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Introduction: The surgical removal of an impacted lower third molar (LM3) is a commonoperation that generally requires the elevation of a mucoperiosteal flap. The triangularand envelope flap designs have been extensively studied and are mostly described in theliterature. However, in Denmark, a technique where the papilla between the adjacentsecond and first molar is spared (papilla sparing flap [PSF]), is used. This has limitedpresence in the literature. The aims were to identify which flap dental students andprofessionals utilised in LM3 removal, and to evaluate the evidence-based approach thatwas taken.Materials and Methods: Dental students and dental professionals were invited tocomplete a 10-item questionnaire on flap technique in third molar removal.Results: The majority of respondents were dental practitioners (N =141) stating thatthey used the PSF design. Almost half that undertook the PSF were aware of the envelopeand triangular designs. The majority (N =159) did not know where to locate the body ofevidence to support their technique.Conclusion: The majority (N =131) of respondents used the PSF. To align to a moreevidence-based approach, it may be that a re-evaluation of the design taught/used isneeded, which can also aid in better predicting postoperative outcomes.

RESUMEN La disposición que puede adoptar un tercer molar mandibular resulta en la mayoría de los casos impredecible. Para facilitar el análisis de la posición e inclinación de los terceros molares autores como Pell-Gregory y Winter, establecieron una clasificación de esas piezas dentarias para guiar la técnica operatoria más adecuada para cada situación. El objetivo fue determinar la frecuencia de la posición, inclinación y grado de dificultad quirúrgica en terceros molares mandibulares. El estudio fue observacional descriptivo, retrospectivo de corte transversal. Formaron parte del estudio radiografías panorámicas de pacientes que acudieron a la Facultad de Odontología UNA entre el 2018 y 2020. Un total de 220 radiografías panorámicas fueron incluidas en el estudio, 120 (54,5%) correspondían al sexo femenino y 100 (45,4%) al sexo masculino, la franja etaria de 18 a 28 años fue la de más participación con 134 (61%) radiografías. Se evidenció una frecuencia en la posición A clase II de 141 (36,6%), en cuanto a la inclinación de las piezas dentarias, la más frecuente fue la mesioangular 174 (45,5%) y en cuanto al grado de dificultad quirúrgica se observó una dificultad mínima a moderada. Se evidenció una frecuencia alta de la posición A clase II e inclinación mesial del total de las radiografías analizadas. ABSTRACT The position a mandibular third molar can adopt is unpredictable in most cases. To facilitate the analysis of the position and inclination of third molars, authors such as Pell-Gregory and Winter established a classification of these teeth to guide the most appropriate surgical technique for each situation. The objective was to determine the frequency of the position, inclination and degree of surgical difficulty in mandibular third molars. The study was descriptive, retrospective, cross-sectional, and observational. Panoramic radiographs of patients who attended the School of Dentistry of the National University of Asuncion between 2018 and 2020 were part of the study. A total of 220 panoramic radiographs were included in the study, 120 (54.5%) corresponded to women and 100 (45.4%) to men, the age group from 18 to 28 years old had the most participation with 134 (61%) radiographs. A frequency in position A class II of 141 (36.6%) was evidenced, while in terms of the inclination the mesioangular was the most frequent, 174 (45.5%) and in terms of the degree of surgical difficulty, minimal to moderate difficulty was observed. A high frequency of position A class II, mesial inclination was evidenced in all the radiographs analyzed.

Objectives: Swelling, pain and trismus after the surgical removal of the mandibular third molars are the most common and expected postoperative complications. The aim of this cross-sectional study was to assess the association of those postoperative complications and BMI after surgical removal of the mandibular third molars. Material and methods: 84 patients who required the surgical removal of their lower third molar were enrolled in this study and were divided into 4 groups dependent on their BMI. Data were tested by one-way analysis of variance (Welch’s ANOVA). The differences were tested by the intragroup using the Games-Howell test. Results: The effect of BMI on pain had a statistically significant difference within the first 24 postoperative hours: 4 hours (p=0.014), 6 hours (p=0.034, p=0.049), 12 hours (p= 0.00.P=0.023), and 24 hours (p=0.010). For swelling and trismus in the exception on first postoperative day between underweight and normal weight groups (p=0.026), and underweight and overweight groups (p=0.014) no statistically significant correlation was found Conclusion: BMI has an impact on a patient’s early postoperative recovery., Cilj: Oteklina, bol i trizmus najčešće su, ali i očekivane, komplikacije nakon operacijskoga uklanjanja donjega trećeg kutnjaka. Cilj ovog istraživanja bio je procijeniti povezanost spomenutih postoperativnih komplikacija i BMI nakon kirurškoga uklanjanja donjih trećih kutnjaka. Materijali i metode: U ovo su istraživanje bila uključena 84 ispitanika kojima je bilo potrebno kirurški ukloniti donje treće kutnjake. Bili su podijeljeni u četiri skupine, ovisno o izračunatom BMI-ju. Za ispitivanje dobivenih rezultata korištena je jednosmjerna analiza varijance (Welchova ANOVA), a razlike između grupa testirane su Games-Howellovim testom.Rezultati: Učinak BMI-ja na bol dokazan je statistički značajnom razlikom unutar prva 24 postoperativna sata: 4 sata (p = 0,014), 6 sati (p = 0,034, p = 0,049), 12 sati (p = 0,00, p = 0,023) i 24 sata (p = 0,010). S druge strane, nije pronađena statistički značajna povezanost za oteklinu i trizmus, s iznimkom otežanoga otvaranja usta prvoga postoperativnoga dana kod skupine pothranjenih u usporedbi s ispitanicima s normalnom tjelesnom masom (p = 0,026) i prekomjernom tjelesnom masom (p = 0,014). Zaključak: BMI utječe na pacijentov rani postoperativni oporavak.

HIV-related non-Hodgkin lymphomas of the oral cavity are rare lesions with aggressive clinical behaviour. The aim of this study is to describe the clinicopathological features of a series of HIV-related oral non-Hodgkin lymphomas. Eleven cases of oral lymphomas affecting HIV-positive patients were retrieved from 2012 to 2019. Clinicopathological features regarding age, sex, tumour location, clinical presentation, laboratory findings, disease stage and follow-up were obtained. Histologic, immunohistochemical and in situ hybridization for EBV detection were done for diagnosis confirmation. Overall survival was estimated by Kaplan?Meier curve. Males predominated, with a mean age of 40.3 years-old. Maxilla and mandible were the mostly affected. Plasmablastic lymphoma and diffuse large B-cell lymphoma not otherwise specified (NOS) were the main histological types. Lesions presented as reddish ulcerated swellings, representing the first sign of AIDS in six cases. Stage IV were common (7 cases) and the mean HIV viral load was 10,557 copies/mL, with a mean of 266 CD4+ cells/mm3, 1,278 CD8+ cells/mm3 and a CD4+/CD8+ ratio of 0.26. Eight patients died of the disease (72.7%). Overall survival revealed that 78.2% of the patients died after 21 months of follow-up. HIV-related oral lymphomas present a poor prognosis usually diagnosed in advanced stages and in our series plasmablastic lymphoma was the most common subtype.

Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.

Made available in DSpace on 2022-04-29T08:38:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective We examined if the association of ibuprofen with arginine has a better anti-inflammatory effect on pain, edema, and trismus after surgery of the impacted mandibular third molar than ibuprofen alone. Materials and Methods The study included 21 patients, 18 to 30 years of age, each with an impacted, and bilateral and symmetric third molar (total n = 21) that required transalveolar extraction. Patients were randomly assigned numbers from 1 to 21. Group A received ibuprofen-arginine as preoperative medication, while Group B received only ibuprofen. Both groups received the same postoperative medications: amoxicillin + acetaminophen. All patients were evaluated for pain at 6, 12, and 24 hours. They were evaluated for edema and trismus before surgery; immediately after surgery; and at 24, 48, and 72 hours postoperatively. Postoperative pain scores used the visual analog scale (BS-11). For facial edema and trismus, linear measurements used the method modified by Gabka and Matsumura. Statistical Analysis For the evaluation of data between Group A and Group B, we used the statistical software SPSS version 22. The Shapiro-Wilk, analysis of variance, the Bonferroni comparisons, and the Wilcoxon test were used. All tests were based on a significance level of 0.05. Results The study results reveal that the facial edema scores of Group A and Group B presented statistically significant differences (p < 0.05), while for postoperative trismus, there was no statistically significant difference (p > 0.05) between the scores of Group A and Group B. Conclusion As a conclusion, we can state that the use of ibuprofen-arginine allows for significantly better control of pain and edema, and shows a tendency toward better recovery from trismus, although without statistical significance. Based on this, we can assert that arginine improves the anti-inflammatory power of ibuprofen, thus generating better tissue healing after surgery of the impacted third molar. Department of Surgery and Integrated Clinic Division of Oral and Maxillofacial Surgery São Paulo State University Araçatuba Dental School, Araçatuba Department of Surgery and Integrated Clinic Division of Oral and Maxillofacial Surgery São Paulo State University Araçatuba Dental School, Araçatuba

Objective: Removing the impacted third molar is the most common surgical procedure in oral and maxillofacial surgery. The removal times and complications can be affected by many factors, and this study evaluated the removal time and complications of the impacted third molar between gendersMethods: This study included 40 patients, 20 female and 20 male patients. In the extraction of impacted third molar teeth with the same operative difficulty score (score 4), operation times and complications were evaluated in terms of gender.Results: With the descriptive statistical analysis, the average age of the patients was 26.85 ±8.37, the removal time of the female patients was 19.65 ± 10.63 minutes, and the average duration of the male patients was 14.30 ± 5.55 minutes. Postoperatively, 4 (10%) of the patients had alveolitis. Dehiscence was not seen. In the extraction of an impacted third molar with the same operative difficulty score, there was a statistically significant difference between genders in terms of operation time (p, Amaç: Gömülü üçüncü molar dişin çekimi oral ve maksillofasiyal cerrahide en sık uygulanan cerrahi işlemdir. Çekim süreleri ve komplikasyonları birçok faktörden etkilenebilmektedir ve bu çalışmada cinsiyetler arasında gömülü üçüncü moların çekim süresi ve komplikasyonları değerlendirildi.Yöntem: Bu çalışmaya 20 kadın ve 20 erkek olmak üzere 40 hasta dahil edildi. Aynı operatif zorluk skoruna sahip gömülü üçüncü büyük azı dişlerinin çekiminde (skor 4), ameliyat süreleri ve komplikasyonlar cinsiyet açısından değerlendirildi.Bulgular: Tanımlayıcı istatistiksel analiz ile hastaların ortalama yaşı 26.85 ±8.37, kadın hastaların dortalama diş çekimi süresi 19.65 ± 10.63 dakika, erkek hastaların ortalama diş çekim süresi 14.30 ± 5.55 dakika olarak bulundu. Ameliyat sonrası hastaların 4'ünde (%10) alveolit görüldü. Dehissens görülmedi. Aynı operatif zorluk skoruna sahip gömülü üçüncü molar diş çekiminde, ameliyat süresi açısından cinsiyetler arasında istatistiksel olarak anlamlı bir fark bulundu (p

Objective This systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery. Study Design Randomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE. Results Two authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference. Conclusion The seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.

The study aimed to generate a fused deep learning algorithm that detects and classifies the relationship between the mandibular third molar and mandibular canal on orthopantomographs. Radiographs (n = 1880) were randomly selected from the hospital archive. Two dentomaxillofacial radiologists annotated the data via MATLAB and classified them into four groups according to the overlap of the root of the mandibular third molar and mandibular canal. Each radiograph was segmented using a U-Net-like architecture. The segmented images were classified by AlexNet. Accuracy, the weighted intersection over union score, the dice coefficient, specificity, sensitivity, and area under curve metrics were used to quantify the performance of the models. Also, three dental practitioners were asked to classify the same test data, their success rate was assessed using the Intraclass Correlation Coefficient. The segmentation network achieved a global accuracy of 0.99 and a weighted intersection over union score of 0.98, average dice score overall images was 0.91. The classification network achieved an accuracy of 0.80, per class sensitivity of 0.74, 0.83, 0.86, 0.67, per class specificity of 0.92, 0.95, 0.88, 0.96 and AUC score of 0.85. The most successful dental practitioner achieved a success rate of 0.79. The fused segmentation and classification networks produced encouraging results. The final model achieved almost the same classification performance as dental practitioners. Better diagnostic accuracy of the combined artificial intelligence tools may help to improve the prediction of the risk factors, especially for recognizing such anatomical variations.

Objectives : The aim of this study was to evaluate correlations between anxiety and preoperative pressure pain assessments and postoperative pain and analgesic requirements in impacted lower third molar tooth surgery. Materials and methods This prospective study enrolled 60 patients who underwent impacted lower third molar surgery. The preoperative State-Trait Anxiety Inventory-I (STAI-I), pressure pain threshold, and pressure pain tolerance scores were measured. At 2, 4, 6, 12, and 24 hours, and at 6 days following surgery, the patients scored their pain on the visual analogue scale and recorded their analgesic drug usage. The data were evaluated, and the results were statistically analyzed. Results Of the 60 patients, 38 were female. Mean age was 24.62±7.42 years. The study found no relationship between preoperative pressure pain assessments and postoperative pain (P>0.05). There was also no relationship observed between preoperative STAI-I scores and postoperative pain (P>0.05). However, there was a positive correlation between operation time and total medication taken (P Conclusion Preoperative pressure pain threshold, pressure pain tolerance, and anxiety level had no significant effects on postoperative pain and analgesic requirements in impacted lower third molar surgery.

Objective: To assess the patterns of impacted 3rd molars and their proximity with adjacent vital structures. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oral & maxillofacial department of Rawalpindi Dental Hospital, from Oct 2016 toFeb 2018. Methodology: Patient sample size was 956. Orthopantomograms (OPGs) were assessed to determine the presence, patterns of impacted third molars and their relation to maxillary sinus and inferior alveolar canal (IAC) in maxilla and mandible respectively. Results: Out of 956 Orthopantomograms with 3499 3rd molars examined, 808 (23.09%) were impacted. Frequency of impaction was much higher in mandible than maxilla. Out of 527 impacted mandibular 3rd molars 238 (45.16%) were mesio-angular, 370 (70.21%) had class 1 relation to mandibular ramus & 266 (50.47%) had level B depth, while among 281 impacted maxillary third molars 134 (47.69%) had vertical angulation and 162 (57.65%) had level B depth. Two hundred and eighty four (53.89%) impacted mandibular 3rd molars showed relationship with the inferior alveolar canal, out of which 187 (35.48%) impacted mandibular 3rd molars showed interruption of white line as the most common radiographic finding. Conclusion: Frequency of impacted third molars was more common in mandible and among females whereasthere is significant difference in patterns of impaction among mandible and maxilla. While most impacted teethhave approximation with IAC and maxillary sinus.

RESUMEN Objetivo: Determinar el nivel de mineralización del tercer molar inferior de acuerdo a la edad cronológica mediante el método Demirjian en radiografías panorámicas digitales de pacientes andinos. Material y métodos: Se realizó un estudio correlacional analizando 706 radiografías panorámicas digitales en la Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca Ecuador, en el período 2015-2016. Los pacientes tuvieron entre 6 y 22 años de edad. Se Evaluó un total de 1412 terceros molares (4.8 y 3.8). Resultados: Un primer análisis descriptivo mostró una correlación fuerte (Rho= 0,99) entre la edad cronológica y el nivel o grado de mineralización del tercer molar inferior. En ambas piezas estudiadas el inicio de la formación del tercer molar se dio en promedio a los 8,13 años y finalizaba a los 20,41 años. Los estadios que mostraron mayor coincidencia en ambos sexos y en ambas piezas fueron B, C, F, G y H y los estadios con menor coincidencia fueron los estadios A, D, E. Conclusiones: De acuerdo a los resultados podemos sugerir que el método Demirjian, es una herramienta útil para determinar la edad cronológica en base a la mineralización de los terceros molares, con un error de +/- 1.2 meses por lo que es posible ser usado para la estimación de la edad en evaluaciones forenses. SUMMARY Objective: To determine the level of mineralization of the third lower molar according to chronological age using the Demirjian method in panoramic digital radiographies of Andean patients. Material and methods: A correlational study was carried out analyzing 706 digital panoramic radiographies in the Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca Ecuador, in the period 2015-2016. The patients were between 6 and 22 years of age. A total of 1412 third molars (4.8 and 3.8) were evaluated. Results: A first descriptive analysis showed a strong correlation (Rho=0.99) between chronological age and the level or degree of mineralization of the lower third molar. In both studied pieces the beginning of the formation of the third molar was given in average at 8,13 years and finished at 20,41 years. The stages that showed greater coincidence in both sexes and in both pieces were B, C, F, G and H and the stages with less coincidence were the stages A, D, E. Conclusions: According to the results we can suggest that the Demirjian method is a useful tool to determine the chronological age based on the mineralization of the third molars, with an error of +/- 1.2 months so it is possible to be used for the estimation of the age in forensic evaluations.

Objectives:The aim of this study is to evaluate the effects of the position of the impacted third molar teeth on preoperative anxiety and possible pain levels of patients. Material and Methods:Fifty patients with impacted third molar teeth (full bone retention) in the horizontal and vertical positions were included in the study. Sociodemographic data of the patients were recorded. The patients have watched the impacted third molar surgery videos which were the position of horizontal and vertical. Subsequently, preoperative anxiety levels of patients were evaluated with The Spielberger State-Trait Anxiety Inventory-STAI part of the state anxiety inventory. In addition, pain levels that patients thought they might feel after the surgeries were evaluated with Visual Analogue Scale (VAS). P Results:The study included 50 patients (25 males and 25 females) who mean the age of was 21.00 ± 2.08. A statistically significant difference was found between the levels of anxiety created by the positions of the impacted third molar teeth (p Conclusion:The position of the third molars are associated with anxiety, stress, and postoperative pain in patients undergoing impacted third molar surgery. Addressing these factors preoperatively may reduce anxiety, probable postoperative perception of pain, and provide more positive treatment results.

Background To describe a technical feature that increases the stability of the intermediate splint in patients where bimaxillary surgery with great maxillary/mandibular advancements are planned. Material and Methods Prospective evaluation of the intermediate splint dental vertical penetration in patients undergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upper and lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9 mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediate splint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018. Results The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with an extra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated better dental penetration, and therefore improved intermediate splint precision with the latter in all cases Conclusions Our results suggest that this is a simple and safe technique that can be easily reproduced and optimizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operating room. Key words:Orthognathic surgery, intermediate splint, accuracy, intermaxillary fixation, bone screw.

Background Metallothioneins (MTs) gene polymorphisms have been associated with the ability of free radical scavenging and detoxification of heavy metals leading to cancer development. Our aim was to revisit, in a Brazilian population, single-nucleotide polymorphisms (SNPs) of the MT gene family previously associated with oral squamous cell carcinoma (OSCC). Material and Methods A case-control investigation with 28 OSCC patients and 45 controls was conducted, using conventional risk factors (tobacco use and alcohol consumption) as covariates. SNPs genotyping for rs8052334 (MT1B), rs964372 (MT1B), and rs1610216 (MT2A) was performed by PCR-RFLP, and SNPs for rs11076161 (MT1A) were analyzed by TaqMan assay. Results The only SNP associated with increased risk for OSCC was the MT-1A AA genotype (OR = 4.7; p = 0.01). We have also evidenced for the first time a significant linkage disequilibrium between the SNPs of MT-2A and MT-1A in this population with the highest frequency (30%) of the unfavorable haplotype G/A/C/T (rs1610216 / rs11076161 / rs964372 / rs8052334) of MT gene polymorphisms (OR = 6.2; p = 0.04). Interestingly, after removing the effects of conventional risk factors, we have uncovered the significance of the AA genotype of the rs11076161 with increased odds of 19-fold higher towards OSCC development. Conclusions This is the first demonstration that a significant linkage disequilibrium among gene polymorphisms of the MT family may affect susceptibility to oral cancer, which is conditioned by the G/A/C/T haplotype (rs1610216/rs11076161/rs964372/ rs8052334) and the MT-1A gene polymorphism has a potential clinical utility for the OSCC risk assessment. Key words:Oral squamous cell carcinoma, polymorphism, metallothionein, oral cancer.

Background Ginger and aloe vera are two medicinal herbs mostly used to produce mouthwash. This study aimed to compare the effects of ginger and aloe vera mouthwashes on the xerostomia in patients referred to Bandar Abbas diabetes clinic (Iran). Material and Methods In this triple-blind clinical trial, three groups (n=35 patients in each group) were studied. One group was given aloe vera mouthwash, the other group used ginger mouthwash, and the control group was only given normal saline. All the mouthwashes were used 20 ccs three times daily for 14 consecutive days. The symptoms and severity of xerostomia were measured before and after the intervention by the questionnaire proposed by Fox et al. as well as VAS scale, respectively. Statistical analysis, including the Shapiro-Wilk test used to measure the normality of variables, and Chi-square and McNemar used to compare the scores questionnaire proposed by Fox et al., were also applied. Scores of VAS were analyzed using a one-way ANOVA test. P

Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Objective: To compare the clinical efficacy of different povidone iodine concentrations for the management of postoperative pain and swelling following mandibular third molar surgery. Methods: The randomised, prospective, double-blind and controlled study was conducted from October 2016 to January 2018 at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Biruni University, Istanbul, Turkey, and comprised individuals aged 18-30 years who underwent surgical removal of pathology-free completely unerrupted mandibular lower third molars. The participants were randomly assigned to four groups: Group I had saline-only controls, Group II was given 0.5% concentration of povidone iodine, Group III had 1% concentration of povidone iodine, and Group IV had 3% concentration of povidone iodine. Facial swelling and trismus were assessed on the 2nd and 7th postoperative days. Data was analysed using SPSS 22. Results: Of the 80 patients, 34(42.5%) were males and 46(57.5%) were females with an overall mean age of 24.6±3.68 years. Each group had 20(25%) subjects. All three concentrations of povidone iodine provided significant reduction in postoperative trismus compared to the controls. Trismus was less in Group III and Group IV compared to Group II up to 7 days after surgery. Conclusion: Irrigation with 3% povidone iodine concentration was found to be more effective in reducing the level of facial swelling after impacted third molar surgery. (Clinical Trials.gov Identifier: NCT03894722) Key Words: Maxillofacial surgery, Third molar, Povidone-Iodine, Swelling, Tismus

Objective This article explores the problem of developing pathologies in the retromolar region. Findings can serve a framework for disease prevention and for the improvement of the quality of life of patients. The present study aims to justify the possibility of utilizing morphometric methods to foresee problems in the eruption of third molars. Materials and Methods A comprehensive morphometric study of the lower jaw and facial skeleton involves 100 skulls of Homo sapiens to identify the anatomical causes of problems with wisdom teeth eruption. All said skulls are divided in two groups: I: skulls with intact dentition; II: skulls with impacted third molars. Results This work allows detecting abnormalities in the eruption of the third molar with high probability of success. The abnormalities in point are considered not only those associated with the generally accepted parameters but also those that occur in the leptoprosopic face cases. Conclusions Face type and the structural features of the facial skeleton play a significant role in the abnormal eruption of the lower third molar.

Objective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS. RESUMO Objetivo: Avaliar a habilidade de ortodontistas e cirurgiões bucomaxilofaciais (CBMF) em propor um prognóstico para terceiros molares inferiores. Métodos: Foram analisados 22 pacientes tratados ortodonticamente sem extração, cujos terceiros molares inferiores irrompidos espontaneamente (n= 44) foram avaliados por meio de radiografias panorâmicas seriadas. A primeira radiografia foi obtida logo após o tratamento ortodôntico (RX1), entre 13 e 19 anos de idade. A segunda radiografia (RX2) foi avaliada dois anos depois, em média. As radiografias foram analisadas aleatoriamente por 54 especialistas, 27 ortodontistas e 27 CBMFs, para obter sua opinião sobre a abordagem a ser adotada na RX1. Em seguida, outra opinião foi coletada adicionando-se a segunda radiografia seriada (RX1+2). Resultados: A concordância das respostas foi moderada para os CBMFs (Kappa = 0,44; p< 0,0001) e significativa para os ortodontistas (Kappa = 0,39; p< 0,0001). Após analisar apenas a primeira radiografia (RX1) dos molares antes deles irromperem espontaneamente, os CBMFs indicaram extração em 44,5% dos casos; enquanto os ortodontistas, em 42%, sem diferença entre os grupos (p= 0,22). Na análise de RX1+2, os ortodontistas mantiveram o mesmo nível de indicação de extração (45,6%, p= 0,08), enquanto os cirurgiões passaram a indicar mais extrações (63,2%, p< 0,0001). Conclusões: Ortodontistas e CBMFs não foram capazes de predizer a erupção de terceiros molares por meio da análise de uma única radiografia panorâmica, indicando extrações em cerca da metade dos terceiros molares examinados. Uma análise de acompanhamento, incluindo mais uma radiografia, não melhorou a precisão do prognóstico entre os ortodontistas, e piorou entre os CBMFs.

Objective: The purpose of the present study was to determine the association between agenesis of the third molar and other dental anomalies. Materials and Methods: This was an observational, retrospective, cross-sectional and analytical study. The sample included 367 patients, aged 14 to 20 years old with adequate digital panoramic radiography. Patients with syndromes, who had extractions of any third molar and with orthodontic treatment prior to panoramic radiographic examination, were excluded. For data collection, each radiograph was recorded with patient code, sex and age. Results: The prevalence of third molar agenesis was 20.71%. Subsequently, patients were divided into two groups, with agenesis of at least one third molar and a control group; the prevalence of other dental anomalies was 48.69% of third molar agenesis group and 21.31% in the control group. A highly significant association was found between the presence of third molar agenesis and the presence of other tooth abnomalities (p= 0.0000; contingency coefficient = 0.2425).The most frequent dental anomaly was dental inclusion with 20.44% of the population studied; followed by the agenesis of other teeth (7.90%) and finally the presence of supernumerary teeth (1.63%). Conclusions: This study demonstrates that there is an association between third molar agenesis and other dental abnormalities, with a higher prevalence of dental abnormalities in patients with third molar agenesis.

Pain and trismus are the most common postoperative complications following a surgical removal of the lower third molar. This randomized, double-blind, placebo-controlled clinical trial evaluated the effect of orally administrated magnesium on postoperative pain and trismus after surgical removal of the lower third molars. The study was conducted on 80 participants who were divided into two groups. Each group took different oral forms of magnesium citrate. Participants in both groups had their two lower molars surgically removed. For one randomly selected third molar, participants received either magnesium citrate tablets or lozenges. For the surgical removal of the lower third molar of the opposite side, the participants received either placebo tablets or lozenges. The data were analyzed using the Wilcoxon signed-ranked test, the Mann-Whitney U test, and the Spearman rank-order correlation with the level of significance set at p

Aim: To evaluate the extraction indications, impaction rates, extraction techniques and gender-age distribution of third molars in individuals.Material and Methods: In this study, 1718 patients whose third molar teeth were extracted at Karabuk University and Istanbul University Faculty of Dentistry were examined between 2018 and 2021. The distribution of extraction indications, extraction techniques and impaction rates by age and gender were determined. To evaluate the extraction indications of the third molars; caries, orthodontics, pericoronitis, cyst-tumor formation, prophylactic, adjacent tooth damage, periodontal destruction, atypical pain, planned implant criterias were used.Results: 53.73% of the patients were male and 46.27% were female. It was observed that the highest third molar tooth extraction was between 18-29 ages (49.94%). Third molar extraction was indicated mostly due to caries (45.11%), followed by pericoronitis (22.41%). It was observed that extractions performed with indications of adjacent tooth damage (6.93%) and caries (50.27%) were more common in men than in women. In women, the third molar extraction performed with the indication of atypical pain and pericoronitis was more common. The lower third molars were extracted more frequently with the surgical approach (87.58%) and they had more bone impaction (85.32%) or mucosa impaction (71.65%) than the upper third molars.Conclusion: Third molar teeth are extracted because of various indications, among which caries and pericoronitis are leading. There are significant differences in extraction indications between different age groups and genders. Considering the impaction differences of the lower and upper third molars and evaluating the extraction approach to be applied before the treatment will provide easiness to both the oral surgeon and the patient., Amaç: Bu çalışma; toplumda üçüncü molarların çekim endikasyonlarını, gömüklük oranlarını, çekim tekniklerini ve cinsiyet-yaş dağılımlarını bulmayı amaçlamaktır.Gereç ve Yöntem: Bu çalışmada; 2018 – 2021 yılları arasında Karabük Üniversitesi ve İstanbul Üniversitesi Diş Hekimliği Fakültelerinde üçüncü molar dişleri çekilen 1718 hasta incelendi. Çekim endikasyonları, çekim teknikleri ve gömüklük oranlarının yaş ve cinsiyete göre dağılımları tespit edildi. Çekim endikasyonlarını değerlendirmek için; çürük, ortodontik amaçlı, perikoronitis varlığı, kist-tümör oluşumu, profilaktik, komşu diş hasarı, periodontal harabiyet, atipik ağrı, planlanan implant kriterlerinden yararlanıldı. Bulgular: Hastaların %53.73’ünün erkek, %46.27’ sinin kadın olduğu görüldü. En fazla üçüncü molar dişi çekilen yaş grubunun 18-29 (%49.94) yaş aralığı olduğu tespit edildi. En çok çürük (%45,11) sebebiyle üçüncü molarlara çekim endikasyonu verildiği ve bunu perikoronitisin (%22.41) takip ettiği görüldü. Erkeklerde komşu diş hasarı (%6.93) ve çürük (%50,27) endikasyonuyla yapılan çekimlerin kadınlardan daha fazla olduğu görüldü. Kadınlarda ise atipik ağrı ve perikoronitis endikasyonuyla yapılan üçüncü molar çekimi daha fazlaydı. Alt üçüncü molarların daha sık cerrahi yaklaşımla (%87.58) çekildiği ve üst üçüncü molarlara göre daha fazla kemik (%85.32) ya da mukoza (%71,65) retansiyonunda pozisyonlandığı belirlendi.Sonuç: Üçüncü molar dişleri çok farklı endikasyonlarla çekilmektedir ve bunlar arasında çürük ve perikoronitis ön plandadır. Farklı yaş gruplarında ve cinsiyetler arasında çekim endikasyonlarında belirgin farklar mevcuttur. Alt ve üst üçüncü molarların gömüklük farklılıklarının göz önünde bulundurulması ve uygulanacak çekim yaklaşımının tedavi öncesi değerlendirilmesi hem hekim hem de hastaya kolaylık sağlayacaktır.

Tooth extraction is followed by a sequence of elaborate local changes affecting hard and soft tissues. Dry socket (DS) can occur as intense pain around and in the extraction site, with an incidence from 1–4% after generic tooth extraction to 45% for mandibular third molars. Ozone therapy has gained attention in the medical field because of its success in the treatment of various diseases, its biocompatible properties and its fewer side effects or discomfort than drugs. To investigate the preventive effect of the sunflower oil-based ozone gel Ozosan® (Sanipan srl, Clivio (VA), Italy) on DS, a double-blind split-mouth randomized placebo-controlled clinical trial was conducted according to the CONSORT guidelines. Ozosan® or the placebo gel were put in the socket, and the gels were washed off 2 min later. In total, 200 patients were included in our study. The patient population comprised 87 Caucasian males and 113 Caucasian females. The mean age of the included patients was 33.1 ± 12.4 years. Ozosan reduced the incidence of DS after inferior third molar extraction from 21.5% of the control to 2% (p < 0.001). Concerning the dry socket epidemiology, the incidence was not significantly correlated with gender, smoking or mesioangular, vertical or distoangular Winter’s classification. Post hoc power calculation showed a power of 99.8% for this data, with alpha = 0.001.

Journal of The Dental Association of Thailand, 72, 3, 434-440

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25–40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery.

Objectives: Cryotherapy is frequently used to diminish postoperative sequelae following mandibular third molar surgery. The objective of this single-blinded randomized controlled trial was to assess the therapeutic efficiency of 30 minutes continuous cryotherapy on postoperative sequelae following surgical removal of mandibular third molars compared with no cryotherapy.Material and Methods: Thirty patients (14 male and 16 female) including 60 mandibular third molars were randomly allocated to 30 minutes of immediately cryotherapy or no cryotherapy. Outcome measures included pain (visual analogue scale score), maximum mouth opening (trismus) and quality of life (oral health impact profile-14). Outcome measures were assessed preoperatively and one day, three days, seven days and one month following surgical removal of mandibular third molars. Descriptive and generalized estimating equation analyses were made. Level of significance was 0.05.Results: No cryotherapy following surgical removal of mandibular third molars revealed a statistically significant lower visual analogue scale score of pain compared to thirty minutes of continuous cryotherapy after one day (P < 0.05). However, no statistically significant difference in trismus or oral health-related quality of life were revealed at any time point compared with no cryotherapy.Conclusions: The therapeutic effect of 30 minutes continuous cryotherapy following surgical removal of mandibular third molars seem to be negligible. Thus, further randomized controlled trials assessing a prolonged application period of cryotherapy, alternative devices or use of intermittent cryotherapy are needed before definite conclusions and evidence-based clinical recommendations can be provided.

Extraction of impacted third molars is a routine procedure performed by oral and maxillofacial surgeons. However, extractions in middle-aged or elderly individuals are not easy, and there are several factors that need to be considered. These factors include decreased healing potential and the risk of complications increasing with age. In addition, third molars can often be fully or deeply impacted in middle-aged individuals, and pathologic changes, such as cysts, caries, or periodontitis of the adjacent second molar, can develop. Furthermore, the rate of ankylosis and systemic disease increases after middle age. It is considered that these factors acting alone or in combination increase the difficulty of extraction.

Background and Objective: Extraction of impacted lower third molars is one of the most frequent surgeries of the oral cavity. This operation might be accompanied by inevitable complications, such as pain, swelling, and trismus after surgery. Therefore, the aim of this study was to evaluate the impact of low-intensity/power laser therapy on swelling and trismus after impacted mandibular third molar surgery. Materials and Methods: This randomized double-blind clinical trial was performed on 40 patients who required similar unilateral impacted third molars. These patients were randomly divided into two groups of 20, including the control group with no laser application and the test group receiving laser irradiation. In the intervention group, 1 cm2 of the tissue was irradiated immediately post-operation by 12 j/cm2 energy using a 980-nm laser setting with continuous wave mode at the output power of 200 MW for 60 s. Radiations were carried out at three regions, including two intraoral sites on the buccal and lingual sides of the operated area and an extraoral area on the joining point of the masseter muscle to the mandible. Inflammation and trismus were assessed by measuring the size of the face and maximum mouth opening on the second and seventh days after surgery. Results: Our findings demonstrated that in the laser group, on the second day post-operation the maximum mouth opening (trismus) was 28±6 and facial swelling was 217.8±12.8. The two groups were not significantly different on this day regarding the two evaluated variables (P>0.05). On the seventh day, trismus and facial swelling were reported as 39.85±6.97 and 209.2±13.45, respectively. Moreover, improvements were observed in the irradiated group at this time point. However, no statistically significant difference was found between the test and control group concerning these factors (P>0.05). Conclusion: According to the results of this study, laser application with the parameters set in this study had no significant positive effects on reducing the post-operation complications.

Objective: To compare the anti-inflammatory effectiveness of dexa-methasone as pre-surgical and post-surgical therapy in mandibular third molar surgery. Materials and methods: Randomized clinical trial conducted in 60 patients in need of mandibular third molar extraction, ages ranging from 16 to 35 years old, at the Department of Oral and Maxillofacial Surgery of the Arzobispo Loayza National Hospital during the period of January-March, 2016. Patients were distributed in two randomized groups: Group A received 4mg dexamethasone intramuscular before the surgery, and Group B received the same medication post-surgery. Facial edema was assessed using the distance between facial points, trismus was evaluated using the interincisal distance, and pain intensity was determined using a Numerical Scale (NS). Results: Facial edema values were lower in Group A at 60 minutes (p=0.002) and after the first (p=0.001) and third days (p=0.009), compared to Group B. Regarding trismus, no significant differences between the groups were found. Regarding pain intensity, the highest point was recorded at 6 hours in both groups; however, no significant differences between the groups were found. Conclusion: Pre-surgical dexamethasone administration produced a significantly greater reduction in facial edema after mandibular third molar surgery.

Made available in DSpace on 2020-12-10T20:04:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions. Material and Methods: Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3. 7 and 14-days. The measured parameters were duration of surgery. pain trismus and swelling. Results: The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p>0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p=0.038; p0.05). Conclusions: Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration. Aracatuba Sch Dent UNESP, Dent Buccomaxillofacial Surg & Traumatol, Dept Surg & Integrated Clin, Sao Paulo, Brazil Aracatuba Sch Dent UNESP, Dept Surg & Integrated Clin, Rua Jose Bonifacio 1193, BR-16015050 Sao Paulo, Brazil Aracatuba Sch Dent UNESP, Dent Buccomaxillofacial Surg & Traumatol, Dept Surg & Integrated Clin, Sao Paulo, Brazil Aracatuba Sch Dent UNESP, Dept Surg & Integrated Clin, Rua Jose Bonifacio 1193, BR-16015050 Sao Paulo, Brazil FAPESP: 2016/14834-9 FAPESP: 2014/14878-0

The atrophy of the periodontal ligament places the tooth very close to the bone or another tooth, as occurs in unerupted teeth. The absent interdental bone and the lack of functional periodontal stimulus may lead to the fusion of the appositional layers of cement between the roots of the teeth. Concrescence almost always occurs in the region of the maxillary molars. Asymptomatic, it should always be remembered when the proper response to orthodontic movement is not obtained, and there is no apparent explanation. When surgically extracting a tooth and there is resistance, insisting will not be the best strategy. Moving the teeth with concrescence is not convenient, as it requires very intense forces. Once separated, these teeth can be considered normal for movement. It is possible to separate two teeth presenting concrescence, but it depends on the extension of the area, the surgical access and, especially, the clinical convenience. The tooth to be extracted will be repaired with new cement deposited in the sectioned area. The simple separation with the maintenance of the proximity and the lack of function of one of the teeth will cause a new concrescence. After a period of 1 to 3 months, the separated teeth are biologically prepared to be moved. The most important detail in this separation of teeth presenting concrescence is that the diagnosis should be made in advance, and not at the time of the intervention.

Introduction Even though is rarely, mandibular fracture after the extraction of third molars can occur in almost 1% of the procedures. Gender, age, position of third molar, tooth volume, bone fragility, systemic disorders, associated lesions, and degree of mandibular atrophy are factors that contribute to increase the incidence of fracture. The installation of the titanium miniplate during exodontia is an important tool to prevent the fracture. Presentation of case The objective of this study is to present a clinical case of extraction of inferior impacted third molar, in atrophic mandible, with posterior installation of titanium miniplate, to prevent mandibular fracture. Discussion and conclusion preventive installation of titanium miniplate was effective and indeed prevented the mandibular fracture. No trans-operative or immediate post-operative complications were observed. Post-operative follow-up was of three years, with no complications, showing the success of the procedure., Highlights • This study will instruct surgeons on third molar surgery in atrophic mandible. • It will allow surgeons to avoid mandibular fracture, by installing titanium plate. • It will ensure the procedure is safe and well conducted for the patients.

SUMMARY: Agenesis of permanent teeth is the most frequent dental anomaly. The most affected tooth is the third molar (M3), and its congenital absence poses interesting questions from a clinical and evolutionary perspective. M3 agenesis can occur isolated or as part of syndromes. Researchers have reported prevalences that vary largely among populations, between 5 % and 56 %, with a mean prevalence of 22.6 %. Previous Chilean studies, mainly in Northern populations, have determined a prevalence between 19.8 % and 26.7 %. The aim of this work was to assess the prevalence of M3 agenesis and to characterize its presentation in a sample from Santiago, the largest to date in a M3 agenesis prevalence study in Chile. In this study, 535 panoramic radiographies and clinical histories of patients from the Dental Clinic of the Universidad de Chile were used to determine prevalence and distribution according to sex, affected tooth, and location (left or right; maxilla or mandible). The Chi-square test was used to assess statistical significance in distribution. The calculated M3 agenesis prevalence was of 12.89 %. No statistically significant differences were found between sexes, sides or location within the jaws. The agenesis of one third molar was more common, then two, three and finally of all the third molars. The prevalence of M3 agenesis in the sample is 12.89 %, with a random manner of presentation. We propose that as it currently stands, M3 agenesis should be considered an anatomical variation rather than a developmental anomaly.

Made available in DSpace on 2020-12-12T00:56:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-12-01 The objective of this study was to evaluate the use of piezosurgery for osteotomy and odontosection in the repair of the alveoli four months after exodontia. Fifteen young patients who needed third molars extracted were included. During the extractions, one of the teeth was included in the Piezo group, in which ultrasound motor tips were used in both procedures. The other tooth was removed with a conventional rotary instrument. The values of density of the repair regions of the right and left third molars were compared using digital panoramic radiographs. There were no significant differences (p > 0.05): piezo group mean (SD) 125.7 (15.4) and control group 126.7 (21.2). The bone density of the alveoli after extraction of the lower third molars with rotary instruments and surgical ultrasound was similar in both groups. The Department of Surgery and Integrated Clinic São Paulo State University (UNESP) School of Dentistry The Department of Surgery and Integrated Clinic São Paulo State University (UNESP) School of Dentistry

Mandibular third molar teeth have the highest impaction frequency for several reasons such as lack of space which may be related to the direction of facial growth. Gonial angle is used for the definition of facial growth pattern with some other measures such as mandibular plane angle. Winter and Pell-Gregory classifications are used for defining the level and pattern of mandibular third molar impaction. The aim of this study is to define the relationship between mandibular third molar impaction pattern and gonial angle; also to evaluate relationship between mandibular third molar roots and inferior alveolar canal. Study included 90 patients who had undergone cone beam computed tomography assessment for mandibular third molar impaction. Impacted teeth were grouped according to Pell-Gregory depth (A, B, C) and ramus (1, 2, 3) classification and sub-groups were composed. Winter classification was used for angulation of third molars and their relationship between with inferior alveolar canal was recorded. Gonial angle was measured on panoramic radiographs. Of the evaluated 90 impacted third molars, mesioangular position was the most frequent (34.4%), followed by vertical, horizontal and distoangular positions. Nearly 77% of the impacted third molar roots were related to inferior alveolar canal. While no correlation was determined between gender, age, third molar angulation and gonial angle, C2 sub-group of Pell-Gregory classification showed statistically significant higher gonial angle values. Although no significance was found, gonial angle was higher in level C group. In conclusion, gonial angle is higher in patients with C2 impaction level. Also, although statistically insignificant, Pell-Gregory C group had higher gonial angle averages.

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. Both the patient and dentist must therefore have scientific evidence-based information concerning the estimated level of surgical difficulty of every case to consider in referring cases of impacted third molars for specialists’ handling. We have undertaken a study in which demographic and radiological variables were considered together to evaluate the risk factors for surgical difficulty in a cohort of 100 impacted mandibular third molars. There were 13 variables evaluated for surgical difficulty. Total surgical time intervention was noted at the end of each surgery. Each variable was analysed with total surgical time intervention with univariate and multiple linear regression. Out of 13 variables, 9 were found statistically significant. The most significant predictors for surgical difficulty were Body Mass Index, Depth of impacted tooth and Retromolar space. No postoperative complications were reported.

The aim of this study was to determine whether cone beam computed tomography (CBCT) before mandibular third molar removal can improve the risk assessment for neurosensory disturbances of the inferior alveolar nerve (IAN) compared to panoramic radiography (PAN). One hundred and six mandibular third molars examined by PAN and CBCT were removed. A temporary sensory disturbance of the IAN was present in 20 cases; a permanent disturbance was found in one case. Three blinded observers assessed radiographic risk factors in PAN and CBCT images. Positive (PPV) and negative (NPV) predictive values and positive (LR+) and negative (LR−) likelihood ratios were calculated for all parameters for all observers. Inter-observer reproducibility was expressed as both the percentage accordance and the kappa-statistic. Generally, the PPV and LR + were the same for PAN and CBCT, and there was good inter-observer reproducibility. The highest PPV and LR + for PAN were found when part of the roots were positioned inferior to the lower white border line of the canal, and for CBCT when the canal was positioned between the roots of the tooth. In conclusion, parameters assessed in PAN and CBCT are not reliable risk factors for neurosensory disturbances of the IAN, and CBCT appears not to improve the risk assessment.

We conducted a systematic review of epidemiological studies to assess the prevalence of distal surface caries (DSC) in second molars adjacent to third molars. We searched the Cochrane Library, Lilacs, Embase, and Medline through Ovid ® (Wolters Kluwer) to retrieve English and non-English papers from inception to June 2016, and supplemented this with a search of the references and by tracking citations. Three reviewers contributed: one reviewed all the papers, and the other two divided the rest between them. They extracted data, completed structured quality assessments with a validated risk of bias tool for observational studies, and categorised the summary scores. The search yielded 81 records and 11 studies were analysed. The considerable methodological diversity meant that five were not eligible for inclusion in the quantitative synthesis. A meta-analysis of six studies on the prevalence of DSC and a subgroup analysis of three on various third-molar angulations were indicated. The overall pooled prevalence estimate calculated with a random-effects model was 23% (95% CI 2% to 44%) among patients. Prevalence subtotals were 20% (95% CI 5% to 36%) for prospective, and 15% (95% CI 5% to 36%) for retrospective studies among teeth. A subgroup analysis of three studies with 1296 patients (1666 molars) yielded a prevalence of DSC of 36% (95% CI 5% to 67%) for mesial impactions and 22% (95% CI 1% to 42%) for horizontal impactions. DSC was present in 3% of distally-inclined impactions, (95% CI 1% to 5%) and in 7% (95% CI 1% to 13%) of vertical third molars. The studies varied. The risk of bias was low in one and moderate in two. European studies suggested that DSC may be present in about one in four referrals for the assessment of third molars, and that the risk is considerably higher in those with convergent third molar impactions.

Introducción: Los terceros molares inferiores son los dientes más frecuentemente incluidos o semi-incluidos. La exodoncia de estos elementos es un procedimiento habitual que se realiza en las clínicas y hospitales de cirugía bucomaxilofacial. La extracción profiláctica o el mantenimiento en la arcada de los terceros molares mandibulares genera controversia entre autores y cirujanos, y debe realizarse analizando cada caso de forma individual. Objetivo: Este estudio pretende comparar los resultados del uso de las técnicas de exodoncia y coronectomía en el abordaje quirúrgico de los terceros molares mandibulares íntimos con el canal mandibular. Metodología: Se realizó una revisión narrativa de la literatura utilizando artículos de los años 2004 a 2022 encontrados en las plataformas de datos Scielo y PubMed. Discusión: La odontectomía parcial intencional (IPO) se considera una técnica segura y eficaz capaz de limitar la incidencia de daños en el NAI. La mayoría de los estudios analizados informaron de una menor incidencia de lesión del nervio alveolar inferior cuando se utilizó la técnica de coronectomía en comparación con la exodoncia convencional y ningún estudio encontró una lesión permanente de este nervio. Conclusión: En este contexto, a partir de la información recogida en la literatura, se puede percibir que la coronectomía, cuando está correctamente indicada y realizada, es considerada por muchos autores como una técnica segura para ser utilizada en la práctica clínica. Introduction: The mandibular third molars are the teeth that are most frequently included or semi-included. Exodontia of these elements is a common procedure performed in oral and maxillofacial surgery clinics and hospitals. The prophylactic removal or maintenance in the arch of mandibular third molars generates controversy among authors and surgeons, and should be performed by analyzing each case individually. Objective: This study aims to compare the results of the use of exodontia and coronectomy techniques in the surgical approach of mandibular third molars intimal to the mandibular canal. Methodology: A narrative literature review was conducted using papers from 2004 to 2022 found in Scielo and PubMed data platforms. Discussion: Intentional partial odontectomy (IPO) is considered a safe and effective technique capable of limiting the incidence of damage to the NAI. Most of the studies analyzed reported a lower incidence of inferior alveolar nerve injury when the coronectomy technique was used compared to conventional exodontia and no study found permanent injury to this nerve. Conclusion: In this context, based on the information collected in the literature, one can see that coronectomy, when correctly indicated and performed, is considered by many authors a safe technique to be used in clinical practice. Introdução: Os terceiros molares inferiores são os dentes que se apresentam mais frequentemente inclusos ou semi-inclusos. A exodontia desses elementos é um procedimento comumente realizado em clínicas e hospitais de cirurgia bucomaxilofacial. A remoção profiláctica ou a manutenção na arcada dos terceiros molares inferiores gera controvérsia entre autores e cirurgiões, e deve ser realizada analisando cada caso individualmente. Objetivo: O presente trabalho tem como objetivo comparar o resultado do uso das técnicas de exodontia e coronectomia na abordagem cirúrgica de terceiros molares inferiores íntimos com o canal mandibular. Metodologia: Realizou-se uma revisão de literatura do tipo narrativa utilizando trabalhos dos anos de 2004 a 2022 encontrados nas plataformas de dados Scielo e PubMed. Discussão: A odontectomia parcial intencional (OPI) é considerada uma técnica segura e eficaz capaz de limitar a incidência de danos ao NAI. A maioria dos estudos analisados relatou uma menor incidência de lesão do nervo alveolar inferior quando utilizada a técnica de coronectomia em comparação com exodontia convencional e nenhum estudo constatou lesão permanete a esse nervo. Conclusão: Nesse contexto, baseado nas informações coletadas na literatura, pode-se perceber que a coronectomia quando corretamente indicada e executada, é considerada por muitos autores uma técnica segura para ser usada na prática clínica.

The purpose of this retrospective study was to evaluate bone healing after autogenous demineralized dentin matrix (DDM) grafts, focusing on the distal root of the mandibular second molar after the extraction of the third. We included retrospective data from 20 patients who had undergone molar extractions (15 male, 41.9 ± 12.0 years) between January 2020 and September 2022 and had DDM grafts implanted on the extraction socket, immediately (“immediate graft”) or 6 weeks (“delayed graft”) after the first surgery without primary closure. Patients who underwent grafting on only one side were used as the control group (n = 4). Bone defects at the mandibular second molar were measured preoperatively and 4 months after the graft surgery using cone-beam computed tomography (CBCT). Improvement of bone defect (i.e., the change in the bony defect pre- vs. postoperatively) was compared between the control and graft groups using the Wilcoxon Signed Rank test, and the difference between immediate and delayed grafts was analyzed with the Mann-Whitney U test. Complications such as infections or graft failure did not occur. Although pre-operative defects were smaller in the control than in the graft group (2.98 ± 1.77 and 10.02 ± 3.22 mm, p = 0.001), post-operative defects were similar in both (2.12 ± 0.59 and 2.29 ± 1.67 mm, respectively). The improvement ratio was not statistically significant in the control group (22.68 ± 15.36%) but a difference was observed in the graft group (76.70 ± 15.36%, p = 0.001). The amount of improvement of bone defect was not affected by graft timing or patient sex. In conclusion, DDM can improve bone defect at the distal aspect of the mandibular second molar after third molar extraction.

Pericoronitis is characterized by inflammation of the tissues surrounding an erupting tooth and occurs most commonly in lower wisdom teeth. The extent of inflammatory phenomena can significantly affect the patient’s quality of life because of the pain, bleeding, and discomfort caused by it. The treatment of pericoronitis is carried out locally by irrigation and debridement in the early stages, but also generally by antibiotic therapy, when purulent secretion is present under the operculum and in the periodontal area. This study aims to evaluate the effect of beech bark extract (BBE) in the treatment of pericoronitis of the lower third molar. Parameters evaluated were pain, trismus, and bleeding index in a clinic study. Four groups of 20 patients were evaluated and grouped according to the irrigation solution used during the treatment: chlorhexidine 0.2% (CHX), BBE and chlorhexidine mixture solution 0.2% (1:1), and BBE and saline solution (control). The evaluation was carried out before and after the irrigation. Following the assessment of pain and trismus, a significant decrease in pain and a significant increase in mouth opening after 3 days was observed in patients treated with BBE, CHX, and BBE + CHX (p = 0.00). In the case of control patients, no significant decrease in pain (p = 0.83) was observed after 3 days, nor was there a significant increase in the opening of the oral cavity (p = 0.157). The evaluation of the inflammation index showed a significant decrease in gingival bleeding after 3 days for most patients treated with tested solutions (p < 0.05). It was concluded that irrigation with BBE was more effective in reducing pain, trismus, and bleeding compared to the other solutions (control, CHX, BBE + CHX), and this natural extract can be a choice in case of pericoronitis debut.

Objective: Extraction of semi-impacted or impacted, lower, third molars is one of the most performed procedures in the maxillofacial surgery, and inherent to it, there may be post-operative inflammatory response. Among the most common factors related to this response, pain, swelling, and trismus are the main ones. In this sense, therapeutic bandage has been used in the post-operative physiotherapy for several specialties so that muscular functions can be fully resumed and swelling, muscle spasms and pain reduced. Materials and Methods: The randomized, split-mouth, clinical trial was to assess 20 post-operative patients who underwent extraction of lower third molars with therapeutic bandage. Seven days after the extraction, swelling and trismus were the variables evaluated and pain was assessed according to the visual analogue scale (VAS). The Student’s t-test was used for comparison at significance level of 5% (α = 0.05). Results: With the results found, it was not possible to state that the therapeutic bandage protocol used in this study, given the evaluated signs and symptoms, were favorable, even providing greater comfort to patients. Conclusion: Therefore, we suggest that further studies should be performed in order to develop a protocol for application of therapeutic bandage for stomatognathic system. Clinicaltrials.gov NCT03393533. 12/05/2017 retrospectively registered. Objetivo: La extracción de terceros molares inferiores semi-impactados o impactados es uno de los procedimientos más realizados en cirugía oral y maxilofacial, y inherente a ella, puede existir una respuesta inflamatoria postoperatoria. Entre los factores más comunes relacionados con esta respuesta, el dolor, el edema y el trismus son los principales. En este sentido, el apósito terapéutico se ha utilizado en fisioterapia postoperatoria de varias especialidades para que las funciones musculares se recuperen por completo y se reduzcan la hinchazón, los espasmos musculares y el dolor. Materiales y métodos: el ensayo clínico aleatorizado de boca dividida evaluó a 20 pacientes postoperatorios que se sometieron a la extracción de terceros molares inferiores con un apósito terapéutico. Siete días después de la extracción, el edema y el trismo fueron las variables evaluadas y el dolor se evaluó según la escala analógica visual (EVA). Se utilizó la prueba t de Student para la comparación a un nivel de significación del 5% (α = 0,05). Resultados: Con los resultados encontrados, no se pudo afirmar que el protocolo de vendaje terapéutico utilizado en este estudio, dados los signos y síntomas evaluados, fue favorable, incluso brindando mayor comodidad a los pacientes. Conclusión: Por lo tanto, sugerimos que se realicen más estudios con el fin de desarrollar un protocolo para la aplicación de vendajes terapéuticos al sistema estomatognático. Clinicaltrials.gov NCT03393533. 12/05/2017 registrado retrospectivamente. Objetivo: A extração de terceiros molares inferiores semi-impactados ou impactados é um dos procedimentos mais realizados na cirurgia bucomaxilofacial, e inerente a ele, pode haver resposta inflamatória pós-operatória. Dentre os fatores mais comuns relacionados a essa resposta, a dor, o edema e o trismo são os principais. Nesse sentido, o curativo terapêutico vem sendo utilizado na fisioterapia pós-operatória para diversas especialidades para que as funções musculares possam ser totalmente retomadas e o inchaço, os espasmos musculares e a dor sejam reduzidos. Materiais e Métodos: O ensaio clínico randomizado, de boca dividida, avaliou 20 pacientes em pós-operatório que foram submetidos à exodontia de terceiros molares inferiores com curativo terapêutico. Sete dias após a extração, edema e trismo foram as variáveis avaliadas e a dor foi avaliada de acordo com a escala visual analógica (EVA). O teste t de Student foi utilizado para comparação ao nível de significância de 5% (α = 0,05). Resultados: Com os resultados encontrados, não foi possível afirmar que o protocolo de curativo terapêutico utilizado neste estudo, diante dos sinais e sintomas avaliados, foi favorável, mesmo proporcionando maior conforto aos pacientes. Conclusão: Portanto, sugerimos que mais estudos sejam realizados a fim de desenvolver um protocolo para aplicação de curativo terapêutico para o sistema estomatognático. Clinicaltrials.gov NCT03393533. 12/05/2017 registrado retrospectivamente.

During dental appointments, patients often present anxiety and exacerbated fear, especially in surgical procedures. These reactions can promote systemic alterations, such as elevated blood pressure, fainting, and convulsions. The aim of this study was to evaluate the level of anxiety of patients during the lower third molar extraction procedure, seeking indicative parameters of possible complications and, at the same time, contributing to a safe and less uncomfortable procedure for the patient. Forty patients needing extraction of the lower third molar were selected. The study had an evaluator to monitor the systemic variables: blood pressure, oxygen saturation, respiratory and heart rate - while the same surgeon performed the surgical procedures, always using the same surgical technique for all patients. At the anamnesis and at the end of the surgery, the patients answered a visual analogue scale (VAS) questionnaire on anxiety. The results showed that for the four variables observed during the surgery, only the oxygen saturation did not present a statistically significant variation during the procedure. All the others showed changes, mainly during the use of the high-speed engine. We concluded that anxiety, fear and stress showed influences on systemic factors during the extraction procedure. It shows the importance of careful anamnesis and the knowledge of patient systemic diseases before starting any surgery to prevent risks or complications. Durante la consulta odontológica, los pacientes a menudo presentan ansiedad y medicación exacerbada, especialmente en los procedimientos quirúrgicos. Estas reacciones pueden promover cambios sistémicos, como presión arterial alta, desmayos y convulsiones. El objetivo de este estudio fue evaluar el nivel de ansiedad de los pacientes durante el procedimiento de extracción del tercer molar inferior, buscando parámetros indicativos de posibles complicaciones y, al mismo tiempo, contribuir a un procedimiento seguro y menos incómodo para el paciente. Se seleccionaron 40 pacientes que requerían la extracción del tercer molar inferior. El estudio contaba con un evaluador para controlar las variables sistémicas -presión arterial, saturación de oxígeno, frecuencia respiratoria y cardíaca- mientras el mismo cirujano realizaba los procedimientos quirúrgicos, utilizando siempre la misma técnica quirúrgica para todos los pacientes. En la anamnesis y al final de la cirugía, los pacientes respondieron a un cuestionario de escala visual analógica (EVA) sobre la ansiedad. Los resultados mostraron que de las cuatro variables observadas durante la cirugía, sólo la saturación de oxígeno no presentó una variación estadísticamente significativa durante el procedimiento. Todos los demás mostraron cambios, especialmente durante el uso de la alta rotación. Se puede concluir que la ansiedad, el miedo y el estrés mostraron influencia en los factores sistémicos durante el procedimiento de exodoncia. Indicando la importancia de una cuidadosa anamnesis y conocimiento de las enfermedades sistémicas del paciente antes de iniciar cualquier cirugía, previniendo riesgos o complicaciones. Durante a consulta odontológica, os pacientes frequentemente apresentam ansiedade e medo exacerbado, especialmente em procedimentos cirúrgicos. Essas reações podem promover alterações sistêmicas, como pressão arterial elevada, desmaios e convulsões. O objetivo deste estudo foi avaliar o nível de ansiedade dos pacientes durante o procedimento de extração do terceiro molar inferior, buscando parâmetros indicativos de possíveis complicações e, ao mesmo tempo, contribuindo para um procedimento seguro e menos desconfortável para o paciente. Foram selecionados 40 pacientes que necessitavam de extração do terceiro molar inferior. O estudo teve um avaliador para monitorar as variáveis sistêmicas - pressão arterial, saturação de oxigênio, frequência respiratória e cardíaca - enquanto o mesmo cirurgião realizava os procedimentos cirúrgicos, utilizando sempre a mesma técnica cirúrgica para todos os pacientes. Na anamnese e no final da cirurgia, os pacientes responderam a um questionário de escala visual analógica (EVA) sobre ansiedade. Os resultados demostraram que para as quatro variáveis observadas durante a cirurgia, apenas a saturação de oxigênio não apresentou uma variação estatisticamente significativa durante o procedimento. Todas as outras apresentaram alterações, principalmente durante o uso da alta rotação. Conclui-se que a ansiedade, medo e estresse mostraram influências sobre os fatores sistêmicos durante o procedimento de exodontia. Indicando a importância de uma anamnese cuidadosa e o conhecimento das doenças sistêmicas do paciente antes de iniciar qualquer cirurgia, prevenindo riscos ou complicações.

Background How to prevent pain after the extraction of impacted teeth is a serious challenge for all patients. The purpose of this clinical trial was to investigate whether pre-emptive low dose of etoricoxib can reduce postoperative pain in patients undergoing third molars surgery. Methods Patients were randomised to receive etoricoxib 60 mg or placebo 30 min before surgery. Post-operative pain was recorded using a visual analogue scale during 24 h within the post-operative period. The total dose of ibuprofen rescue intake was recorded. Kaplan–Meier curves and log-rank analyses were used to evaluate the proportion of patients without rescue analgesic. Results Scores for the post-operative pain in the etoricoxib group were significantly lower than those in the placebo group during first 12 h (p p = 0.004). Etoricoxib resulted in the long-term survival of patients without rescue analgesic (p Conclusions This study revealed that etoricoxib has a substantial pre-emptive analgesic effect, resulting in the reduced use of analgesics after third molar removal. Trial registration: Registered on ChiCTR1900024503. Date of Registration: 13/07/2019.

O objetivo desse estudo foi de avaliar o efeito da fotobiomodulação em baixa potência (LLLT) com duplo comprimento de onda no reparo alveolar em sítios pós-extração de terceiros molares inferiores. Para isso, 20 pacientes foram submetidos a extrações de terceiros molares inferiores tratados da seguinte forma, em modelo de boca dividida: Lado Teste recebeu irradiação com laser de baixa intensidade com duplo comprimento de onda (660 nm laser vermelho e 808 nm laser infra-vermelho) e o lado controle não foi irradiado. A seleção dos lados que receberam os tratamentos ocorreu de forma aleatória. A LLLT foi aplicada imediatamente e após 3 e 7 dias do procedimento cirúrgico. O reparo alveolar foi analisado por meio de um score de reparo ósseo, da densidade óssea e análise fractal nos períodos de 1 semana e 90 dias após o procedimento cirúrgico por meio de tomografias. Adicionalmente, foram realizadas análises clínicas nos períodos de 3, 7, 14, 30 e 90 dias após o procedimento cirúrgico, considerando ocorrência de dor, edema e sangramento, bem como a qualidade do reparo da mucosa bucal, avaliado por meio de escala visual analógica. A análise clínica demonstrou que a LLLT reduziu o edema e melhorou o reparo da mucosa bucal, até o período de 7 dias do pós-operatório enquanto a analise tomográfica não demonstrou diferença significativa entre os grupos. A LLLT em duplo comprimento de onda melhorou o curso clínico do pós-operatório em pacientes submetidos a exodontia de terceiros molares inferiores, sem alterar o reparo ósseo. This project aimed to evaluate the effect of fibrin-rich plasma membranes (FRP) and low-intensity dual-wavelength laser therapy on alveolar repair in post-extraction sites of third molars. For this, 20 patients were involved in this study who underwent extraction of 4 third molars, which were treated as follows in a split-mouth model: Upper molars: Test side was treated filled with PRF membrane while the control side was kept with blood clot. Mandibular molars: Test side was treated for low-intensity dual wavelength laser irradiation (660 nm red laser and 808 nm infrared laser) while the control side was not irradiated. The selection of sides that received the treatments will occur randomly. LLLT was applied immediately and 3 and 7 days after the surgical procedure. The healing of the alveolar process was analyzed by means of a bone healing score, bone density and fractal analysis in the periods of 1 week and 90 days after the surgical procedure by means of CT scans. Additionally, clinical analyzes were performed in the periods of 3, 7, 14, 30 and 90 days after the surgical procedure to assess the occurrence of pain, edema and bleeding, as well as the quality of soft tissue healing, which were assessed using a visual scale analog. It was found that the application of LLLT reduced edema and improved soft tissue healing up to 7 days after surgery. Regarding the use of PRF, there were no clinical differences regarding treatments in any experimental period. Within 7 days, the alveoli treated with PRF had higher bone density than the control alveoli. It can be concluded that dual-wavelength LLLT improved the postoperative clinical course in patients undergoing lower third molar extraction, without altering bone healing. On the other hand, the use of L-PRF does not add clinical advantage in the healing of alveoli after maxillary third molar extraction. Dissertação (Mestrado) 2023-07-08

When lower third molar inclusion is associated with neurosensorial complications, the treatment of choice is its surgical avulsion. One of these complications, that may be the most alarming during a first medical examination, is hemi-lip paraesthesia, that can appear in the presence of several mandibular lesions. This is a report of a rare clinical case in which paraesthesia was linked to the closeness between the root block of the dental element and the mandibular canal, which houses the neurovascular trunk of the lower mandibular nerve. A 64 year-old male Caucasian patient, presented with the chief complaint of past periodic inflammatory events in the retromolar region of the oral cavity and hemi-lip paraesthesia. Upon local clinical and radiological examination, a lower left third molar with class 3 position C inclusion was incriminated. The medical history of the patient revealed well compensated diabetes mellitus type II, and pharmacologically controlled hypertension. The tooth was surgically removed using piezoelectric instruments. Before and after surgery, three types of tests (tactile, pain and thermal sensitivity) were carried out to delimit the area affected by paraesthesia. At 7 days, the area of hypoesthesia of the hemi-lip was significantly reduced. Further improvement in tactile and thermal sensitivity occurred in subsequent follow-up, at 1 and 3 months, postoperatively. This clinical case demonstrates that the surgical intervention performed with piezoelectric instruments prevented the damage of an important structure such as the lower mandibular nerve, and promoted regression of a contingent paraesthesia.

Dental injury to the second molar (SM) caused by the surgical extraction of the impacted third molar tends to be underestimated. The necessity of assessment of the impact of the removal of the wisdom tooth in the mandible on the second molar arose. The study group (n = 60) was the one with the second molar on the surgical side, and the control group (n = 60) was the one with the tooth on the opposite side of the alveolar arch. Before the surgery, the difficulty level was assessed according to the Pederson scale. The periodontal status of the SM was assessed by probing depth (PD), gingival index (GI), tooth mobility (TM) examination by the percussion method and resonance frequency. Measurements were taken before and after the surgery, 7 days and 8 weeks after the surgery. The study demonstrated the significant impact of the surgical removal of the wisdom tooth on the PD, GI and TM of the SM. The predicted degree of difficulty of the very difficult surgery had an influence on the increase in PD on the distal buccal and lingual surface of the SM, and on the GI in the proximity of the examined tooth. The results of the presented research confirm the necessity of the clinical assessment of the lower SM before and after the surgical removal of the impacted wisdom tooth in the mandible.

To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis. A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: “Ectopic teeth”, “Third molar”, “Mandibular”. One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles. From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p

Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.