Retrospective analysis of the effects of impacted third molar on hematologic patients undergoing hematopoietic stem cell transplantation.

Objective: This study aimed to investigate the incidence, treatment status, and impact position of impacted third molars (ITM) and their effects on patients undergoing hematopoietic stem cell transplantation (HSCT). Methods: A retrospective analysis was conducted on the medical records of 454 patients who underwent HSCT, out of which 188 patients had ITM. The presence of ITM and its association with transplant-related infections and complications were recorded and analyzed. Results: Patients with ITM were significantly younger. The number of mandibular ITM was notably higher than maxillary ones, and the risk of pericoronitis in mandibular ITM was significantly higher than in maxillary ones. Out of 311 ITM in 188 patients, 25 were extracted before transplantation. The proportion of extraction and treatment for ITM with pericoronitis or caries was significantly higher than that for ITM without such problems. Moreover, patients with a history of pre-transplant pericoronitis had a significantly higher probability of developing tooth-related complications during transplantation, caused by pericoronitis in ITM compared to patients without a history of pericoronitis. Conclusion: Pre-transplant examination and treatment of ITM are essential, especially in cases with a history of pericoronitis. Oral intervention can significantly reduce the occurrence of tooth-related complications related to ITM during transplantation.

Comparison of perineural and systemic dexamethasone use in impacted third molar surgeries in terms of anesthesia duration and postoperative complaints: a controlled, randomized observational study.

BACKGROUND: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited. METHODS: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant. RESULTS: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups. CONCLUSIONS: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries. TRIAL REGISTRATION: This study was conducted at Ahmet Kelesoglu Faculty of Dentistry with the permission of Karamanoglu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).

Dentigerous cyst in the medial wall of maxillary sinus.

This is the image of dentigerous cyst detected in the medial wall of maxillary sinus, a rare location for the mentioned cyst, which emphasizes the superiority of radiographic features from the site of the lesion. Moreover, the present case showed no facial asymmetry despite the extension of the lesion.

The Management of a Geriatric Patient Using Dabigatran Therapy on Dentigerous Cyst with Oral Bleeding.

Jaw cysts represent a great matter of interest in oral and maxillofacial surgery. Jaw cyst surgery is a common intervention in oral surgery but, in the case of a multidisciplinary patient, the oral surgeon needs to meet with other specialists. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, and commonly few or no symptoms are reported. However, the most common diagnosis for dentigerous cyst is represented by eruption of the affected tooth or accidental diagnosis. Commonly, dentigerous cysts may be related to impacted third molars; in the case of impacted third molars and a dentigerous cyst, the tooth should be removed along with the cyst in the same intervention. Mandibular dentigerous cysts are common in children and adults, while dentigerous cysts are a rare neoformation in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with the mandibular nerve, and/or the patient has a medical history that may represent a relative or absolute contraindication. We present the case of a rare symptomatic manifestation of dentigerous cyst in an elderly patient in treatment with dabigatran therapy; for the treatment of dentigerous cysts in the elderly, we suggest a multidisciplinary approach with the use of the histological examination and a careful follow-up.

PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY.

OBJECTIVE: To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS: One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS: The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION: Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

Spatial Position and Anatomical Characteristics Associated with Impacted Third Molars Using a Map-Reading Strategy on Cone-Beam Computed Tomography Scans: A Retrospective Analysis.

(1) Background: This study assessed the spatial position and anatomical features associated with impacted third molars through a map-reading strategy employing cone-beam computed tomography (CBCT). (2) Methods: The positioning of impacted third molars on CBCT was assessed using Winter's and Pell and Gregory's classifications. External root resorption in mandibular second molars was categorized according to Herman's classification. Additionally, the relationship between the mandibular third molar root apex and the mandibular canal was examined. Comparative statistical analysis was conducted using Fisher's exact test, with a significance level considered as 5%. (3) Results: The results indicated that, based on Winter's classification, 48.06 % of impacted teeth were positioned mesioangularly. Employing Pell and Gregory's classification, 43.22% of the impacted molars fell into positions B and C, with 54.2% classified as Class II. A notable 69.7% of teeth exhibited no contact between the root apex and the mandibular canal, and external root resorption in the distal aspect of the second molar was absent in 88.7% of cases. (4) Conclusions: Utilizing the map-reading strategy with CBCT scans to assess the anatomical positions and characteristics of impacted third molars enhances professional confidence and sets a standard for quality and safety in the surgical procedure for patients.

Transcriptome Sequencing of Gingival Tissues from Impacted Third Molars Patients Reveals the Alterations of Gene Expression.

OBJECTIVE: The removal of impacted third molars by surgery may occur with a series of complications, whereas limited information about the postoperative pathogenesis is available. The objective of this study is to identify changes in gene expression after flap surgical removal of impacted third molars and provide potential information to reduce postoperative complications. METHODS: The gingival tissues of twenty patients with flap surgical removal of impacted third molars and twenty healthy volunteers were collected for gene expression testing. The collected gingival tissues were used RNA sequencing technology and quantitative real-time PCR validation was performed. DEG was mapped to protein databases such as GO and KEGG for functional annotation and, based on annotation information, for mining of differential expression genes in patients with mpacted third molars. RESULTS: A total of 555 genes were differentially expressed. Among the top up-regulated genes, HLA-DRB4, CCL20, and CXCL8 were strongly associated with immune response and signal transduction. Among the top down-regulated genes, SPRR2B, CLDN17, LCE3D and LCE3E were related to keratinocyte differentiation, IFITM5, and BGLAP were related to bone mineralization, UGT2B17 is associated with susceptibility to osteoporosis. KEGG results showed that the DEGs were related to multiple disease-related pathways. CONCLUSION: This first transcriptome analysis of gingival tissues from patients with surgical removal of impacted third molars provides new insights into postoperative genetic changes. The results may establish a basis for future research on minimizing the incidence of complications after flap-treated third molars.

Outcomes of Coronectomy and Total Odontectomy of Impacted Mandibular Third Molars.

OBJECTIVE: The aim of this research was to evaluate the surgical complications and neurosensory deficits after coronectomy and the complete removal of mandibular third molars. METHODS: The study sample included patients requiring surgical removal of mandibular third molars. A coronectomy was conducted on 220 teeth showing signs of close proximity to the inferior alveolar canal. A complete extraction was performed on 218 teeth with no risk signs. The patients were evaluated at 1 week and 1, 3, 6, 12, and 24 months after surgery for pain, swelling, neurologic deficit, dry socket, postoperative bleeding, infection, root migration, and eruption. RESULTS: No significant difference was noted in pain and swelling; however, bleeding and dry socket were significantly higher in the odontectomy group (P = .017). The inferior alveolar nerve deficit was higher in the odontectomy group (3.7%) than the coronectomy group (0.5%) (P = .017). The percentage and distance of root migration of coronectomised teeth at 3, 6, and 12 months were 60% (2.37 ± 0.96 mm), 66% (3.35 ± 0.86 mm), and 74% (3.85 ± 0.93 mm), respectively. CONCLUSIONS: Coronectomy is a safe procedure and should be performed when the roots are closely associated with the mandibular canal. Although root migration is common, the likelihood of root exposure is low and roots rarely need removal.

The Clinical and Radiological Evaluation of Impacted Third Molar Position, Crown and Root Morphology.

OBJECTIVE: This study aimed to analyze the crown and root morphology of maxillary and mandibular third molars, and assess their position in relation to adjacent anatomical structures using clinical examination and radiographic images. MATERIALS AND METHODS: A total of 176 extracted impacted or partially impacted third molars were included in this study. Orthopantomogram images (OPG) were used to evaluate the number of roots, position, depth of impaction relative to the occlusal plane of the second molar, and angulation of maxillary and mandibular third molars. The extracted teeth were examined to determine the actual number of roots. The root morphology was classified using the Alavi classification system for maxillary third molars and the Machado classification for mandibular third molars. Additionally, the number of cusps, crown dimensions, and morphology were analyzed using digital and dental calipers. RESULTS: The extracted samples exhibited a significantly higher number of roots compared to the number assessed on OPG images (P<0.001). The majority of mandibular third molars had two fused roots (37.39%) and a five-cuspid crown (48.70%), while maxillary third molars had three fused roots (26.23%) and four cusps (42.62%). Both maxillary (60.66%) and mandibular third molars (61.74%) were predominantly vertically positioned. Regarding the depth of impaction, maxillary third molars were primarily classified as Class C (65.57%), while mandibular third molars were classified as Class B (47.83%). Differences in crown shape were observed, with maxillary crowns being mostly triangular (36.07%) and mandibular crowns being oval (38.26%). Maxillary third molars had shorter crowns compared to mandibular third molars (P<0.05). CONCLUSION: The root morphology of maxillary and mandibular third molars in the population of Bosnia and Herzegovina displays variability. Orthopantomogram imaging was found to be inadequate for accurate determination of the number of roots in third molars. The number of cusps on third molars cannot be relied upon as a predictor of the number of roots. The study's findings will have implications for dental practice, particularly for oral surgeons and restorative dentists.

The effect of impacted third molars on second molar external root resorption, a cross-sectional cone beam computed tomography study

Background: Third molars have the highest prevalence of impaction in teeth and can cause pathological damage on the adjacent second molars. This study aims to evaluate the effects of factors related to impacted third molars on external root resorption (ERR) in adjacent second molars using cone-beam computed tomography (CBCT). Material and Methods: In CBCTs, the effect of impacted third molars on the root surface of adjacent second molars was investigated. Inclusion criteria for subjects were being older than 16 and younger than 55, presence of at least one impacted third molar and adjacent second molar. Exclusion criteria were pathology, a follicle gap greater than 5 mm, crowned second molar, severe decay, an artifact on a radiologic image, and previous surgery on the second or third molars. The investigations were made based on age range, gender, tooth inclination, Pell-Gregory classification, retention type, contact area, root formation, pericoronal width, and tooth absence on the same quadrant for potential risk factors. The collected data were statistically analyzed with R software. The Chi-Square test was used to find out any significant difference. Logistic regression analyses were done for potential risk factors for ERR. Results: A total of 437 impacted third molars and adjacent second molars were investigated using CBCT. Of these, 381 met the inclusion criteria. Mesioangular and horizontal inclination, Pell-Gregory Class B-C, contact area, and retention type were found the statistically potential risk factors for ERR. Conclusions: The impacted third molar with horizontal or mesioangular position, and osseous retention, with Pell and Gregory Class B and C, are more likely to cause external root resorption in adjacent second molars. (AU)

Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study.

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.

Microbiological and Clinical Assessments of Suture Materials and Cyanoacrylate Application in Impacted Third Molar Surgeries: A Scoping Review.

The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing complications. This scoping review aimed to assess the clinical and microbiological aspects of various suture materials and cyanoacrylates. Unlike existing studies, we included more articles and comprehensively compared suture materials. Articles published in languages other than English; duplicate studies; studies deemed irrelevant for the specific research questions, including those analyzing different supplementary treatments or not corresponding to the abstract's content; ex vivo or experimental animal studies; studies lacking approval from an ethics committee; and narrative reviews, systematic reviews, or systematic and meta-analysis reviews were excluded. Thus, only 17 studies, published between 2000 and 2023, were included in the search. Suture techniques varied among surgeons, with debates on primary and secondary closure methods. A comparison of different suture materials and their effects on wound healing, infection rates, and other factors was described. Cyanoacrylate has also been used as an alternative to traditional sutures. Microbiological analysis showed varying bacterial adhesion based on the suture material, with silk sutures retaining more microbes than PTFE sutures. Clinical assessments have revealed differing inflammatory responses that affect wound healing and complications. Cyanoacrylate has emerged as a promising alternative to traditional sutures, owing to its rapid polymerization and early healing. However, the choice of suture material in impacted third molar surgery remains controversial, considering microbiological factors and clinical outcomes. More extensive randomized clinical trials are required to better understand the effect of suture materials on surgical outcomes and potential improvements. This study could enhance the safety and effectiveness of this common oral surgical procedure.

A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study.

BACKGROUND: The extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically. MATERIALS AND METHODS: A total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant. RESULTS: In PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05). CONCLUSION: Both two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians. TRIAL REGISTRATION: This study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

OBJECTIVES: The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. MATERIALS AND METHODS: A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. RESULTS: The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6 months after operation (P > 0.05 for all). CONCLUSIONS: Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. CLINICAL RELEVANCE: This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.

Evaluation of the effectiveness of tube drain on postoperative discomfort in mandibular third molar surgery: prospective randomized split-mouth study.

INTRODUCTION: The present randomized split-mouth study aimed to investigate the clinical effectiveness of postoperative discomfort of the use of a surgical drain after lower third molar extraction. MATERIALS AND METHODS: It was conducted a prospective randomized split-mouth study involving 30 patients with bilateral symmetric lower third molar. Each patient underwent two operations for the extraction of impacted teeth: test site (tube drain) and control site (conventional total closure of surgical flap), resulting in 30 cases in the test group, and 30 cases in the control group.Pain, swelling, and mouth opening were evaluated immediately before the surgeries, after 1, 3 and 7 days postoperatively in both groups. Data were analyzed with non-parametric test (Kruskal-Wallis test and the post hoc Dun test, and Wilcoxon matched-pairs signed rank test). RESULTS: Facial swelling (p < .001) was significantly less in test group compared with the control group on all examined days. Trismus is significantly reduced only on the third day (p < .001); Pain measurements did not differ statistically significantly between the two groups on all post-operative days (p > .05). CONCLUSION: The use of the tube drain reduced facial swelling and trismus, but had no influence on the subjective perception of postoperative pain.

Effects of collagen membrane on bone level and periodontal status of adjacent tooth after third molar surgery: a randomized controlled trial.

BACKGROUND: The periodontal status and distal bone level of the adjacent second molar can be negatively affected by the surgical extraction of an impacted lower third molar. Absorbable materials have some benefits, including enhancing primary wound coverage and promoting wound healing through isolation, clotting, wound stabilization and haemostasis. This study set out to compare primary and secondary healing and collagen-membrane-based primary healing after surgical removal of partially erupted impacted third molars (3Ms), evaluating the distal alveolar bone level (ABL) and periodontal status of the adjacent second molars (2Ms). METHODS: Patients who met the inclusion criteria were randomized into three groups: secondary healing (n = 28), primary healing (n = 27) and membrane-based primary healing (n = 29). Digital panoramic radiographs were obtained preoperatively (T1) and three months postoperatively (T2). The distances between the cemento-enamel junctions and the alveolar bone crests on the distal aspects of the adjacent 2Ms were measured using calibrated radiograph measurement software. The pocket depth and plaque index measurements were performed preoperatively and three months postoperatively. The periodontal plaque index (PPI) scores were registered on the distal aspects of the 2Ms, and the mean values were used. RESULTS: Three of the applied healing types positively affected periodontal pocket depth (PPD) and periodontal index values (p < 0.05). In terms of the ABL of the adjacent 2Ms, primary healing (p < 0.05) and membrane-based primary healing (p < 0.05) had superior results to secondary healing. CONCLUSION: Membrane use is promising for the distal bone gain and periodontal status of the adjacent 2M. TRIAL REGISTRATION: This clinical study was registered by the Australian New Zealand Clinical Trials Registry, with the trial number ACTRN12618001551280.

Application of sequential multimodal analgesia before and after impacted mandibular third molar extraction: Protocol for a randomized controlled trial.

Background: Several analgesics have been applied under various protocols to control the moderate-to-severe postoperative pain caused by the surgical extraction of an impacted mandibular third molar. However, a consensus on optimal pain management while minimizing side effects is yet to be reached. Methods: This multi-center, prospective, double-blind, randomized controlled trial aims to evaluate the efficacy and safety of sequential multimodal analgesia combined with postoperative zaltoprofen along with multiple preemptive analgesics. A total of 80 participants with bilateral impacted mandibular third molar from two hospitals were randomized into two groups. Two surgical extractions were performed at one-month intervals, and in a crossover design, celecoxib or tramadol/acetaminophen was administered before one extraction and placebo before the other extraction. Following extraction, all subjects took zaltoprofen for 5 days. The outcome measures included pain at specific times, time and intensity of the first pain onset after extraction, need of rescue drugs, and occurrence and frequency of side effects. Conclusions: This ongoing clinical trial was designed to provide evidence regarding a new protocol for effective postoperative pain management of a commonly performed surgical extraction. The results of this study will provide guidance to clinicians regarding the timing and combination of oral analgesics in various oral surgeries performed under local anesthesia. Trial registration: KCT0005450, registered on October 7, 2020.

Efficacy of low-level laser therapy in the management of postoperative surgical sequelae after surgical removal of impacted mandibular third molars.

Introduction: The study is aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in the control of pain, swelling, and trismus after the surgical removal of impacted mandibular third molars. Materials and Methods: A prospective study was conducted on thirty patients requiring surgical removal of the impacted mandibular third molar. Mesioangular impacted third molar with class I level B position (according to the Pell and Gregory classification) were included in the study. The study group (n = 15) received LLLT using diode laser of wavelength 980 nm and the control group (n = 15) received routine postoperative care without LLLT. The parameters evaluated were intensity of pain, maximum mouth opening, postoperative swelling, healing at the surgical site, and presence of dry socket. Results: The mean score of pain, swelling, and trismus in the study group were statistically lower as compared to the control groups. Healing assessment using Laury and Turnbull healing index inferred that the healing at the seventh postoperative day was superior in the study group as compared to the control group. Conclusions: LLLT with a diode laser of wavelength 980 nm can effectively reduce pain, swelling, and trismus in the postoperative phase after surgical extraction of the mandibular impacted third molar and promote healing at the operative site.

The effect of different positions of unerupted lower third molar teeth on the fragility of mandibular angle: Finite element analysis.

Background: The mandibular bone is the largest and strongest bone in comparison to the other bones in the face skeleton. However, it is the most commonly fractured in facial injuries. The location of the fracture in mandible depends on various factors. The relationship of the impacted lower third molar teeth to mandibular angle fracture has been the subject of many epidemiological studies. It is argued that the risk of fracture in mandibular angle is two to four times more when there are particularly an impacted or partially impacted third molar teeth. However, the effect of the position of the impacted tooth on mandibular angle fracture is not clear yet. Aim: This study seeks to reveal the effect of third molar teeth that are impacted in various positions on the angle fragility. Materials And Methods: This study was performed using three-dimensional finite element stress analysis and static linear analysis methodology. Computed tomography (CT) images obtained previously from a patient were used to construct models of the bone tissue. An ILUMA CBCT device (3M Imtec, OK, USA) was used for tomographic scans. Impacted teeth in various positions were digitally modeled separately. Different direction forces were applied to the mandible, the stress values on the bone surrounding the third molar teeth impacted in different positions were determined. Results: Third molar teeth are impacted in mandibular bone in the following positions: mesioangular, vertical, horizontal, and distoangular positions. The study showed that the force that created the highest stress in the Mandibular angle among the modelled groups is the force by ipsilateral angle. Conclusion: For all kinds of impacted teeth, there was more stress accumulation in the buccal area than in the lingual area when the force is from the symphisis.

Comparative Study of the Efficacy of Advanced Platelet-rich Fibrin and Standard Platelet-rich Fibrin in Mandibular Third Molar Surgery.

Background: Disimpaction of mandibular of third molar is one of the commonest minor oral surgical procedures. Platelet-rich fibrin (PRF) plays a vital role in both hard and soft tissue healing. There are various subtypes of PRF used for different surgical sites. Objective: The purpose of this study is to compare and evaluate the effectiveness of Advanced PRF (A-PRF) and Standard PRF (S-PRF) in the healing process of the surgical sites after the removal of mandibular third molars. Changes in swelling, pain, and mouth opening were evaluated. Materials and Methods: 10 patients (3 men, 7 women; 18-35 years old) were selected for the removal of bilateral impacted mandibular third molar teeth. A-PRF and S-PRF were placed in the right-hand side for 5 patients in each group. In both the groups, the left side of the patients was taken as the control group. Postoperative pain was measured using a visual analogue scale (VAS), postoperative swelling was calculated using the distance between multiple facial landmarks (method) and mouth opening measured interincisally on the 1st postoperative day, 3rd day, and the 7th day, respectively. SPSS version 26.0 was used for data analysis. Results: Advanced PRF group recorded noteworthy improvement in pain (P = 0.063), swelling (P = 0.001), and mouth opening (P = 0.013) when compared to the standard PRF group. There was statistically substantial variance between the advanced PRF and standard PRF groups. Conclusion: Advanced PRF group showed decreased swelling, pain, and increased mouth opening compared to standard PRF group.