A mechanical and three-dimensional finite element study of the optimum tooth sectioning depth during the extraction of low-level horizontally impacted mandibular third molar.

The present study aims to determine the optimum sectioning depth for the extraction of low-level horizontally impacted mandibular third molar (LHIM3M) using mechanical and finite element analysis. One hundred and fifty extracted mandibular third molars were randomly divided into three groups: 1, 2 or 3 mm of tooth tissue was retained at the bottom of the crown. The breaking force of teeth was tested in a universal strength testing machine. The fracture surface was observed and the type of tooth breakage was recorded. According to the three groups, corresponding 3D finite element models were created. The breaking force obtained in the mechanical study was, respectively, applied and the stress and strain of the teeth and surrounding tissues were analysed. Breaking force decreased as sectioning depth increased. The 2 mm group produced the lowest rate of incomplete breakage (10%). In the 2 mm model, the stresses were evenly distributed in the tooth tissue at the bottom of the fissure, and the maximal stress was located in the tissue close to the root segment. The maximum values of stresses in the bone and of strains in the periodontal ligament of the second molar and bone were lower in the 1 mm model than in other models. Their distribution was similar in the three models. A sectioning depth of 1 mm group saves labour during the extraction of LHIM3M, compared to 2 and 3 mm; 2 mm might be the appropriate sectioning depth in terms of breakage shapes.

Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury.

OBJECTIVES: Extraction of impacted mandibular third molars (IMTMs) is the most common surgery performed in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher in cases of IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. MATERIALS AND METHODS: From August 2019 to June 2022, 23 patients underwent IMTM extraction by Dr. Zhao at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, and were found to have IMTMs in close proximity to the IAC. Due to high IAN injury risk, these patients underwent coronectomy-miniscrew traction to extract their IMTMs. RESULTS: The time between coronectomy-miniscrew insertion and complete removal of the IMTM was 32.65 ± 2.110 days, which was significantly shorter than that of traditional orthodontic traction. Two-point discrimination testing revealed no IAN injury, and no injury was reported by patients during follow-up. Other complications, such as severe swelling, severe bleeding, dry socket, and limited mouth opening, were not observed. Postoperative pain levels were not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. CLINICAL RELEVANCE: For IMTMs that are in close proximity to the IAC and must be extracted, coronectomy-miniscrew traction is a novel approach to minimize the risk of IAN injury in a less time-consuming way with a lower possibility of complications.

Does the "Root Removal First" strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position? - a randomized clinical trial.

OBJECTIVE: To evaluate the clinical outcomes of the "Root Removal First" strategy in the surgical removal of impacted mandibular third molar (IMTM) in the class C and horizontal position. MATERIALS AND METHODS: A total of 274 cases were finally included in the statistics. The positions of IMTM in the horizontal position were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the "Root Removal First" strategy was applied in the new method (NM) group, and the conventional "Crown Removal First" strategy was executed in the traditional method (TM) group. The clinical information and relevant data upon follow-up were recorded. RESULTS: The duration of the surgical removal and the incidence rates of lower lip paresthesia in the NM group were significantly lower than those in the TM group. The degree of mobility of the adjacent mandibular second molar (M2) in the NM group was significantly lower than that in the TM group at 30 days and 3 months post-operation. The distal and buccal probing depth of the M2, as well as the exposed root length of M2 in the NM group, were significantly lower than those in the TM group 3 months post-operation. CONCLUSIONS: The "Root Removal First" strategy can reduce the incidence rate of inferior alveolar nerve injury and periodontal complications of the M2 in the surgical removal of IMTM in class C and horizontal position with high efficiency. TRIAL REGISTRATION: ChiCTR2000040063.

Three-dimensional positional relationship between impacted mandibular third molars and the mandibular canal.

OBJECTIVE: To observe the three-dimensional positional relationship between impacted mandibular third molars (IMTMs) and mandibular canal close contacts using cone beam computed tomography (CBCT). METHODS: A total of 101 patients with IMTMs were selected who met the diagnostic criteria for 142 teeth (no bone wall imaging area between IMTMs and the mandibular canal, a high-density bone cortical imaging area only, or a ≦1 mm bone imaging area). The parameters of the rotating CBCT anode were set as follows: 110 kV, 40-50 mA; the focal point and exposure field were set as 0.3 mmh and a high-resolution zoom, respectively; the exposure time and image layer thickness were set as 5.4 s and 0.25 mm. Three-dimensional reconstruction was performed, and the position of the mandibular canal through the IMTM area was observed continuously from the coronal, horizontal and sagittal planes. RESULTS: We found that the mandibular canal was interrupted below the third molar (TM) in 85 cases, accounting for 59.86% of all cases. The mandibular canal was located below the buccal and lingual curvatures in 33 and 19 cases, respectively, accounting for 23.23% and 19%. In addition, a small number of mandibular canals were also located on the buccal side of the mandibular molars (2.82%). We also found one case of direct insertion of the mandibular third molar (MTM) into the mandibular canal. In addition, the mandibular canal passed through the IMTM region with 125 close contacts at the roots (88.03%); 14 mandibular canals were in contact with all teeth and 3 were in contact with the crown. CONCLUSION: The use of CBCT can provide a dynamic and comprehensive understanding of the three-dimensional positional relationship of the mandibular alveolar nerve canal passing through the IMTM area, providing a high clinical reference value when extracting IMTMs and reducing the risk of injury to the inferior alveolar nerve.

Automatic classification of 3D positional relationship between mandibular third molar and inferior alveolar canal using a distance-aware network.

The purpose of this study was to automatically classify the three-dimensional (3D) positional relationship between an impacted mandibular third molar (M3) and the inferior alveolar canal (MC) using a distance-aware network in cone-beam CT (CBCT) images. We developed a network consisting of cascaded stages of segmentation and classification for the buccal-lingual relationship between the M3 and the MC. The M3 and the MC were simultaneously segmented using Dense121 U-Net in the segmentation stage, and their buccal-lingual relationship was automatically classified using a 3D distance-aware network with the multichannel inputs of the original CBCT image and the signed distance map (SDM) generated from the segmentation in the classification stage. The Dense121 U-Net achieved the highest average precision of 0.87, 0.96, and 0.94 in the segmentation of the M3, the MC, and both together, respectively. The 3D distance-aware classification network of the Dense121 U-Net with the input of both the CBCT image and the SDM showed the highest performance of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve, each of which had a value of 1.00. The SDM generated from the segmentation mask significantly contributed to increasing the accuracy of the classification network. The proposed distance-aware network demonstrated high accuracy in the automatic classification of the 3D positional relationship between the M3 and the MC by learning anatomical and geometrical information from the CBCT images.

Amoxicillin vs third-generation cephalosporin for infection prophylaxis after third molar extraction.

OBJECTIVES: Although amoxicillin is the first-line prophylactic drug for impacted mandibular third molar extraction, third-generation cephalosporins are widely prescribed in Japan. The lack of real-world evidence may be one reason for this inappropriate use. We evaluated differences in the incidence of surgical site infection between amoxicillin and third-generation cephalosporins for impacted mandibular third molar extraction. METHODS: Using the JMDC Claims Database, we identified dental visits with fully or horizontally impacted mandibular third molar extraction from April 2015 to March 2020. One-to-one propensity-score matching was conducted between amoxicillin and third-generation cephalosporin groups. The incidence of surgical site infection following extraction was compared in the matched pairs using McNemar's test. RESULTS: We identified 109,266 dental visits, including 39,514 (36.2%) patients who received amoxicillin and 69,752 (63.8%) patients who received third-generation cephalosporins. In the 39,514 matched pairs, the incidence of surgical site infection was 3.5% (n = 1399) for amoxicillin group and 3.7% (n = 1467) for third-generation cephalosporin group (p = 0.003). CONCLUSIONS: Amoxicillin was associated with a lower incidence of surgical site infection after impacted mandibular third molar extraction compared with third-generation cephalosporins. This result supports current guidelines and strengthens the importance of disseminating and implementing antimicrobial resistance control in dentistry.

Low-level laser therapy is effective in controlling postoperative pain in lower third molar extractions: a systematic review and meta-analysis.

This systematic review aimed to evaluate the effectiveness of low-level laser therapy in controlling postoperative pain in lower third molar extractions. A search was carried out in MEDLINE/PubMed, Web of Science and Cochrane Library (CENTRAL) databases, using the "low-level laser therapy", "photobiomodulation therapy", "impacted mandibular third molar", "mandibular third molar", "third molar extraction" descriptors and 2625 studies were found, including only randomized clinical trials published until July 2020, with no restrictions on language and country of study. Selected studies were submitted to initial screening based on the reading of titles, abstracts and full article, and duplicate studies were excluded. Overall, 2562 articles were found, of which only 15 randomized clinical trials were included in this review. A total of 648 patients (16-44 years) who received low-level laser therapy as an intervention and placebo in their control group were evaluated. The pain evaluation criterion was the Visual Analog Scale (VAS) on the second and seventh days after surgery. Photobiomodulation with low-level laser showed statistically significant reduction in postoperative pain in lower third molar extractions, both on the second (MD: - 0.59; CI: - 0.92, - 0.27) and seventh day after surgery (MD: - 0.76; CI: - 1.21, - 0.32).

Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial.

BACKGROUND: Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. METHODS: A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. RESULTS: The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). CONCLUSION: The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. TRIAL REGISTRATION: NCT04889781 ( https://clinicaltrials.gov/ ), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1.

Age estimation using pulp/enamel volume ratio of impacted mandibular third molars measured on CBCT images in a northern Chinese population.

The present study aims to evaluate the relation between chronological age and the ratio of pulp volume (PV) to enamel volume (EV) of impacted mandibular third molars (IMTMs) by using cone-beam computed tomography (CBCT) images and an improved 3D image segmentation technique. A sample of CBCT images of IMTM was collected from 414 northern Chinese subjects (214 male and 200 female clinical patients) ranging in age from 20 to 65 years. The GrowCut effect image segmentation (GCEIS) module algorithm was used to calculate the PV and EV from CBCT images. The total sample was divided into a training group and validation group in a ratio of 7 to 3. The PV/EV ratio (PEr) in the training sample was used to develop a mathematical formula for age estimation as follows: age = - 5.817-21.726 × Ln PEr (p < 0.0001) (Ln, natural logarithm). The mean absolute error (MAE) and root mean square error (RMSE) were used to determine the precision and accuracy of the mathematical formula in the validation group and all samples. The MAEs in the male, female, and pooled gender samples were 9.223, 7.722, and 8.41, respectively, and the RMSEs in the male, female, and pooled gender samples were 10.76, 9.58, and 9.986, respectively. The precise and accurate results indicate that the PEr of IMTM in CBCT images is a potential index for dental age estimation and is possible to be used in forensic medicine.

Measuring the impact of simulation practice on the spatial representation ability of dentists by means of Impacted Mandibular Third Molar (IMTM) Surgery on 3D printed models.

INTRODUCTION: The ability of spatial representation is one of the most important competences of an oral surgeon, but also a challenging competence to assess in educational settings. The aim of this pilot study was to investigate the impact of a hands-on simulation practice on the development of the Dental Anatomy Spatial Representation Ability (DASRA) of recent dental graduates, using a novel assessment instrument based on CBCT radiographic data. MATERIALS AND METHODS: A novel instrument for the measurement of DASRA for oral surgery was developed, utilising panoramic, sagittal and horizontal slices from 3D radiographic imaging of impacted wisdom teeth. Twenty-one young dentists (nine males and 12 females) were enrolled in this study. After measurement of dentists' perceptual ability (PA), all dentists completed a DASRA drawing test and thereafter practiced surgical extraction on 3D printed models, which were based on actual patients' anatomy. A second DASRA was administered after the hands-on exercise, followed by a feedback survey. RESULTS: A slight increase in DASRA scores was revealed after practicing on models, which however did not reach statistical significance. However, statistically significant decrease in drawing time was observed after hands-on experiences (P < 0.001), while important qualitative improvements were noted, such as dentists' ability to position the mandibular nerve. Dentists perceived 3D printed model as a very effective and efficient manner in planning and practicing of surgical interventions. CONCLUSIONS: An instrument for the measurement of DASRA based on 3D radiographic imaging might support educators in the assessment of spatial skills of novice surgeons. Practice on 3D printed, anatomically precise models can benefit dentists on pre-clinical surgical training and has the potential of improving their dental anatomy spatial representation ability.

Comparative Study of the Efficacy of 4% Articaine vs 2% Lidocaine in Surgical Removal of Bilaterally Impacted Mandibular Third Molars.

AIM: The aim of this study was to evaluate the safety and efficacy of 4% articaine with epinephrine (1:200,000) vs 2% lidocaine with epinephrine (1:200,000) during surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: The present study was undertaken in 20 patients belonging to American Society of Anesthesiologists (ASA) class I, of the age group between 18 and 30 years with bilaterally impacted mandibular third molars. Each patient underwent similar surgical procedure. In the first appointment, the patient was randomly selected to receive either 4% articaine or 2% lidocaine (both with epinephrine 1:200,000). Intraoperative and postoperative evaluation was done for both the anesthetic solutions. Following parameters were evaluated: total volume of anesthetic solution used during the surgery, onset of action of the anesthetic agent, duration of anesthesia, duration of postoperative analgesia, incidence, type and severity of adverse reactions, any need to reanesthetize the surgical zone and quality of anesthesia provided by the local anesthetic. Subjective pain evaluation was done with the aid of 100 mm length visual analog scale (VAS) both intraoperatively and postoperatively. RESULTS: In the present study, 4% articaine was found to have a significantly shorter onset of action than 2% lidocaine. Duration of anesthesia and postoperative analgesia of 4% articaine with epinephrine 1:200,000 was found to be significantly (1.44 and 1.28 times respectively) longer than 2% lidocaine with epinephrine 1:200,000. But no significant difference was found in other parameters. CONCLUSION: 4% articaine in comparison with 2% lidocaine (both with epinephrine 1:200,000) provided a shorter onset of action and longer duration of anesthesia. CLINICAL SIGNIFICANCE: No significant difference was recorded in the anesthetic efficacy between the two solutions.

Laser Therapy has Minimal Clinical Efficacy at Reducing Postsurgical Complications After the Removal of Impacted Mandibular Third Molars.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: A systematic review update and meta-analysis. Dawdy J, Halladay J, Carrasco-Labra A, Araya I, Yanine N, Brignardello-Petersen R. J Am Dent Assoc 2017;148(12):887-902.e884. SOURCE OF FUNDING: None of the authors reported any disclosures TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Prevalence and Pattern of Mandibular Third Molar Impaction in Eritrean Population: A Retrospective Study.

INTRODUCTION: The most commonly impacted tooth in the oral cavity is the mandibular third molar. Various etiologic factors have been suggested for impacted mandibular third molars. The pattern and prevalence of impacted mandibular third molars vary with different population and region. This study throws light on the prevalence and pattern of impacted mandibular third molars in Eritrea, East Africa. This is the first reported study regarding the same from Eritrea. AIM: To assess the prevalence and pattern of impacted mandibu-lar third molars in the population of Eritrea, East Africa by conducting a retrospective study from January 2009 to January 2014. MATERIALS AND METHODS: This study was conducted in the Department of Oral and Maxillofacial Surgery, Orotta School of Medicine and Dental Medicine and the Orotta Referral Medical and Surgical Hospital, Asmara, Eritrea. A total of 1,813 clinical and radiographic records [orthopantomograms] were assessed and 276 cases were selected for the study as per the inclusion criteria. They were evaluated for the frequency among the various age groups, gender and region along with the sides affected, angulation and level of impaction. The presence of systemic conditions and associated pathologies was also assessed according to the type of impaction. RESULTS: The average age of these patients in the study was found to be 30 years, with the 20 to 30 years age group being the most affected (67.4%). Females (53.3%) were affected more than the males (46.7%). People from the Asmara region showed significantly more prevalence (79.7%) than the adjoining areas (20.3%). Mesioangular impaction was the most common angulation with a definite relationship to the age groups (p = 0.032). The level of impaction had no significant relationship to the age groups, gender, or region, although class I position A was found to be the most common type. Mesioangular class I position A impac-tion showed an apparent relationship with underlying systemic conditions, but it was statistically insignificant. Mesioangular impaction was found to be associated with the most number of pathologies (p = 0.001). CONCLUSION: The prevalence of mandibular impaction was less in Eritrea (15.2%) compared with other populations. This study provides useful baseline data for the prevalence and pattern of mandibular impaction in the Eritrean population. CLINICAL SIGNIFICANCE: This study throws light on the pattern, type, and frequency of mandibular impacted teeth as per age, sex, and region among the population of Eritrea.

Evaluation of deproteinised bovine bone matrix combined with absorbable biofilm for the preservation of extraction sites of mandibular impacted wisdom teeth.

BACKGROUND: Bone defects and deep periodontal pockets often exist distal to the second molar after mandibular third molar extraction, seriously threatening the periodontal health of the second molar. OBJECTIVE: To evaluate the effect of socket preservation with bone substitute materials on alveolar bone resorption and prevention of the distal periodontal defect of the adjacent tooth after mandibular impacted third molar extraction compared with natural healing. METHODS: Ninety-nine patients with mandibular impacted teeth, treated in our hospital from January 2018 to December 2020, were randomly divided into the control and experimental groups. The experimental group underwent minimally invasive tooth extraction and socket preservation using the deproteinised bovine bone mineral, Bio-Oss and the bioabsorbable collagen membrane, Bio-Gide. The control group healed naturally after minimally invasive tooth extraction. The alveolar ridge dimension of the extraction sites, the probing depth, tooth mobility and gingival index on the distal aspect of the mandibular second molars were examined and recorded before and six months after the operations. RESULTS: There was a significant difference between the experimental group and the control group in the alveolar bone width (P< 0.05) and height (P< 0.05) before and after surgery. The probing depth of the extraction sites in both groups was reduced. CONCLUSION: Using Bio-Oss and Bio-Gide to preserve extraction sites of impacted teeth can promote recovery more effectively than natural healing on the height of the distal alveolar bone and the width of the alveolar crest of the second molar and thus improve the periodontal status of the adjacent second molar.

Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study.

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is to compare changes in bone level distal to the mandibular second molar (MSM) in patients with an extracted IMTM versus non-extracted IMTM using OPG. Methods: In this retrospective case-control study, 160 orthopantomograms (OPGs) of 80 patients who attended Dental Hospital of the University of Barcelona (HOUB) were randomly selected. Participants were stratified into a study group and control group. Results: Males and females experienced bone gain in the study group and bone loss in the control group. However, the difference in bone-level change was not statistically significant regarding gender in the study group. Within the study group, the age group of 29-39 years demonstrated significant (p-value = 0.042) bone gain after extraction compared to other age groups. However, the control group demonstrated bone loss in all age groups in which the difference is not statistically significant (p-value 0.794). Conclusions: Bone improvements distal to the MSM were observed after the extraction of an IMTM compared to when an IMTM was not extracted.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve.

BACKGROUND: Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). AIM: To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. METHODS: Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. RESULTS: All IMM3s were extracted easily without symptoms of IAN injury after extraction. CONCLUSION: Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

Comparative Evaluation of Efficacy of Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) in Bone Regeneration after Surgical Removal of Impacted Bilateral Mandibular Third Molars - A Comparative Study.

Aims and Objectives: To compare the efficacy of platelet rich plasma (PRP) and platelet rich fibrin (PRF) in bone regeneration after removal of impacted bilateral third molars. Materials and Methods: The study was carried out as an open clinical trial on 20 patients chosen from the ones referred to the department of Oral & Maxillofacial Surgery for surgical removal of bilateral mandibular third molar. Patients were prepared for surgical procedure, Inferior alveolar nerve block given using 2% lignocaine hydrochloride with 1:2,00,000 adrenaline. Third molar were removed by flap reflection and bone drilling. Finally, PRF in lower left mandibular third molar region and PRP in lower right mandibular third molar region was inserted and wound closure was done. Cone bean computer tomography (CBCT) was made on 1st postoperative day and 4 months after surgery to evaluate alveolar bone height and density. Result: Alveolar bone height and bone density at post-operative 1st day and 4 months were compared between PRP and PRF group. The bone density and bone volume were analyzed, and there was no significant difference between bone density in PRP and PRF at day 1 and 4th month. Conclusion: As per our study and evaluation, in our postoperative follow up there was no statistically significant differences in bone regeneration by placement of PRP and PRF in extracted socket of third molar. Thus, with this study we can conclude that PRF, would be a good option to Oral and Maxillofacial Surgeons in the near future due to ease of extraction.

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial.

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

Mesial Inclination of Bur for the Sectioning of Impacted Distoangular Mandibular Third Molar: A Novel Technique.

Distoangular impacted teeth account for about 4.8% of all impacted tooth angulations. Various indices in the literature used to assess the difficulty of surgically extracting impacted third molars indicate that distoangular impactions are the most complex. This complexity necessitates the development of specific skills by the operator. The difficulty arises primarily due to the challenging position of these teeth, which complicates access and instrumentation. The proposed method aims to simplify the sectioning process for distoangular third molars by avoiding unnecessary buccal bone removal, improving the accuracy of root sectioning, and preserving buccal bone. Consequently, this technique reduces postoperative pain and swelling, resulting in better patient outcomes.

Role of Prophylactic Dose of Oral Amoxicillin Trihydrate in Prevention of Bacteremia Post Surgical Removal of Impacted Mandibular Third Molar: A Clinical Study.

The current study is designed to evaluate the efficacy of pre-operative prophylactic antibiotic for prevention of bacteremia after surgical removal of impacted mandibular third molar SRIMTM. The study was carried out as an open clinical trial. Fifty patients who fulfilled the criteria were included. Twenty five randomly selected patients (study group) were administered two grams oral dose of amoxicillin trihydrate, one hour prior to the procedure. Twenty five patients (control group) were not administered any antibiotic prior to the procedure. All patients underwent surgical removal of impacted mandibular third molar through intraoral approach under local anesthesia. Blood culture for detection of aerobic and anaerobic micro-organisms was done for all 50 patients. Eleven out of the twenty five patients (44%) in the control group showed positive growth, including mixed growth (aerobic and anaerobic). Seven patients showed purely anaerobic, 2 patients purely aerobic and two mixed growth. In the study (antibiotic) group, 7 out of the 25 patients (28%) showed positive growth, including mixed growth. Three patients showed purely anaerobic, 2 patients purely aerobic and 2 mixed type of growth. The study suggests that the judicious use of antibiotic prophylaxis, in conjunction with optimal oral health care serves to minimize the adverse effects of antibiotic therapy; and at the same time reduce the significant morbidity and mortality associated with systemic infections that might occur due to bacteremia resulting from surgical procedures of the oral cavity.