Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment.

This study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis. PURPOSE: To describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT). METHODS: This retrospective cohort study collected clinical and CBCT data from 176 patients. The study group (n = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected (n = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher's exact, Mann-Whitney U, and t-tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ - , and bisphosphonate and denosumab patients/sites. Significance was set at p ≤ 0.05. RESULTS: From the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features (p > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis. CONCLUSION: Osteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.

Occurrence and Predictors of Postoperative Preauricular and Masticatory Muscle Pain Symptoms After Surgical Removal of Third Molars: A Single-Blind Randomized Controlled Trial Comparing Dental Assistants Supporting the Mandible and the Restful Jaw Device.

BACKGROUND: During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support instead of the DA. PURPOSE: This study compared the occurrence of postoperative preauricular and masticatory muscle pain symptoms (PMMPS) between the device and DAs providing mandibular support, using two outcome measures. Secondary aims identify predictors of outcome and providers' opinions of the device. STUDY DESIGN, SETTING, SAMPLE: In this multisite, single-blind, two-arm parallel randomized trial, participants without preoperative PMMPS had surgical removal of third molars, with sedation and bite blocks were randomly assigned to manual support or the device. EXPOSURE VARIABLE: The exposed group was randomly assigned to the device and the nonexposed group to manual support. MAIN OUTCOME VARIABLE(S): The primary outcome was patient-reported PMMPS. Two secondary outcomes were pain assessed with the temporomandibular disorder Pain Screener and providers' views on the device. Outcomes were assessed at 1-, 3-, and 6-month postsurgery. COVARIATES: The covariates are baseline demographics (eg, sex), clinical characteristics (eg, eruption status), and third molar surgeries. ANALYSES: For occurrence of pain, generalized estimating equations assessed differences between groups. Logistic regression analysis assessed predictors of pain at 1 month, per the Screener. The level for statistical significance was 5%. RESULTS: Enrollment was 86 and 83 participants in the device and DA groups, respectively. The average age was 20.8 years; the majority were female (65%) and Caucasian (66%). The retention rate was ≥95.9%. The groups did not differ significantly for occurrence of pain using the primary and secondary outcome measures at any follow-up (P ≥ .46). Fully impacted molars were associated with occurrence of pain (odds ratio = 3.44; 95% confidence interval 1.49-7.92; P = .004). CONCLUSION AND RELEVANCE: Occurrence of pain using the primary and secondary outcome measures did not differ significantly between groups at any follow-up and was associated with removal of fully impacted third molars. Four out of five surgeons reported wanting to use the device on a regular basis when performing this procedure in sedated patients.

Removal of Horizontally Impacted Mandibular Third Molars Using the Three-Piece or T-Shaped Tooth Sectioning Method.

BACKGROUND: The extraction of horizontally impacted mandibular third molars (HM3) can be a complicated surgery. Appropriate tooth sectioning methods can reduce the operation time and postoperative complications. PURPOSE: The current study compares operative time and postoperative pain between HM3 removed using the three-piece or T-shaped tooth sectioning techniques. STUDY DESIGN, SETTING, SAMPLE: A randomized single-blind prospective clinical trial on HM3 extraction was carried out between June and December 2022 in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University. Patients with local or systemic infection, poor oral hygiene, and systemic disease were excluded. PREDICTOR VARIABLE: The predictor variable was the tooth sectioning method. The subjects were randomized to a three-piece or T-shaped group. MAIN OUTCOME VARIABLE(S): The primary outcome variables were the operative time and postoperative pain measured using a visual analog scale (VAS). The secondary outcome variables were the rates of primary bleeding, mouth opening reduction, swelling, patient satisfaction measured using a VAS, and quality of life measured using a postoperative symptom severity scale. COVARIATES: The covariates included age, sex, side and classification of HM3, and the relationship of HM3 to the inferior alveolar nerve canal. ANALYSES: The data were analyzed using the independent samples t-test, paired t-test, χ2, and rank sum test. A significance level set at P < .05. RESULTS: The sample included 60 patients in the three-piece group and 66 patients in the T-shaped group. The operative time of the three-piece group (14.73 ± 3.21 minutes) was shorter than that of the T-shaped group (19.25 ± 4.29 minutes) (P < .05). On days 3 and 7, VAS of pain were 2.24 ± 1.89 and 0.15 ± 0.40 in the three-piece group and 3.95 ± 2.44 and 0.48 ± 0.68 in the T-shaped group (P < .05). The VAS of patient satisfaction in the three-piece group (6.05 ± 1.29) was better than the T-shaped group (4.90 ± 1.05) on day 7 (P < .05). CONCLUSION AND RELEVANCE: The three-piece tooth sectioning for HM3 removal was associated with shorter duration, slighter postoperative symptoms, and higher patient satisfaction and may be considered as a recommended practice for dentists.

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth.

OBJECTIVE: With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. METHODS: This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. RESULTS: The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88 min and 22.00 ± 7.71 min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group. CONCLUSION: Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Can concentrated growth factor prevent postoperative complications of impacted third molar surgery? A split-mouth randomized double-blind trial.

OBJECTIVES: The purpose of the present study was to evaluate the effect of concentrated growth factor (CGF) on prevention of postoperative complications in the impacted third molar extraction. MATERIALS AND METHODS: A total of 25 healthy patients with symmetrical bilaterally impacted third molars (50 extraction sites) were enrolled in this split-mouth, randomized, double-blind clinical trial. Third molar extractions were performed in both sites of the mandible at the same appointment. Randomization was performed using a coin toss to choose the test and control sites. CGF was placed in the extraction socket and the socket was sutured (test group), while the contralateral socket was only sutured (control group). Each patient acted as their own control. The primary outcome were pain assessed by visual analog scale (VAS) and facial swelling on the1st, 3rd and 7th postoperative days. The secondary outcomes were bone healing in extraction sockets through alveolar bone height (ABH) and alveolar bone density (ABD) evaluated by cone beam computed tomography (CBCT) immediately after extraction and in the 3rd and 6th months. RESULTS: Twenty-five patients (12 female, 13 male; mean age 29.17) with bilateral impacted third molars participated in the study. A statistically significant reduction in pain was determined on the 3rd and 7th postoperative days in the CGF sites compared to the control sites while no statistically significant difference was found between the groups on the 1st postoperative day (3rd day, p = 0.009; 7th day, p = 0.039). There were no statistically significant differences in facial swelling and bone healing between the test and control groups at different time intervals, although the data obtained were slightly favoring the CGF group (p > 0.05). There were no serious adverse effects such as infection, alveolitis, paraesthesia, fracture through the follow-up period in all of the cases. CONCLUSION: The study has demonstrated the effect of CGF on relieving the severity of pain after the third molar extraction. CLINICAL RELEVANCE: Placement of CGF in the extraction socket could relieve postoperative pain and reduce patient discomfort after the third molar extraction. CGF is recommended during the third molar extraction due to its good biological effects, low cost and simple preparation procedures. TRIAL REGISTRATION NUMBER: ChiCTR2300077819.

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery. MATERIALS AND METHODS: Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023. RESULTS: Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively. CONCLUSIONS: The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports. CLINICAL RELEVANCE: The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures - a prospective clinical study.

OBJECTIVES: To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters. MATERIALS AND METHODS: Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups. RESULTS: Both groups had significant decreases in ridge dimensions over 6 months (p < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months (p < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months (p > 0.001). CONCLUSIONS: APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group. CLINICAL RELEVANCE: Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.

Treatment of Class II malocclusion with 2-maxillary premolar extractions: Monthly vs biweekly appointments, which is more efficient?

INTRODUCTION: This study compared whether there is a difference in treatment time (TT) and efficiency when appointments are held once a month or at 2-week intervals in patients with Class II malocclusion treated with 2-premolar extractions METHODS: The patients of this retrospective sample were treated with the same orthodontic mechanics and divided into 2 groups according to frequencies of orthodontic appointments. Group 1 consisted of 18 patients (10 males, 8 females), with an initial mean age of 14.38 ± 1.38 years and appointments once a month. Group 2 consisted of 19 patients (9 males, 10 females), with an initial mean age of 14.12 ± 1.38 years and biweekly appointments. Edgewise fixed appliances with a slot size of 0.022 × 0.028 mm were used, and the anterior teeth were retracted en-masse with a rectangular wire and elastic chains. The Peer Assessment Rating and Objective Grading System indexes were measured in the dental models at the beginning and the end of treatment. Efficiency was assessed by dividing the percentage of improvement of each occlusal index concerning the multiplication of TT and the number of appointments. RESULTS: Both groups presented similar Peer Assessment Rating and Objective Grading System indexes at the end of treatment. Groups 1 and 2 presented different TTs (28.06 and 22.05 months, respectively); however, there were no differences regarding the efficiency of both protocols. CONCLUSIONS: Patients with Class II malocclusion treated with 2-maxillary premolars had significantly shorter treatment times when seen on biweekly appointments than those with monthly appointments; however, there was no difference in efficiency between protocols.

Soft-tissue profile changes in adult patients treated with premolar extractions.

INTRODUCTION: The objective of this study was to identify the soft-tissue profile changes and the potential pretreatment cephalometric parameters that clinicians could use to predict the lip response after premolar extraction treatment in adult patients. METHODS: Pretreatment and posttreatment lateral cephalograms of 75 white patients treated with premolar extractions were analyzed. The following initial cephalometric measurements were recorded: upper and lower lip to E-plane, vermilion thickness, lip length, maxillary and mandibular incisor inclination, and mentolabial and nasolabial angle. Pretreatment and posttreatment radiographs were superimposed using the Björk structural method to record lip retraction and incisor/lip retraction ratio. Pearson correlation and Kruskal-Wallis tests were used to compare lip retraction and incisor/lip retraction ratio with the cephalometric variables. The sample was divided according to different extraction patterns. RESULTS: The mean upper and lower lip retraction values were 1.4 mm and 1.7 mm, respectively. Vermilion thickness showed a negative and statistically significant correlation (P <0.05) with lip retraction and incisor/lip retraction ratio. In addition, the mean incisor/lip retraction ratio was 61% and 98% for the upper and lower thin lip, respectively, whereas the mean incisor/lip retraction ratio was 17% and 44% for the upper and lower thick lip, respectively. The comparison among extraction patterns did not highlight any noticeable difference. CONCLUSIONS: The choice of a specific extraction pattern did not impact lip response. The vermilion thickness was the key factor influencing lip retraction: an increase in this parameter was related to a decrease in lip retraction and vice versa.

Evaluation of the effectiveness of the platelet-rich plasma compared to the injectable platelet-rich fibrin on the rate of maxillary canine retraction: a three-arm randomized controlled trial.

BACKGROUND: Blood-derived materials have been used recently to accelerate orthodontic tooth movement, but there are conflicting reports on their effectiveness. OBJECTIVE: To evaluate the potential effect of local injection of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on the rate of orthodontic tooth movement. TRIAL DESIGN: A single-center, three-arm, parallel-group randomized controlled trial. MATERIALS AND METHODS: The sample consisted of 60 patients aged between 18 and 25 years (mean age: 21.1 ±â€…2.2 years) with Class II division 1 malocclusion requiring anterior retraction. Using a computer-generated list of random numbers, patients were assigned to three groups of canine retraction: (i) assisted with PRP injection (PRP group), (ii) assisted with i-PRF group, and (iii) conventional treatment with no injections (Cont. group). In the interventional groups, injections were done immediately and at 8 weeks after the onset of canine. Transpalatal arches (TPAs) were used to reinforce anchorage. The upper canines were distalized on 0.019 × 0.025-inch stainless archwires using coil springs with a force of 150 g. The primary outcome was the amount of canine retraction, whereas the secondary outcomes were canine rotation and anchoring loss. Assessment was done at five-time points: the beginning of tooth movement (T0) and at 4, 8, 12, and 16 weeks following T0 on three-dimensional superimposed digital models. RESULTS: Sixty patients were randomized and included in this study (20 patients in each group), there were no dropouts. The rate of canine retraction was faster in the experimental groups. The PRP group showed a significantly slower movement in the second and fourth months than the i-PRF group while in the first and third months, there were nonsignificant differences between the two experimental groups. LIMITATIONS: Blinding was not possible during the clinical stage of this trial. CONCLUSIONS: PRP and i-PRF were found to be effective in accelerating orthodontic tooth movement during canine retraction. However, the effect of i-PRF was longer than that of PRP. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT05335824).

Effectiveness of Oroantral Communication Closure Using Solid Platelet-Rich Fibrin Compared to a Conventional Treatment Approach: A Randomized Clinical Trial.

This study aimed to compare the effectiveness of platelet-rich fibrin clot (PRF) and conventional oroantral communication (OAC) repair techniques following tooth extractions from the maxilla. The study involved 22 patients, divided into 2 groups: a study group treated with PRF and a control group undergoing conventional OAC repair. The primary outcome measured was the effectiveness of OAC closure, with pain intensity and postoperative complications as secondary outcomes. Cone-beam computed tomography (CBCT) was used to evaluate post-extraction bone regeneration. Pain was assessed using the Visual Analogue Scale (VAS) on days 0, 1, 7, and 14 postoperatively. The results showed that the PRF group experienced a significant decrease in pain within the first 24 hours and after 7 days (P < .0001; P < .05). In contrast, complications were reported in 45.45% of patients in the conventional repair group and 18.18% in the A-PRF group. Three months postsurgery, CBCT revealed appreciable bone healing in both groups, with no significant difference (P > .05). In conclusion, the study suggests that A-PRF treatment for OACs resulted in fewer complications and quicker pain reduction than traditional repair methods, making it a promising alternative for managing OACs. However, future studies are needed to confirm these findings and establish the full therapeutic potential of PRF.

Application of an ultrasonic bone knife combined with a dental electric motor in the extraction of mandibular middle and low impacted teeth.

OBJECTIVE: To investigate the clinical application of an ultrasonic bone knife (UBK) combined with a dental electric motor (DEM) in the extraction of mandibular middle and low impacted teeth. METHODS: From January 2022 to May 2023,200 patients with wisdom teeth were randomly divided into three groups: experimental group A (UBK combined with DEM), experimental group B (UBK combined with high-speed turbine mobile phone (HSTMP)), and the control group (bone chisel split crown (BCSC)). The operation time, psychological state during operation, pain, swelling, limitation of mouth opening and other complications on the first, second and third days after operation were recorded. RESULTS: The operation time of experimental group A (EAG) (12.95 ± 2.12) minutes was shorter than that of experimental group B (EBG) (17.06 ± 2.25) minutes and the control group (CG) (23.43 ± 2.18) minutes, and the difference was statistically significant (P < 0.05). The psychological state of the EAG was significantly lower than that of the EBG and CG (P < 0.05). The postoperative pain, swelling, limitation of mouth opening and complications in the EAG were significantly lower than those in the EBG and CG (P < 0.05). CONCLUSION: UBK combined with DEM in the extraction of mandibular middle and low obstructed teeth has good results, good prognosis, high safety, short operation time, better psychological status of patients, low postoperative pain, swelling, mouth opening restriction and complication rate, and is currently the preferred extraction method.

Evaluation of complications and quality of life of patient after surgical extraction of mandibular impacted third molar teeth.

BACKGROUND: The aim of our study is to evaluate the postoperative complications after the extraction of impacted third molar teeth and to investigate the effects of these complications on the quality of life of patients. METHODS: Demographic, clinical, and radiological evaluations were conducted, covering factors like age, gender, and tooth position. Clinical measurements, pain and edema assessments, and quality of life evaluations through OHIP-14 scores were performed. Preoperative and postoperative mouth opening, trismus, alveolitis and dehiscence were evaluated. RESULTS: A total of 100 patients were included in our study. No significant gender-based differences were found in measurements, pain, or swelling. There was no statistically significant difference between the preoperative and postoperative results of difference A-C, difference B-E, difference A-D, and difference mouth opening. Procedure duration correlated positively with age, alveolar osteitis, trismus, and swelling. Postoperative quality of life, assessed by OHIP-14, demonstrated a negative correlation with age and trismus. It was observed that the gender and the tooth positions of the patients had no effect on the severity of postoperative pain and edema. CONCLUSIONS: As the age of the patients increases and the duration of the procedure increases, the rate of postoperative complications increases and it is concluded that the quality of life decreases significantly.

Artesunate-loaded thermosensitive chitosan hydrogel promotes osteogenesis of maxillary tooth extraction through regulating T lymphocytes in type 2 diabetic rats.

BACKGROUND: Type 2 diabetes mellitus (T2DM) causes severe bone loss after tooth extraction as a hyperglycemic environment causes aberrant bone homeostasis. Artesunate (ART) is known to possess anti-inflammation and osteogenic properties. However, its osteogenesis property in alveolar bone remains unclear. This study aimed to explore the osteogenic and immunoregulatory effects of artesunate-loaded thermosensitive chitosan hydrogel (ART-loaded TCH) on maxilla tooth extraction in T2DM rats. METHODS: T2DM rats were induced by a high-fat diet and streptozotocin. Different concentrations of ART-loaded TCH were applied in tooth extraction sockets. Bone loss and the expression of osteogenic regulatory factors (OPG, ALP, RANK) were evaluated. The immunoregulatory effects of ART-loaded TCH were observed through detecting the infiltration of T lymphocytes and their cytokines. The underlying mechanisms were explored. RESULTS: Results showed that the 150 mg/ml ART-loaded TCH group significantly ameliorated maxilla bone height and bone mineral density when compared with the T2DM group (p < 0.05). It also improved the expression of OPG, ALP, and RANK. Although the alteration of CD4+ T, CD8+ T, and CD4+:CD8+ T ratio has no significant difference among groups, the release of Th1 and Th2 in the 150 mg/ml ART-loaded TCH group has been significantly regulated than in the T2DM group (p < 0.05). Besides, ART-loaded TCH treatment inhibited the expression of p38 MAPK and ERK1 in T2DM maxilla. CONCLUSIONS: Therefore, the results indicated that 150 mg/ml ART-loaded TCH could be an effective method to prevent bone loss in T2DM tooth extraction rats by modulating the immunoregulation of Th1 and Th2 and the MAPK signaling pathway.

Endoscopically-assisted extraction of broken roots or fragments within the mandibular canal: a retrospective case series study.

PURPOSE: To assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN). METHODS: Six patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin. RESULTS: The average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters. CONCLUSIONS: All endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.

Investigation of the relationship between the mandibular third molar teeth and the inferior alveolar nerve using posteroanterior radiographs: a pilot study.

BACKGROUND: The most severe complication that can occur after mandibular third molar (MM3) surgery is inferior alveolar nerve (IAN) damage. It is crucial to have a comprehensive radiographic evaluation to reduce the possibility of nerve damage. The objective of this study is to assess the diagnostic accuracy of panoramic radiographs (PR) and posteroanterior (PA) radiographs in identifying the association between impacted MM3 roots and IAN. METHODS: This study included individuals who had PR, PA radiographs, and cone beam computed tomography (CBCT) and who had at least one impacted MM3. A total of 141 impacted MM3s were evaluated on CBCT images, and the findings were considered gold standard. The relationship between impacted MM3 roots and IAN was also evaluated on PR and PA radiographies. The data was analyzed using the McNemar and Chi-squared tests. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of PR and PA radiographies were determined. RESULTS: Considering CBCT the gold standard, the relationship between MM3 roots and IAN was found to be statistically significant between PR and CBCT (p = 0.00). However, there was no statistically significant relationship between PA radiography and CBCT (0.227). The study revealed that the most prevalent limitation of the PR in assessing the relationship between MM3 roots and IAN was the identification of false-positive relationship. CONCLUSIONS: PA radiography may be a good alternative in developing countries to find out if there is a contact between MM3 roots and IAN because it is easier to get to, cheaper, and uses less radiation.

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases.

BACKGROUND: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. MATERIAL AND METHODS: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. RESULTS: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. CONCLUSIONS: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure.

Piezosurgery versus conventional rotary surgery for impacted third molars: A randomised, split-mouth, clinical pilot trial.

BACKGROUND: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied. MATERIAL AND METHODS: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibular impacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553). RESULTS: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times. CONCLUSIONS: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.

Influences of ultrasound osteotome on wound infection and wound complications following removal of mandibular wisdom teeth.

We conducted this study to assess the effect of ultrasound osteotome on surgical site wound infection and pain following removal of mandibular wisdom teeth. A computerised search of Embase, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for publicly available randomised controlled trials (RCTs) on the clinical effects of applying ultrasound osteotome to extract mandibular wisdom teeth was conducted from the inception of the databases to September 2023. Two researchers independently screened the retrieved results for literature screening, quality assessment and data extraction. RevMan 5.4 software was applied for data analysis. A total of 17 RCTs were included in this study, including 848 cases in the ultrasound osteotome group and 842 cases in the control group. The analysis revealed, compared with the control group, the ultrasound osteotome group showed a significantly lower incidence of postoperative wound infection (1.42% vs. 5.46%, odds ratio [OR]: 0.30, 95% confidence intervals [CI]: 0.17-0.53, p < 0.0001), fewer postoperative complications (6.35% vs. 22.12%, OR: 0.23, 95% CI: 0.17-0.32, p < 0.00001), shorter operative time (standardised mean differences [SMD]: -1.30, 95% CI: -1.97 to -0.64, p = 0.0001) and lower wound pain scores (SMD: -2.26 95% CI -2.80 to -1.73, p < 0.00001). Strong evidence suggests that ultrasound osteotome applied to extract mandibular wisdom teeth is more advantageous in terms of lower postoperative wound infection, less wound pain, fewer postoperative complications and shorter operative time compared with conventional treatment methods, but large-scale, multicentre RCTs are still needed to obtain more accurate results.

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.