Comparison of the Efficacy of Corticosteroids With Enzymatic Agents in the Postoperative Sequelae for Lower Third Molar Surgery: A Prospective Study.

Introduction The presence of impacted third molars is a prevalent problem associated with varying degrees of difficulty in extraction and potential consequences, including pain, swelling, and trismus. According to studies, enzymatic combinations, such as bromelain, rutoside, trypsin, and serratiopeptidase, are known to have a very promising role in reducing inflammation and promoting wound healing. This study compared natural enzymatic agents with corticosteroids for postoperative pain, swelling, and trismus in the impacted lower third molar surgery. Objectives The present study aimed to compare the efficacy of prednisolone, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain, and serratiopeptidase in the postoperative sequelae after surgical extraction of impacted mandibular third molars. The primary objective was to assess the difference in swelling between the three groups. The secondary objectives were to assess the difference in postoperative pain and trismus between the three groups. Materials and methods A total of 150 patients who presented to the department of oral and maxillofacial surgery for surgical removal of an impacted mandibular third molar with a moderately difficult score of 5-7 in the Pederson difficulty index were chosen for a prospective study. Patients were categorized into three groups based on the postoperative drug prescribed. In group 1, prednisolone 10 mg was prescribed; in group 2, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was prescribed; and in group 3, serratiopeptidase 15 mg was prescribed. All patients were prescribed a combination drug of aceclofenac 100 mg and paracetamol 325 mg twice daily as a standard analgesic. Swelling, pain, and trismus in each patient were recorded preoperatively and at postoperative day one and day seven. The Friedman test was employed to evaluate the variation in pain levels within the groups over time, while the Kruskal-Wallis test was utilized to investigate the disparity in pain levels between the groups. The difference in swelling and trismus within the groups across the timeline was measured by repeated measures analysis of variance (ANOVA), and the difference in swelling and trismus between the groups was measured by one-way ANOVA. A p-value below 0.05 was deemed to be statistically significant. Results Group 1 showed less swelling, pain, and trismus on both postoperative day one and day seven compared to group 2 and group 3, which was a statistically significant difference (P < 0.05). It was found that swelling, pain, and trismus measurements in postoperative day one and day seven in group 2 were comparatively less than in group 3. Neither group demonstrated any side effects or other complications during the follow-up period. Conclusion It can be concluded that the use of prednisolone postoperatively following surgical removal of the mandibular third molar provided better relief with regard to pain, trismus, and swelling compared to the enzymatic agents. Among enzymatic agents, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was better in reducing pain, trismus, and swelling than serratiopeptidase drug.

The success rates and outcomes of mandibular third molar coronectomy: 167 cases.

PURPOSE: The purpose of this study was to assess success rates and to report complications of coronectomy of mandibular third molars (M3M), including intra-operative failure, pain, infection, dry socket, inferior dental alveolar (IAN) and lingual nerve (LN) injuries and re-operation rates. METHODS: Retrospective analysis of 167 coronectomies completed between January 2017 to December 2022 was undertaken. RESULTS: The success of coronectomy was 93%. Intra-operative failure was reported to be 3.6% (n = 8). Complications accounted for pain (15%, n = 24), infection (9%, n = 15) and dry socket (3.6%, n = 6). Three patients required removal of M3M root at 3 months (n = 2) and 24 months (n = 1), accounting for 1.8% re-operation rate. A total of number of patients who suffered a nerve injury was 12; three of these were permanent (LN - 1.2%, n = 2; IAN - 0.6%, n = 1), nine were temporary (IAN - 1.2%; n = 2, LN - 2.4%; n = 4; site not specified - 1.8%, n = 3). No patients with intra-operative failure and re-operation suffered IAN or LN injury post-operatively. CONCLUSION: Coronectomy offers a successful strategy for management of high risk M3M. The treatment outcomes can be improved with careful case selection and adjusting surgical technique, including assessment of root morphology, incomplete crown sectioning technique and avoidance of lingual retraction. Reporting of coronectomy success as a factor of surgical outcome, presence or absence of permanent IAN injury, persistent symptoms or any other long-standing complications (such as LN injury), and the need for re-operation accounting for root migration status may be a useful tool to measure coronectomy outcomes.

Histopathological Changes of Dental Follicles of Impacted Third Molars in Ibb Governorate.

OBJECTIVE: There is a lack of data pertaining to the examination of dental follicles (DFs) in asymptomatic impacted lower third molars (ILTMs) using cone beam computed tomography (CBCT) and histopathological analysis in the Yemeni population. The objective of this study was to explore the DFs of asymptomatic ILTMs through radiological (CBCT) and histological analysis. MATERIALS AND METHODS: This prospective study comprised 60 patients aged 18-50 years with ILTMs. The ILTMs in these patients exhibited a DF with measurements ranging between 3 and 5 mm. CBCT was employed to evaluate the maximum width of the DF surrounding the crown of ILTMs in horizontal, sagittal, and coronal sections. After the extraction, the DFs were examined for any pathological changes and categorized as normal, inflammatory, cystic, or neoplastic. The data analysis was performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the statistical significance was determined by employing chi-square tests with a significance level of 0.05. RESULTS: In the study, a total of 60 patients were included, with 17 (28.3%) being male and 43 (71.7%) being female. The majority of the patients 26 (43.3%) fell within the age range of 26-35 years. Regarding the angulation of the ILTMs, most of them were mesioangular 45 (75%), followed by vertical 7 (11.7%), horizontal 4 (6.6%), buccoangular 3 (5%), and distoangular 1 (1.6%). Histopathological changes were observed in 44 of the samples (73.3%). The majority of histopathological changes identified in the DFs were dentigerous cysts 26 (59%) followed by odontogenic keratocysts 11 (25%). Thirty-six (81.8%) of histopathological changes were found in females, whereas in only eight samples (18.1%), histological changes were observed in males. This difference was statistically significant (p=0.004). However, there were no statistically significant differences observed in the occurrence of histopathological changes based on age, angulation, and follicle size (p>0.05). CONCLUSION: Follicles in ILTMs varied significantly based on gender, with a higher occurrence in females, and tooth impaction angle, mainly in the mesioangular position. Furthermore, a follicular size of 3-5 mm was associated with a higher incidence of pathological changes. Hence, histopathologic examination is recommended for surgically removed ILTMs irrespective of the follicle size observed in radiographic images.

Assessment of Patient Characteristics Influencing the Analgesic Effects of Ibuprofen Gargle After Mandibular Third Molar Extractions.

Introduction In our previous work, we investigated the analgesic effects of ibuprofen gargle after mandibular third molar extractions. However, a subsequent detailed review of individual patient data revealed variations in postoperative pain reduction among patients. Consequently, the present study was designed to conduct post-hoc subanalyses that identified factors contributing to variation in the analgesic response to ibuprofen gargle after third molar extractions. Materials and methods This study involved thirty-five Japanese patients from a prior randomized, double-blind, placebo-controlled, crossover study, which focused on the analgesic effects of ibuprofen gargle after mandibular third molar extractions. Participants were categorized as responders (n = 13) and non-responders (n = 22) based on the within-subject difference (ibuprofen-placebo, IP) of visual analog scale (VAS) changes. Baseline characteristics were compared, along with variables, such as age, sex, the reason for extraction, extraction site, Pell Gregory (space and depth) classification, Winter's classification, surgeon's experience, and surgery time. Baseline characteristics predicting responder status were examined using multivariate logistic regression. Results In the univariate analysis, variables such as age, sex, and baseline VAS scores with p-values <0.2 were evaluated using a stepwise approach. This analysis identified age (per -10 years) with an odds ratio of 4.163 (95% confidence interval (CI): 1.170-31.952, p = 0.0233) and sex (female) with an odds ratio of 9.977 (95% CI: 1.336-208.256, p = 0.0213) as significant predictors of responder status. Conclusions In young and female patients, ibuprofen gargle decreased postoperative pain after mandibular third molar extractions.

Influence of experiencing SARS-CoV-2 infection on anxiety levels in Chinese patients undergoing third molar surgery.

Background: In China, most of the citizens experienced SARS-CoV-2 infection since the end of 2022. The Coronavirus disease 2019 (COVID-19) pandemic affected people's physical health and also had a significant impact on mental well-being. The present study aims to discover if the experience of SARS-CoV-2 infection influences patients' anxiety toward third molar surgery in the Chinese population. Materials and methods: The present study took the form of a questionnaire survey. From January 1, 2023, to June 30, 2023, patients who went to the Stomatology Center of China-Japan Friendship Hospital (Beijing, China) for the third molar extraction were included according to the inclusion criteria. The information on COVID-19 infection and the Modified Dental Anxiety Scale (MDAS) was collected. The software SPSS 22.0 was used for the statistical analyses. Results: A total of 574 survey results were harvested in the present study. The infection rate of COVID-19 was 86.6% (p > 0.05). The Average MDAS scores between patients who had been infected with COVID-19 and patients who were never infected were not significantly different (11.65 ± 4.41 vs. 11.42 ± 4.41, p > 0.05). The subgroup analysis was conducted according to the length of time after the recovery of COVID-19 (Model 1), and the highest temperature during the infection (Model 2). In Model 1 and Model 2, the one-way ANOVA test did not find statistical significance between the groups (Model 1 p = 0.114; Model 2 p = 0.481). The MDAS scores in female patients were significantly higher than in male patients (12.29 ± 4.53 vs. 9.91 ± 3.80, p < 0.001). Patients who extracted double teeth got significantly higher MDAS scores than those who extracted single teeth before the surgery (12.03 ± 4.74 vs. 11.24 ± 4.18, p = 0.037). Conclusion: The present study did not establish a significant impact of SARS-CoV-2 infection on the anxiety levels associated with third molar surgery among Chinese patients. The potential long-term biopsychological effects of the virus warrant further investigation.

Selective outcome reporting in randomized clinical trials using the third molar surgery model.

Selective outcome reporting (SOR) can threaten the validity of results found in clinical trials. Some studies in the literature have analyzed SOR in dentistry, but there is no study that has observed SOR in clinical trials in oral and maxillofacial surgery. Impacted third molar surgery is one of the most used models in clinical trials to study mainly analgesic and anti-inflammatory drug interventions. Our study aimed to evaluate the prevalence of SOR in publications employing the third molar extraction clinical trial model, and to verify whether there was an association between the statistical significance of outcomes and other characteristics that could lead to SOR. A systematic search was performed on the ClinicialTrials.gov platform for randomized clinical trial protocols, using the condition of third molar extraction. The corresponding published articles were sourced in PubMed, Scopus, and Embase databases, and compared with the registered protocols regarding the methodological data, in terms of: sample calculation, primary outcome identification, end-point periods, insertion of new outcomes in the publication, and results of outcomes. 358 protocol records were retrieved; 87 presented their corresponding articles. SOR was identified in 28.74% of the publications, and had a significant relationship with changes in the protocol, insertions of new outcomes, and discrepancies in the types of study. General risk of bias was found to be low. There were associations between SOR and the discrepancies in terms of the type of study, the choice of new outcome, and changes in the history of protocol records. The prevalence of SOR in clinical research using the third molar extraction surgery model is moderate. The quality of the scientific reporting of the results and, consequently, the certainty of evidence relating to the intervention tested can be overstated, increasing the chances of misinterpretation by health professionals.

How effective are concentrated growth factor and injectable platelets in reducing complications following impacted third molar surgery?

OBJECTIVES: This study examines the impact of injectable platelet-rich fibrin (iPRF) and concentrated growth factor (CGF) on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and CGF. Our secondary objective was to compare the postoperative effects of these products. METHOD AND MATERIALS: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variable was the implementation of CGF, and i-PRF which was categorized as CGF, i-PRF and control groups. The outcome variables include pain levels and analgesic consumption measured on a VAS scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. RESULTS: Total analgesic use was notably lower in the CGF group (p = .044). CGF and iPRF outperformed the control group in all edema measurements by the 7th day (T-Pog, L-A, T-C; p<.05). CGF significantly reduced trismus on the 2nd and 7th days. Quality of life was notably higher in the CGF group than in the control group (p = .026), although iPRF group differences were not significant. CONCLUSION: The results of this study indicate that CGF has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with CGF highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results.

Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study.

Background Third molar extraction is a routine oral surgical procedure that is often complicated by the development of a dry socket (alveolar osteitis). This prospective observational study aimed to investigate the prevalence of dry sockets and identify associated risk factors and causes, contributing to a comprehensive understanding of the postoperative outcomes of oral surgery. Methods This study employed a prospective observational design with a 12-month follow-up period. Participants aged 18-40 years scheduled for third molar extraction were included, whereas those with coagulopathies, pregnant or lactating women, patients with vitamin deficiencies, and individuals on medications affecting healing were excluded. Data collection involved comprehensive assessments at baseline, intraoperative details, and postoperative evaluations at 48 hours, one week, and two weeks. Statistical analyses included descriptive statistics, chi-square tests, t-tests, or Mann-Whitney U tests, and logistic regression for the risk factor analysis. Results A total of 238 participants with diverse demographic characteristics were enrolled in this study. The prevalence of dry sockets increased progressively from 20.6% at 48 hours to 41.2% at two weeks post-extraction. Smoking, poor oral hygiene, and surgical technique emerged as significant risk factors, with corresponding odds ratios of 6.41 (95% CI: 2.86-14.36, p < 0.001), 9.53 (95% CI: 2.12-42.84, p = 0.003), and 3.27 (95% CI: 2.08-5.15, p < 0.001), respectively. Pain intensity, measured using a Visual Analog Scale, gradually decreased from 48 hours to two weeks post-extraction. Conclusion This study provides valuable insights into the prevalence and risk factors associated with dry sockets following third molar extractions. Smoking, poor oral hygiene, and poor surgical techniques were identified as significant contributors, emphasizing the importance of preoperative counseling and targeted interventions.

The Management of a Geriatric Patient Using Dabigatran Therapy on Dentigerous Cyst with Oral Bleeding.

Jaw cysts represent a great matter of interest in oral and maxillofacial surgery. Jaw cyst surgery is a common intervention in oral surgery but, in the case of a multidisciplinary patient, the oral surgeon needs to meet with other specialists. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, and commonly few or no symptoms are reported. However, the most common diagnosis for dentigerous cyst is represented by eruption of the affected tooth or accidental diagnosis. Commonly, dentigerous cysts may be related to impacted third molars; in the case of impacted third molars and a dentigerous cyst, the tooth should be removed along with the cyst in the same intervention. Mandibular dentigerous cysts are common in children and adults, while dentigerous cysts are a rare neoformation in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with the mandibular nerve, and/or the patient has a medical history that may represent a relative or absolute contraindication. We present the case of a rare symptomatic manifestation of dentigerous cyst in an elderly patient in treatment with dabigatran therapy; for the treatment of dentigerous cysts in the elderly, we suggest a multidisciplinary approach with the use of the histological examination and a careful follow-up.

Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar.

OBJECTIVES: To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS: The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS: The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS: Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE: MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.

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

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

The diagnostic performance of impacted third molars in the mandible: A review of deep learning on panoramic radiographs.

Background: Mandibular third molar is prone to impaction, resulting in its inability to erupt into the oral cavity. The radiographic examination is required to support the odontectomy of impacted teeth. The use of computer-aided diagnosis based on deep learning is emerging in the field of medical and dentistry with the advancement of artificial intelligence (AI) technology. This review describes the performance and prospects of deep learning for the detection, classification, and evaluation of third molar-mandibular canal relationships on panoramic radiographs. Methods: This work was conducted using three databases: PubMed, Google Scholar, and Science Direct. Following the literature selection, 49 articles were reviewed, with the 12 main articles discussed in this review. Results: Several models of deep learning are currently used for segmentation and classification of third molar impaction with or without the combination of other techniques. Deep learning has demonstrated significant diagnostic performance in identifying mandibular impacted third molars (ITM) on panoramic radiographs, with an accuracy range of 78.91% to 90.23%. Meanwhile, the accuracy of deep learning in determining the relationship between ITM and the mandibular canal (MC) ranges from 72.32% to 99%. Conclusion: Deep learning-based AI with high performance for the detection, classification, and evaluation of the relationship of ITM to the MC using panoramic radiographs has been developed over the past decade. However, deep learning must be improved using large datasets, and the evaluation of diagnostic performance for deep learning models should be aligned with medical diagnostic test protocols. Future studies involving collaboration among oral radiologists, clinicians, and computer scientists are required to identify appropriate AI development models that are accurate, efficient, and applicable to clinical services.

Effectiveness of wearing glasses with green lenses on dental anxiety for third-molar surgery: A randomized clinical trial.

BACKGROUND: Dental anxiety is a common problem for oral surgeries. This study investigated the effectiveness of wearing glasses with green lenses in reducing dental anxiety, blood pressure, heart rate, and intraoperative pain in patients undergoing first-time third-molar surgery. METHODS: The authors planned this study as a randomized and parallel-group clinical trial. Patients' dental anxiety was measured with the use of a visual analog scale and a State-Trait Anxiety Inventory for baseline measurement purposes. At the same time, blood pressure, oxygen saturation, and heart rate values were recorded. Patients were given glasses with clear or green lenses, depending on their group. After 10 minutes, all parameters were measured again for preoperative measurement. Patients wore glasses with either green or clear lenses throughout the operation. After the operation, patients were asked to estimate the degree of intraoperative pain using the visual analog scale. RESULTS: The study included 128 patients. On the basis of the change between baseline and preoperative measurements, the authors found a statistically significant difference in anxiety and heart rate. Intraoperative pain showed a significant difference between groups. No significant changes were found in blood pressure and oxygen saturation. CONCLUSIONS: Patients with anxiety could wear low-cost, easy-to-use glasses with green lenses for 10 minutes before an operation to reduce anxiety and heart rate. In addition, wearing glasses during the surgical procedure can reduce intraoperative pain. PRACTICAL IMPLICATIONS: By means of using glasses with green lenses throughout the procedure, existing anxiety and pain can be reduced. An operation can be performed more comfortably for both the patient and the dentist. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05584696.

The Accuracy of Bone Assessment Distal to Lower Second Molars Using Panoramic Radiography: A Systematic Review and Meta-Analysis.

Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar.

Prediction of extraction difficulty for impacted maxillary third molars with deep learning approach.

OBJECTIVE: The aim of this study is to determine if a deep learning (DL) model can predict the surgical difficulty for impacted maxillary third molar tooth using panoramic images before surgery. MATERIALS AND METHODS: The dataset consists of 708 panoramic radiographs of the patients who applied to the Oral and Maxillofacial Surgery Clinic for various reasons. Each maxillary third molar difficulty was scored based on dept (V), angulation (H), relation with maxillary sinus (S), and relation with ramus (R) on panoramic images. The YoloV5x architecture was used to perform automatic segmentation and classification. To prevent re-testing of images, participate in the training, the data set was subdivided as: 80 % training, 10 % validation, and 10 % test group. RESULTS: Impacted Upper Third Molar Segmentation model showed best success on sensitivity, precision and F1 score with 0,9705, 0,9428 and 0,9565, respectively. S-model had a lesser sensitivity, precision and F1 score than the other models with 0,8974, 0,6194, 0,7329, respectively. CONCLUSION: The results showed that the proposed DL model could be effective for predicting the surgical difficulty of an impacted maxillary third molar tooth using panoramic radiographs and this approach might help as a decision support mechanism for the clinicians in peri­surgical period.

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis.

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6-9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Radiographic Detection Rate of Distal Surface Caries in the Mandibular Second Molar in Populations with Different Third Molar Management Strategies: A Multicenter Study.

Background: Distal surface caries (DSC) has been associated with partially erupted impacted third molars. The purpose of this study was to compare the rates of DSC between populations that had undergone different third molar management strategies. Methods: Radiographs that had been taken during routine examinations of 1012, 251 and 250 patients in Manchester, Bucharest and Amsterdam, respectively, were evaluated. The following parameters were assessed: the state of the distal surface in the second mandibular molar, loss of periodontal support, impaction type of the third molar, contact point localization, and patients' genders, ages and their cumulative history of dental health. Results: The rate of DSC in the second mandibular molar was 63.9%, 19.9% and 26.0% in the Manchester, Bucharest and Amsterdam populations, respectively. A loss of lamina dura of ≥2 mm, increased percentages of decayed, missing or filled teeth and male gender were risk factors in all three populations. All assessed parameters apart from the site of the mandible reached statistical significance in the Manchester sample (p < 0.001). The DSC rate was cumulative with increasing age in the Manchester population, in which third molars were strategically retained. Conclusions: The UK population, treated according to strict guidelines that limit the removal of third molars, had a statistically significant higher DSC prevalence rate (p < 0.001) than the Romanian or Dutch populations. The active surgical management of mandibular third molars seems to have the potential to reduce the DSC rate in the adjacent second molar.

An Evaluation of the Effects of Pineapple-Extract and Bromelain-Based Treatment after Mandibular Third Molar Surgery: A Randomized Three-Arm Clinical Study.

A three-arm, randomized, placebo-controlled clinical study was conducted to assess the impact of lyophilized pineapple extract with titrated bromelain (Brome-Inf®) and purified bromelain on pain, swelling, trismus, and quality of life (QoL) following the surgical extraction of the mandibular third molars. Furthermore, this study examined the need for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) by comparing their effects with a placebo group. This study enrolled 42 individuals requiring the extraction of a single mandibular third molar under local anesthesia. The patients were randomly assigned to receive Brome-Inf®, purified bromelain, or a placebo orally, initiating treatment on the day of surgery and continuing for the next 7 days. The primary outcome measured was the requirement for NSAIDs in the three groups. Pain, swelling, and trismus were secondary outcome variables, evaluated postoperatively at 1, 3, and 7 days. This study also assessed the comparative efficacy of freeze-dried pineapple extract and single-component bromelain. Ultimately, the placebo group showed a statistically higher need for ibuprofen (from days 1 to 7) at the study's conclusion (p < 0.0001). In addition, reductions in pain and swelling were significantly higher in both the bromelain and pineapple groups (p < 0.0001 for almost all patients, at all intervals) than in the placebo group. The active groups also demonstrated a significant difference in QoL compared to the placebo group (p < 0.001). A non-significant reduction in trismus occurred in the treatment groups compared to the placebo group. Therefore, the administration of pineapple extract titrated in bromelain showed significant analgesic and anti-edema effects in addition to improving QoL in the postoperative period for patients who had undergone mandibular third molar surgery. Moreover, both bromelain and Brome-Inf® supplementation reduced the need for ibuprofen to comparable extents, proving that they are good alternatives to NSAIDs in making the postoperative course more comfortable for these patients. A further investigation with larger samples is necessary to assess the pain-relieving and anti-inflammatory impacts of the entire pineapple phytocomplex in surgical procedures aside from mandibular third molar surgery.

Risk factors for post-extraction infection of mandibular third molar: A retrospective clinical study.

Post-extraction infection is one of the most concerning complications of mandibular third molar extraction, which is the most common procedure in oral and maxillofacial surgery. We investigated risk factors for post-extraction infection by retrospectively analyzing 2,513 teeth/cases of mandibular third molar extraction (1,040 males, 1,473 females) performed at a single medical facility in Kobe, Japan from January 2014 to May 2022. The predictive variables were categorized as patient attributes, health status, and anatomic, pathological, and operative variables that may be associated with post-extraction infection. The outcome variable was the post-extraction infection rate. The post-extraction infection rate was 5.73 % (144 of the 2,513 teeth), and the mean age of the patients with a post-extraction infection was 41.76 ± 16.8 years. Our analyses also revealed that the postoperative infection rate was significantly increased in patients aged ≥36 years. A multivariate logistic regression analysis showed that the following variables were significantly associated with post-extraction infection: preoperative antibiotic administration (odds ratio [OR] 4.68, p < 0.001), postoperative paresthesia of the inferior alveolar nerve (OR 4.34, p < 0.001), intraoperative hemostatic procedure (OR 1. 74, p = 0.008), position of Pell and Gregory classifications (OR 1. 70, p < 0.001), Winter's classification (OR 1.28, p < 0.03), and age (OR 1.03, p < 0.001). Oral and maxillofacial surgeons should be aware of these risk factors.