Artificial Intelligence in Predicting Surgical Problems and Postoperative Morbidity in Mandibular Third Molar Extractions.

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

To compare the Ward’s Flap Versus Modified Ward’s flap in relation to access, healing & postoperative complications in surgical extraction of mandibular third molar impaction. Study Design: Comparative Cross Sectional. Setting: Department of Oral & Maxillofacial Surgery LUMHS Jamshoro/Hyderabad: Period: March 2017 to November 2017. Materials and Methods: The history, clinical examination and radiographs (OPG and periapical) had done by team of researchers and recorded on proforma. After selection of patient into either group (Group A=Wards Flap, Group B Modified Wards), the surgical extraction was carried out under local anesthesia. For group A, a standard full thickness mucoperiosteal flap (ward’s flap) was raised. The incision was given mesial to the impacted lower third molar. For group B, a standard full thickness mucoperiosteal flap (Modified ward’s flap) was given mesial to second molar. At the end of the surgery, the flap design used for the extraction of impacted lower third molar tooth and the duration of each operation (from the first extraction maneuver to the completion of the last suture), Pain, Swelling and Trismus13 were recorded on the proforma. Every patient was called for follow up on the 3rd day and 7th day. Results: Mean age was found 27.93 years, with range of minimum 20 years and maximum 35 years. Male were found in the majority 72.3%. Majority of the cases 51.5% were found with class B, in class A 37.5% and 10.9% were found with class C. According to the impaction position 50% cases were in class I, and 50% cases were in class II. Preoperative pain measurement was done according VAS, 71.9% patients were found with mild pain, 9.4% were with moderate pain while 18.8% patients were without pain. Modified Wards flap showed good efficacy regarding duration of third molar extraction as compare to Ward’s flap P-value 0.018. Modified ward’s flap had showed less postoperative pain as compare to ward’s flap p-value 0.022. No significant difference was found between both groups on 3rd and 7th postoperative day in Mouth opening. Conclusion: This study concluded that both ward’s flap and modified ward’s flaps showed good efficacy, while duration of surgery and postoperative pain were significantly less in the modified ward’s flaps as compare to ward’s flap. More large sample size studies are required to evaluate more accurate findings.

Surgical extraction of impacted mandibular third molars is one of the most common oral and maxillofacial procedures and is frequently associated with postoperative pain, swelling, and limitation of mouth opening. Pharmacological agents such as corticosteroids and proteolytic enzymes are widely prescribed to minimize these complications; however, comparative evidence on their efficacy remains limited. Objective: To compare the effectiveness of methylprednisolone and serratiopeptidase in reducing postoperative pain, swelling, and trismus following surgical extraction of impacted mandibular third molars. Methods: A randomized controlled trial was conducted at the Department of Oral and Maxillofacial Surgery, Sandeman Provincial Hospital, Quetta, Pakistan, from December 2021 to June 2022. Ninety-six eligible patients were randomly allocated into two equal groups. Group A received oral methylprednisolone 4 mg every 8 hours, and Group B received oral serratiopeptidase 10 mg every 12 hours for five days postoperatively. Pain was assessed using a visual analogue scale, swelling was measured using standardized anatomical landmarks, and mouth opening was recorded using interincisal distance. Data were analyzed using SPSS version 23, with p ≤ 0.05 considered statistically significant. Results: Both groups were comparable in age, gender distribution, impaction side, and impaction classification. Methylprednisolone demonstrated significantly lower postoperative pain (1.3 ± 0.32 vs 7.3 ± 2.0, p < 0.001) and greater improvement in mouth opening (1.3 ± 2.5 vs 7.2 ± 4.1, p < 0.001) than serratiopeptidase. Serratiopeptidase showed relatively better reduction in postoperative swelling (p = 0.04). Similar outcome trends were observed among participants aged 23–30 years. Conclusion: Methylprednisolone was more effective in reducing postoperative pain and trismus, whereas serratiopeptidase provided superior reduction in swelling following third molar surgery. The predominant clinical requirement may guide the selection of either medication. Both agents appear safe and beneficial when used short-term in postoperative management.

Introduction: The evaluation of surgical difficulty preoperatively is important during mandibular third molar (MTM) extraction. This study aimed to evaluate the difficulty index for the removal of impacted MTM using Pederson difficulty index (PDI), Parant Scale (PS), and total operation time (TOT). Materials and Methods: This was a prospective study of patients referred for the extraction of impacted MTM between April, 2019 and July, 2020. Estimated level of difficulty was done before a standardized surgery using the PDI and classified as: Minimally difficult (I), moderately difficult (II), and very difficult (III). Intraoperatively, it was classified as extraction requiring ostectomy only (II); extraction requiring ostectomy and coronal section (III); and complex extraction requiring coronal and root sectioning (IV) using the Modified PS. TOT was recorded by a resident with stopwatch. Results: A total of 502 patients (203 [40.4%] males and 299 [59.6%] females) with an M:F of 1:1.5. The age ranged from 17 to 69 years with a mean age ± standard deviation (SD) (31.6 ± 9.6) years. The majority of the patients were in the age group of 21–40 years. TOT ranged from 10 to 35 min with mean TOT ± SD (15.35 ± 7.02) min. The mean TOT according to PDI was 11.30 ± 2.22, 12.74 ± 4.14, and 26.44 ± 4.39 min in I, II, and III, respectively, while according to PS were 10.91 ± 0.9, 19.60 ± 4.5, 28.82 ± 3.5 min in II, III, and IV, respectively. The observed correlation coefficients® for PDI and PS were 0.716 and 0.870, respectively. Conclusion: Analysis of the surgical difficulty of impacted MTM extraction is essential for treatment planning and patient satisfaction. PS has been found to be significantly associated with TOT.

Background and Objectives: This study aimed to evaluate the role of A-PRF (advanced platelet-rich fibrin) in the enhancement of wound healing and protecting the periodontal health of mandibular second molars after the extraction of mandibular third molars. Additionally, the study assessed the levels of pro-inflammatory cytokines in the gingival crevicular fluid (GCF) of mandibular second molars as markers of inflammation. Materials and Methods: Twenty-five systemically healthy adult patients with bilateral removal of impacted mandibular third molars were included. Each patient received A-PRF in one extraction site, while the contralateral site served as a control. Periodontal parameters of the adjacent second molar, including probing depth (PD) and clinical attachment level (CAL), were measured in distal-vestibular (DV) and distal-lingual (DL) sites. Pain, swelling, and overall healing were subjectively evaluated. Levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) in the GCF were analyzed. Evaluations occurred at baseline and three months post-surgery. Results: A-PRF significantly improved PD (from 4.69 ± 0.61 mm to 3.85 ± 0.34 mm in DV, and from 4.71 ± 0.65 mm to 3.79 ± 0.27 mm in DL, respectively) and CAL (from 2.41 ± 0.25 mm to 1.82 ± 0.21 mm in DV, and from 2.40 ± 0.36 mm to 1.75 ± 0.19 mm in DL, respectively) of the adjacent second molar, compared to control sites, three months post-surgery. Pain and swelling scores were notably lower on the 7th postoperative day in the A-PRF group. A-PRF also reduced pro-inflammatory cytokines in GCF, significantly more than in control sites, at three months post-surgery. Conclusions: A-PRF enhances the periodontal and inflammatory status of adjacent teeth and wound healing after the extraction of mandibular third molars.

The research aims to determine the relationship between the mandibular third molars and the nearby lingual cortical bone as well as to determine the frequency of lingual cortex perforation.The analysis was carried out by “CBCTs (cone beam computed tomographic scans)” of 18-65 years old patients. Lingual cortex fenestration at both root tips was observed. Almost three-quarters of radiographs showed the majority of the lingual area on the upper portion of a root (51.2% and 52.8%). The most lingual region and the area surrounding the root tip were both 1.25 mm thick. Mandibular third molars and perforated across both base levels were shown to be significantly related (P value.001). More than 50% of patients had lingual cortical perforation brought on by mandible third-molar teeth. The likelihood of lingual cortical rupture following extraction of the mandibular third molars is a sign of a prior problem rather than surgery.

BackgroundThe inferior alveolar nerve (IAN) may be injured during extraction of the mandibular third molar, causing severe postoperative complications. Many methods have been described for evaluating the relative position between the mandibular third molar and the inferior alveolar canal (IAC) on panoramic radiography and computed tomography, but conventional radiography provides limited information on the proximity of these two structures. The present study assessed the benefits of three-dimensional computed tomography (3D-CT) prior to surgical extraction of the mandibular third molar, to prevent IAN damage.MethodsThis retrospective study included 4917 extractions in 3555 patients who presented for extraction of the mandibular third molars. The cases were classified into three groups, according to anatomical relationship between the mandibular third molars and the IAC on panoramic radiography and whether 3D-CT was performed. Symptoms of IAN damage were assessed using the touch-recognition test. Data were compared using the chi-square test and Fisher’s exact test.ResultsAmong the 32 cases of IAN damage, 6 cases were included in group I (0.35 %, n = 1735 cases), 23 cases in group II (1.1 %, n = 2063 cases), and 3 cases in group III (0.27 %, n = 1119 cases). The chi-square test showed a significant difference in the incidence of IAN damage between groups I and II. No significant difference was observed between groups I and III using Fisher’s exact test. In the 6 cases of IAN damage in group I, the mandibular third molar roots were located lingual relative to the IAC in 3 cases and middle relative to the IAC in 3 cases. The overlap was ≥2 mm in 3 of 6 cases and 0–2 mm in the remaining 3 cases. The mean distance between the mandibular third molar and IAC was 2.2 mm, the maximum distance 12 mm, and the minimum distance 0.5 mm. Greater than 80 % recovery was observed in 15 of 32 (46.8 %) cases of IAN damage.Conclusions3D-CT may be a useful tool for assessing the three-dimensional anatomical relationship and proximity between the mandibular third molar and IAC in order to prevent IAN damage during extraction of mandibular third molars.

The comparison between piezoelectric surgery and the conventional rotary bur technique along incorporation of plateletrich brin (PRF) in both groups after the surgical extraction of impacted mandibular third molars reveals several advantages and considerations. Piezoelectric surgery demonstrates superior soft tissue healing, while the conventional rotary bur technique may present quicker procedural durations, appealing to those seeking expedited procedures. The gentleness of piezoelectric instruments contributes to improved bone preservation and regeneration, contrasting with the potentially reduced trismus and postoperative swelling observed in the conventional group. When considering the integration of PRF, both techniques benet from its regenerative properties, supporting tissue healing and reducing inammation. Piezoelectric surgery, with its minimally invasive nature, aligns with favorable long-term outcomes, even though it requires a longer duration than the traditional rotatory technique, the piezoelectric device was effective in reducing the short-term effects of pain and swelling. The innovation and precision associated with piezoelectric surgery, albei requiring specialized training, contribute to a more comfortable patient experience. While upfront costs may be higher for piezoelectric surgery, the potential for faster healing and reduced complications may lead to long-term cost savings. Ultimately, the choice between these techniques, guided by patient preferences. This paper has intricately explored the nuanced advantages arising from the strategic application of platelet-rich brin (PRF) in conjunction with both piezoelectric surgery and conventional techniques during the 30 surgical extraction of impacted mandibular third molars. The relatively modest sample size, the presence of age-specic considerations particularly among the younger demographic, and the deliberate choice not to dene the angulation of impacted mandibular molars introduces an additional layer of complexity. By doing so, we can foster a more nuanced and universally applicable understanding of the advantages conferred by PRF application, especially in navigating the intricacies of challenging extraction scenarios.

BackgroundExtraction of mandibular third molars (MTM) is one of the most frequent surgical procedures in Oral Surgery. This intervention is not without risks, as one of the most common is an injury of the inferior alveolar nerve (IAN). The main objective of this systematic review is to compare the coronectomy technique with conventional extraction of MTM with a high risk of injury to the IAN, thus determining whether coronectomy is an effective surgical alternative in preventing nerve injuries.Material and MethodsA bibliographical search was conducted in October 2024 in the Pub-Med and Cochrane-Database databases, and 211 studies were obtained. Finally, 16 studies were included in the systematic review, with a total sample of 2551 patients. 2280 coronectomy procedures and 841 extractions were performed.Results6.22% of the coronectomies performed were unsuccessful. The incidence of IAN injury was 6.53% in the extraction group, while in the coronectomy group, it was only 0.56%. Permanent IAN injury was 1.18% and 0.13%, respectively. The most common complication in both groups was postoperative pain, with similar results, 15.69% in the extraction group vs. 14.21% in the coronectomy group. Lingual nerve injury was infrequent and transient in both groups, affecting 0.12% of extractions and 0.26% of coronectomies. The complication with the highest incidence in the coronectomy group was root migration, mainly during the first 6 months.ConclusionsCoronectomy is a safe and effective alternative technique for the management of MTM with a high risk of IAN injury.

Vertical control in impacted mandibular molar uprighting.

Introduction. Extraction of impacted mandibular third molars is often accompanied by intraoperative and postoperative complications such as damage of the inferior alveolar nerve, prolonged difficulty in mouth opening, alveolitis, pain and swelling in the region of surgery. The aim of this study was to compare two surgical techniques (standard and piezo) in the extraction of mandibular third molars and to assess their postoperative complications. Material and Methods. Study included 16 patients (8 male and 8 female) age 17 to 32 years treated in the period from 2012 to 2014. All patients had both mandibular molars impacted. One third molar was extracted using classical technique while the other one using a piezo device. Preoperative preparation was the same for all patients and included radiological analysis and verification of teeth by ortopan tomography (OPG) and CT. Patients were assessed one, seven and 14 days after the procedure. Results. After the extraction, all patients were followed for postoperative symptoms: pain, swelling and paresthesia of the inferior alveolar nerve. The results confirmed advantages of piezosurgery in the removal of impacted mandibular third molars. Average duration of the intervention was 18 minutes with standard technique while the duration with piezo technique was 23 minutes. According to the visual-analog scale (VAS) the average pain in the standard group was 9 whereas in the piezo group it was 6. Postoperative swelling was 10 mm (pronounced) the first day after the procedure in the standard group while in the piezo group it was 6 mm (moderate). Conclusion. The use of piezo technology for the extraction of impacted wisdom teeth is reliable method which reduces the risk of the most common postoperative complications following mandibular wisdom teeth removal.

Surgical and social implications of extraction of mandibular third molars as a separate procedure before bilateral sagittal split osteotomy

Piezoelectric compared with conventional rotary osteotomy for the prevention of postoperative sequelae and complications after surgical extraction of mandibular third molars: a systematic review and meta-analysis

INTRODUCTION The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in two separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analogue scale pain scores obtained immediately after surgical extraction were primarily evaluated for the two groups receiving different epinephrine concentrations. Visual analogue scale pain scores obtained 2, 4, and 6 h after administering an anesthetic, onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the two groups. RESULTS There were no statistically significant differences between the two groups in any measurements except hemodynamic factors (P > .05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (Pleq01). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

This systematic review and meta-analysis aimed to examine more recent data to determine the extent of lingual nerve injury (LNI) following the surgical extraction of mandibular third molars (M3M). A systematic search of three databases [PubMed, Web of Science and OVID] was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria encompassed studies on patients who underwent surgical M3M extraction using the buccal approach without lingual flap retraction (BA-), buccal approach with lingual flap retraction (BA+), and lingual split technique (LS). The outcome measures expressed in LNI count were converted to risk ratios (RR). Twenty-seven studies were included in the systematic review, nine were eligible for meta-analysis. Combined RR for LNI (BA+ versus BA-) was 4.80 [95% Confidence Interval:3.28-7.02; P<0.00001]. The prevalence of permanent LNI following BA-, BA+ and LS (mean%±SD%) was 0.18±0.38, 0.07±0.21, and 0.28±0.48 respectively. This study concluded that there was an increased risk of temporary LNI following M3M surgical extractions using BA+ and LS. There was insufficient evidence to determine whether there is a significant advantage of BA+ or LS in reducing permanent LNI risk. Operators should use lingual retraction with caution due to the increased temporary LNI risk.