Search Results (92)

Adequate bleeding control is crucial in surgical procedures. Surgifoam and Hemospon are absorbable hemostatic sponges made from lyophilized porcine gelatin, commonly used in oral surgery. This clinical study aimed to evaluate bleeding control, soft tissue healing, and postoperative pain in dental sockets after mandibular third molar extractions filled with Surgifoam and Hemospon. Twenty-five volunteers requiring extractions of both left and right lower third molars participated in this randomized, double-blind, split-mouth study. After extraction, each socket was randomly filled with Hemospon (test group) or Surgifoam (control group). Postoperative pain was assessed using the Visual Analog Scale (VAS) on days 1, 2, 3, and 7. Bleeding at 30 and 60 min (Souto and Mühlemann scales) and soft tissue healing at 7 and 14 days (Brancaccio scale) were evaluated using Fisher’s exact test. Bleeding scores at 30 min predominantly showed no bleeding (score 0) in 80% of participants using Surgifoam, compared to 60% in the Hemospon group. No significant differences in bleeding were observed between groups (p > 0.05), and both showed a similar reduction over time. Soft tissue healing was revealed at 14 days complete healing (score 0) in 90% of participants in both groups. No significant differences between Hemospon^® and Surgifoam^® were observed (p > 0.05). Postoperative pain evaluation showed highly variable scores on the first day (median: 2; range: 1–6) for both Surgifoam^® and Hemospon^®. By the seventh day, pain levels significantly reduced (median: 0), with no significant differences observed between the groups at any time point (p > 0.05). In conclusion, the results of this study suggest that Hemospon and Surgifoam are equally effective in bleeding control, healing, and pain control after third molar surgery. This research aims to guide surgeons on the clinical aspects of using these specific hemostatic sponges in post-extraction procedures for posterior molars and seeks to direct future clinical studies involving these materials. Full article

Background and Objectives: The extraction of mandibular third molars poses challenges due to their proximity to the mandibular canal and risk of inferior alveolar nerve (IAN) injury. Accurate preoperative evaluation is essential to minimize complications. This study assessed the three-dimensional positional relationship between the mandibular canal and lower third molars using cone-beam computed tomography (CBCT), aiming to identify anatomical positions associated with increased surgical risk. Materials and Methods: This retrospective study analyzed 253 CBCT scans of fully developed lower third molars. The mandibular canal position was classified as apical (Class I), buccal (Class II), lingual (Class III), or interradicular (Class IV). Contact was categorized as no contact, contact with a complete or defective white line, or canal penetration. In no-contact cases, the apex–canal distance was measured. Statistical analysis included descriptive and contingency analyses using the Chi-Square Likelihood Ratio test. Results: Class I was most common (70.8%) and presented the lowest risk, while Classes III and IV showed significantly higher frequencies of canal contact or penetration. Class II exhibited shorter distances even in no-contact cases, suggesting residual risk. Statistically significant associations were found between canal position and both contact type (p < 0.001) and apex–canal distance (p = 0.046). Conclusions: CBCT offers valuable insight into the anatomical relationship between third molars and the mandibular canal. High-risk positions—particularly lingual and interradicular—require careful assessment. Even in the absence of contact, close proximity may pose a risk and should inform surgical planning. Full article

Objectives: We aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) in promoting wound healing after the surgical removal of inferior third molars. Methods: Patients in need of unilateral mandibular third molar extraction were randomly assigned to either a test or control group before surgery. During the test, a photoactive substance activated with laser light (20 mW, 660 nm) was applied to the post-extraction site for 60 s before suturing to promote healing and disinfection. The control group did not receive any laser applications after tooth removal. The probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and levels of clinical attachment loss (CAL) before surgery (T0), 14 days after surgery (T1), and after 3 months after surgery (T2) were evaluated for the adjacent second molar. Post-operative swelling, pain (VAS index), the number of painkillers taken, alveolar probing, and Landry’s healing index were recorded at T1. Results: Sixty-five patients, aged between 14 and 39 years, were assigned randomly to test (n = 32) or control (n = 33) groups. Five dropouts occurred. Post-operative swelling and the VAS index were significantly lower in the test group compared to the control (p = 0.002 and p = 0.04, respectively). All periodontal indexes except recession significantly worsened at T1 in both groups. After three months, a significant improvement for PPD, CAL, and PI was recorded in the test group compared to the control (p = 0.001). Conclusions: According to the results of this study, the use of aPDT seems to have a beneficial effect on post-operative swelling and pain, as well as the plaque index, in the short-term follow-up. Full article

Background/Objectives: Coronectomy is an alternative to complete third molar extraction to reduce the risk of inferior alveolar nerve injury. This systematic review of systematic reviews evaluates re-intervention rate, timing, and indications after mandibular third molar coronectomy. Methods: A systematic search following PRISMA guidelines was conducted across Scopus, MEDLINE/PubMed, BioMed Central, Web of Science, Cochrane Library and PROSPERO. Studies reporting re-intervention rates after at least six months from coronectomy were included. Data extraction focused on re-intervention timing, indications, and complications. Results: Six systematic reviews, including 5896 subjects and 7913 successful coronectomies (not requiring immediate tooth extractions), were analyzed. The overall re-intervention rate was 4.45%, with timing ranging from six months to ten years (mean: 10.4 months). Root exposure (16.76%) was the primary cause, followed by infection (4.55%) and pain (2.84%). Root migration (12.20%) was common, while inferior alveolar nerve injury remained rare (0.76%). Conclusions: Coronectomy is a viable alternative in high-risk cases, with a low re-intervention rate. Root migration and exposure require long-term follow-up. Standardized imaging protocols and refined re-intervention criteria are needed. Full article

Background and Objectives: To evaluate the impact of impacted mandibular third molars on temporomandibular joint dysfunction using the Modified Helkimo Index, analyzing symptom severity across age groups. Materials and Methods: A cohort of 140 patients (70 with impacted molars, 70 without) was assessed using the Modified Helkimo Index. Patients were categorized by age (<25, 26–30, 31–35, >36 years), and statistical comparisons between Icdⁱ (with impacted molars) and Icd^a (without impacted molars) were performed. Key parameters included mandibular movement limitation, joint noises, and pain scores. Data were analyzed using descriptive statistics and statistical tests, with significance set at p < 0.05. Results: TMJ dysfunction was significantly more prevalent in patients under 25 years (Icdⁱ = 13.5, Icd^a = 11.0; p = 0.045), with a progressive decrease in severity in older groups (>36 years: Icdⁱ = 3.5, Icd^a = 4.5; p = 0.072). Women exhibited a higher prevalence across all age categories (female-to-male ratio: <25 years = 2.7, >36 years = 3.0). The most frequent symptoms were mandibular movement restriction (42.5%), joint noises (38.2%), and pain (35.7%). Conclusions: Impacted third molars may significantly exacerbate TMJ dysfunctions, particularly in younger individuals and females, with a strong association between impacted molars and increased Modified Helkimo Index scores. Early extraction might mitigate symptoms, emphasizing the need for proactive clinical management. Full article

Background/Objectives: Despite the increasing popularity of lacto-ovo vegetarian (LOV) diets, their impact on oral wound healing remains underexplored. The aim of this study was to evaluate the potential influence of the LOV diet on soft tissue healing following lower wisdom tooth operation. Methods: This prospective study involved 40 participants equally divided into two groups: the LOV group (lacto-ovo vegetarians for at least seven years) and the control group (general diet). The main inclusion criterion was the need for third molar extraction, while smoking, pregnancy, and systemic diseases that may compromise wound healing were disqualifying factors. Parameters such as wound length, swelling, pain, analgesic use, and bacterial plaque index were assessed on the 3rd and 7th days post-surgery. Results: LOV participants exhibited significantly faster wound healing, with reduced wound length and swelling by the 7th day compared to the control group. Pain levels and analgesic consumption were also lower in the LOV group at the end of the observation period. Although the LOV group had higher trismus on the 3rd day, it normalized by the 7th day. These outcomes may be, apart of the diet type followed, partially attributed to the younger age and shorter surgical time observed in the LOV group. Conclusions: The findings highlight the potential role of dietary interventions in optimizing recovery, warranting further research to confirm these benefits in broader populations. Full article

Background: This study evaluated the postoperative effects of hyaluronic acid (HA) on pain, swelling, and trismus following mandibular third molar surgery. Material and Methods: Thirty healthy patients with bilateral impacted mandibular third molars underwent two surgeries at 21-day intervals. In a split-mouth design, one extraction socket was treated with 0.2 mL of high-molecular-weight hyaluronic acid gel (Monovisc^® [molecular weight ≈ 1.5–2.2 million Da]), while the contralateral socket received no additional treatment. Perioperative medications, including NSAIDs, were standardized for all patients. Data collection included postoperative pain, swelling (using Gabka and Matsumura’s method), analgesic consumption, and trismus (mouth opening) on designated days. Data were analyzed using the Mann–Whitney U and Wilcoxon signed-rank tests with Bonferroni correction (adjusted significance level: p > 0.0083). Results: The mean VAS pain scores on day 1 were 63.5 ± 22.3 in the HA group and 61.9 ± 12.5 in the control group, decreasing to 3.9 ± 7.6 and 3.3 ± 7.2, respectively, by day 7 (p > 0.0083). The maximum interincisal distance on day 7 was 45.9 ± 7.4 mm in the HA group and 43.5 ± 7.3 mm in the control group, showing a slight improvement (p = 0.002). Swelling, measured using the tragus–pogonion distance, was 164.6 ± 20.7 mm in the HA group and 166.3 ± 18.9 mm in the control group on day 7 (p > 0.0083). Analgesic consumption remained comparable across all postoperative days (p > 0.0083). No statistically significant differences were observed between the HA and the control groups at any evaluated time point. Conclusions: Hyaluronic acid application after mandibular third molar surgery demonstrated a slight improvement in trismus on day 7, but no significant long-term advantages in pain or swelling. While early postoperative improvements in trismus were observed, these findings require further validation. Additional studies are needed to explore HA’s potential clinical applications in oral surgery. Full article

Background/Objective: This study aimed to develop an AI-supported clinical tool to evaluate the difficulty of mandibular third molar extractions based on panoramic radiographs. Methods: A dataset of 2000 panoramic radiographs collected between 2023 and 2024 was annotated by an oral radiologist using bounding boxes. YOLO11 sub-models were trained and tested for three basic scenarios according to the Pederson Index criteria, taking into account Winter (angulation) and Pell and Gregory (ramus relationship and depth). For each scenario, the YOLO11 sub-models were trained using 80% of the data for training, 10% for validation, and 10% for testing. Model performance was assessed using precision, recall, F1 score, and mean Average Precision (mAP) metrics, and different graphs. Results: YOLO11 sub-models (nano, small, medium, large, extra-large) showed high accuracy and similar behavior in all scenarios. For the calculation of the Pederson index, nano for Winter (average training mAP@0.50 = 0.963; testing mAP@0.50 = 0.975), nano for class (average training mAP@0.50 = 0.979; testing mAP@0.50 = 0.965), and medium for level (average training mAP@0.50 = 0.977; testing mAP@0.50 = 0.989) from the Pell and Gregory categories were selected as optimal sub-models. Three scenarios were run consecutively on panoramic images, and slightly difficult, moderately difficult, and very difficult Pederson indexes were obtained according to the scores. The results were evaluated by an oral radiologist, and the AI system performed successfully in terms of Pederson index determination with 97.00% precision, 94.55% recall, and 95.76% F1 score. Conclusions: The YOLO11-supported clinical tool demonstrated high accuracy and reliability in assessing mandibular third molar extraction difficulty on panoramic radiographs. These models were integrated into a GUI for clinical use, offering dentists a simple tool for estimating extraction difficulty, and improving decision-making and patient management. Full article

Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third molar extraction were randomly assigned to two groups: an experimental group (EG) receiving 2 g of amoxicillin and a placebo group (PG) receiving empty capsules, one hour before the surgery and before taking the first saliva sample. Primary outcomes measured were pain levels at different time points and salivary PGE2 concentrations measured before, 24 h, and 7 days after the surgery, while secondary outcomes included changes in maximum mouth opening (MMO) immediately after the surgery at 1 day and a week post-surgery, and facial swelling at 24 h and 7 days post-surgery. Results: The results showed no significant differences between the EG and PG in terms of pain levels, salivary PGE2 concentration, MMO changes, or facial swelling at different time points (p-values > 0.05). One instance of surgical site infection was noted in the PG in the 7-day follow-up session, but it was not statistically significant (p-value = 0.303). Correlation analyses indicated that a higher number of sutures and a higher difficulty index of surgery were associated with increased pain, while longer surgery duration and osteotomy were linked to more MMO changes and facial swelling (p-values < 0.05). In addition, while longer surgery duration and performing tooth section were correlated with lower PGE2 concentrations, PGE2 concentrations were positively correlated with pain levels (p-values < 0.05). Conclusions: Based on the results of this study, administering 2 g of prophylactic amoxicillin did not significantly affect postoperative clinical or laboratory outcomes in healthy patients undergoing mandibular third molar surgery. Full article

The extraction of deeply impacted lower third molars is a common yet challenging surgical procedure associated with complications such as mandibular fractures, pain, and swelling. This study evaluated the effectiveness of customized 3D-printed titanium plates in reducing the risk of intraoperative iatrogenic mandibular fractures. This innovative approach aims to improve surgical outcomes, enhance patient safety, and boost confidence for both surgeons and patients. Eighteen patients with Pell and Gregory class II/IIIC impacted lower third molars underwent preoperative CBCT scans, which facilitated the design and fabrication of customized plates and drilling guides. The surgical procedure involved incision, flap elevation, precise plate placement, osteotomy, odontotomy, extraction, and the postoperative assessment of pain, swelling, trismus, and anxiety using validated scales and facial scanning. The results show that customized titanium plates successfully prevented mandibular fractures in all cases. Although initial postoperative discomfort, including swelling, trismus, and pain, was observed, significant improvements occurred within one week. This technique provided structural reinforcement during surgery and healing without adverse events or fractures. Customized 3D-printed titanium plates represent a safe and effective solution for minimizing mandibular fractures, offering promising improvements in surgical outcomes. Full article

Background and Objectives: This study aimed to evaluate the role of A-PRF (advanced platelet-rich fibrin) in the enhancement of wound healing and protecting the periodontal health of mandibular second molars after the extraction of mandibular third molars. Additionally, the study assessed the levels of pro-inflammatory cytokines in the gingival crevicular fluid (GCF) of mandibular second molars as markers of inflammation. Materials and Methods: Twenty-five systemically healthy adult patients with bilateral removal of impacted mandibular third molars were included. Each patient received A-PRF in one extraction site, while the contralateral site served as a control. Periodontal parameters of the adjacent second molar, including probing depth (PD) and clinical attachment level (CAL), were measured in distal–vestibular (DV) and distal–lingual (DL) sites. Pain, swelling, and overall healing were subjectively evaluated. Levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) in the GCF were analyzed. Evaluations occurred at baseline and three months post-surgery. Results: A-PRF significantly improved PD (from 4.69 ± 0.61 mm to 3.85 ± 0.34 mm in DV, and from 4.71 ± 0.65 mm to 3.79 ± 0.27 mm in DL, respectively) and CAL (from 2.41 ± 0.25 mm to 1.82 ± 0.21 mm in DV, and from 2.40 ± 0.36 mm to 1.75 ± 0.19 mm in DL, respectively) of the adjacent second molar, compared to control sites, three months post-surgery. Pain and swelling scores were notably lower on the 7th postoperative day in the A-PRF group. A-PRF also reduced pro-inflammatory cytokines in GCF, significantly more than in control sites, at three months post-surgery. Conclusions: A-PRF enhances the periodontal and inflammatory status of adjacent teeth and wound healing after the extraction of mandibular third molars. Full article

Background/Objectives: This systematic review and meta-analysis aimed to investigate the prevalence of surgical site infections (SSIs) following coronectomy of mandibular third molars. Methods: A comprehensive literature search was conducted in Medline, Scopus, Web of Science, and Google Scholar databases up to 30 July 2024. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle–Ottawa Scale. Observational studies assessing SSI prevalence following coronectomy were included. The pooled prevalence of SSI with 95% confidence intervals (CI) was calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and meta-regression was conducted to explore the influence of continuous variables. Results: A total of 22 studies involving 2173 coronectomy procedures were included. The overall pooled prevalence of SSI was 2.4% (95% CI: 1–4.3%), with substantial heterogeneity (I² = 81%). Meta-regression showed no significant effect of the examined variables on SSI prevalence. No study was identified as a significant outlier. Quality assessments revealed that all studies had moderate methodological quality. Conclusions: Considerable heterogeneity was observed, likely due to variations in study settings, geographical regions, and timeframes, among other factors. Therefore, this study underscores the need for further rigorous research to better understand SSI risk factors and enhance management strategies for this postoperative complication. Full article

Background/Objective: We assessed the analgesic and anti-inflammatory effects of kale extract (500 mg anthocyanin equivalent) in patients after mandibular molar surgery. Methods: In our randomized clinical trial, postoperative subjects (n = 20) aged 18–25 years old took kale extract or ibuprofen (400 mg) capsules for 7 days, or vice versa, after surgical removal of each impacted tooth. Their pain intensity was then assessed using a visual analogue scale (VAS). Moreover, salivary α-amylase (AA) activity, matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta2 (TGF-β₂) concentrations were measured. Levels of VAS and AA decreased 7 days after the first and second molar extractions in the two treatment groups. Results: The kale extract was more effective than ibuprofen. MMP-9 and TGF-β₂ levels were reduced on days 4 and 7 following the two extractions in the kale group, whereas they were reduced on days 4 and 7 following the first extraction in the ibuprofen group. There was a positive correlation between MMP-9 and TGF-β₂. Thus, the consumption of the kale extract exerted analgesic and anti-inflammatory effects during the postoperative period in patients who had undergone molar extractions. In conclusion, anthocyanin-abundant kale extract is preferable when administered in a postoperative course and could reduce the need for a prescription of ibuprofen. Full article

Background: The surgical removal of impacted mandibular third molars is routine in oral and maxillofacial surgery and common postoperative complications are widely reported in the literature. Therefore, this prospective split-mouth study aims to compare the postoperative sequelae of piezoelectric surgery versus conventional surgery of the lower third molar, focusing on pain and swelling. Methodology: In total, 41 patients were treated under local anesthesia and surgical removal on one side of their mouth was performed using conventional rotary surgery (micromotor) while the other side’s was by piezosurgery, with an interval of 15 days from the previous procedure (82 extraction sites); in addition, pain and swelling analyses were conducted. Results: The pain analysis demonstrated a median of one day of pain in patients treated with piezoelectric surgery compared to two days with conventional surgery (p < 0.001). The probability of not feeling pain was greater in sites treated with experimental surgery on the first and second days (p < 0.001). The swelling was worse in places treated with the conventional method, with the most significant difference being the distance between the angle of the mandible and the upper lip vermilion on both days and the more subtle difference between the angle of the mandible and the anterior nasal spine on the seventh day. Conclusions: When a piezosurgical unit is used, according to the literature, is well known that it takes more time to perform the surgical extraction of third molars. Despite that, our results show that it causes less pain postoperatively, with faster improvement and a quicker reduction in swelling compared to conventional surgery. Full article

Background/Objectives: The extraction of impacted mandibular third molars (M3Ms) carries significant risks, especially regarding the inferior alveolar nerve (IAN). This study aimed to evaluate the effectiveness of a 3D-planned inward fragmentation technique (3Dp-IFT) to improve surgical outcomes, reduce complications, and preserve bone structure in cases involving complex M3M impactions. Methods: Twenty-three patients aged between 18 and 36 years requiring M3M removal were included. Preoperative planning involved the use of cone–beam computed tomography (CBCT) for precise localization of the furcation area, followed by the creation of a 3D navigation template using PlastyCAD software version 1.7. The surgical procedure was performed under local anesthesia, with meticulous endoscopic assistance to ensure accurate access and minimize trauma. Postoperative outcomes, such as bone loss, pain, swelling, and mouth opening range, were carefully measured. The data were systematically organized and analyzed descriptively using Microsoft Excel. Results: No disturbances to the IAN or lingual nerve were observed. The mean buccal bone loss was 2.2 mm, with a standard deviation of 1.2 mm. Postoperative pain and swelling were generally low, with significant reductions within the first week. The use of the 3D navigation template significantly improved surgical access, enhancing safety and minimizing complications. Conclusions: The 3Dp-IFT technique represents a significant advancement in the minimally invasive removal of M3M by allowing precise access to critical anatomical areas while minimizing bone loss and postoperative complications. This approach is particularly beneficial for complex cases involving M3M near the IAN, thereby improving surgical safety and patient outcomes. Full article