Comparison of panoramic radiography and cone-beam computed tomography images for detecting external root resorption of mandibular second molar associated with third molar impaction / 口腔医学

Objective@# To compare the diagnostic performance between panoramic radiography(PR)and cone beam computed tomography(CBCT)in the assessment of external root resorption(ERR)of mandibular second molars associated with impacted third molars. @*Methods@# A total number of 832 patients with 1 074 mesially and horizontally impacted mandibular third molars treated at our institution from January 2019 to December 2020 were retrospectively analyzed. Presence of ERR on the adjacent second molar was investigated with PR and CBCT. Factors affecting the diagnostic accuracy of PR were determined. @*Results@# The overall incidence of ERR in second molars was 33.15%(356/1 074)as detected by CBCT images. The accuracy of PR was 66.39%. Multivariate Logistic regression analyses further revealed that middle and Class Ⅲ impaction, crown contact or overlap with the root of adjacent tooth were risk factors for inaccurate diagnosis of PR(P<0.05). @*Conclusion@#The accuracy of detection on ERR of mandibular second molar associated with impacted third molar using panoramic radiography is lower. CBCT is recommended for this clinical scenario.

Multiple Accessory Cusps Expression at Mandibular Third Molar: A Unique Variation of Dental Crown Morphology - A Case Report

@#Accessory cusps are occasional variations in tooth morphology that can be detected clinically. Third molars have a wide range of eruption patterns and shapes but are commonly impacted. Unlike root morphology, variations in the crown morphology of the third molar have rarely been reported. Variations in crown morphology are important because they can affect clinical outcomes. Here, we present a rare case of fully erupted mandibular third molar (MTM) with multiple accessory cusps. This case report describes a case of a 31-year-old female Kenyah with a unique crown morphology of her fully erupted, vital, and functional mandibular third molar (MTM) which has multiple accessory cusps seen on the buccal surface, giving the appearance of a double tooth. Her MTM presented with an incipient caries lesion, which was managed conservatively. Documenting variations in tooth morphology is crucial for individual identification. While most people opt to have their MTMs extracted, early management of well-erupted and functional teeth should be undertaken to prevent disease progression.

Effectiveness of three different local routes of dexamethasone administration on postoperative sequelae following mandibular third molar surgery. A prospective randomised single-blind clinical study / Eficácia de três diferentes vias locais de administração de dexametasona em sequelas pós-operatórias após cirurgia de terceiros molares inferiores. Um estudo clínico prospectivo randomizado simples-cego

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively. Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus were evaluated for one week postoperatively. Results: There was no significant difference between the three groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days. The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower maximum interincisal opening measurement than group II after two days. Conclusion: Local administration of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain, and less facial edema and trismus at the second postoperative day compared to the submucosal injection and transalveolar application. However, at one week the difference in measurements of the three variables between the groups was not significant. (AU)

Objetivo: O objetivo deste estudo foi fornecer evidências para comparar a eficácia de três diferentes vias de administração local de dexametasona na dor pós-operatória, edema e trismo após a remoção cirúrgica do terceiro molar inferior impactado. Material e Métodos: Quarenta e cinco pacientes foram submetidos à remoção cirúrgica de terceiros molares inferiores impactados e distribuídos aleatoriamente no pós-operatório em 3 grupos: 8 mg de dexametasona injetados na submucosa vestíbular próximo ao local da cirurgia (grupo I), 8 mg de dexametasona injetados no espaço pterigomandibular (grupo II) e 10 mg de pó de dexametasona aplicados no local da extração, após o controle do sangramento (grupo III). Edema facial e abertura interincisal máxima foram medidos no pré-operatório. A dor foi medida pela resposta do paciente a uma escala visual analógica. Percepção de dor, edema facial e trismo foram avaliados por uma semana de pós-operatório. Resultados: Não houve diferença significativa entre os três grupos em relação à dor após 1, 2, 5, 7 dias de acompanhamento. No entanto, o grupoII mostrou menos dor em 3 e 4 dias. A diferença entre as medidas de edema não foi significativa nos três grupos em 1, 5, 7 dias, embora nos grupos I e II o edema cedeu a partir do dia 2. Quanto ao trismo, os grupos I e III apresentaram medida de abertura interincisal máxima inferior estatisticamente significativa do que o grupo II depois de dois dias. Conclusão: A administração local de dexametasona por três vias diferentes é benéfica na redução das sequelas pós-operatórias após a cirurgia do terceiro molar. A injeção de dexametasona no espaço pterigomandibular resultou na resolução mais precoce da dor e menos edema facial e trismo no segundo dia de pós-operatório em comparação com a injeção submucosa e a aplicação transalveolar. No entanto, em uma semana, a diferença nas medidas das três variáveis entre os grupos não foi significativa.(AU)

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.

A Comparative Study to Evaluate Efficacy of Fentanyl Transdermal Patch VS Ketoprofen Patch in Pain Control after Mandibular Third Molar Surgery

Background: Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. Aims and Objectives: to evaluate and compare the degree of post-operative analgesia, patient compliance and frequency of adverse events between transdermal ketoprofen patch and transdermal fentanyl patch following third molar extraction. Methods: Total 7 patients aged 18-65 years with impacted mandibular third molar teeth were included in the study. The study drugs transdermal patches of fentanyl and ketoprofen was applied one hour before the surgical procedure on the skin, preferably in an area devoid of any hair. The selected mandibular third molar tooth of either of the side was extracted in the first appointment using an aseptic protocol. Every patient was given a Verbal Pain Intensity and Pain Relief chart ( both 5- point scales with values 0-4 ) for assessing pain intensity and pain relief for all the three post-operative days. Results: During the first four hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.881). Whereas during the first eight hours of operative day the difference observed between the two groups was not found to be statistically significant (p=0.141). During the first twelve hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.276). At the end of operative day, the difference observed between the two groups was found to be statistically significant (p=0.048). Conclusion: Transdermal fentanyl patch was more effective for immediate pain relief than transdermal ketoprofen patch for pain control following removal of mandibular impacted third molars.

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

Frequency of Different Types of Mandibular Third Molar Impactions

Objective: Impacted third molars are a major problem in modern dentistry and the decision of whether to remove an impacted third molar is probably one of the most frequent treatment decisions faced by dentists. Impacted mandibular third molars are often associated with pericoronitis, periodontitis, cystic lesions, neoplasm, and pathological root resorption and can cause detrimental effects on the adjacent tooth. Therefore, the objective of the present study was to determine the frequency of different types of mandibular third molar impactions. Materials and Methods: This cross-sectional study was carried out in the outdoor patient Department of Oral and Maxillofacial Surgery, Multan Medical and Dental College, Multan during a period of 6 months from 15 December 2017 to 14 June 2018. After written informed consent, a total of 200 patients were recruited, diagnosed clinically and radiographically as having impacted mandibular 3rd molar. Angulation of impacted third molar was classified according to the long axis of the adjacent second molar on periapical and OPG radiographs. Statistical analysis was done through SPSS version 20. Results: Out of 200 patients, the frequency of mesioangular, vertical, distoangular, and horizontal impactions were 84 (42%), 60 (30%), 40 (20%), and 16 (8%) respectively. The depths of the impactions were 67 (33.5%) depth A, 92 (46%) depth B, and 41 (20.5%) depth C. Conclusion: Mesioangular impaction was more common followed by vertical. Depth B was the most common.

Prevalence of impacted mandibular third molars and its association with distal caries in mandibular second molars using cone beam computed tomography / Prevalencia de terceros molares mandibulares impactados y su asociación con caries distales en segundos molares mandibulares mediante tomografía computarizada de haz cónico

This study evaluated the prevalence and eruption's pattern of impacted mandibular third molars (IMTM) and the influence of their eruption status on the distal caries of mandibular second molars (MSM) using cone-beam computed tomography (CBCT). Material and methods: CBCT images taken for different purposes in private dental practices were analyzed retrospectively. Radiographic assessment included: prevalence of IMTM, degree of angulation, level of impaction and type of IMTM. Furthermore, the distance between the cement-enamel junctions (CEJ) of second and third molars and the occurrence of caries lesion on the distal surface of MSM was also evaluated. Data were analyzed by chi square test and logistic regression was used to find the association between distal caries of MSM and eruption status of IMTM. Results: Three hundred and eight CBCTs were screened, the prevalence of IMTM was 36.88% and their angulation degree were mostly less than 90º (mesioangular). Amongst those with impaction, 58 subjects (43%) had distal caries on MSM, 29.6% in females and 30.4% in the age group 19-27 years. Caries on the distal side of MSM were significantly associated with age, level and type of impaction, angulation degree and CEJ distances (p<0.05). Conclusions: The prevalence of IMTM is high (36.88%) and there are significant relationships between angulation degree, level and type of impaction, and CEJ distances with caries on the distal side of MSM.

Introducción: Este estudio evaluó la prevalencia y el patrón de erupción de terceros molares mandibulares impactados (TMMI), y la influencia de su estado de erupción en la caries distal de los segundos molares mandibulares (SMM) mediante tomografía computarizada de haz cónico (TCHC). Material y métodos: se analizaron retrospectivamente las imágenes de TCHC tomadas para diferentes fines en prácticas dentales privadas. La evaluación radiográfica incluyó: prevalencia de TMMI, grado de angulación, nivel de impacto y tipo de TMMI. Además, también se evaluó la distancia entre la unión amelocementaria (UAC) de los segundos y terceros molares y la aparición de lesión de caries en la superficie distal de SMM. Los datos se analizaron mediante la prueba de chi cuadrado y se usó la regresión logística para evaluar asociaciones entre la caries distal de SMM y el estado de erupción de TMMI. Resultados: Se examinaron 308 TCHC, la prevalencia de TMMI fue de 36.88% y su grado de angulación fue mayoritariamente menor a 90º (mesioangular). Entre aquellos con impacto, 58 sujetos (43%) tenían caries distales en los SMM, 29.6% eran mujeres y 30.4% pertenecieron al grupo de edad de 19-27 años. Las caries en el lado distal de MSM se asociaron significativamente con la edad, el nivel y el tipo de impactación, el grado de angulación y las distancias UAC (p<0.05). Conclusiones: la prevalencia de TMMI es alta (36.88%) y existen relaciones significativas entre el grado de angulación, el nivel y el tipo de impacto, y las distancias UAC con presencia de caries en el lado distal de los SMM.

Impacted mandibular third molar: Comparison of coronectomy with odontectomy

Damage to the inferior alveolar nerve (IAN) while extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. The aim of this study was to compare the sequelae of coronectomy with odontectomy in impacted mandibular third molars. Patients and Methods: This study included thirty patients which were divided into two groups, Group-I (test group) including 15 patients undergoing coronectomy and Group-2 (control group) of 15 patients undergoing odontectomy. Investigations included digital orthopantomogram. The parameters for this study included pain, swelling, nerve paresthesia, trismus, postoperative infection, postoperative wound dehiscence, postoperative pocket depth, and migration. Results: In Group-1 (coronectomy group), the patients underwent follow-up for 6 months to evaluate migration of the retained mandibular third molar root which was in proximity with the IAN. There was a mean increase in migration when the distance from the inferior border of IAN until the apex of the retained mandibular third molar root was measured which was by 3.43 mm after 6 months of follow up. Conclusion: On statistical analysis, the result in this study showed no statistical difference in both the groups in all the parameters that were taken.

The relative location between the mandibular third molar and inferior alveolar canal studied by CBCT / 实用口腔医学杂志

Objective: To determine the positional relationship between impacted mandibular third molar(IMTM) and mandibular canal(MC) by CBCT. Methods: 664 IMTMs with root apexes contacted to MCs on panoramic radiograph were further examined by CBCT,the exact positional relationship between IMTMs and MCs was observed and analyzed by I-Dixel software. Results: The 664 cases were divided into lowly(6. 3％),intermediately(60. 7％) and highly(33. 0％) impacted groups by the depth of IMTMs in mandibulae showed on CBCT images. The distance(mm) from the root apexes of IMTMs to the intact superior wall of MCs(n = 329) in lowly, intermediately and highly impacted cases were 1. 39 ± 1. 38,1. 28 ± 1. 03 and 1. 79 ± 1. 54 respectively(P ＜ 0. 05). MCs on the buccal side,lingual side,under the IMTMs and between the root apexes were found in 49. 8％,12. 0％,36. 6％ and 1. 5％ of the cases; the MC wall deffect was found in 65. 8％,27. 5％ and 95. 0％ of the cases with the MCs under,on buccal and lingual side of the IMTMs, respectively(P ＜ 0. 001). Conclusion: CBCT examination is necessary for the determination of the positional relationship between MC canal and IMTM with the root apex cotacted or overlapped to MC.

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.

C–reactive protein estimation: A quantitative analysis for three nonsteroidal anti‑inflammatory drugs: A randomized control trial.

Context: C‑reactive protein (CRP) estimation for quantitative analysis to assess anti‑inflammatory action of nonsteroidal anti‑inflammatory drugs (NSAIDs) after surgery in maxillofacial surgery. Aims: This study was to evaluate the efficacy of CRP as a quantitative analysis for objective assessment of efficacy of three NSAIDs in postoperative inflammation and pain control. Settings and Design: The parallel study group design of randomization was done. Totally 60 patients were divided into three groups. CRP was evaluated at baseline and postoperatively (immediate and 72 h) after surgical removal of impacted lower third molar. The respective group received the drugs by random coding postoperatively. Subjects and Methods: The assessment of pain control and inflammation using NSAIDs postoperatively after surgical removal of impacted lower third molar was qualitatively and quantitatively assessed with CRP levels. The blood sample of the patient was assessed immediate postoperatively and after 72 h. The visual analog scale (VAS) was used for assessment of pain and its correlation with CRP levels. Statistical Analysis: Comparison of difference in levels of CRP levels had P < 0.05 with immediate postoperative and baseline levels. The duration of surgery with association of CRP levels P = 0.425 which was nonsignificant. The pain score was increased with mefenamic acid (P = 0.003), which was significant on VAS. Results: Diclofenac had the best anti‑inflammatory action. There was a significant increase in CRP levels in immediate postoperative values and 72 h. CRP test proved to be a useful indicator as a quantitative assessment tool for monitoring postsurgical inflammation and therapeutic effects of various anti‑inflammatory drugs. Conclusions: CRP test is a useful indicator for quantitative assessment for comparative evaluation of NSAIDs.

A clinical comparison of impacted mandibular third molar extraction at different ages of patients / 实用口腔医学杂志

330 cases of impacted mandibular third molar were divided into 3 groups,A:younger than 18 years,B:18-25-year-old,C:ol-der than 25-year.Operation time(min)of group A,B and C was 21.95 ±5.86,6.45 ±4.92 and 18.77 ±9.64(B vs A or C,P <0.01), intraoperative complication rates were 2.73%,6.36% and 30.91%(P <0.01),postoperative complication rates were 51.82%,23.64%and 66.36%(P <0.05),respectively.18-25 year-old is the suitable age for removal of impacted mandibular third molars.

Clinical observation of the disto-lingual root of the impacted mandibular third molars / 实用口腔医学杂志

Cone beam CT(CBCT)data of 4 550 impacted mandibular third molars were divided into 6 groups by the direction of teeth im-paction.Analyzed by SPSS 19.0 statistical package and Pearson Chi-square Test,the incidence of disto-lingual roots was 5.38% and was various with different impation direction.

Evidence-based medical analysis of the applicaiton of microport extraction to impacted mandibular third molar removal / 实用口腔医学杂志

Objective:To evaluate the effectiveness of microport extraction of the impacted mandibular third molar removal.Meth-ods:According to the systematic review and meta-analysis,the randomized controlled clinical trials published till October 2012 were searched and collected using the method of evidence-based medicine.Results:8 clinical research papers including 1 915 subjects were collected.Complication of microport extraction(958 cases)was less than that of traditional operation(957 cases).Conclusion:Microport extraction of impacted mandibular third molar may reduce the complications.

Immunohistochemical analysis of CK 18 in dental follicles of impacted third molars: A pilot study.

Objective: Odontogenic tumors are lesions derived from epithelial, ectomesenchymal, and/or mesenchymal elements that still are, or have been, part of the tooth-forming apparatus. Approximately 80% of odontogenic tumors occur in the mandible, with a marked predilection for the posterior region, and are often associated with an unerupted tooth. The aim of this study was to determine whether cytokeratin (CK) 18 immunostaining decorated the follicular tissue removed at the time of prophylactic extraction of impacted mandibular third molars, which might suggest oncofetal transformation. Materials and Methods : Fifty-four impactions met the study inclusion criteria, of which 24 cases showed the presence of reduced enamel epithelium and/or connective tissue with odontogenic epithelium, which were subjected to CK 18 immunostaining. Results: All 24 cases with adequate epithelium were CK 18 immunonegative. Conclusion: There was no oncofetal transformation in the odontogenic epithelia of the dental follicles studied. Thus, although we reaffirm that evaluation of follicular tissue is imperative since disease conditions may be found in minute follicular spaces, development of odontogenic cysts and tumors is unlikely.

Sublingual piroxicam in the management of postoperative pain after surgical removal of impacted mandibular third molar.

Introduction: Surgical removal of impacted mandibular third molar is one of the most commonly performed procedures in oral and maxillofacial surgical practice. The role of preoperative and postoperative medications for management of postoperative complications has been extensively evaluated. Aim: To assess the therapeutic effect of a single dose of 40 mg sublingual piroxicam (study group) vs 150 mg oral diclofenac (50 mg thrice a day) (control group) in patients undergoing surgical removal of impacted mandibular third molar. Materials and Methods: A total of 100 patients with asymptomatic impacted mandibular third molars were randomized into two groups. One group received two 20-mg tablets of piroxicam once daily on the first and second postoperative days, followed by one 20-mg tablet on the third post-operative day. The other group received one tablet of diclofenac 50 mg orally thrice daily on the first, second, and third post-operative days. Repeated extraoral examinations were done for continuous assessment of swelling, trismus, and reduction in pain. Ovearall impression of the treating physician and the patient regarding efficacy of study drugs were recorded at the end of the study. Results: In the piroxicam group there was >50% reduction in pain on all three days postoperatively. The incidence of swelling and trismus was found to be higher in the control group as compared to the study group. Adverse events, such as gastrointestinal (GI) disturbances, were significantly higher in the diclofenac group (11%) as compared to the piroxicam group (0%). Conclusion: Two sublingual piroxicam 20 mg tablets once daily has better efficacy and tolerability profile than diclofenac 50 mg one tablet thrice daily in the management of pain after surgical removal of impacted mandibular third molar. Study Title: A Comparative Study to Evaluate Clinical Efficacy and Safety of Sublingual Piroxicam and Diclofenac in the Management of Pain after Surgical Removal of Impacted Mandibular Third Molar.

Tooth in the line of fracture: Its prognosis and its effects on healing.

Aims and Objective: The aim of this prospective study was to compare the postoperative results of mandibular angle fracture cases treated by open reduction and internal fixation wherein the third molar in the line of fracture was preserved in one group while it was extracted in the second group. Materials and Methods: Group I consisted of 30 patients in which the mandibular third molar in the line of fracture was preserved and group II consisted of 24 patients in which it was extracted following specific criteria. Various parameters like postoperative healing, infection, occlusion, tooth vitality, and mobility were graded numerically. Statistical analysis using a t-test was done. Data were expressed as mean±SD and a probability (P) value of <0.05 was considered significant. Results: The presence of infection with pain and tenderness was higher in group I. Osteogenesis was higher in group I till the end of the third week but the difference was not significant later. Discrepancy in occlusion was more in group II. Mobility of tooth decreased and status of periodontal tissue improved significantly with time. In the tooth involved, the return of vitality and decrease in pain/tenderness was significant after 1 week and continued till 24 weeks to normalcy. Two teeth showed mild root resorbtion and none showed ankylosis. Conclusion: Postoperative occlusal discrepancy is less but infection is higher when the tooth in the line of fracture is preserved as compared to when it is removed. More than half of the teeth in the fracture line show complete recovery within a period of 6 months to 1 year. Despite the risk of an increase in the rate of complications, the tooth in the line of fracture should be preserved for its merits.