Comparison of Efficacy of Topical Carica papaya Leaf Extract and Hemocoagulase in Postoperative Wound Healing After Therapeutic Orthodontic Premolar Extractions: a Split Mouth Study.

Introduction Postoperative wound healing is the most important factor in the outcome of any surgical procedure. Wound healing is a dynamic process involving inflammation, neovascularization, granulation, fibroblast proliferation, re-epithelization, and remodeling. It repairs tissue integrity, restoring the body's natural defense barrier. A hastened wound healing will help in the quicker re-establishment of the body's homeostasis. Carica papaya includes vital nutrients and bioactive substances such as minerals, vitamins, and antioxidants. Its primary active ingredient papain causes the enzymatic debridement of wounds. Hemocoagulase is a thrombin-like serine protease that is mostly employed for its procoagulant and wound-healing characteristics. It is derived from the venom of Bothrops species of snakes. This study aims to compare the wound-healing properties of topical Carica papaya leaf extract and Hemocoagulase after dental extractions. Materials & Methods For 48 patients requiring bilateral therapeutic dental extraction for orthodontic intervention, Carica papaya leaf extract (Caripill 275mg/5ml) was topically applied to the extraction socket on one side, and Hemocoagulase 0.2 CU solution (Botroclot) was applied to the extraction socket on the other side. The bilateral premolars were extracted for orthodontic treatment under local anesthesia. Patients were asked to apply the solution topically twice daily for seven days and were called for review on the seventh day. The assessment of the efficacy of both solutions in post-operative wound healing was the objective of the study. Healing was assessed by using a blinded single observer for all patients using Landry's healing index. Results A total of 48 subjects with 96 sites completed the study, with a mean age of 15.4 years. The study population consisted of 24 males and 24 females, which were evenly distributed among the two study groups. On comparison of wound healing index (WHI) scores between the two groups using the Wilcoxon signed rank test, Group A had a significantly higher mean rank than Group B with regards to the wound healing index score, and the results were statistically significant (p = 0.037). Conclusion It can be concluded from the study that Carica papaya leaf extract showed better wound healing in post-extraction sockets compared to Hemocoagulase. This study presents the promising use of natural extracts such as Carica papaya in wound healing because they are easily accessible to patients, more economical, and have no adverse reactions. More studies that focus on natural extracts to promote wound healing are required in the future.

Oral surgery in people with inherited bleeding disorder: A retrospective study.

INTRODUCTION: The objectives were to describe the peri-operative management of people with inherited bleeding disorders in oral surgery and to investigate the association between type of surgery and risk of developing bleeding complications. MATERIALS AND METHODS: This retrospective observational study included patients with haemophilia A or B, von Willebrand disease, Glanzmann thrombasthenia or isolated coagulation factor deficiency such as afibrinogenemia who underwent osseous (third molar extraction, ortho-surgical traction, dental implant placement) or nonosseous oral surgery between 2014 and 2021 at Bordeaux University Hospital (France). Patients and oral surgery characteristics were retrieved from medical records. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression. RESULTS: Of the 83 patients included, general anaesthesia was performed in 16%. Twelve had a bleeding complication (14.5%) including six after osseous surgery. The most serious complication was the appearance of anti-FVIII inhibitor in a patient with moderate haemophilia A. All bleeding complications were managed by a local treatment and factor injections where indicated. No association was observed between type of surgery (osseous vs. nonosseous) and risk of bleeding complications after controlling for sex, age, disease type and severity, multiple extractions, type of anaesthesia and use of fibrin glue (OR: 3.21, 95% CI: .69-14.88). CONCLUSION: In this study, we have observed that bleeding complications after oral surgery in people with inherited bleeding disorders were moderately frequent and easily managed. However, in this study, we observed a serious complication highlighting the necessity of a thorough benefit-risk balance evaluation during the preoperative planning of the surgical and medical protocol.

Isolated fracture of the coronoid process following a molar extraction: A rare case report.

Isolated coronoid process fractures are uncommon, and iatrogenic isolated fractures are extremely rare. This case describes a displaced fracture of an isolated coronoid process thought to be due to excessive force applied by a dentist that had been overlooked and left untreated for about a month. The patient was a woman in her late 50's and she had undergone a molar extraction. Her dentist had confused her symptoms of trismus, pain, and facial oedema with the complex tooth extraction procedure. Following a cone-beam computed tomography (CBCT) scan we showed that the mandibular coronoid process on her right side had suffered a longitudinal fracture, and the fractured fragment had rotated upwards and inwards. Following successful surgical elimination of the fragmented coronoid process, the patient received targeted physiotherapy sessions that yielded excellent results. At the five-month follow-up, the ability of the patient to open her mouth had improved enormously, and her facial appearance almost recovered to its original state.

Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures.

The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment.

Assessing modalities used to alleviate postoperative pain in children receiving dental treatment under general anaesthesia: a systematic review.

Postoperative pain is generally a novel experience among paediatric patients. Topical anaesthetics, distraction procedures, and buffering of anaesthetic solutions have been used in reducing the postoperative pain. In this review, the authors assessed various modalities used to alleviate postoperative pain in children's dental treatment under general anaesthesia. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol were strictly adhered to in this systematic review. Specific keywords including postoperative pain, general anaesthesia, children, and dental extraction were used in the search for relevant randomized control trial studies in Web of Science, Scopus and PubMed, and included articles published until June 2021. From a total of 191 abstracts, 21 were reviewed. From the six studies with the usage of non-steroidal anti-inflammatory drugs (NSAIDs) alone or in combination with paracetamol, four observed that the preoperative use of NSAIDs alone or in combination was better than paracetamol alone, one discovered preoperative intravenous paracetamol was better than postoperative intravenous paracetamol, and the remaining study found no difference among various groups. Of two studies comparing the usage of non-steroidal anti-inflammatory drugs with opioid analgesics, one stated intravenous fentanyl in combination was better, while the other study found no difference among groups. The results obtained in this review can be utilized by physicians to control postoperative pain in children undergoing dental treatment under general anaesthesia.

Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study.

Background and objective This study aims to explore the concept of preemptive analgesia, which is the technique of administration of analgesic agents before the painful stimulus. This bridges the time gap between the onset of action of the analgesic agents and the wear-off of local anesthesia. Existing literature also brings up the concept of central sensitization, which is the hyper-activity of the nervous system in response to a noxious stimulus. Administration of preemptive analgesia prevents central sensitization and hence provides prolonged analgesia to the patient. For the benefit of this study, tab. Etoricoxib 90 mg was used as the analgesic agent. In addition, this study aims to investigate the effects of the administration of tab. Etoricoxib 90 mg 30 minutes before extraction of a single mandibular third molar on the effects of pain experienced by the patient after tooth extraction as compared to a placebo. Methodology This was a double-blinded, prospective, observational study. The pain experienced by 50 participants in each group was measured at 1 hour, 6 hours, 12 hours, and 24 hours postoperatively using a visual analog scale (VAS). The independent samples t-test was then conducted to evaluate the results and draw out conclusions. Results The average difference in pain experienced was maximum in the first hour after the procedure. The mean VAS score reported by patients was 3.14 in the study group but was 6.40 in the control group within the first hour. This difference was reduced in the first six hours after the procedure, with the average score being 3.82 in the study and 7.16 in the control group. The difference was the least after 12 hours, with the study group experiencing a VAS score of 4.64 and controls experiencing a VAS score of 6.14. After the first 24 hours, the mean VAS score was 3.80 in the study group and 5.60 in the control group. Conclusions Preemptive administration of tab. Etoricoxib 90 mg can reduce postextraction pain in healthy adult patients as compared to placebo tablets, with a maximum difference in pain reduction seen at the end of the first six hours (P = 0.012) and the minimum at the end of 12 hours (P = 0.0197).

Do oral conditions influence the incidence of bloodstream infection after hematopoietic stem cell transplantation? A retrospective study in Japan.

PURPOSE: This study aimed to evaluate the incidence of bloodstream infection (BSI) among patients undergoing hematopoietic stem cell transplantation (HSCT) for teeth indicated for extraction. METHODS: Patients who underwent HSCT at Toranomon Hospital (Tokyo, Japan) between January 2017 and December 2019 were retrospectively evaluated. The incidence of BSI among patients with teeth indicated for extraction who did not undergo extraction (oral high-risk group) and patients who did not have this risk (oral low-risk group) was compared. RESULTS: Among the 191 consecutive patients included in this study, 119 patients were classified as undergoing high-risk transplantation. BSI after HSCT was observed in 32 out of 60 (53.3%) patients and 56 out of 131 (42.7%) patients in the oral low-risk and oral high-risk groups, respectively (p = 0.173). Multivariable analyses revealed that the presence of > 3 teeth as intraoral sources of infection and age over 50 years were determinants of BSI originating from the oral cavity after engraftment (odds ratio [OR], 9.11; 95% confidential interval [CI] 2.27-36.61]; p = 0.002; OR, 3.22; CI [1.47-7.08], p = 0.004, respectively). CONCLUSION: In patients undergoing HSCT, the presence of less than three intraoral sources of infection did not affect the incidence of BSI after HSCT.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing.

Background: The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing. Materials and Methods: This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated. Results: At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%). Conclusion: This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Efficacy of Tranexamic Acid in Preventing Alveolar Osteitis in Post-extraction Sockets of First Premolars.

OBJECTIVES: The present study is a randomized trial for comparing the effectiveness of tranexamic acid as an antifibrinolytic agent in preventing alveolar osteitis in the post-extraction period in patients receiving orthodontic therapy that requires extraction. METHODOLOGY: This research was carried out in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients were considered subjects for the research. Patients undergoing orthodontic treatment referred to the Department of Oral and Maxillofacial Surgery for the therapeutic extractions of the first premolars were considered for this study. Randomization was done to split the population into study and control. After the atraumatic extraction of the first premolars under local anesthesia using 2% lignocaine with 1:80000 adrenaline, a tranexamic acid solution of 500 mg soaked gauze over the extraction sockets was used as the intervention in the study group, and plain gauze was used on the control group. Patients were asked to hold the gauze in place for one hour. Participants were reviewed after three days for the incidence of alveolar osteitis and pain severity and healing of the extraction sockets.  Results: The prevalence of Alveolitis sicca dolorosa was found to be 5% in the research group and 15% in the control group. Patients in the control group showed more pain than the patients in the research group. The period taken for healing ranged from 7 days to 10 days in the control group and 10 days to 12 days in the study group.  Conclusion: This study gives an edge that tranexamic acid can be used as a local hemostatic agent in preventing fibrinolysis of clots and preventing alveolar osteitis.

Radiological assessment of the inferior alveolar canal and mental foramen using cone beam computed tomography for pre-operative evaluation of surgeries in the mandible: A single-center five-year retrospective study.

Introduction: Cone beam computed tomography (CBCT) plays a significant role in studying the anatomical structures of the mandible. Aim: This retrospective study aimed to assess the role of CBCT at the pre-assessment stage of mandibular surgery. Materials and methods: A total of 250 CBCT images were collected. The inferior alveolar canal (IAC) and mental foramen (MF) were measured bilaterally to the mandibular teeth apexes, including molars, premolars, and canines, to the buccal, lingual cortical bone, and to the inferior border of the mandible. Results: There were no differences in the average number of extracted teeth between the right and left sides (P-value > 0.05, median = three teeth). It was noticed that the average measures of each point of the IAC and MF on the right side were closely matched to the similar point on the left side (P-value > 0.05). T-tests showed that there were differences between males and females on the M2 and M3 on the right side (P-value < 0.05) and on the M1, M2, and M3 on the left side (P-value < 0.05). Using one-way ANOVA tests, results showed that there were some differences in measures at P0 (F = 3.376, P-value = 0.003), P4 (F = 3.782, P-value = 0.001) on the right side, and at P3 (F = 5.620, P-value = 0.019) on the left side of the mandible. Conclusions: There were no significant differences in IAC and MF positions between the right and left sides. However, between males and females, MF measurements showed significant differences on some points on the right and left sides. Although the history of extracted teeth showed no statistically significant difference in the location of IAC and MF, the number of extracted teeth showed an effect in the IAC position on the right and left sides, but not with the MF.

Autologous Tooth Granulometry and Specific Surface Area with Three Grinding Methods: An In Vitro Study.

A postextraction socket becomes a clinical challenge due to the fact that a series of changes associated with bone remodelling and resorption of the socket that occur after extraction, which limits the aesthetic and functional prognosis of implant-supported rehabilitations. It has been studied that the use of the autologous tooth-derived graft (ATDG) has regenerative properties and could therefore be useful for solving this type of problem. There is no consensus in the scientific literature on a standardized protocol for the use of the autologous tooth. Therefore, the aim of the present study was to evaluate the most relevant parameters to achieve the best properties of ground ATDG using three methods, namely Gouge forceps, electric grinder, and manual, that made up the study group (SG) and compared with the control group (CG) consisting of Bio-Oss®. The sample obtained by the electric grinder had the highest value of specific surface area (2.4025 ± 0.0218 m2/g), while the particle size as average diameter (751.9 µm) was the lowest and most homogeneous of the three groups. Therefore, the electric grinder allowed for obtaining ATDG with more regenerative properties due to its specific surface-area value and particle size in accordance with the xenograft with the greatest bibliographical support (Bio-Oss®). The higher specific surface increases the reaction with the physiological media, producing faster biological mechanisms.

A Dental Extraction Revealing a Multisystem Burkitt's Lymphoma: A Case Report.

Burkitt's lymphoma is rare but highly aggressive and very fast-growing B-cell non-Hodgkin's lymphoma (NHL). It can affect any organ such as the central nervous system, jaw, intestines, kidneys, ovaries, and other organs. It results from the malignant evolution and proliferation of B-type lymphoid cells. The diagnosis is based on a biopsy of a tumor mass or bone marrow aspiration revealing the presence of tumor cells. We report the case of a 7 year old child who was referred for a gingival swelling evolving since 1 month following a dental extraction. Imaging and anatomopathological examination after biopsy concludes to a multi systemic Burkitt's lymphoma. A chemotherapy was immediately started with spectacular complete remission.

The role of leukocyte and platelet-rich fibrin in the prevention of medication-related osteonecrosis of the jaw, in patients requiring dental extractions: an observational study.

PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is a significant complication which can present following a dental extraction in patients receiving anti-resorptive and anti-angiogenic medications. The purpose of this study was to investigate the possible beneficial effect of L-PRF in the prevention of MRONJ in patients receiving these medications and requiring dental extractions. METHODS: Thirty-nine patients were included and divided into two groups, depending on whether L-PRF was used after the required dental extraction or not. Subsequently, the patients were categorised into low and high-risk for developing MRONJ, as recommended by the SDCEP guidance. RESULTS: None of the patients in the L-PRF group returned with established MRONJ. Five high-risk patients in the control group presented with established MRONJ in the follow-up appointment. A significant statistical difference (p = 0.04) was observed following a comparison of the high-risk patients of the two groups. CONCLUSION: These encouraging results suggest that L-PRF may be useful in the prevention of MRONJ following a dental extraction especially in patients of the higher risk category. A protocol for the management of this type of patients is also introduced.

Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders / Guía de práctica clínica de la sociedad española de cirugía bucal para cirugía oral en pacientes con trastornos de la coagulación

Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulanttherapy, has increased worldwide in recent years due to increased life expectancy in developed countries. Theprotocols for managing this type of patient in oral surgery has varied over recent years, especially after the appear-ance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patientwhen undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general prac-titioners. The objective of this document is to offer recommendations, based on evidence, for decision making forpatients with coagulopathies who require dental surgical intervention. Material and Methods: Based on the indications of the “Preparation of Clinical Practice guidelines in the NationalHealth System. Methodological manual”, we gathered a group of experts who agreed on 15 PICO questions basedon managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dentalextractions.Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due tothe lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation,while the rest were answered with grade D.Conclusions: The results of this review highlight the need to undertake well designed clinical trials with controlgroups and with a representative sample size.(AU)

Surgical difficulty and postoperative course of the third molar extraction under general anesthesia: An intervention trial.

BACKGROUND: Third molar extractions are one of the most common surgical procedures in the area of ​​stomatology. However, we know that even if they are minor surgeries, they can cause a postoperative period with local and systemic repercussions. Thus, the aim of this intervention trial is to determine the relationship between clinical parameters (pain, inflammation and trismus) and serum parameters (C-reactive protein (CRP), IL-6 and fibrinogen) that are modified in the first postoperative week, and the appearance of complications after extraction with general anesthesia, using the Pederson scale. METHODS: The research question was: Can postoperative discomfort after third molar extraction under general anesthesia be predicted using Pederson scale? An interventional trial was carried out of third molar extractions under general anesthesia in Dr. Peset University Hospital. Patient selection was performed randomized using MS Excel. Then were divided into two groups (n = 126): group A (2 complex extractions) and group B (4 extractions: 2 simple and 2 complex). All parameters were collected at the surgery and 7 days after surgery. RESULTS: The clinical postoperative parameters showed significant differences in relation to surgical difficulty. In summary, the degree of surgical difficulty can be predicted with the Pederson scale before extracting mandibular third molars. CRP and fibrinogen levels increase significantly with the degree of surgical difficulty. CONCLUSION: Significant differences (p < 0.001) were observed in all the intraoperative parameters according to surgical difficulty as assessed by the Pederson scale. Therefore, this scale was a good indicator to estimate the patient's postoperative period.

Extracción terapéutica de primeros molares Permanentes severamente destruidos en dentición mixta

En dentición mixta, el 1°Molar permanente es el más susceptible a caries, que desencadena un ciclo restaurador repetitivo y pérdida. El objetivo de este estudio fue evaluar factores determinantes de la extracción terapéutica de 1°Molares permanentes severamente destruidos en dentición mixta antes de la erupción del segundo molar permanente con un favorable cierre espontáneo del espacio residual. La metodología consistió en una revisión sistemática exploratoria en PubMed mediante búsqueda estratégica/específica. Incluyó diez artículos que abordaron factores como la edad cronológica ideal, etapa de desarrollo del segundo premolar y molar permanente, presencia del tercer molar, cierre espontáneo residual, pronóstico, y necesidad de tratamiento ortodóncico. En conclusión, la extracción terapéutica del 1°Molar antes de la erupción del segundo molar permanente está asociada con un favorable cierre espontáneo del espacio residual. Se evidencia mayor éxito con la presencia del tercer molar, segundo molar en etapa E y segundo premolar en etapa F (Demirjian).

Abstrato: Em dentição mista, o 1°molar permanente é o mais suscetível a cáries, desencadeando um ciclo restaurador repetitivo e perda. O objetivo deste estudo foi avaliar fatores determinantes da extração terapêutica de 1°molares permanentes severamente destruídos na dentição mista antes da erupção do segundo molar permanente com uma região espontânea favorável do espaço residual. A metodología utilizada no PubMed consistiu em uma revisão exploratória por meio de busca estratégica/específica. Foram incluídos dez artigos, abordando fatores como a idade cronológica ideal, estágio de desenvolvimento do segundo pré-molar e molar permanente, presença do terceiro molar, cierre espontâneo residual, pronóstico e necessidade de tratamento ortodôntico. Em conclusão, a extração terapêutica do 1°molar permanente antes da erupção do segundo molar permanente está associada a um fechamento espontâneo favorável do espaço residual. Maior sucesso está descrito quando na presença de terceiro molar, segundo molar no estágio E e segundo pré-molar no estágio F (Demirjian).

During mixed dentition, the 1st permanent molar is the most susceptible to caries, triggering a repetitive restorative cycle and loss. This study aimed to evaluate determinants of therapeutic extraction of severely damaged 1st permanent molars in mixed dentition before the eruption of the second permanent molar with favorable spontaneous closure of the residual space. The methodology involved a scoping review on PubMed using a specific search strategy. Ten articles were included addressing factors such as the ideal chronological age, stage of development of the second premolar and permanent molar, presence of the third molar, residual spontaneous closure, prognosis, and need for orthodontic treatment. In conclusion, therapeutic extraction of the 1st molar before the eruption of the second molar is associated with favorable spontaneous closure of the residual space. Greater success is evident with the presence of the third molar, the second molar in stage E, and the second premolar in stage F (Demirjian).

Imaging Evaluation of Platelet-Rich Fibrin in Post-Exodontic Bone Regeneration: A Systematic Review.

Tooth extraction is the most common procedure in dental practice. However, in the long term, it may cause alveolar ridge atrophy. This systematic review aimed to evaluate the role of platelet-rich fibrin (PRF) in post-exodontic alveolar ridge preservation in terms of its effectiveness in the regeneration of bone tissue as assessed by imaging and its efficacy compared to physiological bone healing. The study is presented in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. This systematic review was conducted using electronic databases such as PubMed, Scopus, Web of Science, and Science Direct. The gray literature search was conducted in the New York Academy of Medicine Grey Literature Report. All the studies in this systematic review were randomized controlled trials (RCTs). The risk of bias was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 6.2 (RevMan 6.2). Considering the inclusion and exclusion criteria, we included 17 randomized clinical trials published up to 2022 investigating the efficacy of PRF in post-exodontic bone regeneration. Based on the results of clinical studies, it can be stated that despite not being statistically significant, PRF promotes neoformation and prevents bone loss between three and four months post-extraction.

Imaging in Third Molar Surgery: A Clinical Update.

Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management.

A swollen face and neck after dental surgery: Think of subcutaneous emphysema and pneumomediastinum.

Pneumomediastinum and subcutaneous emphysema are defined as the pathological presence of free air in the mediastinum or subcutaneous tissue, respectively. In the majority of cases, pneumomediastinum is secondary to an iatrogenic cause, but has rarely been described after a routine dental extraction. This condition is generally self-limiting, but major complications can occur, such as mediastinitis, which is more frequently associated with iatrogenic pneumomediastinum. To highlight the importance of including this presumably underdiagnosed complication in the differential diagnosis, we present a case of a 50-year-old man with dysphagia, facial pain and swollen face and neck following a dental extraction.

Anesthetic Management for Dental Extraction in a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia Syndrome: A Case Report.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited genetic disorder that predisposes patients to potentially fatal arrhythmia when under physical or emotional stress. Anesthetic management of patients with CPVT poses a huge challenge as physical and emotional stressors are common in the operating room. Stressors, such as pain and anxiety, must be carefully controlled to prevent life-threatening tachyarrhythmias. Currently there is a paucity of data on the anesthetic management of patients with CPVT. Herein, we present the anesthetic management that was implemented to ensure a safe perioperative course for a 16-year-old male with a history of CPVT who underwent dental extraction under general anesthesia.