Clasificación alternativa para terceros molares / Alternate classification for third molars

Resumen Introducción En el presente artículo se describen las diferentes clasificaciones de terceros molares retenidos y se recomienda una nueva clasificación que permite predecir la dificultad para la remoción respectiva. Objetivo Lo anterior tiene la finalidad servir de guía para que los estudiantes o profesionales en Odontología utilicen como clasificador el grado de dificultad de terceras molares, el cual se constituiría en un instrumento de medición del tiempo necesario para remover la pieza dental, los pasos necesarios para dicha remoción y la morbilidad relacionada.

Abstract Introduction Different literaly classifications of impacted wisdom teeth will be shown in adddition to a new categorization wich predicts their removal difficulty. Aim The goal of the above statement is to be used as a guide for students and/or collegues to classify the degree of difficulty as a tool to measure the needed time to extract the tooth and the necessary steps to remove it and the related morbility.

Estimation of time utilized in suturing of oral flaps post-surgical wisdom teeth removal using Negus knot pusher instrument (a comparative study) / Estimativa do tempo utilizado na sutura de retalhos orais após exodontia de terceiros molares utilizando o instrumental Empurrador de nó Negus: um estudo comparativo

Objective: Wisdom teeth were the most common teeth affected among the rest of the teeth, these teeth need accurate evaluation and diagnosis, surgical removal of impacted wisdom needs time for incision, bone removal and suture, so the use of any instrument helps to reduce this time is essential. The objectives of this study were to estimate the time needed for the suture of oral flaps post-surgical removal of the lower wisdom teeth by using Negus knot pusher and compare it with the time used for stitching in conventional manual holding single stitching. Material and Methods: Data had been collected from thirty patients through history, clinical examination and radiographic assessment, followed by classical surgical removal performed on the same principles for all patients, at the suture level patients divided arbitrarily into two groups, control group 15 patients and 15 patients Negus pusher group, using Negus knot pusher, which is usually used to hold the stitch and stop bleeding post tonsillectomy operations by ligation, time elapsed for suturing with knot tying is calculated for both groups. Results: Among the 30 patients incorporated in the clinical study, control group mean was (1 minutes and 11 seconds and 70 milliseconds) while for the pusher group was (1 minutes and 32 seconds and 57 milliseconds), the comparison by means of T-test was not significant with the (0.424) value. Conclusion: the Negus pusher instrument can be used for the knotting stiches post wisdom teeth removal as an auxiliary tool and the time can be shortened by the use of a modified handling technique and more satisfaction for patients. (AU)

Objetivo: Os terceiros molares são os dentes mais afetados entre o resto dos dentes e necessitam de avaliação e diagnóstico precisos. A exodontia desses elementos impactados requer tempo para incisão, remoção óssea e sutura, portanto, é essencial o uso de instrumentos que ajudem a reduzir o tempo de procedimento. Os objetivos do presente estudo foram estimar o tempo necessário para a sutura de retalhos orais após a exodontia de terceiros molares inferiores utilizando o instrumental Empurrador de nó Negus (Negus Knot pusher) e compará-lo com o tempo necessário para a realização de sutura única convencional. Material e Métodos: Os dados foram coletados de 30 pacientes através da história, exame clínico e avaliação radiográfica, seguidos pela remoção cirúrgica clássica realizada através do mesmo princípio para todos os pacientes. Considerando o nível da sutura, os pacientes foram divididos arbitrariamente em dois grupos, grupo controle (n=15) e grupo Empurrador de nó Negus (n=15), o qual é geralmente utilizado para segurar o ponto e estancar o sangramento após cirurgia de tonsilectomia por ligadura. O tempo decorrido para sutura foi calculado para ambos os grupos. Resultados: Entre os 30 pacientes incluídos no estudo, a média do grupo controle foi de 1 minuto e 11 segundos e 70 milissegundos, enquanto para o grupo Empurrador de nó Negus foi de 1 minuto e 32 segundos e 57 milissegundos. A comparação intergrupo por meio do teste T não foi estatisticamente significativa (p=0,424). Conclusão: O instrumental Empurrador de nó Negus pode ser usado para sutura após a extração de terceiros molares como ferramenta auxiliar e o tempo pode ser reduzido pelo uso de uma técnica de manuseio modificada. Ademais, pode estar associado a maior satisfação dos pacientes. (AU)

Reasons for Third Molars Extraction by Different Health Care Providers

Background: Third molars extraction is one of the most common surgical procedures in daily dental practice.However, the reasons for extraction varies in the literature. Objectives: The primary objective of this study wasto investigate the reasons for the extraction of third molars. The secondary objectives were to evaluate if patientand dentist- related factors affect the reasons for extraction. Methodology: A questionnaire was completed byhealth care providers in four dental centers in Jeddah, Saudi Arabia. A total of 195 patients (118 females and 77males), who had their third molars extracted (n=227) were included in this study. Statistical analysis wasperformed using Fisher’s exact test. Results: Caries (42.3%) and prophylaxis (39.2%) were the most commonreasons for the extraction of third molars. Extraction for prophylactic reasons was significantly higher amongfemale patients and patients younger than 40 years old (p<0.01 and p<0.05, respectively). Furthermore, thedecision to extract for prophylactic reasons was significantly higher among specialists or consultants ascompared to students, interns or residents (74.0% vs. 26.0%; p<0.001). No difference was found betweenmaxillary and mandibular third molars extraction. Conclusion: This study identified caries and prophylaxis asthe most common causes of third molars extraction. It was also found that patients' age, gender, as well as dentists'qualification were factors influencing the reasons for extraction.

Effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammatory response and pain / 局解手术学杂志

Objective To explore the effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammation and pain. Methods A total of 110 patients with impacted wisdom teeth removed in our department from June 2016 to February 2018 were divided into observation group(55 cases,minimally invasive removal) and control group (55 cases, traditional chisel) according to the surgical method. The operative status, the inflammatory mediators and pain mediators in the gingival sulcus before and after the treatment, and the therapeutic effects of the two groups were compared. Results The operative time of the observation group was shorter than that of the control group,the intraoperative blood loss was less than that in the control group, the differences were significant(P ＜ 0. 05). The levels of PTX3, cells in the gingival sulcus adhesion of cytokine 1 (ICAM1),peroxidase (MPO),prostaglandin E2 (PGE2) levels,pain mediator 5-hydroxytryptamine(5-HT), calcitonin gene-related peptide(CGRP), substance P(SP), galanin(Gla) and adenosine triphosphate(ATP) in the observation group after treatment was lower than those in the control group, the differences were significant(P ＜ 0. 05); The degree of mouth opening restriction, facial swelling and visual analog scale score(VAS) in the observation group were lower than those in the control group, the differences were significant(P ＜ 0. 05). Conclusion Compared with traditional chisel in extraction of impacted wisdom teeth, the minimally invasive wisdom tooth extraction can relieve the inflammatory response and pain sensation of patients,and the clinical treatment effect is significant.

The effects of two different cold compress modes on swelling and pain among patients receiving extraction of impacted tooth of mandibular / 中国实用护理杂志

Objective To examine the effects of two different cold compress modes (continuous cold compress and intermittent cold compress) on the pain and swelling among patients receiving extraction of impacted tooth of mandibular. Methods From January 2016 to August 2016, 64 cases of adult patients with impacted mandibular impacted wisdom teeth and 24 h in the outpatient department of Oral and Maxillofacial Surgery of Affiliated Stomatological Hospital of Fujian Medical University were selected. They were randomly assigned to the control group and the experimental group (32 cases in each group) by random digital table. The participants in the control group received the usual care plus intermittent cold compress. The participants in the experimental group received the usual care plus continuous cold compress. And the treatment was continued for 24 hours. Outcomes including pain and skin temperature were measured in the intervention cycle, and the swelling was measured at baseline, 6 hour, 12 hours,18 hours, and 24 hours after the intervention. All the participants were asked to have further consultation at 7th days after the operation. Results At 6 hour, 12 hours,18 hours, and 24 hours, the pain of the experimental group was lower than the control group ,and there was significant difference (F=63.665-290.872, P<0.05 ). At 12 hours,18 hours, and 24 hours after the intervention ,number of the swelling grades (0-I-Ⅱ-III) in the control group was 16, 14, 2, 0 cases, 11, 13, 8, 0 cases, 11, 12, 8, 1 cases,number of the swelling grades (0-I-Ⅱ-III) in the experimental group was 27, 5, 0, 0 cases, 26, 6, 0, 0 cases, 26, 6, 0, 0 cases, and there was significant difference (Z=-2.968,-4.017,-4.052, P<0.05). A positive correlation between swelling grade and time (M2=45.22, P<0.05). At 6 hour, 12 hours,18 hours, and 24 hours , the skin temperature of the experimental group was lower than the control group, and there was significant difference (F=1 735.106-23 993.33, P<0.05). Conclusions This study showed that the continuous cold compress was more effective in reducing the pain and swelling among the patients receiving extraction of impacted tooth of mandibular. Compared with the intermittent cold compress, it suggested that continuous cold compress can be integrated into usual care to reduce the pain and swelling among the patients receiving extraction of impacted tooth of mandibular.

Coronectomía en terceros molares mandibulares como alternativa de tratamiento seguro en la prevención del daño al nervio alveolar inferior: revisión bibliográfica y reporte de 30 casos / Coronectomy in third mandibular molars as an alternative treatment to prevent damage to the inferior alveolar nerve: bibliographic review and 30 cases report

La lesión del nervio alveolar inferior (NAI) al extraer los terceros molares mandibulares esa menudo causada por la íntima relación entre el nervio y las raíces dentarias. La técnica de coronectomía ola retención intencionada de raíz, podría mitigar este problema. Treinta pacientes fueron sometidos a coronectomia en 30 terceros molares mandibulares con seguimiento de al menos 6 meses. Todos los pacientes fueron radiografiados antes de la intervención, inmediatamente después de la operación, y después de 6meses. La técnica se realizó con protección del nervio lingual como parte del procedimiento quirúrgico. Todas las raíces quedaron al menos 3 mm por debajo de las tablas óseas bucal y lingual. No hubo ningún caso de daño del NAI. Hubo un caso de afectación transitoria del nervio lingual, probablemente por el uso del retractor lingual. Un paciente requirió la retirada posterior de las raíces de los terceros molares, debido a la falta cicatrización, y otro paciente requirió la retirada posterior de una raíz a causa de migración posterior ala superficie. La migración de las raíces se observó en aproximadamente el 30 % de los pacientes durante un período de 6 meses. La coronectomia parece ser una técnica viable en aquellos casos en que la extracción completa del diente podría poner al NAI en un riesgo considerable de daño. La técnica parece estar asociada con una baja incidencia de complicaciones, pero la migración posterior de las raíces puede ser un problema en el largo plazo.

The inferior alveolar nerve (IAN) injury to remove the third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. Coronectomy technique or intentional root retention, may minimize this problem. Thirty patients underwent coronectomy in 30 third molars with follow up of at least 6 months. Coronectomy technique deliberately protected the lingual nerve as part of the surgical procedure. All roots were at least 3 mm below the buccal and lingual bony walls. All patients were radiographed preoperatively, immediately postoperatively, and after 6 months. There were no cases of IAN damage involved in this study of 30 patients who underwent 30 coronectomies. There was one case of transient lingual nerve involvement, probably by the use of lingual retractor. One patient required subsequent removal of the roots of both lower third molars, due to lack of healing, and one patient required subsequent removal of a root cause of migration back to the surface. migration of the roots was observed in approximately 30 percent of patients during a period of six months. Coronectomy seems to be a viable technique in those cases where the removal of all tooth could put the IAN at considerable risk of damage. The technique appears to be associated with a low incidence of complications, but the subsequent migration of the roots can be a problem in the long term.

Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial

<p><b>INTRODUCTION</b>Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.</p><p><b>METHODS</b>This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.</p><p><b>RESULTS</b>Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.</p><p><b>CONCLUSION</b>Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.</p>

Remark on epidemiology and clinical complication of wisdom teeth

A prospective study was conducted on 120 patients (65 males and 55 females) with displaced wisdom tooth at the Dentistry and Stomatology Department of Hospital 103 between 9/2003 and 10/2004. Results: There was no difference between male and female. The surgery for extracting displaced wisdom tooth caused complications depending on ages 25-34 (51.16%), 15-24 (37.5%), 35-45 (8,33%). Patients need examination and treatment for pain (55.85%), swelling (11.66%), choking on food (29.16%) and the other causes (33.3%). Two kinds of displaced wisdom tooth that have high rates were: Mesio–angular wisdom tooth: (54.16%), vertical wisdom tooth, jaw-bone clamp (22.5%)