Mandibular third molar coronectomy in older adults and its effects on oral health-related quality of life.

OBJECTIVE: The purpose of this study was to investigate the effect of coronectomy on postoperative quality of life in older adults. BACKGROUND: Coronectomy is an alternative to complete surgical removal of a mandibular third molar that lies close to the inferior alveolar nerve. MATERIALS AND METHODS: This prospective study included patients >60 years old who had an indication for coronectomy of a mandibular third molar. Patients were asked to complete the Dutch version of the Oral Health Impact Profile-14 (OHIP-14) daily during the first postoperative week. Postoperative pain, swelling, limited mouth opening, chewing ability and infection were also recorded. Furthermore, the effect of the impaction pattern, state of eruption, presence of preoperative pathology, patient health status according to the American Society of Anaesthesiologists score, gender, smoking on the postoperative OHIP-14 and pain scores were investigated. RESULTS: Thirty patients (16 males, 14 females) with a mean age of 71.2 (SD 8.3, range 60-91) years were included in the study. OHIP-14 and pain scores were highest on the first postoperative day and gradually declined during the first postoperative week. Patients who underwent coronectomy of a fully impacted mandibular third molar had significantly higher OHIP-14 scores on the first postoperative day than those who underwent coronectomy on a (partially) erupted mandibular third molar. We did not observe any postoperative complications up to 1 year after the surgery. CONCLUSION: Mandibular third molar coronectomy seems to present a valid treatment option in older adults.

Postoperative Outcome After Coronectomy Versus Surgical Removal of Impacted Mandibular Third Molars - Clinical and Oral Health-Related Quality of Life Follow-Up.

BACKGROUND: Coronectomy is an alternative procedure for removing mandibular third molars near the inferior alveolar nerve. Limited research exists on the effect of coronectomy on the postoperative quality of life (QoL). PURPOSE: This study compared postoperative QoL after coronectomy and complete surgical removal of mandibular third molars during the first postoperative week. STUDY DESIGN, SETTING, AND SAMPLE: This prospective cross-over study was conducted in the Oral and Maxillofacial Department of Amstelland Hospital, Amstelveen, The Netherlands. The study sample consisted of patients with indications for removal of both mandibular third molars, with one at increased risk of nerve injury undergoing coronectomy, while the other molar was extracted. Exclusion criteria were ibuprofen allergy, anticoagulant therapy, systemic disease, local pathology, or failure to complete the Oral Health Impact Profile-14 (OHIP-14) questionnaire. INDEPENDENT VARIABLE: The independent variable was the surgical procedure, categorized as coronectomy or complete mandibular third molar removal. An 8-week period was maintained between procedures. MAIN OUTCOME VARIABLE: The primary outcome measure was the mean OHIP-14 score during the first postoperative week. Secondary outcome measures were pain, self-perceived discomfort, and self-care behaviors. COVARIATES: Sex, age, impaction patterns, and treatment order were analyzed as covariates. ANALYSES: Nonparametric tests, including the Friedman test for within-patient differences and the Wilcoxon signed-rank test for repeated measures, were used for non-normally distributed data. Significance was set at 5%, with P value adjustments per Bonferroni correction. RESULTS: The sample included 55 patients (18 male and 37 female) with a mean age of 24.6 ± 4.7 years. Mean OHIP-14 scores during the first 6 postoperative days were significantly higher after coronectomy compared to after surgical removal (day 1: 24.93 ± 9.82 vs 22.7 ± 9.5; day 6: 11.27 ± 10.36 vs 8.49 ± 10.93) (P < .05). Pain was significantly higher on the second to sixth postoperative days after coronectomy (day 2: 6.02 ± 1.92 vs 5.78 ± 1.73; day 6: 4.11 ± 2.49 vs 3.09 ± 2.41) (P < .05). Patients used more analgesics after coronectomy (day 2: 4.09 ± 2.53 vs 3.27 ± 1.9; day 6: 2.76 ± 2.62 vs 2.13 ± 2.49) (P < .05). We found no differences in outcomes for sex or molar impaction (P > .05). CONCLUSION AND RELEVANCE: Coronectomy significantly impacted postoperative oral health-related QoL compared to complete surgical removal of mandibular third molars.

Association of indications for mandibular third molar coronectomy and the Pell and Gregory and the Winter classification systems.

PURPOSE: The purpose of this study was to determine how the surgeon's decision to perform a mandibular third molar coronectomy or surgical removal is associated with the impaction pattern as classified using Pell and Gregory or Winter's system. METHODS: This observational, cross-sectional study was conducted on 813 mandibular third molars belonging to 565 patients. All patients were referred for removal of the mandibular third molar and had radiographic signs indicating a close relationship with the inferior alveolar nerve. Panoramic images were classified according to the impaction pattern. RESULTS: A coronectomy was performed on 492 (60.5%) mandibular third molars. Most impacted mandibular third molars were class IIB with a mesioangular inclination. A significant association was found between the Pell and Gregory classification and the surgeon's choice (p = 0.002). Winter's classification was not significantly associated with surgeon choice (p = 0.425). CONCLUSION: Mandibular third molar coronectomy is chosen more frequently than surgical removal if molars are class III and position B. TRIAL REGISTRATION NUMBER: Not applicable.

Assessing change in quality of life using the Oral Health Impact Profile in patients undergoing orthognathic surgery: A before and after comparison with a minimal follow-up of two years.

PURPOSE: Here we evaluated how orthognathic surgery impacted oral health-related quality of life among patients with dentofacial deformities in the immediate postoperative period and during ≥2 years of follow-up, using the OHIP-14-NL questionnaire. METHODS: This prospective study included 86 patients. Quality of life was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14-NL) preoperatively (T0, baseline), over 7 days postoperatively (T1-T7), and at 4 weeks (T8), 6 months (T9), 1 year (T10), and ≥2 years (T11) postoperatively. Total OHIP score was determined for each patient. Lower OHIP scores indicated higher oral health-related quality of life. Patients also answered questions regarding self-care, discomfort, and experienced pain at all time-points, starting from T1. RESULTS: Compared to baseline (T0), median OHIP scores were significantly higher from T1 to T8. However, at T9 to T11, OHIP scores were significantly lower compared to baseline (T0) (p < 0.01). OHIP scores were not correlated with gender, age, or blood loss; and did not significantly differ according to surgery type or surgery indication (p > 0.01). Pain scores were positively correlated with OHIP scores for all time-points, except T6 and T10. Pain was not correlated with sex, age, blood loss, surgery duration, surgery indication, or surgery type. Compared to at T1, pain was significantly decreased at T9-T11. CONCLUSION: Among patients who underwent orthognathic surgery, oral health-related quality of life was decreased in the immediate postoperative period, but improved at ≥6 months postoperatively. The improvement was significant 2 years after orthognathic surgery.

Early root migration after a mandibular third molar coronectomy.

PURPOSE: This prospective cohort study aimed to assess early root migration after a coronectomy of the mandibular third molar at 2 and 6 months after surgery. METHODS: We included all patients treated with a coronectomy of an impacted mandibular third molar. The primary outcome measure was the extent of postoperative root migration after 2 and 6 months. Migration was measured as the distance between the root complex and a fixed point on the inferior alveolar canal. The secondary aim was to identify factors (age, impaction pattern, and patient sex) that affected the extent of root migration. RESULTS: One hundred and sixty-five coronectomies were performed in 141 patients (96 females and 45 males; mean age 33.1 years, SD 16.0). The 2-month checkup was completed by 121 patients that received 141 coronectomies. The 6-month check-up was completed by 73 patients that received 80 coronectomies. The mean root migrations were 3.30 mm (SD 2.53 mm) at 2 months and 5.27 mm (SD 3.14 mm) at 6 months. In the 2-6-month interval, the mean root migration was 2.58 mm (SD 2.07 mm). The extents of migration were similar during the 0-2-month interval and the 2-6-month interval (p = 0.529). Younger age was associated with greater root migration, and females experienced significantly greater migrations than males (p = 0.002). CONCLUSION: Roots migrated more rapidly in the first two postoperative months, compared to the 2-6-month interval. Age was negatively correlated with the extent of root migration, and females showed significantly greater migrations than males.

Impact of orthognathic surgery on quality of life in patients with different dentofacial deformities: longitudinal study of the Oral Health Impact Profile (OHIP-14) with at least 1 year of follow-up.

OBJECTIVE: The objective of this study was to assess the impact of orthognathic surgery for dental facial deformities on oral health-related quality of life (OHRQoL) in the immediate postoperative period up to at least 1 year after surgery. STUDY DESIGN: This prospective study evaluated data from 85 patients. OHRQoL was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14NL) preoperatively (T0), each day for 7 days postoperatively (T1-T7) and 4 weeks (T8), 6 months (T9), and at least 1 year (T10) after surgery. The total OHIP score was calculated for each patient, with higher OHIP scores indicating a worse impact on oral health. Patients also completed an extra questionnaire about self-care, discomfort, and experienced pain (rated on a 10-point scale) in the postoperative period (T1-T10). RESULTS: The mean OHIP score increased sharply at T1 compared to T0 but decreased significantly in the first postoperative week. The mean OHIP score at T8 was still higher than before surgery. However, at T9 and T10, the mean OHIP score was significantly lower than at T0 (P < .05). No significant difference in OHIP score was found between gender, age, type of surgery, and indication for surgery. Pain significantly decreased from T6 to T0. The OHIP and pain scores significantly positively correlated at every time point except T9. CONCLUSION: The findings indicate that OHRQoL is reduced from baseline in the immediate postoperative period but improves over time. By 1 year, OHRQoL improves significantly after orthognathic surgery in patients with dentofacial deformities.

Effect of periapical surgery on oral health-related quality of life in the first postoperative week using the Dutch version of Oral Health Impact Profile-14.

OBJECTIVE: To evaluate whether periapical surgery affects oral health-related quality of life (OHRQoL) within the first postoperative week. STUDY DESIGN: The primary outcomes in 133 patients (54 men, 79 women; mean age 50.8 years) undergoing periapical surgery were the Oral Health Impact Profile-14 (OHIP-14) score and postoperative sequelae, including pain, analgesic intake, swelling, limited mouth opening, chewing difficulties, and postoperative infection. RESULTS: We found a significant effect on OHIP-14, pain, and analgesics, which decreased throughout the week. We found no significant differences in mean OHIP-14, pain scores, or analgesic use for gender, medical history, surgical flaps, operation time, or location of the operated teeth. Younger patients had a higher OHIP-14 score in the first 2 days after surgery and more pain on the first postoperative day. Women experienced more pain during the first 3 days. Smokers had a higher OHIP-14 score on the first postoperative day and greater pain during the first 3 days compared to non-smokers. CONCLUSION: We identified a low incidence of pain and reduced OHRQoL following periapical surgery. The postoperative reduction in OHRQoL and pain were of short duration, with maximum intensity in the early postoperative period and rapidly decreasing with time.

Alveolar iodine tampon packing after impacted third molar surgery improves oral health-related quality of life and postoperative sequela: a randomized study.

OBJECTIVE: The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar. MATERIAL AND METHODS: Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort. RESULTS: This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort. CONCLUSIONS: Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.

Alveolar Iodine Tampon Packing Reduces Postoperative Morbidity After Third Molar Surgery.

PURPOSE: The aim of this study was to assess the efficacy of an iodine tampon after mandibular third molar surgery on oral health-related quality of life (OHRQoL), use of painkillers, postoperative sequelae, and self-care behaviors in the first postoperative week. MATERIALS AND METHODS: This prospective, crossover, randomized controlled study included patients undergoing surgical removal of bilateral symmetrically, horizontally impacted mandibular third molars. The surgical site was randomly allocated to receive an iodine tampon after surgery or wound closure and rinsing with a Monoject syringe (Tyco/Healthcare-Kendall, Mansfield, MA). The primary outcomes measured each day during the first postoperative week were the Oral Health Impact Profile 14 score and postoperative sequelae, including pain, swelling, limited mouth opening, postoperative infection, and alveolar osteitis. The secondary outcome measures were several self-care behaviors. Data were analyzed using repeated-measures analysis of variance and paired-samples t tests. RESULTS: A total of 54 patients (25 men and 29 women; mean age, 25.1 years) were enrolled, with a total of 108 surgically removed impacted mandibular third molars. The use of an iodine tampon resulted in a significantly lower impact on OHRQoL (mean of 21.5 [standard deviation (SD), 9.6] vs 26.5 [SD, 10.6]) on the first postoperative day, which was observable until the seventh postoperative day. In addition, after removal of the impacted third molar, patients with the iodine tampon condition reported less pain (mean of 5.2 [SD, 1.9] vs 6.1 [SD, 2.1] on day 1, lasting throughout the week), less use of painkillers, less limited mouth opening, fewer problems chewing, less swelling, and earlier recovery. CONCLUSIONS: The use of postoperative iodine packing after the removal of impacted mandibular third molars significantly reduces OHRQoL and postoperative sequelae.

Anxiety and pain related to mandibular block injections: comparison of self-reported measures and physiological response.

OBJECTIVE: The aim of this study was to determine whether patients with a pain score ≥7 (high pain group) after a mandibular block injection had a higher physiologic response compared with patients with scores <7 (low pain group). STUDY DESIGN: Before oral surgery, patients (n = 66) filled out questionnaires to measure anxiety and expected pain. The questionnaires also assessed patients' experiences with dental injections and dental anxiety, as well as their emotional state and intensity of anxiety. Before, during, and after the injection, physiologic responses were measured by using Nexus-10. Patients were then asked about the pain and anxiety they had experienced. RESULTS: The mean score for pain experienced was 3.45 (standard deviation 2.17) on an 11-point rating scale. Eight patients (12.1%) experienced high injection pain. There was a significant increase in mean sweat secretion and a significant decrease in mean respiration between the relaxing phase and the injection phase. There was a significant positive relationship between experienced anxiety and mean heart rate during the injection phase. No significant difference in physiologic response was found between patients who experienced high pain and those who experienced low pain. CONCLUSIONS: Reported pain was not associated with the physiologic response of patients receiving mandibular block injections.

Analgesic effects of preinjection low-level laser/light therapy (LLLT) before third molar surgery: a double-blind randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the analgesic effects of low-level laser therapy (LLLT) on preinjection sites in patients scheduled for third molar removal. STUDY DESIGN: This double-blind randomized controlled trial included 163 healthy patients undergoing third molar extractions. The study participants were randomly divided into an LLLT and a placebo group. Objective and subjective data sets were obtained from physiologic feedback (heart rate and sweat response) and a questionnaire, respectively. In the LLLT group, each targeted injection site was irradiated twice with 198 mW continuous wave for 30 seconds with a 0.088 cm2 focal spot at an applied energy of 5.94 J and fluence of 67.50 J/cm2. Measurements were recorded from 4 time-points during data acquisition. RESULTS: There was no significant difference between the LLLT and placebo groups in pain experience scores associated with the injected sites for maxillary or mandibular third molar extractions. Mean heart rates before and during injection were lower in the LLLT group than in the placebo group for both maxillary and mandibular regions. No statistically significant differences were observed for any remaining parameters. CONCLUSIONS: The present data indicated that preinjection LLLT did not effectively decrease the pain felt during local anesthetic injections before third molar surgery.

Pain related to mandibular block injections and its relationship with anxiety and previous experiences with dental anesthetics.

OBJECTIVE: Anesthetic injections should reassure patients with the prospect of painless treatment, but for some patients it is the main source of their fear. We investigated pain resulting from mandibular block injections in relation to anxiety and previous experience with receiving injections. STUDY DESIGN: Patients (n = 230) filled out questionnaires before oral surgery. They were then asked to raise their hand when they felt pain as a result of the injection. The injection was administered, and pain intensity (11-point numeric rating scale) and pain duration (in seconds) was measured. RESULTS: In general, patients expected (mean 4.2, SD 2.7) significantly more pain than they experienced (2.4 ± 2.2). About 8.3% of patients reported a score in the range of 7 to 10. On average, pain lasted for 6.2 seconds (range 1-24.5 s), ≈ 36% of patients raised their hand for ≤ 2 seconds, and 14.6% raised their hand for ≥ 10 seconds. Pain was significantly positively associated with anxiety and the way previous injections were experienced. CONCLUSIONS: Mandibular block injections can be considered to be mildly painful, with pain lasting only a few seconds. The pain experience of a mandibular block seems only partly dependent on experienced anxiety and previous experiences with receiving injections.

A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone grafting procedures: single-dose clindamycin versus 24-hour clindamycin prophylaxis.

PURPOSE: The objective of this study was to compare the efficacy of a single oral dose of clindamycin with a 24-h protocol of clindamycin administration in local buccal onlay grafting procedures. MATERIAL AND METHODS: A prospective randomized study in 124 patients was performed. Eligible patients were randomized to receive antibiotic prophylaxis either as a single dose (group I) or over a 24-h period (group II). In both groups prophylaxis started with an oral dose of 600 mg clindamycin 1 h before surgery, followed by either placebo or 300 mg clindamycin every 6 h. The primary endpoint of this study was wound infection at the receptor site within 8 weeks after surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. RESULTS: The mean age of the patients was 35.9+/-10.1 years (range 18-59 years). Infections at the receptor site were seen in two patients (3.2%, 95% CI 0-7.6%) of the single-dose group and in three patients (4.8%, 95% CI 0-10.1%) of the 24-h group. Infection at the donor site occurred in four patients (6.4%, 95% CI 0-12.5%) of the single-dose group and in two patients (3.2%, 95% CI 0-7.6%) of the 24-h group. Postoperative infections were predominantly caused by alpha-hemolytic streptococci sensitive to penicillin. CONCLUSIONS: No statistically significant difference was found between the prophylactic single dose of clindamycin and the 24-h regimen of clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures.