New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications.

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.

Preinterventional Third-Molar Assessment Using Robust Machine Learning.

Machine learning (ML) models, especially deep neural networks, are increasingly being used for the analysis of medical images and as a supporting tool for clinical decision-making. In this study, we propose an artificial intelligence system to facilitate dental decision-making for the removal of mandibular third molars (M3M) based on 2-dimensional orthopantograms and the risk assessment of such a procedure. A total of 4,516 panoramic radiographic images collected at the Center of Dental Medicine at the University of Zurich, Switzerland, were used for training the ML model. After image preparation and preprocessing, a spatially dependent U-Net was employed to detect and retrieve the region of the M3M and inferior alveolar nerve (IAN). Image patches identified to contain a M3M were automatically processed by a deep neural network for the classification of M3M superimposition over the IAN (task 1) and M3M root development (task 2). A control evaluation set of 120 images, collected from a different data source than the training data and labeled by 5 dental practitioners, was leveraged to reliably evaluate model performance. By 10-fold cross-validation, we achieved accuracy values of 0.94 and 0.93 for the M3M-IAN superimposition task and the M3M root development task, respectively, and accuracies of 0.9 and 0.87 when evaluated on the control data set, using a ResNet-101 trained in a semisupervised fashion. Matthew's correlation coefficient values of 0.82 and 0.75 for task 1 and task 2, evaluated on the control data set, indicate robust generalization of our model. Depending on the different label combinations of task 1 and task 2, we propose a diagnostic table that suggests whether additional imaging via 3-dimensional cone beam tomography is advisable. Ultimately, computer-aided decision-making tools benefit clinical practice by enabling efficient and risk-reduced decision-making and by supporting less experienced practitioners before the surgical removal of the M3M.

A preliminary study on the assessment of pain using figures among patients administered with dental local anesthesia for mandibular third molar extraction.

The aim of this study was to clarify or determine any possible association between pain reports with a visual analogue scale (VAS) and a figures based scale. This research was a preliminary study aimed at developing a new pain scale without any verbal description. Healthy Japanese patients aged 20 to 39 years who received anesthetic injections for mandibular third molar extraction at our department were enrolled. Regarding pain from dental local anesthetic injections, we recorded figures selected by participants (among options of a circle, triangle, square, bar, and cross), and VAS scores. Overall, 29 men and 31 women participated in the study. Pain caused by local dental anesthesia tended to remind both men and women of the triangle among the suggested figures. Furthermore, patients who chose a cross also reported higher VAS scores than those who chose other figures. Acute pain caused by local dental anesthesia was associated with triangles, and patients who selected a cross were associated with higher VAS scores. The results of this study provide clinicians with important information for dental practice, and could prove useful in developing new pain scales.

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life.

BACKGROUND: The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction. MATERIAL AND METHODS: This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction. RESULTS: The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05). CONCLUSIONS: Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.

Assessment of Dry Socket after Mandibular Third Molar Surgery Using Platelet-Rich Fibrin - A Prospective Clinical Study.

OBJECTIVE:  To determine the efficacy of Platelet-Rich Fibrin (PRF) in preventing Dry Socket (DS) after mandibular third molar surgery in comparison with the control group. STUDY DESIGN: Experimental study. Place and Duration of the Study: Oral and Maxillofacial Surgery Department, Dental Section, Faisalabad Medical University, Faisalabad, Pakistan, from July 2019 to June 2021. METHODOLOGY: Patients aged 18-35 years with good oral hygiene, and requiring surgical extraction of their mandibular third molar were included in the study. Those with periodontal disease, pregnant or nursing women, smokers, or allergic to the agents that were recommended for use before and after surgery, were excluded. Patients presenting for surgical removal of the mandibular third molar and meeting the inclusion criteria were enrolled and randomly divided into 2 groups. Standard protocol for tooth removal was followed in both groups. Group1 (study group) received PRF and group 2 (control group) did not receive PRF. RESULTS: A total of 170 consecutive patients (85/group) were randomly selected and allocated to the study group and control group. The mean age in the study group was 24.28±3.7 years while the mean age in the control group was 24.14±3.64 years. Out of them, 51.2% (n=87) were males and 48.8% (n=83) were females with a M: F of 1:1.05. On the 3rd postoperative day, DS frequency in the study group was 2.4% (n=2) and 18.8% (n=16) in the control group (p=0.0001), which reduced to 01 and 05 respectively on 7th day (p=0.096). CONCLUSION: PRF administration was effective in preventing DS on the third postoperative day in mandibular third molar surgery, with statistically significant results. However, on postoperative day 7, the results were not statistically significant. KEY WORDS: Third molar, Tooth extraction, Dry socket, PRF.

Assessment of Difficulty in Mandibular Third Molar Surgery by Lambade-Dawane-Mali's Index.

PURPOSE: The evaluation of mandibular third molar (M3) difficulty is extremely important. This study aims to measure the association between preoperative Lambade-Dawane-Mali's (LDM) M3 difficulty index and postoperative assessment of difficulty score. MATERIAL AND METHODS: This prospective cohort study included patients with impacted M3 reported to the Department of OMS, RRK Dental College, Akola, from 2017 to 2022. The preoperative surgical difficulty was estimated using the predictor, LDM index with scores, easy (15-25), moderate (25-30), and difficult (>30). The postoperative surgical difficulty was analyzed with the primary outcome variable, total time intervention measured from the beginning of incision to the final suturing, wherein extraction was classified as easy if time (<15 minutes), moderate (15-30 minutes), and difficult (>30 minutes). The secondary outcome variable, Modified Parant's Scale (MPS), defines four levels of difficulty required for extraction of M3: Easy I (forceps extraction), Easy II (requiring osteotomy), Difficult III (coronal sectioning), and Difficult IV (complex extraction). Data were analyzed using agreement between LDM difficulty with three established criteria (time, MPS, Pederson index) and were assessed with Cohen's Kappa statistics. McNemar's test for paired data was used to assess concordance between two criteria of evaluation with a P-value <.05 was considered statistically significant. RESULTS: The study sample included 1000 patients with a mean age of 26.7 ± 7.6 years and 456 (45.6%) females. Those assessed preoperatively with LDM to be difficult and easy outcomes were found upon postoperative assessment with MPS to be 99% and 99% correct, respectively. Inter-criteria agreement and Kappa statistics suggested a positive Kappa value (κ) and statistically significant agreement between the LDM index with perioperative time (κ = 0.8930), MPS (κ = 0.6488), and Pederson index (κ = 0.4920) at P-value 0.0001. Pair-wise comparisons of LDM criteria with perioperative time, MPS, and Pederson scale were assessed by McNemar's test, which evaluated concordance between the two criteria. CONCLUSION: Postoperative evaluation of surgical difficulty in M3 extraction was strongly correlated with preoperative variables in the LDM difficulty-scoring index. Preoperative evaluation helps in anticipating the difficulty, planning surgical management, and scheduling time more optimally.

Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study.

OBJECTIVE: To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial. METHODS: From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality. RESULTS: For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters. CONCLUSION: This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT. CLINICAL SIGNIFICANCE: This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.

Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Assessment of Relationship between Hemodynamic Changes and Anxiety in Patients During Lower Third Molar Surgery.

OBJECTIVE: To investigate the relationship between anxiety and hemodynamic changes in patients who have undergone impacted third molar surgery under local anaesthesia. STUDY DESIGN: Observational clinical study. PLACE AND DURATION OF STUDY: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey, from January 2018 to December 2019. METHODOLOGY: Normotensive patients aged over 18 years, not using antidepressant medicine and ASA I included. A total of 83 patients were monitored and operated on for impacted third molar surgery. Blood pressure, pulse, and oxygen saturation values of the patients were noted at eight different stages during the surgery. Only the mesioangular impacted lower third molars of the patients were removed by a surgical operation. STAI forms were given before the operation. RESULTS: There is a significant difference between values of blood pressure, pulse, and oxygen saturation and gender (p<0.05). However, there was found to be an increased blood pressure in male patients while an increase in pulse and oxygen saturation was observed in female patients (p<0.05). CONCLUSION: Male patients were more concerned than female patients by having higher blood pressure which may cause longer postoperative bleeding. KEY WORDS: Anxiety, Impacted third molars, Dental surgery, Hemodynamic changes.

Do Race and Ethnicity Affect the Age When Third Molars are Extracted?

PURPOSE: Socioeconomic and racial statuses 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 postoperative complications. Descriptive, univariate, and multivariate statistics were conducted. P < .05 was considered statistically significant. Covariates included gender, insurance type, interpreter requirements, and preoperative symptoms. RESULTS: This study included 3,933 patients after exclusion criteria were 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 preoperative 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 more preoperative symptoms than other races (46.2% vs 29.2%, P < .001). White patients experienced the most postoperative complications (7.7% vs 5.0%, P = .003), while Black or African American patients experienced less postoperative complications (2.7% vs 7.5%, P < .001). CONCLUSION: This study provides no evidence that patients from historically under-represented 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.

Novel strategy to predict high risk of inferior alveolar nerve injury during extraction of lower third molars based on assessment of computed tomographic images of multiple anatomical features.

Preoperative assessment is essential to prevent inferior alveolar nerve (IAN) injury during surgical extraction of the lower third molar (LM3). Here, we aimed to establish an assessment system to predict IAN injury during surgical extraction of the LM3. We conducted a retrospective cohort study on 115 patients diagnosed as 'high-risk' based on our previous risk assessment method involving three anatomical features of the inferior alveolar canal using computed tomographic (CT) images. We evaluated the occurrence of neurosensory impairment in these high-risk patients, and its association with novel anatomic features based on CT images. Neurosensory impairments were observed in 19 patients (16.5%). The inferior alveolar canal major diameter (p < 0.0001) and lingual bone thickness (p = 0.0039) were significantly associated with the occurrence of neurosensory impairment during LM3 extraction. Receiver operating characteristic curves were used to determine cut-off values of these quantitative factors to specifically predict IAN injury. Preoperative risk assessment with quantitative factors based on anatomical features observed on CT images may facilitate more appropriate surgical planning for patients at a high risk of IAN injury.

The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study.

Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.

Third molar surgical difficulty scales: systematic review and preoperative assessment form.

BACKGROUND: The main objective of this systematic review was to collect the pre-existing scales for assessing the difficulty of third molar extraction. The secondary objective was to design a proposal for a preoperative evaluation protocol for the difficulty of third molar extraction. MATERIAL AND METHODS: Two independent researchers conducted an electronic search in Pubmed (MEDLINE), Cochrane, and Scopus databases during March 2021. Included studies evaluated the prediction of the difficulty of surgical removal of impacted upper or lower third molars using new indices/scales or pre-existing scales with or without modifications. Articles referring to coronectomies or assessing pre-surgical difficulty using other tools were excluded. Neither language nor publication date restrictions were applied. RESULTS: Out of 242 articles, 13 prospective cohort studies were finally selected. Seven developed new indices/scales, and 6 assessed the predictive ability of some pre-existing scales. Most of the indices/scales contained radiological variables and few added any patient-related variables. We proposed a preoperative assessment protocol of the difficulty of third molar extraction to facilitate treatment planning and/or considerate referral in cases of high difficulty. This proposal used patient-related, radiological and surgical variables. CONCLUSIONS: Using a preoperative protocol to evaluate the surgical difficulty, including different patient-specific, radiological and surgical variables, could facilitate treatment planning, help clinicians prevent complications and assess the possibility of referral.

The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population.

Classifications of impacted teeth allow defining the type and degree of retention, as well as assessing the degree of difficulty of the procedure. The aim of this study was to conduct retrospective analysis of the degree of retention and difficulty in the surgical removal of impacted mandibular third molars in the clinical material of the Department of Oral Surgery in 2013-2018. This study included 1585 dental panoramic radiographs of patients of the Department of Oral Surgery, who reported in 2013-2018, in order to perform surgical removal of the impacted mandibular third molar. Based on dental panoramic radiographs, the degree of retention was determined based on classifications according to Winter, according to Pell and Gregory, according to Tetsch and Wagner, and according to Asanami and Kasazaki. The difficulty of the procedure was also assessed based on the Pederson index. The most common types of lower wisdom tooth impaction are as follows: in Winter's classification, mesial-angular impaction; in Tetsch and Wagner's classification, oblique medial-angular impaction; in Pell and Gregory's classification, impaction grade 2A; and in Asanami and Kasazaki's classification, 3A and anterior inclination. In most cases of surgical removal of an impacted tooth, the anticipated difficulty of the procedure was rated as very difficult.

Assessment of Passiflora incarnata L for conscious sedation of patients during the extraction of mandibular third molars: a randomized, split-mouth, double-blind, crossover study.

OBJECTIVE: The aim of the present study was to evaluate the efficacy of Passiflora incarnata L for the control of anxiety during third mandibular molar extraction and compare it to midazolam, the most used benzodiazepine in dentistry. METHOD AND MATERIALS: The investigators implemented a prospective, randomized, double-blind, split-mouth study. The degree of anxiety of the patients was assessed before the surgical procedure. The surgeries took place in two sessions: one on each side of the hemi-mandible and, on each of them, the patient received one of the drugs, crosswise. Anxiety control was measured through physical parameters, at the following periods during the surgery: (1) immediately administration of anxiolytic medication, (2) 30 minutes after anxiolytic medication, (3) after extraoral antisepsis, (4) after local anesthesia, (5) during incision, (6) during osteotomy, (7) between osteotomy and odontosection, (8) during odontosection, (9) during surgical store curettage, (10) during suture, and (11) immediately after postoperative care guidelines. Lastly, the volunteers received a self-assessment form in order to report their experience. Statistical analysis was performed using the Wilcoxon test. RESULTS: The final sample was composed of 20 patients, with a mean age of 22.5 years. The results of the physical parameters showed statistically significant differences (P < .05) for certain times and physical parameters, especially heart rate (P = .036), which showed the highest control for Passiflora at time point (3). The undesirable effects reported by patients such as drowsiness, muscle relaxation, and dizziness were greater with benzodiazepine. CONCLUSION: The results of this study suggest that Passiflora may be considered as an alternative to midazolam in controlling anxiety in dentistry. Future studies will focus on other benzodiazepines and herbal medicines.

Assessment of the Retromolar Canal in Taiwan Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study in a Medical Center.

The retromolar canal is an anatomical variation that occurs in the mandibular bone. The retromolar canal typically originates in the mandibular canal on the distal side of the third molar and extends forward and upward to the retromolar foramen (RMF), which contains the neurovascular bundle. Accidentally damaging the neurovascular bundle in the retromolar canal during the extraction of the third molar, dental implant surgery, or maxillofacial orthognathic surgery may lead to subsequent complications such as incomplete local anesthesia, paresthesia, and bleeding during operation. The objective of this study was to investigate the prevalence of the RMF in the Taiwanese population in a medical center by using dental cone-beam computed tomography (CBCT) and to identify the position of the RMF in the mandibular bone. The dental CBCT images for the mandibular bone of 68 hemi-mandible were uploaded to the medical imaging software Mimics 15.1 to determine the prevalence of the RMF in the Taiwanese population and the three positional parameters of the RMF in the mandibular bone: (1) The diameter of the RMF, (2) the horizontal distance from the midpoint of the RMF to the distal cementoenamel junction of the second molar, and (3) the vertical distance from the midpoint of the RMF to the upper border of the mandibular canal. Seven RMFs were observed in the 68 hemi-mandibles. Thus, the RMF prevalence was 10.3%. In addition, the diameter of the RMF was 1.41 ± 0.30 mm (mean ± standard deviation), the horizontal distance from the midpoint of the RMF to the distal cementoenamel junction of the the second molar was 12.93 ± 2.87 mm, and the vertical distance from the midpoint of the RMF to the upper border of the mandibular canal below second molar was 13.62 ± 1.3487 mm. This study determined the prevalence of the RMF in the Taiwanese population in a medical center and its relative position in the mandibular bone. This information can provide clinicians with a reference for posterior mandible anesthesia and surgery to ensure medical safety.

Assessment of C-reactive Protein Level and Efficacy of Diclofenac Sodium and Mefenamic Acid in Relieving Pain in Mandibular Impacted Third Molar Surgery.

AIM: To compare the efficacy of diclofenac sodium and mefenamic acid in relieving pain in mandibular impacted third molar surgery and to assess the level of the C-reactive protein (CRP) level. MATERIALS AND METHODS: This study was conducted on 90 patients of impacted mandibular third molars. All patients were administered with 2% lignocaine with 1:80,000 adrenaline, and surgical removal of impacted third molar was done following the standardized surgical procedure by a single oral surgeon. Patients were divided into two groups of 45 each. In group I, patients were prescribed 50 mg diclofenac sodium and in group II patients were prescribed 500 mg mefenamic acid for three times a day for 3 days. The CRP level was again evaluated after 3 days of analgesics. Pain was assessed using the visual analog scale (VAS). RESULTS: The mean VAS was 2.58 in group I and 3.46 in group II, which was statistically considerable (p < 0.05). The mean CRP level postoperatively in group I was 15.7 and after 3 days was 27.2 in group I, whereas it was 25.1 postoperatively and 31.5 after 3 days in group II. CONCLUSION: Authors found that diclofenac sodium as useful as mefenamic acid. The CRP level was raised significantly following surgery, thus reflecting that it is an indicator of inflammation. CLINICAL SIGNIFICANCE: Diclofenac sodium can be used to relieve pain. The CRP level evaluation can be helpful to assess inflammation following surgery.

Does prescription drug monitoring program usage affect opioid analgesic prescriptions by oral and maxillofacial surgeons after third molar surgery?

OBJECTIVE: To curb opioid overprescription and diversion, 49 states have implemented mandatory prescription drug monitoring programs (PDMPs). This study aims to examine the changes in analgesic prescription patterns associated with mandatory PDMP usage by oral and maxillofacial surgeons. DESIGN: This retrospective observational cohort study analyzed analgesic prescriptions after third molar surgeries from the University of Pennsylvania from July 2016 to December 2019. Because Pennsylvania mandated PDMP usage on January 1, 2017, we analyzed prescriptions 6 months prior to and for each 6-month interval after implementation. RESULTS: Prescriptions after 13,430 procedures on 6437 patients across 7 6-month periods were analyzed. Patients in all study periods had an average age of 40 years and there was a slight majority of females. After PDMP implementation, patients who received analgesics had an 80% lower odds of receiving an opioid option after adjusting for age, sex, and procedural severity. When an opioid was prescribed, the mean pills per script decreased from 20.18 to 10.96 1 year after PDMP implementation. CONCLUSIONS: Mandatory PDMP usage was associated with decreased odds of a patient receiving an opioid analgesic and with a decrease in mean opioid pills per script. PDMPs may be helpful in reducing opioid prescriptions by oral and maxillofacial surgeons after third molar surgery.

Three-dimensional assessment of root migration and rotation patterns after coronectomy: bone-embedded roots versus soft tissue-covered roots.

In this study, a three-dimensional evaluation was performed to explore differences between bone-embedded and soft tissue-covered roots after mandibular third molar (M3M) coronectomy. Patients were recruited according to the results of cone-beam computed tomography, 6 months after coronectomy. Completely bone-embedded M3Ms were assigned to group B, while completely soft tissue-covered M3Ms were assigned to group S. Data were recorded using digital software. A total of 213 M3Ms in 181 patients were investigated, of which 170 were assigned to the two study groups. Age was the primary factor influencing root migration (P<0.001). The smaller the degree of angulation of the M3M, the more likely was the root complex to rotate distally (r=-0.37, P<0.001). The depth of the impacted M3M contributed to the regeneration of new bone (P≤0.008). The length of the root complex (odds ratio 0.82, P=0.048) and distance from the root to the alveolar crest (odds ratio 1.23, P=0.026) were two critical factors influencing whether the root complex was bone-embedded. Ensuring that the length of the root complex is <7.6mm and the distance between the root and alveolar crest is ≥5mm were both found to be critical to the remaining root being completely bone-embedded and thus preventing eruption and the need for secondary surgery.

Computer-aided three-dimensional assessment of periodontal healing distal to the mandibular second molar after coronectomy of the mandibular third molar: a prospective study.

BACKGROUND: The periodontal healing distal to the mandibular second molar (M2M) after coronectomy of the M3M has shown controversial results. We aimed to combine a digital method with cone-beam computed tomography (CBCT) and estimate periodontal healing of M2M after M3M coronectomy. An accurate and stable indicator in three dimensions was also explored tentatively. METHODS: Patients with a M3M in contact with the inferior alveolar canal were included. CBCT was applied immediately after coronectomy (baseline) and 6-months later. Data were investigated with digital software for registration. Previously reported and coronectomy-related factors were included for univariate and multivariate analyses. RESULTS: A total of 181 patients (213 M3Ms) completed 6-month follow-up. Significant reduction in the distal intra-bony defect (DBD) depth of the M2M was shown (1.28 ± 1.24 mm, P < 0.001). DBD depth of the M2M at baseline was the most influential factor (r = 0.59), followed by preoperative M3M condition, age, rotation and migration of the root complex. Remaining enamel (OR = 6.93) and small retromolar space (0.67) contributed to re-contact of the root complex and M2M. Bone volume regenerated in the distal 2 mm was associated significantly with DBD-depth reduction (r = 0.74, P < 0.001). CONCLUSIONS: Bone volume regenerated in the distal 2 mm of the M2M denoted stability of distal periodontal healing of the M2M. DBD depth at baseline was the most influential factor for healing of a DBD of the M2M after M3M coronectomy. The remaining enamel and a small retromolar space could contribute to re-contact of the root complex and the M2M. TRIAL REGISTRATION: China Clinical Trial Center, ChiCTR1800014862 . Registered 10 February 2018.