Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.@*METHODS@#Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.@*RESULTS@#Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), @*CONCLUSIONS@#Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.

Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial / 华西口腔医学杂志

OBJECTIVES@#This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars.@*METHODS@#Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests.@*RESULTS@#The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (@*CONCLUSIONS@#The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.

Potential for Osseous Regeneration of Platelet Rich Fibrin: A Comparitive Study in Mandibular Third Molar Socket.

Aims: To evaluate the effi cacy of autologous platelet- rich fi brin in regeneration of bone and to assess clinical compatibility of the material in mandibular third molar extraction socket. Materials and Methods: This study was conducted in 20 patients visiting the out patient department of Oral & Maxillofacial Surgery, Subbaiah Institute of Dental Sciences. Patients requiring extraction of bilateral symmetrical mandibular third molars were taken for the study. Following extraction, platelet rich fi brin prepared from patients own blood was placed in one extraction socket. The patients were assessed for postoperatively pain, periodontal pocket depth and bone blending and trabecular formation. Radiological assessment of the extraction site was done for a period of 6 months to evaluate the change in bone density. Results: All the local signs and symptoms of infl ammation were mild to moderate and subsided in normal course of time. Pain was less in study site compared to control site. Soft tissue healing was better in study site. Evaluation for bone blending and trabecular bone formation showed earlier in study (prf)site compared to control(non prf) site in 10 patients. The evaluation of bone density by radiological assessment showed the grey level values calculated at 4months at the prf site were comparatively higher than the average baseline value of bone density at extraction site in control site. Conclusion: The study showed that autologous PRF is biocompatible and has signifi cant improved soft tissue healing,bone regeneration and increase in bone density in extraction sockets. However a more elaborate study with a larger number of clinical cases is very much essential to be more conclusive regarding its effi cacy.

Establishment of a simulation model for mandibular third molar extraction / 实用口腔医学杂志

Objective:To establish a model of mandibular impact third molar extraction with common dental materials for pre-clinical trai-ning.Methods:Based on the characteristics of the common dental materials,the anatomy and extraction skill of mandibular impact third molar,the dental model for mandibular impact third molar extraction was designed and made.Then,this dental model was placed in the head-simulation model as required,and used by the dentists and the students.The questionnaire was designed and used to evalu-ate the effects of the model.Results:A new method of designing and making a dental model for mandibular impact third molar extraction with the common dental materials was established successfully.The questionnaire results showed that all the dentists and students agreed that this model could simulate the mandibular third molar extraction procedure.Conclusion:Simulation model of the mandibular third molar extraction can help students for the following clinical practice.

Effect of a combination of oral midazolam and low-dose ketamine on anxiety, pain, swelling, and comfort during and after surgical extractions of mandibular third molars.

Purpose: To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars. Materials and Methods: Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared. Results: Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used. Conclusions: Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

Análise comparativa entre articaína 2% e articaína 4%, ambas com adrenalina 1:200.000: avaliação da eficácia anestésica, sangramento intraoperatório e parâmetros hemodinâmicos em exodontias de terceiros molares / Comparative analysis between 2% and 4% articaine, both with 1:200,000 adrenaline: evaluation of the anesthetic efficacy, intraoperative bleeding and hemodynamic parameters in lower third molar removal

Este ensaio clínico randomizado comparou a eficácia clínica do anestésico local articaína em duas concentrações, 2% e 4%, associado à adrenalina na concentração de 1:200.000, em exodontias de terceiros molares inferiores. Para tanto, 50 voluntários saudáveis foram submetidos, em sessões cirúrgicas distintas (com intervalo de 1 a 2 meses), à extração de dois terceiros molares inferiores com posições semelhantes sob anestesia local com articaína 2% ou 4%, ambas com adrenalina 1:200.000, de forma duplo-cega, randomizada e cruzada. Foram avaliados: início de ação das soluções anestésicas, tempo de duração da analgesia pós-cirúrgica, tempo de duração da anestesia pós-cirúrgica sobre tecidos moles, sangramento intraoperatório, parâmetros hemodinâmicos durante as cirurgias e abertura bucal dos voluntários e cicatrização dos sítios operados 7 dias após a realização das cirurgias. Três voluntários receberam volumes diferentes de anestésico nas duas cirurgias e por este motivo seus resultados foram descartados. Portanto, foram considerados os resultados de 47 voluntários (média de idade de 23±4 anos, variação de 18 a 44 anos). As duas soluções apresentaram início de ação bastante similar (1,48±0,60 e 1,50±0,69 min, respectivamente; p>0,05). Volumes idênticos de ambas as soluções anestésicas foram utilizados em todos os voluntários (3,33±1,00 mL e 3,28±0,83 mL). As soluções anestésicas proporcionaram tempo de analgesia pós-cirúrgica similar (133,02±110,72 min e 125,72±101,80 min; p>0,05), e a duração da ação anestésica sobre tecidos moles também foi similar, sendo de 190,52±90,07 min para articaína 2% e de 215,15±77,51 min para articaína 4% (p>0,05). O sangramento intraoperatório, no julgamento do cirurgião, foi muito próximo do escore mínimo durante todas as cirurgias. As mudanças transitórias nos valores de pressão arterial, frequência cardíaca e saturação de oxigênio não tiveram relevância clínica e não puderam ser atribuídas a nenhuma das soluções...

The present clinical trial randomized compared the clinical efficacy of the local anesthetics articaine in two concentrations, 2% and 4%, in association with 1:200,000 adrenaline, for the removal of lower third molars. Onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, hemodynamic parameters, postoperative mouth opening and wound healing at the 7th postoperative day were evaluated. For this purpose, 50 healthy volunteers underwent removal of symmetrically positioned lower third molars, in two separate appointments (one to two months apart), under local anesthesia with either articaine 2% or 4% (both with 1:200,000 adrenaline) in a double-blind, randomized and crossed manner. Three volunteers received different volumes of local anesthetic in both surgeries and for this reason their results were discarded. Therefore, the results of 47 volunteers were considered (mean age of 23±4 years, range 18-44) The two solutions presented very similar onset (1.48±0.60 and 1.50±0.69 min, respectively; p>0.05). Identical volumes of both anesthetic solutions were used 3.33±1.00 mL and 3.28±0.83 mL. Both solutions provided similar duration of postoperative analgesia (133±110 min and 125±101 min; p>0,05), and the duration of anesthetic action on soft tissues evoked by 2% articaine (190±90 min) and 4% articaine (215±77 min) was also similar (p>0.05). The surgeon’s rating of intraoperative bleeding was considered very close to minimal throughout all the surgeries. Transient changes in blood pressure, heart rate and oxygen saturation were observed, but they were not clinically significant, nor were the changes attributable to the type of local anesthetic used (p>0.05). There were no significant differences between preoperative and 7th postoperative day values of mouth opening when the patients were operated with either articaine 2% or 4% (p>0.05). Wound healing was rated normal for all the...

Effect on complications associated with its position and angulation following mandibular third molar extraction

INTRODUCTION: Mandibular third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. Although the overall complication rate is low with most complications being minor, mandibular third molar removal is so common that the population morbidity of complications might be significant. Therefore, efforts to limit intraoperative or postoperative complications might have a significant impact in terms of enhancing the patient outcome. The aims of this study were to identify the position and angulation associated complications after mandibular third molar extractions. MATERIALS AND METHODS: This study surveyed 568 patients who had a mandibular third molar extracted, showed clinical complications and underwent a radiographic measurement of the available space, depth and spatial relationship. RESULTS: The results obtained were as follows: 1. The complications were a dry socket, nerve injury, root rest, infection, bleeding, hamatoma, and adjacent teeth injury. 2. There were no significant differences between the complication and ramus relationship (available space) of the mandibular third molar. 3. There were no significant differences between the complications and depth of the mandibular third molar. 4. There were no significant differences between the complications and spatial relationship of the mandibular third molar. CONCLUSION: There were no significant differences in the complication rate, ramus relationship, depth and spatial relationship of the mandibular third molar. This suggests that the position and angulation of the mandibular third molar may not have an impact on the complications. The relationship between the position and angulation of the mandibular third molar, and complications deserves a further study using longitudinal data.

Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

A extração de terceiros molares é o procedimento cirúrgico mais comum na prática diária em cirurgia oral, e complicações podem ocorrer a despeito da habilidade e experiência do cirurgião. Complicações observadas durante ou após extração de terceiros molares podem incluir dor, edema, sangramento, infecção, perfuração de seio e dano nervoso. Felizmente, a incidência de tais eventos é baixa quando se emprega conduta adequada e boa técnica cirúrgica. O enfisema subcutâneo associado à extração dentária ocorre quando o ar da turbina de alta rotação é forçado para dentro dos tecidos moles através de um retalho rebatido e invade os tecidos adjacentes, causando edema, crepitação à palpação, e eventualmente espalhando-se pelos espaços teciduais dos planos fasciais. Embora seja raro, o enfisema subcutâneo iatrogênico pode ter conseqüências sérias e com risco de morte. É necessário ter cuidado com o uso de turbinas de alta rotação durante a realização de procedimentos cirúrgicos orais. A penetração de ar nos tecidos faciais não está limitada às extrações dentárias, e pode ocorrer também por outras vias de acesso, tais como dentes tratados endodonticamente, periodonto e lacerações de tecidos moles intraorais. Quando ocorre, o enfisema subcutâneo deve ser diagnosticado rapidamente e tratado adequadamente para diminuir o risco de outras complicações. Este relato apresenta um caso de enfisema subcutâneo ocorrido durante a extração de um terceiro molar inferior com emprego de turbina de alta rotação. O manejo do caso é descrito e os aspectos relacionados ao diagnóstico e à prevenção desta complicação cirúrgica são discutidos.

Subcutaneous Emphysema and Pneumomediastinum After Mandibular Third Molar Extraction: a Case Report

The Efficacy of Prophylactic Antibiotics for Mandibular Third Molar Extraction

This study analyzed the incidence of wound infection after the operation of mandibular third molar extraction in relation with antibiotic prophylaxis with the object of young and healthy patients. The study object was 1,177 mandibular third molars of 850 men of 20 to 25 years old without any specific systemic disease. Three methods of preventive antibiotic medication were selected according to the preventive antibiotic medication previously reported; three experimental groups were selected based on them, and the antibiotic used was amoxicillin((R)Kymoxin, Yuhanyanghaeng, Seoul). The group 1 includes the patients that took the antibiotic orally before the operation(one hour earlier, 500mg) and for three days after the operation(250mg per time, three times/day), the group 2 is the ones that took the same antibiotic orally only once about one hour before the operation(500mg), and the group 3 did not take any antibiotics before and after the operation. And to compare the difficulties and the degrees of extraction during operations which can be possibly related to the wound infection after the operations, the mandibular third molars' impacted depths and extraction methods were investigated as well. To check if the wound was infected, observations with an internal of one week were performed twice after the operation, and the meaningfulness of the infection incidence was verified through Chi-square test using SPSS program(SPSS Inc., IL, USA). There was no statistically significant difference between the antibiotic medication methods and the wound infection incidence after the operation among the experimental groups. As examining the relations between the mandibular third molar operation methods and the wound infection incidence after the operation, there existed a statistically meaningful difference in the infection incidence according to the operation methods(p=0.020). And there was no statistically significant difference in the wound infection incidence according to the impacted depth of the mandibular third molar. Therefore, it is thought that there exists little necessity of prophylatic antibiotics medication when extracting the mandibular third molar of young and healthy men without any systemic disease in general; however, in case when it is expected that the possibility of infection will be high or the wound on the tissue will be severe, it is sure that the prophylactic antibiotics medication will be necessary.

The anxiety in patients undergoing third molar extraction

The purpose of this study is to understand anxiety in patients undergoing third molar extraction and care patients of third molar extraction. The subjects in the study were Sixty-three patients who visited the department of dentistry at Pusan Paik Hospital from May 2006 to September 2006 and who underwent third molar extraction. Patients' anxiety(state anxiety and trait anxiety) to use Spielberger's state-trait anxiety inventory(STAI) were measured. They were asked to fill out STAI question paper immediately before third molar extraction(pre-extraction) and on the day after the extraction(post-extraction). And visual analog scale(VAS) to measure patient's postoperative pain on the day after extraction(postextraction day) was used. Then Differences in anxiety before and after extraction, between men and women, between the first and second extraction, with impacted versus nonimpacted third molar extraction, between extraction time and anxiety, and between postoperative pain and anxiety were evaluated. The anxiety status of patients undergoing third molar extraction could be quantitatively evaluated using the STAI-KYZ. There were significant difference before and after third molar extraction. Especially women and patients of more severe postoperative pain was more anxious. We need to alleviate patient's anxiety(especially women) and to control postoperative pain throughout the tooth removal process.

Mucoepidermoid carcinoma in the mandible : review of a case

Evaluation of postoperative prophylactic antibiotic medication in third molar surgery

We evaluated the need for prophylactic postoperative oral antibiotic medication in extraction of asymptomatic impacted mandibular third molars. All patient didn't show sign of pain, inflammation, swelling and trismus at the time of extraction. In the experimental group, oral antibiotic medication(Amoxicillin) was carried out for 5 days postoperatively. In the control group, the patients received no antibiotic medication. All groups didn't use antibiotic irrigation solution. Rule of group composition randomized. The surgical technique was the same in all cases. Parameters that were evaluated were infection, pain, facial swelling, trismus. We could not find any significant difference between the experimental and control groups.(P<0.05) The results of our study show that post operative oral prophylactic antibiotic medication after the extraction of impacted mandibular third molars does not contribute to less infection, pain, facial swelling and increased mouth opening after surgery. Therefore we suggest that prophylactic postoperative oral antibiotic medication is not needed in extraction of asymptomatic impacted mandibular third molars.

The effect of third molar extraction on the periodontal status of the adjacent second molar / 대한치주과학회지

The aim of this study was to investigate the effect of third molar extraction on the periodontal status of the adjacent second molar. A total of 61 second molars in 31 adult periodontitis patients were examined. Among them, 27 second molars without adjacent third molars were included in the test group, and 34 second molars with third molar were included in the control group. Clinical parameters including plaque index, gingival index, and pocket depth and radiographic bone loss were measured around the second molar both in test and control group. The result showed that: (1) the mean plaque index and gingival index of control group were higher than these of the test group but the difference was not statistically significant, (2) the mean pocket depth of the control group was higher than the test group significantly at distal and buccal surface, (3) radiographic bone loss was greater in control group than test group significantly, (4) in Pearson correlation analysis between the age of extraction and radiographic bone loss in the test group, a positive relationship was shown(p<0.01). Within limitation of this study, it may be concluded that third molar extraction in periodontitis patients showed an improvement in periodontal status in contrast the patients group having third molar, therefore earlier a removal of third molar may minimize radiographic bone loss of the adjacent second molar.

Acquired Lymphangioma Associated With Adenomatoid Hyperplasia Of The Minor Salivary Glands

Active Bleeding Acre During Surgical Extraction of Mandibular Third Molar: Report of Two Cases

The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatic agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.