RESUMEN
BACKGROUND: There is a general consensus among dental professionals regarding the extraction of impacted third molars in the presence of clinical symptoms. However, there is less agreement on the management of asymptomatic third molars. The objective of this study is to compare the perspectives of oral surgeons and orthodontists regarding the indications for the extraction of asymptomatic third molars. It is possible that healthcare professionals from different specialties may approach the extraction of these teeth in different ways. METHODS: In this cross-sectional study, a web-based questionnaire has been employed to collect data by inquiring about the reasons why participants prefer the extraction of asymptomatic third molars. Descriptive statistics were employed to evaluate the data obtained. The level of significance was set at P < 0.05. RESULTS: Prophylactic extraction of partially impacted molars was more favored among the participants (P < 0.05). The orthodontists preferred prophylactic extraction due to the risk of late anterior dental crowding (LADC); however, the oral surgeons preferred pre-pregnancy extractions (P < 0.05). The extraction decision for partial impaction was higher in females when the risk of distal caries was considered. For fully impacted ones, it was higher in males when the risk of caries and pericoronitis were considered (P < 0.05). CONCLUSIONS: Orthodontists preferred extraction because of the risk of LADC and caries, while oral surgeons focused on preventing pericoronitis, pathology, focal infection, and symptoms during pregnancy. This divergence between the participants may inform the guidelines for prophylactic management of third molars. These findings may be pertinent in gender medicine. CLINICAL RELEVANCE: This study has been enlightening for departments to consult each other before the extraction of a patient's asymptomatic third molar.
Asunto(s)
Tercer Molar , Ortodoncistas , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Estudios Transversales , Masculino , Femenino , Diente Impactado/cirugía , Pautas de la Práctica en Odontología/estadística & datos numéricos , Adulto , Encuestas y Cuestionarios , Cirujanos Oromaxilofaciales , Actitud del Personal de Salud , Caries Dental/prevención & control , Maloclusión/prevención & controlRESUMEN
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 analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block. METHODS: Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic. RESULTS: The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia. CONCLUSION: US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery. CLINICAL TRIAL REGISTRATION: https://classic. CLINICALTRIALS: gov/ct2/show/NCT06009302 , identification number: NCT06009302, date of registration: 18/08/2023.
Asunto(s)
Nervio Mandibular , Tercer Molar , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Bloqueo Nervioso/métodos , Tercer Molar/cirugía , Femenino , Estudios Prospectivos , Adulto , Masculino , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodos , Dimensión del Dolor , Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Adulto Joven , Extracción DentalRESUMEN
BACKGROUND: Alveolar Bone loss occurs frequently during the first six months after tooth extraction. Various studies have proposed different methods to reduce as much as possible the atrophy of the alveolar ridge after tooth extraction. Filling the socket with biomaterials after extraction can reduce the resorption of the alveolar ridge. We compared the height of the alveolar process at the mesial and distal aspects of the extraction site and the resorption rate was calculated after the application of HA/ß-TCP or synthetic co-polymer polyglycolic - polylactic acid PLGA mixed with blood to prevent socket resorption immediately and after tooth extraction. METHODS: The study was conducted on 24 extraction sockets of impacted mandibular third molars bilaterally, vertically, and completely covered, with a thin bony layer. HA/ß-TCP was inserted into 12 of the dental sockets immediately after extraction, and the synthetic polymer PLGA was inserted into 12 of the dental sockets. All sockets were covered completely with a full-thickness envelope flap. Follow-up was performed for one year after extraction, using radiographs and stents for the vertical alveolar ridge measurements. RESULTS: The mean resorption rate in the HA/ß-TCP and PLGA groups was ± 1.23 mm and ± 0.1 mm, respectively. A minimal alveolar bone height reduction of HA/ß-TCP was observed after 9 months, the reduction showed a slight decrease to 0.93 mm, while this rate was 0.04 mm after 9 months in the PLGA group. Moreover, the bone height was maintained after three months, indicating a good HA/ß-TCP graft performance in preserving alveolar bone (1.04 mm) while this rate was (0.04 mm) for PLGA. CONCLUSION: The PLGA graft demonstrated adequate safety and efficacy in dental socket preservation following tooth extraction. However, HA/ß-TCP causes greater resorption at augmented sites than PLGA, which clinicians should consider during treatment planning.
Asunto(s)
Pérdida de Hueso Alveolar , Sustitutos de Huesos , Ácido Láctico , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Extracción Dental , Alveolo Dental , Humanos , Alveolo Dental/cirugía , Pérdida de Hueso Alveolar/prevención & control , Sustitutos de Huesos/uso terapéutico , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/uso terapéutico , Masculino , Femenino , Ácido Láctico/uso terapéutico , Adulto , Ácido Poliglicólico/uso terapéutico , Proceso Alveolar/patología , Tercer Molar/cirugía , Diente Impactado/cirugía , Estudios de Seguimiento , Adulto Joven , Colgajos Quirúrgicos , Materiales Biocompatibles/uso terapéutico , Aumento de la Cresta Alveolar/métodos , Hidroxiapatitas/uso terapéutico , Mandíbula/cirugía , Fosfatos de Calcio/uso terapéutico , Resultado del TratamientoRESUMEN
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
OBJECTIVES: The aim of this study was to compare leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation (PBM) applications, which have been repeatedly reported to be superior to control groups, in terms of pain, soft tissue and bone healing in tooth extraction sockets. MATERIALS AND METHODS: This double-blind, randomized clinical study was completed with 34 patients, who had an indication for extraction of their bilaterally impacted teeth. The right and left teeth of the patients were randomly divided into L-PRF and PBM groups. L-PRF group was treated with the blood product centrifuged for 12 min at 2700 rpm, and the PBM group was treated with a diode laser at different points for 60 s with a wavelength of 940 nm in repeated sessions. Postoperative pain was evaluated using Visual Analogue Scale (VAS), soft tissue healing with Landry Index (LI), tissue healing in the distal region of mandibular second molar by probing depth measurement, and bone healing via panoramic x-ray using the Image J program. RESULTS: No statistically significant difference was found for any variable compared between the groups. CONCLUSION: L-PRF and PBM applications provide similar support in the healing of extraction sockets. Nevertheless, the advantages and disadvantages of both methods determine their usage areas. CLINICAL RELEVANCE: While L-PRF is advantageous in the early healing of extraction sockets, PBM may be preferred in terms of bone trabeculation in the long term.
Asunto(s)
Leucocitos , Terapia por Luz de Baja Intensidad , Tercer Molar , Dolor Postoperatorio , Fibrina Rica en Plaquetas , Extracción Dental , Alveolo Dental , Cicatrización de Heridas , Humanos , Terapia por Luz de Baja Intensidad/métodos , Femenino , Método Doble Ciego , Masculino , Cicatrización de Heridas/efectos de la radiación , Adulto , Tercer Molar/cirugía , Leucocitos/efectos de la radiación , Diente Impactado/cirugía , Diente Impactado/terapia , Radiografía Panorámica , Dimensión del Dolor , Láseres de Semiconductores/uso terapéutico , Resultado del TratamientoRESUMEN
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
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
OBJECTIVE: The aim of the study is reducing the risks of surgical injury to the inferior alveolar nerve, by taking into account individual topographic and anatomical features, improving diagnostic methods, and techniques for removing retinated teeth with a close fit to the mandibular canal. MATERIAL AND METHODS: An examination was conducted in the Department of Surgical Dentistry (CBCT/OPG) and surgical treatment of 223 patients, with a close fit of the roots of the retinated lower third molar to the mandibular canal. Microslips of teeth with roots intact during removal (n=96) of the main group and the control group (n=52) were prepared with a Micromet Remet manual petrographic machine. The sections were carried out along the longitudinal axis of the tooth with the capture of the area of close fitting of the nerve, the teeth from the control group were sawed longitudinally along the axis of the root. The measurement of the macroanatomic features of the roots was carried out with a micrometer (MCC-MP-100 0.001 electronic «CHEESE¼, manufactured in the Russian Federation), measurements of the thickness of dentine and cement tissues on macroglyphs were carried out using a microscope calibration ruler with an accuracy of 0.01 mm. RESULTS: In the main group, three types of attachment of the mandibular canal to the root of the third molars were distinguished: 20 (96) cases of inter-root attachment of the mandibular canal, 42 (96) apical, 34 (96) lateral (buccal and lingual). A number of anomalies in the structure of the roots of the third molars have been revealed, which are a factor in injury to the neurovascular bundle of the mandibular canal during tooth extraction. The surface of the roots, as well as the microscopes of the tooth sections adjacent to the mandibular canal, were studied under a microscope. CONCLUSION: A number of specific anomalies of the roots of retinated third molars formed by root dilaceration, thinning of cement tissues, hypercementosis, which are formed at the site of the mandibular canal.In the presence of a deep indentation on the root of the tooth, as well as in the presence of areas of apical hypercementosis in the form of a «spike¼, the probability of nerve injury during tooth extraction increases many times, which must be taken into account when removing retinated third molars.
Asunto(s)
Mandíbula , Nervio Mandibular , Tercer Molar , Raíz del Diente , Humanos , Tercer Molar/cirugía , Mandíbula/cirugía , Mandíbula/inervación , Mandíbula/anomalías , Raíz del Diente/anomalías , Masculino , Femenino , Nervio Mandibular/anatomía & histología , Adulto , Lesiones del Nervio Mandibular/prevención & control , Diente Impactado/cirugía , Extracción DentalAsunto(s)
Mandíbula , Tercer Molar , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Tercer Molar/diagnóstico por imagen , Femenino , Extracción Dental/métodos , Masculino , Mandíbula/cirugía , Mandíbula/diagnóstico por imagen , Adulto , Diente Impactado/cirugía , Diente Impactado/diagnóstico por imagen , Resultado del Tratamiento , Estudios Retrospectivos , Adolescente , Adulto Joven , Persona de Mediana EdadRESUMEN
The aim of this proposal is to (1) review the current literature, (2) shed light on the importance of creating universally accepted guidelines, (3) provide help and guidance in the decision-making process with regard to the removal of mandibular third molars (M3Ms), and (4) reduce the risk of exposing the patient to unnecessary harm and complications due to the inappropriate removal or retention of M3Ms.It is obvious that the indications for the extraction of M3Ms will continue to be an area of controversy and strong debate. The evidence for or against prophylactic extraction is ambivalent; there is evidence to accept or reject the stance against prophylactic extraction in some specific cases, and there are published articles to support both opposing views. The available guidelines on the extraction of third molars are limited in number, and are mostly tailored to fit specific settings or countries. There are no available guidelines that might be widely used to help in the decision-making process for the international community. We hope this proposal will constitute an important first step toward creating universally accepted guidance.
Asunto(s)
Mandíbula , Tercer Molar , Guías de Práctica Clínica como Asunto , Extracción Dental , Humanos , Tercer Molar/cirugía , Diente Impactado/cirugíaRESUMEN
Distalization of mandibular molars comes with significant challenges, especially in adult and young adult patients. In selected cases, third molar extraction procedures offer the opportunity to place miniplates for anchorage to distalize mandibular molars, providing additional solutions to the traditional extraction of premolars or a single incisor. This approach can be of special interest to adult patients, who may have life commitments and time restraints that limit traditional orthodontic and surgical treatment options, and it can improve the efficiency of dental care. This case series describes 3 clinical scenarios in which miniplates were placed with minimal invasiveness during the removal of impacted third molars, offering the patients nontraditional orthodontic treatment options. Awareness of these options is essential for general dentists so that they can explain all treatment possibilities and provide appropriate referrals to patients with impacted third molars.
Asunto(s)
Métodos de Anclaje en Ortodoncia , Diente Impactado , Humanos , Femenino , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Diente Impactado/cirugía , Diente Impactado/terapia , Extracción Dental , Técnicas de Movimiento Dental/métodos , Técnicas de Movimiento Dental/instrumentación , Derivación y Consulta , Tercer Molar/cirugía , Placas Óseas , Masculino , Adulto , Odontología General , Adulto Joven , Mandíbula/cirugíaRESUMEN
This study aimed to analyze post-coronectomy complications, chronological root survival rate (success rate) using Kaplan-Meier analysis, and postoperative radiographic signs for root extraction. A total of 555 mandibular third molar coronectomies were clinically and radiologically evaluated (mean follow-up period, 27.2 months; range, 1 month to 10.5 years). Complications were observed in 22 (4.0%) cases. Temporary inferior alveolar nerve damage was observed in one (0.2%) case, and 21 (3.8%) retained roots required extraction between 1 and 64 months after coronectomy due to dry socket (two cases, 0.4%), primary non-wound closure (10 cases, 1.8%), secondary root exposure (seven cases, 1.3%), and submucosal root eruption (two cases, 0.4%). Residual enamel after coronectomy was more significantly found on 13 (61.9%) of 21 extracted roots than on 30 (5.6%) of 534 surviving roots. Kaplan-Meier analysis revealed an overall survival rate of 93.8% at 5 years and 92.2% at 10 years. The 5-year survival rates differed significantly (p < 0.001) between the enamel-free (97.0%) and residual enamel-attached (58.3%) roots. The Cox proportional hazards model showed a hazard ratio of 20.87 (95% confidence interval, 8.58-50.72). The long-term outcomes of coronectomy were satisfactory, and a higher success rate is expected when the enamel is completely removed during coronectomy.
Asunto(s)
Mandíbula , Tercer Molar , Complicaciones Posoperatorias , Corona del Diente , Extracción Dental , Humanos , Tercer Molar/cirugía , Estudios Retrospectivos , Masculino , Femenino , Adulto , Mandíbula/cirugía , Corona del Diente/cirugía , Persona de Mediana Edad , Resultado del Tratamiento , Esmalte Dental , Adolescente , Adulto Joven , Raíz del Diente/cirugía , Raíz del Diente/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. MATERIALS AND METHODS: A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. RESULTS: Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6 mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9 mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. CONCLUSIONS: Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. CLINICAL RELEVANCE: Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.
Asunto(s)
Tercer Molar , Extracción Dental , Humanos , Tercer Molar/cirugía , Tercer Molar/diagnóstico por imagen , Femenino , Masculino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Inflamación , AdolescenteRESUMEN
OBJECTIVES: To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators. METHODS: CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1-5 mm), tooth section fissure width (1-3 mm), elevator depth in fissure (2-6 mm), elevator position (buccal, lingual, central), elevator width (2-5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue. RESULTS: Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width (~ 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M. CONCLUSIONS: Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process. CLINICAL SIGNIFICANCE: These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Análisis de Elementos Finitos , Mandíbula , Tercer Molar , Diente Impactado , Humanos , Tercer Molar/cirugía , Diente Impactado/cirugía , Diente Impactado/diagnóstico por imagen , Mandíbula/cirugía , Imagenología Tridimensional , Equipo Dental de Alta Velocidad , Análisis del Estrés DentalRESUMEN
OBJECTIVES: This study aims to compare the sedative effects of remimazolam and midazolam during impacted tooth extraction to provide a comfortable sedation treatment for patients with dental anxiety. METHODS: A prospective randomized controlled trial was conducted, in which 60 patients undergoing intravenous sedation for mandibular impacted third molar extraction were evenly divided into either the remimazolam or midazolam group. Prior to receiving a nerve blocker, the patients were sedated with remimazolam or midazolam. Various parameters were recorded and analyzed, including onset time, awakening time, recovery time, modified dental anxiety scale (MDAS) scores before and after surgery, patient-doctor satisfaction levels, postoperative side effects within 24 hours, heart rate (HR), and mean arterial pressure (MAP) at different time points. RESULTS: Compared with the midazolam group, patients in the remimazolam group demonstrated significantly shorter onset, awakening, and recovery times as well as lower postoperative MDAS scores and higher levels of patient-doctor satisfaction. Fewer postoperative side effects were reported in the remimazolam group, although the differences were not statistically significant. CONCLUSIONS: The use of remimazolam demonstrates faster onset and recovery, superior efficacy in reducing dental anxiety, and enhanced satisfaction among patients and doctors, thereby presenting distinct advantages for sedation treatment for patients with dental anxiety.
Asunto(s)
Benzodiazepinas , Ansiedad al Tratamiento Odontológico , Midazolam , Extracción Dental , Diente Impactado , Humanos , Midazolam/uso terapéutico , Diente Impactado/cirugía , Estudios Prospectivos , Benzodiazepinas/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Tercer Molar/cirugía , Sedación Consciente , Frecuencia CardíacaRESUMEN
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.