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ABSTRACT: The surgical removal of impacted mesioangular mandibular third molars (3Ms) may produce trauma to the soft tissues and bony structures. In particular, healing of postextractive socket may cause periodontal defects at the distal root of the second molar. The aim of the present prospective study was to assess the outcomes of a surgical protocol to remove 3Ms including the use of ultrasound bone surgery devices and platelet-rich fibrin (PRF) as a grafting material.
Twenty-eight impacted mandibular 3Ms were removed. Fourteen 3Ms were removed by piezoelectric osteotomy and PRF application. Instead, the 14 3Ms of the control group were removed by piezoelectric osteotomy but without PRF application. Probing depth in the distal position for all the mandibular second molars was registered before and 6 months after surgery.
No complications were encountered. In the study group, alveolar socket fulfillment was rated as sufficient in 4 cases and adequate in the remaining 10 cases, whereas in the control group, it was rated as insufficient in 3 cases, sufficient in 4 cases, and adequate in 7 cases. Mean preoperative periodontal probing in the control group was 3.78 mm, whereas in the study group, it was 3.93 mm.Six months after surgery, mean periodontal probing was 3.28 mm in the control group and 3.07 mm in the study group.
Combined action of PRF and piezoelectric surgery can be considered a safe and fine technique for third molar surgery and alveolar socket healing.
The Journal of craniofacial surgery 09/2011; 22(5):1951-5. · 0.81 Impact Factor
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ABSTRACT: The aim of this prospective study was to assess the clinical and histologic outcomes obtained with calcium sulfate (CS) used as a filler material in fresh premolar and molar postextraction sockets.
Sixty premolar or molar postextraction sockets were filled with CS. Among the 60 grafted sockets, after 3 months, 50 underwent implant placement and clinical assessment. The removal of a sample core of newly generated intrasocket tissue was performed in 19 sockets. Collected samples were sent for histologic examination. The percentage of vital bone, nonvital bone, residual CS, amorphous material, and connective areas in every sample was calculated and recorded.
Fifty postextraction regenerated sockets that underwent implant placement 3 months after tooth removal were included in this study.A partial postoperative exposition of the graft was observed in 12 of 50 sockets. At the surgical reentry, the augmented extraction sockets were completely filled by a hard material with an adequate alveolar crest in 41 cases. Histologic examination of the cores revealed that 63.16% of the intrasocket tissue was new vital bone, 2.1% was nonvital bone, 4.74% was fibrous tissue, and 30% was amorphous material. No residual CS was identified in bone cores.
This study confirmed that CS is an ideal grafting material. The clinical adequacy aspect of filled sockets at surgical reentry seemed to be indicative of a qualitatively better bone regeneration. Postoperative exposition of graft material after a first intervention seemed to constitute an important risk factor for a worse bone regeneration.
The Journal of craniofacial surgery 03/2011; 22(2):494-8. · 0.81 Impact Factor
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ABSTRACT: The objective of the study was to prospectively assess the intraoperative findings and the radiographic signs of a study population of patients with impacted third molars at risk of inferior alveolar nerve injury. One hundred thirty-four patients with impacted mandibular third molars at risk for nerve injury were included in the study. Radiographic signs of possible close relationship between the 2 structures and intraoperative exposition or damage of the inferior alveolar nerve were recorded. The follow-up controls comprised clinical examinations and assessment for the sensation of the lower lip and chin. In 24 patients, a real contiguity was encountered between the third molars and nerve. Among these, intraoperative neural exposition was observed in 19 patients. Four patients complained of postoperative temporary hypoesthesia. No deficit of sensibility was found in cases with no exposition of the nerve. The accidental exposition of the inferior alveolar nerve is associated with an increased risk for neural injuries. At panoramic radiograph, the presence of signs of bifid and radiolucent apex, superimposition, and radiolucent root band should be considered at high risk for neural damage.
The Journal of craniofacial surgery 11/2010; 21(6):2003-7. · 0.81 Impact Factor
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ABSTRACT: To analyze and discuss the demographic, clinical, and surgical aspects of 261 surgically treated keratocystic odontogenic tumors.
A retrospective review was performed of all cases of treated keratocystic odontogenic tumors. Statistical analysis was used to search for associations among age, presenting symptoms, location, dimension, and locularity.
Keratocystic odontogenic tumors most commonly occurred in patients in the third and fourth decades of life. The ratio of males to females was 2:1. The mandibular angle region was the most frequently involved site. Significant associations were found between multilocular lesions and lesions larger than 31 mm (P < .00000005), a mandibular site and larger lesions (P < .05), patients younger than 41 years old and multilocular lesions (P < .05), and younger patients and larger lesions (P < .00005).
It is likely that most multilocular, larger (and probably aggressive) lesions are found in patients younger than 41 years of age.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 10/2010; 68(12):2994-9. · 1.58 Impact Factor
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ABSTRACT: Inferior alveolar neurovascular bundle (IANB) injury is one of the most common complications of third molar removal and involves important medicolegal issues. An accurate preoperative radiographic assessment of surgical difficulty is necessary to correctly plan the removal of impacted third molars and to estimate the risk of IANB injury. Therefore, the preoperative knowledge of the exact location of the third molar roots in relation to the mandibular canal is mandatory. A direct contact between the tooth and neurovascular bundle is suggested by a radiotransparent band across the roots of the impacted third molar on panoramic radiograph. We present the management of a patient with IANB damage associated with third molar surgery.
The Journal of craniofacial surgery 07/2010; 21(4):1175-7. · 0.81 Impact Factor
