Article

The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study

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Article

The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study

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Abstract

The purpose of this investigation was to assess the frequency of complications of third molar surgery, both intraoperatively and postoperatively, specifically for patients 25 years of age or older. This prospective study evaluated 3,760 patients, 25 years of age or older, who were to undergo third molar surgery by oral and maxillofacial surgeons practicing in the United States. The predictor variables were categorized as demographic (age, gender), American Society of Anesthesiologists classification, chronic conditions and medical risk factors, and preoperative description of third molars (present or absent, type of impaction, abnormalities or association with pathology). Outcome variables were intraoperative and postoperative complications, as well as quality of life issues (days of work missed or normal activity curtailed). Frequencies for data collected were tabulated. The sample was provided by 63 surgeons, and was composed of 3,760 patients with 9,845 third molars who were 25 years of age or older, of which 8,333 third molars were removed. Alveolar osteitis was the most frequently encountered postoperative problem (0.2% to 12.7%). Postoperative inferior alveolar nerve anesthesia/paresthesia occurred with a frequency of 1.1% to 1.7%, while lingual nerve anesthesia/paresthesia was calculated as 0.3%. All other complications also occurred with a frequency of less than 1%. The findings of this study indicate that third molar surgery in patients 25 years of age or older is associated with minimal morbidity, a low incidence of postoperative complications, and minimal impact on the patients quality of life.

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... following the extraction of third molars is reported in the literature. [11][12][13][14][15] Complications may occur intraoperatively or develop during the postoperative period. Intraoperative complications may include bleeding, damage to adjacent teeth, injury to surrounding tissues, displacement of teeth into adjacent spaces, fracture of the root, maxillary tuberosity or the mandible. ...
... Most studies related to complications of third molar removal have stated similar findings. [12][13][14][15] In this study, intraoperative complications were encountered in 40 cases. There were 12 cases of unretrieved root fractures; the root fragments were usually fragments of the apical third and were in close proximity to vital structures such as the inferior alveolar canal (IAC) or the maxillary sinus and required additional bone removal for retrieval with possible risk of damage to adjacent structures. ...
... The most commonly reported postoperative complication of third molar removal in the literature are dry socket, infection, bleeding and sensory disturbances due to nerve injuries. [11][12][13][14][15][16][17][18][19][20][21][22][23] In the present study, the overall postoperative complication rate was 8.3%. Extraction of third molars is often associated with expected and typically transient postoperative pain, swelling and trismus; however, at times, this pain may present beyond the first postoperative week and may require additional treatment such as placement of a dressing or administration of antibiotics during a follow-up visit. ...
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Objectives: This retrospective study aimed to investigate complications associated with the extraction of third molars at a tertiary healthcare centre in Oman. Methods: All consecutive patients who underwent extraction of one or more impacted third molars under general anaesthesia at Sultan Qaboos University Hospital, Muscat, Oman, between January 2007 and December 2017 were included. Age, gender, indication for extraction, teeth removed, procedure and complications were recorded. Results: A total of 1,116 third molars (56% mandibular and 44% maxillary) were extracted and the majority (67.7%) were from female patients. The mean age at extraction was 24 ± 5 years and most patients (77.7%) were 20-29 years old. The intraoperative and postoperative complication rates were 3.7% and 8.3%, respectively. The intraoperative complications included tuberosity fracture (1.2%), root fracture (1.1%), bleeding (0.7%), soft tissue injury (0.5%) and adjacent tooth damage (0.2%). Postoperative complications were sensory nerve injuries (7.2%), swelling/pain/trismus (0.6%) and dry socket (0.5%). Nerve injury was temporary in 41 patients and permanent in four cases. A statistically significant relationship was observed between those aged 30-39 years and dry socket (P = 0.010) as well as bone removal and all postoperative complications (P = 0.001). Conclusion: Most complications resulting from third molar extractions were minor and within the reported ranges in the scientific literature. However, increased age and bone removal were associated with a higher risk of complications. These findings may help to guide treatment planning, informed consent and patient education.
... Surgical removal of impacted lower third molars may cause damage to the inferior alveolar nerve (IAN). The reported incidence of IAN injury after the surgical removal of impacted lower third molars ranges from 0.17 to 1.8% on a tooth/ extraction basis in the recent literature [1][2][3][4][5][6][7]. ...
... The sensitivity of these radiographic risk indicators has been questioned by Gomes et al. [18] on the basis of a study of 260 lower third molar extractions. Another significant risk indicator appears to be the age of the patients [3-5, 7, 19-23], with a cutoff at around 25 years [3,5,7,19,20,24]. The combined effect of age and radiographic features on the occurrence of nerve injury has been investigated by Blondeau and Daniel [25], who reportedly employed the classifications of Pell and Gregory [26] and Winter [27] to evaluate the risk of postoperative complications, in particular neurosensory problems. ...
... The main outcome of this pragmatic prospective study was the frequency of patient-reported postoperative alterations of the lip sensitivity. The expected frequency of permanent damage is so low that a huge sample (thousands of extractions) would be needed to ascertain its incidence, but transient disturbances are rather common in both retrospective [1][2][3][4][5] and prospective studies [6,7]. The incidence of transient neurological impairment was 1.18% in the whole sample. ...
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Objectives The aim of this study was to assess the combined role of current radiographic risk indicators and patient age in predicting lower lip sensitivity disturbances after surgical removal of impacted lower third molars. The question was which combinations indicate low or high risk. Materials and methods A prospective study was implemented involving 247 consecutive outpatients who underwent 423 surgical extractions. The predictor variables were patient age and risk indicators observed on panoramic radiographs. The outcome variable was the incidence of self-assessed lip sensitivity alterations. The extractions were subdivided into four groups according to the predictors. Results Two hundred forty-five teeth were extracted in patients younger than 25 years and 178 in patients 25 years old or older; radiographic risk indicators were associated with 226 out of 423 teeth (53.43%). No permanent neurological damage was observed. Transient lip sensitivity alterations were observed in five cases (1.18%; 95% confidence interval = 0.4 to 2.7%), all in the older group with radiographic risk indicators. Conclusions The data indicate a low overall incidence of transient lip sensitivity impairment that occurred only in the presence of radiographic risk indicators in patients aged ≥ 25 years. Clinical relevance Informed consent should include the possibility of inferior alveolar nerve injury in mature patients with radiographic risk indicators. Prophylactic removal of impacted teeth with radiographic signs of risk may be indicated when the patient is not yet aged 25 years.
... An extraction socket with an exposed bone, either whole or in part, is diagnosed as dry socket, and stimulation of this extraction socket induces sharp persistent pain and odor [1]. Another cause of post-extraction pain is hypersensitivity of the adjacent tooth [2,3,4,5]. Pain in the adjacent tooth could be caused by injuries from the forces exerted during extraction, dislocation of large restorations, subluxations, and crown fractures [2,3,4,5]. There have been a few studies on the clinical features and prognosis of pain associated with injuries of the adjacent tooth. ...
... Another cause of post-extraction pain is hypersensitivity of the adjacent tooth [2,3,4,5]. Pain in the adjacent tooth could be caused by injuries from the forces exerted during extraction, dislocation of large restorations, subluxations, and crown fractures [2,3,4,5]. There have been a few studies on the clinical features and prognosis of pain associated with injuries of the adjacent tooth. ...
Article
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Background: After tooth extraction, pain due to dry socket and pain in the adjacent tooth are common. The aim of this study was to retrospectively analyze pain in the adjacent tooth after surgical extraction of the mandibular third molar. Methods: Postoperative pain due to dry socket, pain in the adjacent tooth, and pain from other causes were present. Group A included patents with dry socket alone; group B included patients with pain in the adjacent tooth alone; and group C included patients with both. The duration of symptoms was recorded. In addition, the prognosis of pain was divided into the complete improvement, improvement, maintenance, deterioration, and complete deterioration groups. Results: A total of 312 mandibular third molars were extracted from 13, 60, and 10 patients in groups A, B, and C, respectively. The mean duration of symptoms was 5 days in group A and B and 15.2 days in group C. There were statistically significant differences in the duration of symptoms between groups A and C and groups B and C. Conclusion: Pain in the adjacent tooth after third molar extraction can be caused by inflammatory reactions and pressure on this tooth. The pain caused by pressure on the periodontal ligament and alveolar bone results from the cytokines released by osteoclasts, which are responsible for bone destruction. However, pain from periodontal ligament damage caused by excessive pressure may be misunderstood as pulpal pain. Unconscious parafunctional habits, such as clenching and bruxism, could also be associated with post-extraction pain.
... Factors that affect the incidence of complications are age, gender, medical history, type of impaction, the relationship of the teeth to the inferior alveolar nerve and the lingual nerve as regards to the third molars of the lower jaw as well as their relationship with the maxillary sinus (antrum of Highmore) as regards to the third molars of the upper jaw, the technique of anesthesia, the experience of the surgeon, etc. and also anxiety and fear of the patient [1][2][3][4]. ...
... both intraoperatively and postoperatively and sometimes can be life-threatening for the patient [1]. The unexpected intraoperative bleeding occurs in 0.7% [4]. It is distinguished in: Expected, primary, secondary and reactive (mainly related to soft tissues). ...
... The most significant complication is postoperative nerve injury, associated with inferior alveolar nerve (IAN) or lingual nerve after the surgical extraction of the mandibular third molar. According to the literature, the incidence of IAN damage and lingual nerve damage after third molar surgery have been reported to be various, at approximately 0.35-8.4% [1][2][3] and 0.02-2% [4]. Consequently, several surgical approaches have been proposed to reconstruct the damaged tissues, with promising short-term outcomes [5]. ...
... The aims of the present study were: (1) to investigate and compare the incidence of IAN injury in groups with and without intraoperative IAN exposure during surgical extraction of the mandibular third molar; (2) to identify additional risk factors for the IAN injury in addition to the IAN exposure. ...
Article
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During extraction surgery, the inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3). The purpose of this study was to investigate and compare the incidence of IAN injury in groups with and without intraoperative IAN exposure during surgical extraction of M3, and to identify additional risk factors for the IAN injury in addition to the IAN exposure. A total of 288 cases in 240 patients, who underwent surgical extraction of M3 by a single surgeon, were divided into the exposed group (n = 69) and the unexposed group (n = 219). The surgeon recorded the information regarding the procedure when the clinical observation of IAN exposure was made during the surgery. The incidence of IAN injury after the extraction surgery was significantly higher in the exposed group than in the unexposed group (4.3% versus 0%, p < 0.05). Paresthesia was recognized in three cases of the exposed group, but it showed complete recovery within three postoperative months. No case of permanent paresthesia was detected in both groups. According to the logistic regression, the only significant risk factor of IAN injury in the exposed group was the increase of age (OR 1.108, p < 0.05). Intraoperative IAN exposure during surgical extraction of M3 may show a higher incidence of IAN injury than the case without IAN exposure, representing an incidence of 4.3%. Even if the paresthesia associated with IAN exposure occurs, it is likely to be a temporary injury, and this risk may increase with age.
... The prevalence of impacted third molars is quite different from county to country but mostly the prevalence ranges between 16.7-68.6% across various populations [7][8][9][10][11][12][13][14]. Studies from the Gulf region have reported an impacted third molars rate of 32-40.5% [13,14]. ...
... across various populations [7][8][9][10][11][12][13][14]. Studies from the Gulf region have reported an impacted third molars rate of 32-40.5% [13,14]. A recently published study from NEPAL found that 54.3% of young Nepali adults between 19-26 years old have at least one impacted third molar [15]. ...
Research
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Objectives: The main objective of this retrospective study is to find out the complications of surgical extraction of third molars under local Anesthesia performed at dental department. Methods: Patients who went surgical extraction of one or more third molars under local anesthesia between 2017 to 2019 were included. Age, gender, indication for extraction, teeth removed, procedure and complications were recorded. Results: A total of 4,220 third molars (91.94% mandibular and 8.85% maxillary) were extracted and the majorities (54.68.7%) were from male patients. The mean age at extraction was 29 ± 5 years and most patients (58.07%) were 25-34years old. The intraoperative and postoperative complication rates were 2.08% and 32.23%, respectively. The intraoperative complications included tuberosity fracture (0.78%), root fracture (0.41%), bleeding (0.26%), soft tissue injury (0.1%) and adjacent tooth damage (0.15%). Postoperative complications swelling/pain/trismus (31.77%) and dry socket (0.36%). A statistically significant relationship was observed between those aged 35-44 years and dry socket (P = 0.010) as well as bone removal and all postoperative complications (P = 0.001). Conclusion: Most complications resulting from third molar extractions were minor and within the reported ranges in the scientific literature. However, increased age and bone removal were associated with a higher risk of complications. These findings may help to guide treatment planning, informed consent and patient education.
... However, people tend to neglect and mostly only go to the dentists when the condition is severe as it is secondarily infected and progressed towards abscess, cyst or tumor. 5 This influenced the writer to discuss further on this issue as there was no previous study performed on this matter which stated its preponderance. This paper includes the treatments and preventions, with the main purpose to find its prevalence in the Department of Oral and Maxillofacial Surgery, Rumah Sakit Hasan Sadikin, Bandung (RSHS). ...
Article
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Introduction: Malposition third molar is a condition when the third molar is erupted but in an abnormal position and relation to maxilla and mandible. Due to a frequent mechanical abrasion between the third molar and oral mucosa, a traumatic ulcer resulted. Hence, this research aims to determine the prevalence of traumatic ulcer in regards to a malposed third molar in Oral and Maxillofacial Surgery Department, Rumah Sakit Hasan Sadikin in a periodic of August 2008 to August 2011.Methods: The samples taken were all medical records which stated the coveted diagnosis which satisfied the variables of the age, gender and malposed third molar. The method of this research was descriptive retrospective study by using secondary data. Results: This research ratiocinates that the prevalence of malposition third molar with traumatic ulcers is 0.012% with tooth 18 caused most traumatic ulcer. Females predominant this condition and it is common in the third decade of age. Conclusion: Derived from the outcomes of this research, it can be concluded that the prevalence of malposition third molar with traumatic ulcer in Oral and Maxillofacial Surgery Department of Rumah Sakit Hasan Sadikin from August 2008 to August 2011 is 0.012%.
... Há discussões quanto ao uso de antibióticos em relação à remoção de tecido mole, remoção total ou parcial de osso, tempo ideal de uso, dose, duração e via de administração (MARIN et al., 2005). Mesmo que, paradoxalmente, a maioria dos cirurgiões britânicos e mais de 50% dos americanos prescreverem antibióticos sistêmicos para as cirurgias de terceiros molares (PERROTT; YUEN; ANDRESEN, 2003, FALCONER;ROBERTS, 1992, HAUG et al., 2005, esta tendência mundial deve ser investigada, questionada e comprovada para uma prática clínica adequada. Desta forma, este estudo demonstrou que a profilaxia antibiótica não deve ser prescrita em todos os casos, desde que a avaliação de fatores como condições sistêmicas do paciente, habilidade do operador, contaminação do ambiente cirúrgico e insalubridade seja feita corretamente. . ...
... The publications by Chuang et al. 80,81 are linked to a series of publications 78,79,222 that report the outcomes of the American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study, 222 a prospective cohort study. Chuang et al. 80 reports on the frequency of complications following 3M surgery, and it was concluded from the results that increased age appears to be associated with a higher rate of complications: patients aged 25-35 years were statistically significantly more likely to have a complication than patients aged < 25 years (OR 1.63; 95% CI 1.12 to 2.37; p = 0.01). ...
Article
Background Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed. Objective The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars. Methods Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care. Results The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group’s lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out. Limitations Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking. Conclusions The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy. Future work Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected. Study registration This study is registered as PROSPERO CRD42016037776. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
... Studies have documented the same observation of no gender difference statistically of third molar impaction despite the female preponderance. [6,14,15,[21][22][23] On the contrary, Kumar et al. [24] have reported a statistically significant female preponderance from the Hail region of the kingdom. Likewise, some studies have reported a higher female predominance in white European females [14,25] and Singapore Chinese females than males. ...
Article
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Objectives: Third molar impaction is a common condition associated with a high standard of living. The main objective of the study was to document the prevalence of mandibular third molar impactions among the Najran populace. Methods: This is a retrospective study reviewing computerized medical records and panoramic radiographs of patients presenting for the extraction of mandibular third molars. Ethical approval was granted from the General Directorate of Health Affairs, Ministry of Health, Najran region. Data such as demographics, indications for third molar removal, position, and pattern of third molar impaction were collected. Data were stored and analyzed using IBM SPSS software version 25 for IOS (Armonk, NY: IBM Corp). Results: Of 6205 extractions, 1024 mandibular third molar extractions were carried out with a prevalence rate of 16.5%. There were 609 (59.5%) female and 415 (40.5%) male (F:M = 1.5:1). The age ranged from 17 to 69 years (mean ± standard deviation, 31.4 ± 9.6 years), with the majority (52.1%) in the age group of 21–30 years. One hundred and ninety‑one (18.6%) of the pericoronitis cases were associated with vertical impaction, while the majority of the caries were associated with mesioangular impaction (323 [31.5%]). Mesio‑angular impactions (40.8%) and Level A depth (477 [46.6%]) were the most common. Class I ramus relationship had the highest distribution (561 [54.8%]). Conclusions: We have reported a prevalence rate of 16.5% of impacted mandibular third molar in mostly 21–30 years of age with female preponderance. Pericoronitis was the main indication for surgical extraction.
... 14 Distal caries in mandibular second molars due to mesially tilted impacted third molars is a tremendous public health concern which needs to be addressed. 15 Various studies prove that early extraction of third molars can prevent this; thereby arresting premature tooth loss. 16,17 There is a lack of local research on the occurrence of distal caries in mandibular second molar due to third molar impactions. ...
Article
Full-text available
OBJECTIVE: This study was conducted to observe the relationship of mesio-angular impacted third molars to the development of distal caries in adjacent second molars. METHODOLOGY: This cross-sectional study was conducted at Nishtar Institute of Dentistry, Multan. Nine hundred and eighty nine periapical, bitewing and Panoramic radiographs were recorded and examined for distally carious second molars and impacted mandibular third molars. SPSS version 23.0 was used for data entry and analysis. RESULTS: Almost 40.8% of the target population reported with distal caries due to third molar impactions. A total of 53.30% of these impactions were of the mesio-angular variety. No distal caries was detected in transverse type of impactions. CONCLUSION: The current study concluded that the prevalence of distal caries in mandibular second molars and the positioning of adjacent impacted mandibular third molars in the dental arch were interlinked. Consequently, extraction of mandibular third molars should be considered to prevent caries and premature loss of second molar teeth. KEYWORDS: Distal caries, Impacted third molar, Infections, Risk Factor HOW TO CITE: Ashar T, Shakoor A, Ghazal S, Parveen N, Saleem MN, Raja HZ. Prevalence of distal carious lesions in mandibular second molars due to mesio-angular impacted third molars. J Pak Dent Assoc 2021;30(1):50-55.
... However, in our study impaction of premolars was to less degree and there no impacted for lower central or lateral incisors. Kamberous et al. and Haug et al. revealed similar findings (Kamberous et al. 1988;Haug et al. 2005). ...
Article
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The aim of this study is to investigate the prevalence and distribution of impaction permanent teeth among orthodontic patient samples and to compare the present results with findings of other populations. A digital panoramic radiograph of 2500 orthodontic patients, age 12-40 years, for two years duration (2018-2019) were used in this study to identify 157 patients with impacted teeth. Whole permanent teeth were included except 3rd molar. The presence, number and depth of all the impacted teeth either soft-tissue impaction (STI) and bony-impactions (BI) were recorded and a statistics analysis was done by using SPSS. The results of present study show that the prevalence of impacted teeth was 6.28%. The teeth impaction was more commonly in younger population and the impaction in females more than in males. The maxillary canine was the most frequently impacted tooth and most of the patients had unilateral impacted teeth. The bony impaction was more than soft tissue impaction. It can be concluded that the Impacted teeth prevalence in a group of the orthodontic patients was within the average value of the majority of published studies in the literature. the impaction was significantly more prevalent in females. In orthodontics, the impacted teeth play a critical part in aesthetics, occlusion and arch development. The early recognition of these dental anomalies is very important to offer preventive modalities of management.
... The reported incidence of IAN injury ranged from 0.35 to 19% when the tooth roots were very close to the IAN (Carmichael & McGowan, 1992;Cheung et al., 2010;Guerrero et al., 2014;Hasegawa et al., 2013;Haug, Perrott, Gonzalez, & Talwar, 2005;Kjølle & Bjørnland, 2013;Lopes et al., 1995;Martin, Perinetti, Costantinides, & Maglione, 2015;Smith, 2013). A recent larger study reported that among 4,338 lower third molar extractions performed by various levels of surgeons, IAN injury occurred in 0.35% (Cheung et al., 2010). ...
Article
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Lower third molar removal is the most commonly performed dental surgical procedure. Nevertheless, it is difficult to ensure that all the informed consent forms given to patients are based on the best evidence as many newer publications could change the conclusions of previous research. Therefore, the goal of this review paper is to cover existing meta-analyses, randomized control trials, and related articles in order to collect data for improved and more current informed consent.
... No scientific studies suggested or supported the early/prophylactic extraction of third molars to prevent future disease, but still it continues to be promulgated by the professionals. 2,3 As a matter of fact, no more than 12% of the impacted teeth have associated pathology, which is similar in terms of incidence to appendicitis (10%) and cholecystitis (12%). 4 Evidence from research suggested that wisdom teeth removal has immediate negative effect on patient's quality of life (QoL), that is, working and social lives. ...
Article
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One of the most important aspects of postsurgical care is finding an efficient way for the management of pain. Third molar extractions/surgical impaction is one of the most frequent surgical procedures in dental hospitals, and it is most often associated with postoperative complications like severe pain, oedema and reduced mouth opening. This study was aimed to evaluate the efficacy of 2 g intravenous
... Third molars continue to erupt till 25 years of age thus before 20 years they remain asymptomatic however after 25 years the chances of pathologies associated with ITM also increases. Thus commonly patients in third decade presents for extraction 20 . ...
... The inferior alveolar nerve (IAN) and lingual nerve (LN) are subjected to manipulation and potential damage during various surgical procedures. Disregarding some major maxillofacial surgeries where nerve manipulation is unavoidable, third molar extraction is considered to be the most common cause of neurosensory disturbance related to both the IAN and LN [3][4][5][6] . Other causes of iatrogenic nerve injury include local anesthetic injections, dental implant placement, pre-prosthetic surgery, endodontic treatment, orthognathic surgery, ablative tumor resection, and maxillofacial trauma [7][8][9][10][11][12][13] . ...
Article
This systematic review and exploratory meta-analysis of the available evidence was performed to examine whether early nerve repair of lingual nerve (LN) and inferior alveolar nerve (IAN) injuries has an effect on neurosensory recovery. A literature search was conducted to identify relevant studies meeting the inclusion criteria. Two reviewers independently evaluated the methodological quality of the included studies and the risk of bias using the ROBINS-I quality assessment tool. For the quantitative analysis, data were pooled using the Mantel–Haenszel random-effects method due to the clinical heterogeneity across the studies. Sensitivity and subgroup analyses were performed based upon the group definition of timing from injury to nerve repair, with breakpoints of 2, 3, and 6 months. A total 1236 citations were identified, with a final 13 studies included in the systematic review. A clear definition of ‘early’ versus ‘late’ repair was not reported in six studies, allowing only seven to be included in the meta-analysis. The effect of early repair on functional sensory recovery was found not to be significant in nine studies, while four studies found a significant effect of early intervention. The meta-analysis showed a combined success rate of 93.0% for the early group and 78.5% for the late group. The odds of improvement were 5.49 (95% confidence interval 1.40–21.45) in the 3-month breakpoint studies and 2.28 (95% confidence interval 1.05–4.98) in the 6-month studies. A trend towards early repair achieving better functional sensory recovery outcomes was observed, but the specific time period is unknown.
... Likewise, it was also the most common type among Chinese (80%) and Korean populations (46.5%). In this study, mesioangular impaction was the most common type (50%) 10 . ...
Article
Full-text available
Clinical assesment of impacted lower third molars
... Several studies have reported an incidence of IAN injury of 0.26-8.4% [9][10][11][12][13][14][15]. Various factors such as the age of the patient, the experience of the surgeon, and the extent and location of the impaction are discussed as the risk factors of the nerve injury [15][16][17]. ...
Article
Full-text available
The purpose of this study was to analyze the incidence and risk factors of possible inferior alveolar nerve (IAN) injury after extraction of the mandibular third molars. A total of 6182 patients were examined for 10,310 mandibular third molar teeth. Panoramic radiography and patients’ medical records were used to analyze age, gender, and impaction pattern of the mandibular third molar. Cone beam computed tomography (CBCT) was used to investigate the detailed pathway of the inferior alveolar nerve and evaluated the presence of symptoms of nerve damage after tooth extraction. In CBCT, 6283 cases (61%) of the inferior alveolar nerve were actually in contact with the root of the mandibular third molar. The correlation with the panoramic signs of root darkening (p < 0.001), root deflection (p < 0.001), interruption of the IAN (p < 0.001), diversion of the IAN (p < 0.001), and narrowing of the IAN (p < 0.001) had statistical significance. Of the 4708 patients who underwent surgical extraction, 31 (0.658%) complained of nerve damage. Among them, 30 patients (0.637%) complained of symptoms of inferior alveolar nerve damage, and 1 patient (0.02%) complained of symptoms of lingual nerve damage. There was a significant correlation with IAN injury in cases where the roots became dark at the IAN area (p = 0.018) and there was diversion of the IAN at the root area (p = 0.041). When the narrowing of the IAN and the lingual driving pathway of the inferior alveolar nerve appeared simultaneously in CBCT, the risk of IAN injury was high.
... The compilation rate of 4.6-30.9% following the extraction of third molars is reported in the literature [4][5][6][7][8], which may occur intraoperatively or develop during the postoperative period. ...
Article
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Background: The goal of this article is to present and evaluate the clinical effectiveness of a new surgical approach using a triangular flap with slight modification and a 3-0 black braided silk surgical suture as flap retractor which is later used after the surgical procedure as a normal suture, aiming to decrease procedure time, soft tissue retraction, and tools for removal of impacted mandibular third molar. Methods: Patients requiring removal of fully impacted or semi-impacted lower third molars are treated with a new approach using minimal steps and tools, a simple triangular flap, slight mucoperiosteum elevation, as the flap sides are secured and reflected with a silk suture by an assistant holding both sides of the suture from behind the patient. Results: The surgical area at the procedure was efficiently exposed, and the separation of the crown from the roots was easily done using a surgical handpiece, separation and removal of the crown, removal of the roots with a straight elevator, without the need of flap retractor or overexposure of the surgical side with a conventional triangular flap or others. After the treatment, the two sides of suture are tied together with double overhand knots, and the surgical site was fully repositioned and closed without any complications. 5- and 7-day follow-up was done on the patients, and no complications were reported. Conclusions: This preliminary study presents a new surgical approach (Sartawi technique) which can be used during extraction of impacted and semi-impacted lower third molars, the results showed that the operation time was noticeably reduced, the size of exposed mucoperiosteum tissue was minimized compared to the conventional method, the use of the mucoperiosteum elevator was eliminated, and number of suture knots and suture used to close the surgical site reduced to a single stitch.
... Though the results were not statistically significant , the age groups 31-40 and 41-50 years showed more complications than the other groups. A study related to American Association of Oral and Maxillofacial Surgeons age related third molar study [30][31][32][33] showed that patients over the age of 25 years were 46% likely to develop the complication that those under that age. Consistent with other studies, our results indicated that mandibular third molars were associated with an increased frequency of complications relative to maxillary third molars. ...
... Isso porque esses elementos dentários por serem os últimos a erupcionarem na arcada, apresentam-se como os de maior incidência de inclusão, semi-inclusão ou impactação. Embora seja um procedimento comum, existem complicações trans e pós-operatória que desafiam o cirurgião a conduzir o processo cirúrgico com segurança e confiança para si e seus pacientes [3][4][5][6] . ...
Article
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A cirurgia de terceiros molares, embora seja um procedimento rotineiro em nível ambulatorial pode evoluir para complicações trans ou pós-operatorias, as quais o cirurgião deverá estar apto para conduzir os casos da maneira mais adequada. O objetivo desta pesquisa foi avaliar a prevalência das complicações associados a terceiros molares em um serviço de referência no sertão paraibano, Brasil. Este estudo se trata de pesquisa retrospectiva com levantamentos de dados através de prontuários odontológicos, os quais para serem inclusos para análise deveriam estar preenchidos completamente e os pacientes terem se submetidos a exodontias de algum terceiro molar e acompanhado por pelo menos 07 dias pós-operatório. A amostra foi formada com 226 prontuários, os quais registram 483 desses tipos de exodontias. Verificou-se que as complicações tiveram uma prevalência geral de 8,9%, de forma que as mais frequentes foram fratura radicular (27,9%), alveolite (20,93%), parestesia do nervo alveolar inferior (18,6%), parestesia do nervo lingual (7,0%), hemorragia trans-operatória (7,0%), fratura do túber da maxila (4,65%), parestesia do nervo facial (2,32%), luxação da ATM (2,32%), fratura de broca (2,32%), hemorragia pós-operatória (2,32%), laceração de tecido mole (2,32%), e lipotínea (2,32%). Conclui-se que os pacientes na faixa etária de 16 a 25 anos, do gênero feminino foram os mais acometidos e a fratura radicular apresentou-se mais prevalente seguida da alveolite e parestesia do nervo alveolar inferior.Descritores: Prevalência; Cirurgia Bucal; Dente Serotino.ReferênciasCosta MG, Pazzini CA, Pantuzo MCG, Jorge MLR, Marques LS. Is there justification for prophylactic extraction of third molars? A systematic review. Braz Oral Res. 2013;27(2):183-88.Chang SK, Perrott DH, Susarla SM, Dodson TB. Age as a risk factor for third molar surgery complications. J Oral Maxillofacial Surg. 2007;65(9):1685-92.Haug RH, Perrott DH, Gonzalez ML, Talwar RM. The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study. J Oral Maxillofac Surg. 2005;63:1106-14.Mahdey HM, Arora S, Wei M. Prevalence and difficulty index associated with themandibular molar impaction among malaysian ethnicities: a clinico-radiographic study. J Clin Diagn Res. 2015;9(9):ZC65-8.Dias-Ribeiro E, Lima-Júnior JL, Barbosa JL, Haagsma IB, Lucena LBS, Marzola C. Avaliação das posições de terceiros molares retidos em relação à classificação de Winter. Rev Odontol UNESP. 2008;37(3):203-9.Kanneppady SK, Balamanikandasrinivasan, Kumaresan R, Sakri SB. A comparative study on radiographic analysis of impacted third molars among three ethnic groups of patients attending AIMST Dental Institute, Malaysia. Dent Res (Isfahan). 2013;10(3):353-58.Reddy KVG, Prasad KVV. Prevalence of third molar impactions in urban population of age 22-30 years in South India: an epidemological study. J Indian Dent Assoc. 2011;5(5):609-11.Al-Anqudi SM, Al-Sudairy S, Al-Hosni A, Al-Maniri A. Prevalence and pattern of third molar impaction - a retrospective study of radiographs in Oman. Sultan Qaboos Univ Med J. 2014;14(3):e388-e92.Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg. 2004;62(11):1363-71.Sursala MS, Blaeser BF, Magalnick D. Third molar surgery and associated complication. Oral Maxillofacial Surg Clin North Am. 2003;15(2):177-86.de Carvalho RW, de Araújo Filho RC, do Egito Vasconcelos BC. Assessment of factors associated with surgical difficulty during removal of impacted maxillary third molars. J Oral Maxillofac Surg. 2013;71(5):839-45.Osborn TP, Frederickson G Jr, Small IA, Torgerson TS. A Prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985;43(10):767-69.Bui, CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J. Oral Maxillofac Surg. 2003;61(12):1379-89.Chiapasco M, De Cicco L, Marrone G. Side effects and complications associates with third molar surgery. Oral Surg Oral Med Oral Pathol. 2006;76(4):412-20.Kato RB, Bueno RBL, Oliveira Neto PJ, Ribeiro MC, Azenha MR. Acidentes e complicações associadas á cirurgia dos terceiros molares realizada por alunos de odontologia. Rev cir traumatol buco-maxilo-fac. 2010,;10(4):45-54.Bachmann H, Cáceres R, Muñoz C, Uribe S. Complicaciones en cirugía de terceros molares entre los años 2007-2010, en un hospital urbano, Chile. Int J Odontostomat. 2014;8(1):107-12.Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc. 2007;73(4):325.Pitekova, L.; Satko, I. & Novotnakova, D. Complications after third molar surgery. Bratisl Lek Listy. 2010;111(5):296-98.Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: Risk indicators for extended operation time, postoperative pain, and complications. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endod. 2004;97(4):438-46.Hupp JR. Cirurgia oral maxilofacial contemporânea. 6. ed. Rio de Janeiro:Elsevier; 2015.Laskin D. Oral and Maxillofacial Surgery. St Louis:Mosby Co; 1985.Killey HC, Kay LW. The impacted wisdom tooth. Edinburgh: Churchill Livingstone; 1975.Araujo OC, Agostinho CNLF, Marinho LMRF, Rabêlo LRS, Bastos EG, Silva VC. Incidência dos acidentes e complicações em cirurgias de terceiros molares. Rev Odontol UNESP. 2011;40(6):290-95.Oliveira LB, Schmidt DB, Assis AF, Gabrielli MAC, Hochuli-Vieira EH, Pereira Filho VAP. Avaliação dos acidentes e complicações associados à exodontias dos 3º molares. Rev cir traumatol buco-maxilo-fac. 2006;6(2):51-6.al-Khateeb TL, El-Marsafi AI, Butler NP. The relationship between the indications of the surgical removal of impacted third molars and incidence of alveolar osteitis. J Oral Maxillofac Surg. 1991;49(2):141-45.Alling CC 3rd. Dysesthesia of the lingual and inferior alveolar nerves following third molar surgery. J Oral Maxillofac Surg. 1986;44(6):454-57.Mercier P, Precious D. Risk and benefits of removal of impacted third molars: a critical review of the literature. J Oral Maxillofac Surg. 1992;21(1):17-27.Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4,338 cases. Int J Oral Maxillofac Surg. 2010;39(4):320-26.Contar CM, de Oliveira P, Kanegusuku K, Berticelli RD, Azevedo-Alanis LR, Machado MA. Complications in third molar removal: a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal. 2010;15(1):e74-8.Silveira KG, Costa FWG, Bezerra MF, Pimenta AVM, Carvalho FSR, Soares ECS. Sinais radiográficos preditivos de proximidade entre terceiro molar e canal mandibular através de tomografia computorizada. Rev Port Estomatol Med Dent Cir Maxilofac. 2016;57(1):30-7.Sebastiani, AM, Todero SRB, Gabardo G, Costa DJ, Rebelatto NLB, Scario R. Intraoperative accidents associated with surgical removal of third molars. Braz J Oral Sci. 2014;13(4):276-80Wofford DT, Miller RI. Prospective study of dysesthesia following odontectomy of impacted mandibular third molars. J Oral Maxillofac Surg. 1987;45(1):15-9.Swanson AE. Removing the mandibular third molar: neurosensory deficits and consequent litigation. J Can Dent Assoc. 1989;55(5):383-86.Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofacial Surg Clin North Am. 2007; 19(1):117-28.Santos MESM, Martins CAM, Beltrao GC, Gallo TB. Paralisia do nervo facial após remoção de enxerto mandibular- relato de caso. Rev cir traumatol buco-maxilo-fac. 2006;6(3):33-8.Santiago JA, Martins Neto RS, Lima VN, Queiroz SBF, Carvalho ACGS, Magro Filho O. Avaliação dos cirurgiões-dentistas de Quixerobim sobre emergências médicas em consultório odontológico. Braz J Surg Clin Res – BJSCR. 2016, 13(1):23-8.
... 1 M3s that are partially or completely impacted in this state are called the impacted third molar (IM3). M3 have a prevalence of impactedness in different populations of 16.7% to 68.6%. 2,3 IM3 extraction is one of the most common procedures performed by oral surgeons. ...
Article
In scientific fields, various statistical analysis methods such as bibliometric analysis have been used to determine the effectiveness of journals, researches and articles. The aim of this study is to conduct a bibliometric analysis to systematically and understandably characterize publications on impacted third molar surgery (ITMS) from 2000 to 2020. The articles were retrieved on the same day from the Web of Science Core Collection (WoSCC) database of the J o u r n a l P r e-p r o o f 2 Web of Science (WoS) on January 01, 2021, to prevent biases due to the daily databases updates. A sum of 3326 publications from 2000 to 2020 were analyzed. United States of America (USA) had the highest number of publications and H-index value. The highest co-citations were from Pell GJ. ITMS research has been collected under 9 clusters. In this study, developments, the most influential publications, journals and countries in the research of ITMS were determined based on evidence through bibliometric analysis.
... Regarding the effect of gender, no statistically significant difference was found between males and females as regards both impaction and transmigration, consistent with the results of a previous study conducted in the United States [22]. ...
Article
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Objectives: The study aimed to evaluate the prevalence and patterns of impacted and transmigrated canine and associated pathologies in a dental population. Methods: The panoramic radiographs of 5531 patients [1820 (32.9%) male and 3711 (67.1%) female] who attended to several dental clinics between August 2018 and January 2019 were retrospectively evaluated. The number, position, impaction and transmigration of canine were noted. An impacted canine was diagnosed to be transmigrated when at least part of its length had crossed the midline. The presence of other coexisting anomalies was also noted. Results: A total of 388 patients (7.0%) presented with at least one impacted tooth. The most common impacted canines were in the maxilla among 368 (94.8%) patients, while 51 (13.1%) patients showed impacted canines in the mandible. About 32 (8.2%) patients showed both co-existed maxillary and mandibular canine impaction, while 126 (32.5%) impacted canines were bilateral either in the maxilla or in the mandible. Transmigrated canine was observed among 26 (6.7%) of impacted canine patients. Impaction of other teeth was found among 173 (44.6%) patients. Certain anomalies were co-existed along with canine impaction in 98 (25.3%) patients. Pericoronal radiolucency was the most common among 84 (21.6%) patients followed by dentigrous cyst among 23 (5.9%) patients. Other anomalies were supernumerary teeth among 5 (1.3%) patients, and odontoms in only 1 (0.3%) patient. Conclusions: The prevalence of impacted teeth was high, and there was a predilection for impacted teeth in the maxilla. Pericoronal radiolucency was commonly seen in relation to the impacted canines followed by dentigrous cyst.
... Regarding the effect of gender, no statistically significant difference was found between males and females as regards both impaction and transmigration, consistent with the results of a previous study conducted in the United States [22]. ...
... Factors thought to influence the incidence of complications after third molar removal include age, gender, medical history, oral contraceptives, presence of pericoronitis, poor oral hygiene, smoking, relationship of third molar to the inferior alveolar nerve, surgical time, surgical technique, surgeon experience, use of perioperative antibiotics, use of topical antiseptics, use of intra-socket medications, and anesthetic technique. [61][62][63][64][65][66][67][68][69][70][71][72] Our institution is passionate about high quality evidence based research and has excelled in various fields [73][74][75][76][77][78][79][80][81][82][83]. ...
... The rate of postoperative infection reported after third molar surgery is in the range of 0.8% to 4.2% [1][2][3][4][5][6][7][8][9] . Numerous randomized controlled trials (RCTs) have evaluated the efficacy of different antibiotics in preventing postoperative infections but have failed to lead to a consensus among practitioners regarding the type of antibiotic to be used and the appropriateness of antibiotic prescription for third molar surgery 10 . ...
Article
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The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.
... Postoperative facial swelling is a common complaint after impacted third molar removal, and the swelling degree is different among the patients. The swelling differs depending on the patients' characteristics, preoperative difficulty index, and intraoperative factors [1][2][3][4][5][6][7][8] . All clinicians stress the need for swelling control in patients who undergo third molar surgery, and many investigations focused on reduction of the swelling [23][24][25][26][27] . ...
Article
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Patients' postoperative facial swelling following third molars extraction may have both biological impacts and social impacts. The purpose of this study was to evaluate the accuracy of artificial neural networks in the prediction of the postoperative facial swelling following the impacted mandibular third molars extraction. The improved conjugate grads BP algorithm combining with adaptive BP algorithm and conjugate gradient BP algorithm together was used. In this neural networks model, the functional projective relationship was established among patient's personal factors, anatomy factors of third molars and factors of surgical procedure to facial swelling following impacted mandibular third molars extraction. This neural networks model was trained and tested based on the data from 400 patients, in which 300 patients were made as the training samples, and another100 patients were assigned as the test samples. The improved conjugate grads BP algorithm was able to not only avoid the problem of local minimum effectively, but also improve the networks training speed greatly. 5-fold cross-validation was used to get a better sense of the predictive accuracy of the neural network and early stopping was used to improve generalization. The accuracy of this model was 98.00% for the prediction of facial swelling following impacted mandibular third molars extraction. This artificial intelligence model is approved as an accurate method for prediction of the facial swelling following impacted mandibular third molars extraction.
... Our study findings showed that diabetic patients and patients on oral contraceptives experienced more complications, which concurs with the results of previous studies. [7,18,19] The literature has validated a positive association between oral contraceptives and postoperative complications due to the interferences with the healing process. Diabetes is a condition also known for compromised healing due to blood circulation deficit, which is associated with M3 removal complications. ...
Article
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Objective: The aim of this study was to determine the complications that were associated with the surgical removal of third molars (M3s), and to assess the association of patient, anatomic, and surgical risk factors with the postoperative complications of surgically removed impacted M3s. Material and Methods: This study was a cohort prospective study conducted on patients, aged 17 and older, admitted to the oral and maxillofacial surgery clinic. All patients who needed 1 or more extractions were included and totalled 268 patients with 314 extracted teeth. Risk factors were divided into patient factors, anatomic factors and surgical factors. The postoperative complication variables mainly included: pain, alveolar osteitis, infection, bleeding, swelling, trismus. Statistical analysis used: Chi-square test was used for the bivariate analyses while Pearson correlation coefficient (1- tailed) test was used for the purpose of determining the association between the study variables. The significance of associations was considered statistically significant at P < 0.05. Results: Patients aged of 25 years and above experienced more complications, 39 (88.6%). With respect to gender, females experienced more complications, 29 (65.9%). Mandibular M3s had more complications than maxillary M3s, 34 (8.0%), followed by distoangular inclined M3s, 23 (52.3%), and last was full bony impaction, 13 (29.5%). Pain was the most frequent complication, 18 (40.9%), followed by alveolar osteitis 12 (27.3%). Conclusion: The results indicated that the most frequently complications were pain, infection, alveolar osteitis. These complications were associated with common risk factors such as age, gender, medical history, M3 angulation, impaction level, bone removal, tooth sectioning, and number of M3 removed per session. Keywords Complications; Surgical extraction; Third molar.
... When incorrectly treated, it can lead to significant sequelae including facial asymmetry, malocclusion, TMJ disorders, nervous system repercussions and infection 1,[6][7] . According to Hough, "the only rule regarding the science of ballistics is that the bullet follows no rules" 8 . Thus, with regard to this type of injury, various factors that affect the physiopathology and extent of the trauma must be taken into account in each case, such as: caliber, composition, projectile velocity, shooting distance, angle of penetration, trajectory and direction of the transferred energy 3,9-12 . ...
Article
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Injuries to the face represent a significant risk to the health of the individual, mainly because of its significance, both functional, because it houses sensory organs and part of the respiratory and digestive systems, as well as esthetic. In this scenario, gunshot wounds in this location cause great concern on account of the magnitude of the damage, and the Oral and Maxillofacial Surgery and Traumatology team must act so that the treatment enables the rehabilitation of the patient in the shortest possible time, with a minimum of complications and sequelae. The objective of this study is to report a clinical case of a 19-year-old female patient with a comminuted fracture of the mandible body caused by a firearm projectile, treated immediately with stable internal fixation using the 2.00 mm plate-screw system for simplification of the fracture and a 2.4 mm reconstruction locking-plate on the bone gap. Relevant aspects of the surgical technique and tactics are reviewed and long-term follow-up of the patient is presented.
... 5 The rate of infection reported after extraction of third molars is less than 5%. [6][7][8][9][10][11][12][13][14] In a study examining the need for surgical and medical management of postoperative infections, 71.8% required antibiotic treatment. 1 Hence, when managing these postoperative infections, the appropriate prescription of antibiotics clinically should comprise a thorough understanding of the likely organisms involved in the infection, which in turn will avoid the prescription of unsuitable antibiotics, reducing the possibility of developing antibiotic resistance. ...
Article
Background: Antibiotic treatment for a clinical infection should be based on a thorough knowledge of the causative organisms involved in the infection. Methods used to evaluate microbiology should provide a comprehensive and accurate assessment of the microbiological spectrum. Currently, there is limited evidence on the microbiology of postoperative infection after third molar surgery, leading to inappropriate antibiotic prescription. Aim: The objective of this review was to summarize the current documented evidence on bacteriology of postoperative infection samples after third molar surgery with a systematic search of the literature. Results: A systematic search was performed in three databases (PubMed, Web of Science, and Medline-Ovid) on March 17, 2017 with no filters applied. After exclusion of duplicates, 142 records were screened, based on predetermined exclusion criteria and finally, 11 case reports recording microbiological data for clinical infection samples were selected. The most common genus of organisms isolated from third molar infections was Streptococcus. Anaerobic species dominated in cases where prior antibiotic treatment was initiated. However, documented microbiological data are only culture based and predominantly report fascial space infections after third molar surgery. Conclusion: Culture-based methods may not be accurately representing the true microbial profile of postoperative infections. There is an urgent need for comprehensive microbiological data employing next-generation sequencing techniques on postoperative infections to prevent inappropriate antibiotic prescription. Clinical significance: Prescribing broad spectrum antibiotics to treat postoperative infections with inadequate information on the microbiology is a questionable clinical practice that propagates antibiotic resistance. Clinicians should utilize recent advances in microbiological diagnosis to reduce unsuitable antibiotic prescription. © 2018, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
... Third molar removal surgery (TMS) is the most frequently performed surgery in the oral and maxillofacial field [1]. There is a wide range of items in the quantification of post-operative complications [2], which can appear in up to 75% of cases [3]. This great variability is due to the various factors: inconsistency in the diagnostic criteria and assessment methods used in the different studies, variation in surgical technique, the surgeon's ability and experience, patient variability and the absence of valid and reliable measurement instruments to record objective and subjective postoperative complication variables [4][5][6][7]. ...
Article
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Third molar removal surgery is the most frequently performed surgery in the oral and maxillofacial field with a wide range of items in the quantification of postoperative complications. For their measure, in 2014 a previous scale design was presented. The aim of this study was to determine the reliability and validity of a scale designed to measure and quantify postoperative complications in third molar surgery (TMS). Methods A cross-sectional study of a measurement model was designed. Sixty-two patients (mean age 20.5 ± 6.6 years; 36 women) underwent TMS in three Chilean hospitals. In the postoperative check-up on the 7th day, a maxillofacial surgeon and a surgical resident performed independent postoperative assessments, applying the scale. A confirmatory factor analysis was conducted to obtain validity, internal consistency, interobserver reliability and a score to categorize the severity of complications using structural equation model analysis. Results Nine patients (14.5%) had complications. The scale was defined by two components: “Secondary complication” and “Infection” (Cronbach’s alpha 0.71; Interobserver reliability 87.7%) and three categories of postoperative complication: “without or mild”, “moderate” and “severe”. Conclusion This study presents a reliability and validity scale called “Surgical complication assessment scale in TMS”.
... They stated the reason that third molar removal is not likely to be a large risk factor for TMD in older population risk of TMD is because the simpler extraction patterns observed in older people. [14,33,42] Further rigorous investigations will be needed to elucidate the correlation of age and post-iLM3 extraction complications. ...
Article
Most of complications after impacted mandibular third molar (iLM3) extraction surgeries are transient and resolved spontaneously within one or two weeks, but some of them are more complicated and required further treatments to alleviate the symptoms. The aim of study is to revisit incidence and predictors of complications after iLM3 surgery by reviewing previous literature and investigating a population-based data. From Taiwan National Health Insurance Research Database, records of 16,609 patients who had received iLM3 extraction under ambulatory settings were retrieved for analysis. Outcomes of interest included dry socket (DS), prolonged temporomandibular joint symptoms (TMD), and surgical site infection (SSI), which necessitated additional appointments to manage. Odds ratios of having those complications between different variables were analyzed. The incidence rates of DS, TMD, and SSI were 3.6%, 0.41%, 0.17%, respectively; while they ranged from 0.33-19.14% (DS), 0-4.17% (TMD), and 0.2-5.17% (SSI) in previous studies. Logistic regression revealed DS significantly correlated with complexity of odontectomy (2.5-fold of risk) and history of gingivitis or pericoronitis (1.3-fold of risk). More TMD was found in female than male patients (0.5% versus 0.3%). However, no factors associated with SSI was found; neither did we find aging as a risk in association with any of above complications. Compared to previous studies, our data supports that surgical intervention should be considered in iLM3 with risk of gingivitis or pericoronitis to reduce the occurrence of DS. The original information in this article, which provides a "real-world" evidence, along with the organizing data we summarized from previous article, can serve as a reference for clinicians in assessing the complication risks before treatment of iLM3.
Article
Purpose: To examine the effect of topical artesunate treatment on peripheral nerve regeneration and compare it with the effects of topical tacrolimus and dexamethasone on nerve regeneration. Materials and methods: Thirty-two Wistar albino rats were used in this study. The rats were divided into 6 groups: sham, saline, petrolatum, artesunate, tacrolimus, and dexamethasone. A compression injury was generated in the right sciatic nerve in all groups except the sham group. In the sham group, the nerve was dissected but compression was not applied. In the groups in which compression was applied, the agents were absorbed through resorbable gelatin sponges applied to the injured region. At the end of 4 weeks, walking analysis, electromyographic measurements, and histopathologic examinations were conducted. Results: When the sciatic function index and electrophysiologic measurements were evaluated, artesunate, tacrolimus, and dexamethasone exhibited positive effects on nerve regeneration (P < .05); there were no significant differences among these 3 agents (P > .05). Histopathologic examination showed that artesunate decreased fibrosis scores and inflammation and increased the diameter of myelinated axons; tacrolimus decreased fibroblast scores; and dexamethasone only decreased fibrosis scores (P < .05). Immunohistochemical analysis showed that the artesunate and dexamethasone groups had more positive immunoreactivity to nerve growth factor than did the saline group (P < .05). Conclusions: Topical artesunate treatment had a positive effect on peripheral nerve regeneration. There were no relevant differences between the topical forms of dexamethasone and tacrolimus for peripheral nerve regeneration.
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ResuMO O objetivo deste artigo é demonstrar as taxas de acidentes e complicações nas cirurgias de terceiros molares realizadas por alunos do último ano do curso de graduação em odontologia. Metodologia: a análise retropectiva do prontuário de 122 pacientes submetidos à extração dos terceiros molares foi realizada. A idade dos pacientes, o gênero, a posição do dente no arco e os acidentes e complicações decorrentes das cirurgias foram considerados. Prontuários com dados incompletos foram excluídos do estudo. Do total, 88 pacientes foram incluídos, totalizando 210 extrações. Resultados: A maioria dos pacientes era do gênero feminino (70,47%), com idade média de 24 anos. Os molares inferiores corresponderam a mais da metade dos procedimentos cirúrgicos (56,2%), senda a posição vertical (60,37%) a mais encontrada. Os casos de acidentes e/ou complicações totalizaram 10,47% dos procedimentos, sendo a hemorragia (2,38%), as fraturas radiculares (1,90%) e as fraturas da tuberosidade maxilar (1,90%) as mais encontradas. Outros acidentes/complicações encontrados foram deiscência de sutura (1,45%), comunicação buco-sinusal (0,95%), parestesia (0,95%), alveolite (0,47%) e infecção (0,47%). Conclusões: a inexpe-riência do cirurgião não pôde ser considerado como um fator determinante para o aumento das taxas de acidentes e complicações em exodontias dos terceiros molares, tendo em vista a semelhança dos resultados deste trabalho com estudos desenvolvidos por cirurgiões experientes. É importante salientar a necessidade do conhecimento por parte dos alunos dos tratamentos mais adequados para os diferentes acidentes e complicações encontradas. AbsTRACT The aim of this work is to demonstrate accidents and complications rates on third molars surgeries performed by senior dentistry students. Methods: a restrospective study of 122 patient charts submitted to third molars surgeries was done. Patient age, gender, dental in arch position, and accidents/complications were considered with the charts presenting incomplete dates being excluded from study. After all, 88 patients (210 surgeries) were included. Results: the majority of the patients were female (70,47%), with average age of 24 years old. Mandibular molars represented more than half of the surgical procedures (56,2%), with teeth at vertical position the most found (60,37%). The cases of accidents and complications totalized 10,47% of all performed procedures, being bleeding (2,38%), root fractures (1,90%) and maxilar tuberosity (1,90%) the most found. Suture dehiscence (1,45%), oro-antral comunications (0,95%), paresthesia (0,95%), alveolitis (0,47%) and infection (0,47%) were also observed. Conclusions: surgeons inexperience was not considered a determinant factor to modify the rates of accidents and complications at third molars surgeries when compared to previous works developed by experienced surgeons. Is important to highlight the necessity of the students knowledge of the most adequate treatments of each of the accidents and complications.
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Background/purpose: Preoperative radiographic examination of mandibular third molars (MTM) is essential to prevent inferior alveolar nerve (IAN) injury. The aim of this study was to assess the panoramic radiography (PAN) signs considered as indicators of increased risk of IAN injury and to correlate them with the cone beam CT (CBCT) findings. Materials and methods: 58 patients who had MTMs extraction between January 2012 and January 2018. OPG were evaluated for the following signs: interruption of the roof of the canal, root darkening, roots deflection and narrowing, canal deviation, superimposition between the MTM roots and mandibular canal. Loss of canal cortication, root grooving, thinning and perforation of lingual cortex were assessed in CBCT images. Chi-square test and multivariate logistic regression tests were used to test the relationship between PAN signs and CBCT findings. Results: A total of 79 MTMs were examined. Loss of canal cortication in CBCT was seen in 22 (27.8%) of the cases. Root darkening in PAN images was the most frequent radiographic sign. Canal deviation and interruption of white line in PAN demonstrated a statistically significant correlation with the loss of canal cortication between the MTM and the mandibular canal on CBCT images (p = 0.004 and p = 0.012, respectively). No statistically significant association was observed for the other PAN signs and CBCT findings. Conclusion: Canal deviation and interruption of white lines were associated with loss of canal cortication on CBCT, indicating a direct contact between the roots and the mandibular canal which required a further assessment prior to the extraction.
Article
Background: Third molar extraction is one of the most common procedures performed by oral surgeons, however with rare complications. The accidental displacement of a maxillary third molar into the infratemporal fossa (ITF) is a rare complication that can occur even with experienced surgeons. Case presentation: We describe the case of a 17-year-old patient whose right upper third molar was accidentally pushed to the ITF associated with a cellulitis and the late discovery of a textiloma (a surgical gauze). Conclusions: Extraction of third molars is a safe surgical procedure when performed in appropriate conditions. The diagnosis of textiloma following a maxillo-facial surgery is extremely rare. It is important to take into account this possibility in order to avoid delaying treatment when it occurs.
Article
Background: Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. Objectives: To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . Selection criteria: We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. Data collection and analysis: Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. Main results: This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure any of our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Authors' conclusions: Insufficient evidence is available to determine whether asymptomatic disease-free impacted wisdom teeth should be removed or retained. Although retention of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is very low certainty. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the current lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision-making with people who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain these teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.
Article
Objective This study examined the frequency of unplanned follow-up visits to the Public Dental Service in Örebro due to postoperative discomfort/complications after mandibular third molar surgery and associated factors. Materials and methods Data were retrieved from the dental records of 465 patients who underwent mandibular third molar surgery in 2017. The collected data covered patient age and gender, health status, diagnosis, surgeon, and planned and unplanned follow-up visits. Results Twenty-eight percent of patients had unplanned visits after mandibular third molar surgery, while 68% of patients without a planned follow-up visit had an unscheduled visit. None of the patients with a planned visit had an unplanned visit. Female patients and patients who had bone removed during surgery had significantly more unplanned follow-up visits due to post-extraction discomfort (p=.047 and .01, respectively). Patients diagnosed with caries made fewer unplanned follow-up visits (p<.012). Conclusions The frequency of unplanned follow-up visits after third molar surgery was relatively high, though no patient with a planned follow-up visit made an unplanned visit. Scheduling follow-up visits could significantly reduce the number of unplanned follow-up visits.
Article
PurposeThe purpose of this study is to compare the suture versus sutureless surgery in impacted mandibular third molar and to evaluate the morbidity and complications associated with each technique.Materials and MethodsA total of 50 patients with asymptomatic impacted mandibular third molars were randomly divided into two groups of 25 patients each. Radiographs were taken to assess the angulation and degree of eruption in the third molar. A small modified Szmyd, V-shaped flap was raised in all cases, and teeth were extracted. In Group I—Suture group (suture was used to close the flap), and in Group II—Sutureless group (no suture used to close the flap). The post-operative pain, swelling, trismus, haemorrhage, periodontal pocket, and alveolar osteitis were evaluated at 24 h, 48 h, 5th days, 7th days, and 2 weeks after surgery. The statistical analysis was done using the Chi-square "t" test and Independent Samples "t" test.Observations and ResultsPain, swelling, and trismus were found to be significantly reduced especially in the immediate post-operative period in the sutureless group as compared to the suture group (p < 0.001). There were no incidences of intra-operative and post-operative haemorrhage in any case. Follow-up of all the patients showed that there was no difference in periodontal sequelae and alveolar osteitisConclusions Sutureless surgery with small flap was found to be less invasive, time-saving, and also a cost-effective method. This technique significantly reduced the early crucial phase of patient discomfort and demonstrates good results.
Chapter
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Third molar impactions is one of the commonest minor oral surgical procedures in the realm of the oral and maxillofacial surgeon. Many basic principles of minor oral surgery have to be applied in a logical manner to attain a good healing. The assessment, clinical and radiographic evaluation plays an important role in selecting the right technique to ensure good results. This chapter aims to go through the basics of third molar impactions in a sequential way to guide the clinician to take the right decisions.
Chapter
Die Entfernung retinierter und verlagerter Zähne ist einer der häufigsten, wenn nicht der häufigste oralchirurgische Eingriff. Er kann sehr einfach sein, aber auch beliebig kompliziert werden. Dementsprechend spielen Fragestellungen rund um retinierte Zähne auch bei der Digitalen Volumentomographien (DVT) eine häufige Rolle. Vermutlich stellen sie neben Implantatabklärungen die häufigste Indikation zur DVT dar. Das vorliegende Kapitel zeigt anhand klinischer Fallbeispiele auf, in welchen Situationen die DVT im Rahmen der Diagnostik, Therapieplanung, Patienteninformation und natürlich des operativen Vorgehens indiziert ist und welche bedeutende Rolle diese dabei spielt. Das breite Spektrum reicht von der Erkennung überzähliger Zähne über anatomische Lagebeziehungen zwischen Zahn und vitalen Strukturen bis hin zur Abklärung von Pathologien.
Article
The most common oral and maxillofacial surgical procedure in adolescents is excision of impacted third molars. Adolescent patients should be evaluated for third molars starting around age 16 years unless symptomatic at an earlier age. The dental examination should include panorex imaging to assess development, pathologic condition, and possibility of eruption versus impaction. Various classification systems are available to identify the position and difficulty of the proposed surgical procedure. Retained impacted teeth increase the patient's risk of various morbidities including recurrent infection, damage to adjacent teeth, cysts and other lesions, and unexplained pain.
Article
Objectives: This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars. Methods: Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests. Results: The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (P>0.05). Conclusions: The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.
Article
Aim: Study of the causes that may contribute to complications during and after tooth extraction to justify treatment and prevention measures. materials and methods: A retrospective analysis of the content of ambulatory cards and protocols of operations of 168 patients for the period from 2016 to 2018 and evaluation of the results of personal work for 2018-2020 related to surgical interventions in 134 patients which removed the third lower molars. Results: According to the retrospective material, damage to the inferior alveolar nerve was found in 5.9% of cases, lingual nerve – in 3.3% of cases, the prevalence of alveolitis with simple removal was 16.3% of cases, at difficult and surgical removal – 3.9% of cases. The application of our proposed treatment and prevention complex allowed to reduce their rates to 3.1%, 2.3%, 8.0% and 3.8% of cases, respectively. Risk factors for complications have been identified. Conclusions: when planning the method of surgical removal of third lower molars it is necessary to take into account the probability of its intimate location in relation to inferior alveolar nerve and lingual nerve. The presence of focus of destruction with signs of acute or exacerbation of chronic inflammation in the periodontal bone tissue of the causative tooth is a risk factor for alveolitis and an indication for the appointment of treatment and prevention in the preoperative period, even with simple removal.
Article
Third molar extraction is a painful treatment for patients, and thus, it can be used to investigate the effects of analgesics on pain. Hypnosis can help to reduce pain and to decrease the intake of postoperative systemic analgesics. In this study, the effectiveness of a brief hypnotic induction for patients undergoing third molar extractions was investigated. Data were collected from 33 patients with third molar extractions on the right and left sides. Patients received 2 different types of pain interventions in this monocentric randomized crossover trial. Third molar extraction was conducted on 1 side with reduced preoperative local anesthetics and an additional brief hypnotic induction (Dave Elman technique). The other side was conducted with regular preoperative local anesthetics without a brief hypnotic induction (standard care). Intake of postoperative systemic analgesics was allowed in both treatments. Patients’ expectations about hypnosis were assessed at baseline. The primary outcome was the area under the curve with respect to ground of pain intensity after the treatment. Secondary outcomes were the amount of postoperative analgesics consumed and the preferred treatment. There was no evidence that the area under the curve with respect to ground of pain differed between the 2 interventions (controlling for gender), but the patients’ expectations affected the effectiveness of the brief hypnotic induction. This means that patients with high expectations about hypnosis benefit more from treatment with reduced preoperative local anesthetics and additional brief hypnotic induction. Perspective Hypnosis is used as a treatment to reduce pain in general and dental settings. In this study, additional a brief hypnotic induction with reduced preoperative local anesthetic use did not generally reduce posttreatment pain after third molar extraction more than regular local anesthetics. The expectation of the patients about the effectiveness of hypnosis affected the effectiveness of the brief hypnotic induction so that patients with high expectations had a larger benefit from a brief hypnotic induction than patients with low expectations.
Chapter
This chapter provides a comprehensive review of the common, as well as the less common and rare, peri‐ and postoperative complications associated with impacted third molar surgery and their prevention and management. The mandibular and maxillary third molars are the most commonly impacted teeth, followed by the maxillary canines and mandibular premolars. Alveolar osteitis is one of the more common complications of third molar surgery. Surgical wound infection rates as a result of third molar extraction range from 0.8% to 4.2% and almost exclusively involve the mandibular third molars. Mandibular fracture following third molar surgery is a rare occurrence, and most often associated with deeply impacted third molars in patients over 40 years of age. Postoperative pain and swelling following third molar surgery are an expected and inevitable consequence of the inflammatory process of healing.
Article
Purpose Socioeconomic and racial status are barriers to dental and medical healthcare in America leading to poor health outcomes. Delayed management of third molars may increase the risk of complications. There have been no large scale studies examining the role race and ethnicity have on timing of third molar extraction. The purpose of this study is to explore the associations of race and ethnicity on age of third molar extractions and complications. Materials and Methods This retrospective cohort study composed of patients who underwent third molar extraction at Boston Children’s Hospital from April 2011, to March 2021. Patients self-identified race as: white, Black/African American, Asian, Native American/Pacific Islander, other, and prefer not to answer. Patients identified ethnicity as Hispanic or non-Hispanic. Subjects with incomplete medical records were excluded. Primary predictor variables were race and ethnicity. The primary outcome variable was the age of third molar extractions, and the secondary outcome variable was post-operative complications. Descriptive, univariate and multivariate statistics were conducted. A p-value of p<.05 was considered significant. Co-variates included gender, insurance type, interpreter requirements, and pre-operative symptoms. Results This study included 3,933 patients after exclusion criteria was applied. The mean age was 18.6 ± 2.49 years. When third molars were removed, white patients were older than the non-white population (18.8 vs 18.2 years, P<.001). Black or African American patients were younger than all other races (18.1 vs 18.7 years, P<.001). Hispanics were younger compared to non-Hispanics (18.1 vs 18.7 years, P<.001). Patients with pre-operative symptoms removed their wisdom teeth at an older age compared to those who were asymptomatic (19.0 vs 18.5 years, P<.001). Black patients experienced greater pre-operative symptoms than other races (46.2% vs 29.2%, P<.001). White patients experienced the most post-operative complications (7.7% vs 5.0%, P=.003) while Black or African American patients experienced less post-operative complications (2.7% vs 7.5%, P<.001). Conclusion There is no evidence patients from historically underrepresented racial and ethnic groups had inadequate access for removal of their third molars. Patients from these communities experienced a lower rate of complications after third molar extractions confirming quality of care was not compromised for these patients.
Article
This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis. Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin- 1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously. At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL on the distal of second molars were normal. At 1 week, patients' pain symptoms and IL-1b levels were reduced, but microbial counts remained high. Three months after surgery, patients had no pain symptoms, and alveolar bone levels and CAL were similar to entry levels. IL-1b levels were elevated at both the distal of second molars and the mesial of first molars for all patients; microbial counts decreased, although not to levels of control patients. No increase in microbial counts for Porphyromonas gingivalis or Bacteroides forsythus, or GCF PGE2 levels, risk factors for progressive periodontal disease, was detected in samples taken from the study patients. Pericoronitis expressed by minor signs/symptoms in these patients was associated with considerable discomfort. Symptomatic mandibular third molars were vertical and at or near the occlusal plane. Additionally, this condition was characterized by microbial flora and GCF inflammatory mediator levels that are more consistent with gingivitis than periodontitis. Removal of third molars eliminated symptoms, but the microbial burden and an affected patient's inflammatory response, as measured by IL-1b levels, remained elevated as compared with controls. Further study is needed to determine which of these factors can be used to identify patients at risk for pericoronitis before symptoms arise.
Article
The purpose of the study was to develop an instrument to measure patients' perceptions of their experiences after the removal of third molar teeth. Nineteen patients (ages 18 to 25 years) who underwent surgical removal of four third molars after local treatment for mild symptoms of pericoronitis completed a newly developed 14-item instrument each evening for the 14-day period after surgery. A focus group was used to further examine the experiences of a subset of subjects. On the first day postsurgery, patients reported a median level of 81 on the 0 to 100 scale of "limitation of daily activity because of pain" (100 = total interference). This dropped to 21 by day 5, and all but two patients returned completely to normal activities by day 8. During the first 3 days, the median level of "average pain" ranged from 51 to 33 (100 = pain as bad as could be), and all but two patient were pain-free by day 10. Bad taste/breath persisted for between 2 to 4 days; food impaction was experienced by nearly all patients from days 3 through 14. Swelling was encountered by 10 of the patients for the first 2 days and was reported by only one patient after day 5. This study demonstrated that patients' perceptions of their experiences could be collected using a self-administered instrument, and it confirmed the changes in postsurgical morbidity that occur in healthy, young adults. This instrument and these data will be valuable to those striving to make informed decisions regarding third molar surgery.
Article
This study evaluated patients' perceptions of recovery after third molar surgery. Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health-Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center. After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period. This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent.
Article
Our goal was to report the detection and levels of gingival crevicular fluid (GCF) inflammatory mediators, sampled at the mesial of 4 first molars and distal of 4 second molars, in 316 patients with asymptomatic third molars. Levels of GCF inflammatory mediators, interleukin (IL)-1 beta and prostaglandin (PG)E(2), were determined and log transformed for each patient. Z scores were calculated using the mean and standard deviation of the log values for the entire sample of 316 patients. The log mediator levels and Z scores of patients who had probing depths (PDs) less than 5 mm (n = 238) were compared with patients with at least 1 PD equal to or greater than 5 mm (n = 78) on the distal of second molars or around third molars. A periodontal Composite GCF Inflammation Score was calculated for each patient by summing the Z scores obtained for IL-1 beta and PGE(2) for that patient. The levels of GCF IL-1 beta and PGE(2) were higher if a patient had a PD equal to or greater than 5 mm in the third molar region. The Composite GCF Inflammation Score indicated "elevated inflammation" if a PD equal to or greater than 5 mm was found in the third molar region as well. These data suggest that asymptomatic patients with PD equal to or greater than 5 mm in the third molar region with associated periodontal attachment loss have increased levels of biochemical mediators of inflammation compared with patients with PD less than 5 mm. These findings are consistent with the concept that early periodontitis in young adults that initiates in the third molar region is associated with increases in key inflammatory mediators.
Article
Our goal was to report the detection and levels of pathogenic bacteria in subgingival plaque samples taken from the distal of all second molars in 295 patients with asymptomatic third molars. Data assessing oral health were collected from each of these healthy patients (ASA Classes I and II). Probing depth (PD), at 6 sites per tooth, including third molars, was obtained to determine periodontal status. Subgingival plaque samples were taken from the distal of all second molars before periodontal probing. The presence and levels of 11 bacterial species were determined using whole chromosomal DNA probes and checkerboard DNA-DNA hybridization. Detected bacterial species were grouped into clusters of periodontal pathogens designated as "red" or "orange" complex microorganisms as described by Socransky et al (J Clin Periodontal 25:134, 1998) who found an association of these specific microorganisms with periodontitis. As a group these relatively young patients were periodontally healthy. "Orange and red" complex microorganisms were detected at levels equal to or greater than 10(5) more often if patients had a PD equal to or greater than 5 mm with periodontal attachment loss at the distal of second molars or around third molars at their entry examination. In patients with no PD equal to or greater than 5 mm in the third molar region, "orange and red" complex microorganisms were detected at levels equal to or greater than 10(5) more frequently than would be anticipated in patients with little clinical evidence of periodontal disease. The clinical findings of increased periodontal PDs and periodontal attachment loss coupled with colonization of periodontal pathogens support the concept that clinical and microbial changes associated with the initiation of periodontitis may present first in the third molar region in young adults.
Article
We report the prevalence of periodontal probing depth (PD) as a clinical measure of the extent of periodontitis associated with asymptomatic third molars at the initial examination in a cohort of patients enrolled in an institutional review board-approved longitudinal clinical trial. Three hundred twenty-nine healthy patients were enrolled during a 30-month period. Full mouth periodontal probing that included third molars was conducted to determine periodontal status. Panoramic radiographs were taken to assess the degree of eruption of the third molars and the angulation of third molars compared with the adjacent second molar. Vertical bitewing radiographs were analyzed to detect alveolar bone levels relative to the cementoenamel junction on the distal of second molars. Twenty-five percent (82 of 329) of all enrolled patients, and 34% (14 of 41) of black patients, had at least one PD equal to or greater than 5 mm on the distal of a second molar or around a third molar. PD equal to or greater than 5 mm was associated with periodontal attachment loss of at least 1 mm in every patient; PD equal to or greater than 5 mm was associated with attachment loss equal to or greater than 2 mm in 80 of 82 patients. A higher proportion of patients 25 years old or older had a PD equal to or greater than 5 mm on the distal of second molars or around third molars compared with patients younger than 25 years (33% vs 17%, P =.002). The distals of second molars and third molars in the mandible were affected more often than in the maxilla (25% vs 5%, P =.0001). Our data indicating that 25% of patients with retained asymptomatic third molars have considerable periodontal pathology in the third molar region were unexpected. National epidemiologic surveys indicate a much lower rate of periodontitis in the population younger than 35 years.
Article
The study goal was to assess both clinical and health-related quality of life (HRQOL) outcomes after third molar surgery. Patients who were having 4 third molars removed were enrolled in a prospective clinical trial. Baseline data were recorded that included demographics, the patient's and surgeon's assessment of third molar conditions, and details of the surgical procedure. After surgery, clinical data were collected that detailed healing and any treatment that was rendered. Each patient was given an HRQOL instrument to complete on each postsurgery day for 14 days; the instrument was designed to assess a patient's perception of recovery in 4 main categories: pain, lifestyle, oral function, and other symptoms related to the procedure. Recovery data were available for 630 of 740 enrolled patients. The median age of the 630 patients was 21 years, and the median operation time was 30 minutes. Recovery for most HRQOL measures occurred within 5 days after surgery. However, recovery from pain to the criterion of "little or none" was delayed relative to other HRQOL measures. Twenty-two percent of patients were treated for delayed healing after surgery. Having both clinical and HRQOL data on recovery after third molar surgery could assist the surgeon when informing prospective patients about what to expect after surgery to remove third molars.
Article
We sought to identify the demographic, oral health, and surgical risk factors associated with prolonged recovery after third molar surgery using health-related quality of life (HRQOL) and clinical outcomes. HRQOL responses from patients and clinical outcomes were obtained after third molar surgery. Criteria were selected for HRQOL outcomes that separated patients with from those without prolonged recovery. Delayed clinical healing was indicated by a patient having at least 1 postsurgery visit with treatment. Risk assessment models for prolonged HRQOL recovery and delayed clinical healing were developed using stepwise logistic regression analysis. We included 547 subjects with HRQOL and clinical outcome data in this analysis. Age, gender, and occlusal plane position were statistically significantly associated with prolonged recovery for early symptoms, oral function, and pain. Recovery for lifestyle was prolonged only if both lower third molars were below the occlusal plane before surgery. Age, gender, prior symptoms related to the third molars, and the surgeon's perception of difficulty were statistically significant predictors of delayed clinical recovery. Certain demographic and oral health conditions available to the surgeon before surgery, and characteristics of the surgery itself, increase the risk of a prolonged recovery for HRQOL outcomes and delayed clinical outcomes after third molar surgery.
Article
We sought to compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without intravenous antibiotics at surgery. Fifty-six patients at least 18 years of age and with all 4 third molars below the occlusal plane, treated at 3 clinical centers, were given intravenous antibiotics just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group (n = 60 patients) who did not receive antibiotics. The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics. The incidence of delayed clinical recovery defined as a postsurgery visit with treatment was higher in the control group compared with the antibiotic group. In the antibiotic group, 4% had 1 postsurgery visit with treatment; no patient had 2 visits. In the control group without antibiotics, 28% had at least 1 postsurgery visit with treatment (P <.0001) and 13% had at least 2 postsurgery visits with treatment. No statistically significant differences in HRQOL outcomes were found between the 2 groups. Administration of intravenous antibiotics before third molar surgery may improve clinical recovery in healthy adult patients with all 4 third molars below the occlusal plane, a presenting characteristic that has been suggested as a risk factor for delayed recovery. The findings from this exploratory trial indicate that evaluation of the effectiveness of systemic antibiotic administration with third molar surgery in a randomized, multi-intervention, explanatory clinical trial is warranted.
Article
Assess the association between visible third molars (VTM) and periodontal pathology in Third National Health and Nutrition Examination Survey (NHANES III). Data were obtained on 5,831 persons aged 18 to 34 from the NHANES III. Relevant to the present study was the presence of VTM and the assessment of periodontal disease in 2 randomly selected (1 maxillary and 1 mandibular) quadrants. Periodontal measures included gingival index, pocket depth, and attachment level on mesiobuccal and buccal sites on up to 7 teeth (excluding third molars) per quadrant. Second molars were compared for periodontal pathology based on the presence or absence of a VTM in the same quadrant. Associations were determined using odds ratios and 95% confidence intervals. Weighted multivariable models were fit using logistic regression, and variances were adjusted to account for the complex sampling design using SUDAAN (Research Triangle Institute, Research Triangle Park, NC). A VTM was associated with twice the odds of a probing depth 5+ mm (PD5+) on the adjacent second molar, while controlling for other factors associated with VTM and periodontal disease. Other factors positively associated with PD5+ in the model were age 25 to 34 years, smoking, and African American race. The finding of more severe periodontal conditions associated with VTM in these young adults indicates that third molars may have a negative impact on periodontal health. The relationship between third molars and periodontal disease pathogenesis deserves further study using longitudinal data.
Article
Our goals were to determine the prevalence of caries experience, carious lesions, or restorations on the occlusal surface, in asymptomatic third molars erupted to the occlusal plane, and to examine the association between caries experience in other molars and third molars within the same mouth and quadrant. Clinical data assessing oral health were collected from healthy patients (ASA I, II). The presence or absence of caries experience on the occlusal surface of third molars and on any surface of the first and second molars was recorded during clinical and radiographic examinations. The occurrence of caries experience for younger and older subjects was compared using the general association Cochran-Mantel-Haenszel statistic and the association of occurrence in the maxilla and mandible by the McNemar test. The association between caries experience in a third molar and caries experience in first and second molars also was assessed. Overall, 28% of the 303 patients with at least 1 third molar at the occlusal plane were affected by third molar caries. Patients 25 years or older had more caries experience in a third molar than those younger than 25 years, 39% versus 11% (P <.0001). Mandibular third molars were affected more often than maxillary third molars, 24% versus 18% (P <.0001). Nearly all patients, 76 of 80 (95%), with third molar caries experience also had caries experience in first/second molars, but only 80 of 223 (36%) of patients with first/second molar caries experience had a history of third molar caries. The prevalence of caries in third molars erupted to the occlusal plane in these young patients was high, but not unique to third molars, particularly in those 25 years of age and older. Although these results provide a baseline description of the association between caries experience in first/second molars and associated third molars, data are needed from longitudinal studies to determine the value of first/second molar caries experience in predicting the risk of caries in third molars.
Article
This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery. The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment. One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5). Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.
Outcomes following third molar surgery with intravenous antibiotics in patients at risk for delayed recovery
  • S P Foy
  • D Shugars
  • C Phillips
Foy SP, Shugars D, Phillips C, et al: Outcomes following third molar surgery with intravenous antibiotics in patients at risk for delayed recovery. J Oral Maxillofac Surg 62:15, 2004
Occlusal caries in patients with asymptomatic third molars
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  • T M Jacks
  • R P White
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Shugars DA, Jacks TM, White RP Jr, et al: Occlusal caries in patients with asymptomatic third molars. J Oral Maxillofac Surg 62:973, 2004
Parameters of care for oral and maxillofacial surgery: A guide for practice, monitoring, and evaluation
Parameters of care for oral and maxillofacial surgery: A guide for practice, monitoring, and evaluation. J Oral Maxillofac Surg 53:36, 1995 (supp1 5)
Developing a measure of patient perceptions of short-term outcomes of third molar surgery
  • D A Shugars
  • K Benson
  • R P White
  • Jr
Shugars DA, Benson K, White RP Jr, et al: Developing a measure of patient perceptions of short-term outcomes of third molar surgery. J Oral Maxillofac Surg 54:1402, 1996
Recovery after third molar surgery
  • White
Outcomes following third molar surgery with intravenous antibiotics in patients at risk for delayed recovery
  • Foy