos , Masculino , Ratas , Modelos Animales de Enfermedad , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & control , Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Ácido Zoledrónico/uso terapéuticoRESUMEN
OBJECTIVE: The aim of this study was to evaluate the effectiveness of a novel biomaterial (FG) for alveolar ridge preservation compared to CTG in terms of soft tissue thickness and bone dimensional changes. MATERIALS AND METHODS: A randomized clinical trial was conducted on 30 patients who required extraction of 30 hopeless mandibular posterior teeth. All patients went through atraumatic tooth extraction, and then, they were randomly allocated to either a CTG, an FG, or a spontaneous healing (SH) group (1:1:1). All patients received a dental implant placed 6 months postoperatively. The soft tissue thickness and bone dimensional changes were measured before and 6 months after the procedure. RESULTS: The study's analysis revealed statistically significant differences in buccal gingival thickness and dimensional bone changes across the three examined groups after 6 months (p < 0.05). The SH group had lower gingival thickness (1.31 ± 0.65 mm) and higher vertical resorption (-1.46 ± 1.67 mm at the buccal aspect) compared with the CTG and FG groups. The CTG and FG groups had similar gingival thickness (2.42 ± 0.70 and 3.00 ± 0.71 mm, respectively) and bone width reduction (+0.86 ± 2.31 and +0.93 ± 2.38 mm, respectively), whereas the CTG group had lower vertical bone loss (-0.30 ± 1.09 mm at the buccal aspect) than the FG group (-0.47 ± 2.30 mm at the buccal aspect). CONCLUSION: FG and CTG demonstrate equivalent soft tissue thickness and comparable horizontal bone dimension outcomes in ARP.
Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Tejido Conectivo , Encía , Extracción Dental , Humanos , Masculino , Femenino , Adulto , Extracción Dental/efectos adversos , Extracción Dental/métodos , Pérdida de Hueso Alveolar/prevención & control , Encía/cirugía , Encía/patología , Persona de Mediana Edad , Aumento de la Cresta Alveolar/métodos , Proceso Alveolar/cirugía , Proceso Alveolar/patología , Mandíbula/cirugía , Resultado del Tratamiento , Implantación Dental Endoósea/métodos , Materiales BiocompatiblesRESUMEN
Antiphospholipid syndrome (APS) is a systemic autoimmune condition characterised by recurrent venous or arterial thrombosis and pregnancy complications, with persistent antiphospholipid autoantibodies. APS is often found in conjunction with other autoimmune diseases, such as systemic lupus erythematosus (SLE). SLE-associated APS patients may require dental procedures like tooth extractions. Due to the complex nature of this autoimmune disorder, perioperative management requires a comprehensive approach involving various medical specialists.These patients are frequently taking medications like anticoagulants, antiplatelet drugs, disease-modifying drugs and immunosuppressants. This medication regimen can increase their risk of postoperative complications, including bleeding, thrombosis, delayed healing and postoperative infections. Currently, there are no established guidelines for performing tooth extractions in individuals with SLE-associated APS.We report a case of SLE-associated APS with pericoronitis requiring surgical extraction. The purpose of this report is to offer practical recommendations for the perioperative management of dental procedures and alteration in medications used in such cases.
Asunto(s)
Síndrome Antifosfolípido , Lupus Eritematoso Sistémico , Tercer Molar , Atención Perioperativa , Extracción Dental , Humanos , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/tratamiento farmacológico , Lupus Eritematoso Sistémico/complicaciones , Extracción Dental/efectos adversos , Femenino , Tercer Molar/cirugía , Atención Perioperativa/métodos , Adulto , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Mandíbula/cirugíaRESUMEN
BACKGROUND: Tooth extraction procedures often lead to bone resorption, which can have adverse effects on the dimensions of the alveolar ridge. Research has shown that socket preservation techniques using bone graft substitutes can effectively minimize early bone loss in such cases. α-calcium sulfate hemihydrate (α-CSH) has garnered significant attention as a potential bone graft material due to its favorable properties, including osteoconductivity, angiogenic potential, and biocompatibility. Considering these facts, we developed a preliminary protocol for applying α-CSH in addressing alveolar bone loss following tooth extraction. OBJECTIVE: This research's general objective is to evaluate the feasibility and initial effectiveness of α-CSH as bone-inducing graft material for socket preservation after tooth extraction. METHODS: This preliminary clinical trial will involve 30 fresh extraction sockets from individuals aged 18-35 years. The participants will be divided into 2 groups: one group will receive α-CSH graft material after tooth extraction for socket preservation, while the other group will not receive any graft material. Throughout the study, the participants will be closely monitored for safety measures, which will include clinical examinations, radiographic imaging, and blood tests. Radiographic imaging will be used extensively to assist the progress of bone formation. RESULTS: The study commenced enrollment in August 2022 and is scheduled to conclude post assessments and analyses by the end of 2023. The results of the study are anticipated to be accessible in late 2024. CONCLUSIONS: This clinical study represents the initial investigation in humans to assess the feasibility and efficacy of α-CSH in alveolar bone regeneration. We hypothesize that the inclusion of α-CSH can greatly expedite the process of bone formation within fresh sockets, resulting in a swift restoration of bone height without the disadvantages associated with harvesting autogenous bone graft. TRIAL REGISTRATION: Indonesia Registry Center INA-D02FAHP; https://tinyurl.com/2jnf6n3s. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49922.
Asunto(s)
Sulfato de Calcio , Estudios de Factibilidad , Extracción Dental , Alveolo Dental , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugía , Sustitutos de Huesos/uso terapéutico , Sulfato de Calcio/uso terapéutico , Sulfato de Calcio/administración & dosificación , Proyectos Piloto , Extracción Dental/efectos adversos , Extracción Dental/métodos , Alveolo Dental/cirugía , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Removal of third molars in healthy patients is considered a procedure with a low risk of bleeding. However, exactly how low the incidence of postoperative bleeding is remains unclear due to the heterogeneity of available studies. To determine the exact postoperative risk of bleeding after the removal of third molars in healthy patients, a prospective observational multicentre study was conducted. A total of 1,035 patients with complete follow-up was included. Of these, 329 patients reported subsequent bleeding, but did not consult their attending physician. A total of 15 patients visited the hospital, 8 of whom required minimally invasive (re)treatment. No hospitalizations were necessary. There was a large difference between the incidence of postoperative bleeding reported by patients and postoperative bleeding requiring clinical examination and/or treatment. To reduce this difference in future, patients should be given detailed information about what degree of postoperative bleeding is considered normal after removal of a third molar.