Search Results (20)

Background: Wisdom tooth extraction is a routine procedure with potential complications. In the lower arch, the displacement of a root or its fragment into the submandibular space is a relatively common occurrence that can lead to permanent damage to peripheral nerve fibers. Recent advancements in dental technologies, including CAD-CAM and artificial intelligence, have contributed to improved clinical outcomes in surgical procedures. Methods: Following a brief introductory narrative review, this clinical case describes the extraction of the left third inferior molar, which was sectioned by the oral surgeon to facilitate its removal. The procedure led to the progressive migration of a root fragment into the submandibular space, triggering an infective process. Efforts to retrieve the root fragment resulted in irreversible damage to the somatosensory motor nerves associated with the inferior alveolar nerve after the second surgery was performed by a maxillofacial surgeon. Results: Determining the responsibility for the damage (caused either by the oral or maxillofacial surgeon) involves both technical and ethical considerations, which are particularly relevant in cases involving re-intervention by different specialists. This case highlights the importance of a thorough preoperative evaluation of the patient’s anatomical, bone, and dental characteristics. The use of new technologies can significantly reduce the risk of complications that may otherwise lead to permanent damage and complex determinations of professional responsibility. Conclusions: Given the potential, albeit rare, for permanent disturbance of sensory and motor functions, managing complications and assessing the resulting damage are critical and sensitive steps in resolving such case both clinically and legally. 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 and Objectives: Third molar (wisdom tooth) extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Traditional rotary instruments and burs have long been the standard tools for this procedure. However, recent advancements in surgical techniques, such as piezoelectric surgery, have gained popularity due to their purported advantages in terms of precision, safety, and postoperative outcomes. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of third molar surgery performed using burs versus piezoelectric surgery. Materials and Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using the PubMed, Scopus, Web of Science, and Cochrane databases to identify relevant studies published up until October 2024. Randomized controlled trials (RCTs), clinical trials, and comparative studies assessing third molar surgery using either burs or piezoelectric instruments were included. The primary outcomes evaluated were surgical time, postoperative pain, swelling, nerve damage, and healing time. The data extraction and quality assessment were performed independently by two reviewers using standardized tools, and any discrepancies were resolved by a third reviewer. Results: A total of five studies met the inclusion criteria, and the meta-analysis revealed that piezoelectric surgery resulted in significantly lower postoperative pain and swelling compared to traditional bur techniques (p < 0.05). Additionally, the incidence of nerve injury was lower in the piezoelectric group, though the difference was not statistically significant. Surgical time was found to be longer with piezoelectric devices, but this was offset by improved healing outcomes and patient comfort. Conclusions: Piezoelectric surgery offers a less traumatic alternative to traditional burs for third molar extraction, with reduced postoperative morbidity and enhanced patient outcomes. Although the longer surgical duration may be a drawback, the overall benefits, particularly in terms of pain management and tissue preservation, support the adoption of piezoelectric techniques in clinical practice. Further high-quality randomized trials are recommended to strengthen the evidence base for these findings. Full article

Background: There is only limited research on the coronal cementum of a tooth, and the mechanisms of its forming process are not well-defined. This report presents a coronal cementum on the occlusal surfaces of enamel in an impacted wisdom tooth in a human, which is not nearly the cervical portion. Materials and Methods: The tooth (Tooth #1) was derived from a 46-year-old female. Histological analysis, including hematoxylin and eosin (HE) and toluidine blue (TB) staining, and Scanning Electron Microscopy and Energy Dispersive X-ray Spectrometer (SEM-EDS) analysis of the extracted tooth were conducted. Radiographic examination showed that Tooth #1 was horizontally impacted in the maxilla and had the apex of a single root placed between the buccal and palatal roots of Tooth #2. Results: Coronal cementum was distributed widely on the enamel, and reduced enamel epithelium was also found with enamel matrix proteins histologically. The formation of acellular cementum was observed to be more predominant than that of the cellular cementum in Tooth #1. SEM showed that the occlusal cementum connected directly with enamel. Calcium mapping revealed an almost similar occlusal cementum and enamel. In addition, the spectrum of elements in coronal cementum resembled the primary cementum according to SEM-EDS. Discussion: Thus, coronal cementogenesis in impacted human teeth might be related to the existence of reduced enamel epithelium. Full article

Background: Oral surgery involves the diagnosis and surgical treatment of diseases affecting the soft and hard tissues of the oral cavity and encompasses a wide range of surgical interventions. The aim of this investigation was to study the characteristics and age-related diagnoses of these oral surgeries, as well as to describe the surgical procedures performed in a pediatric oral and maxillofacial surgery service. Methods: A descriptive, retrospective, observational, and relational study was conducted on children and adolescents aged from 0 to 22 years who were treated in a pediatric oral and maxillofacial surgery service at a children’s hospital. Results: We analyzed 1311 surgical interventions (51.4% were on boys and 48.6% on girls), consisting of 24.8% soft tissue surgeries, 65.9% bone and dental tissue surgeries, and 9.3% mixed tissue surgeries. The most common pathologies were tooth eruption disorders (65.9%), followed by ankyloglossia (20.5%). The most frequent treatment was wisdom teeth extraction (31.3%). A statistically significant association (p < 0.05) was found between surgical treatments and variables such as age, sex, tissue type, and biopsy. Conclusions: This study enhances our understanding of pediatric oral surgery, emphasizing that the most common pathology is altered tooth eruption, while the most frequent surgical intervention is the extraction of wisdom teeth at different stages of development. Full article

A healthy man in his 40s was referred to the Oral Surgery and Implantology Unit of Geneva University Hospital for diagnosis and management of facial swelling affecting the right side of his lower jaw. The patient’s history revealed that the patient had been hit by several punches to the face a few months earlier. To investigate the swelling, an intra-oral radiograph, an orthopantomographic radiograph, and computed tomography were performed, which revealed no fracture of the lower jaw but the presence of a partly impacted fractured wisdom tooth (third molar). This finding, together with the clinical status, indicated cellulitis most likely related to the presence of a fractured wisdom tooth. The decision was made to proceed with tooth extraction, and follow-up at 3 weeks showed good healing and complete resolution of facial swelling. This case highlights that odontogenic infection can also occur as a result of necrosis following the fracture of an impacted wisdom tooth. Full article

Background: A new access technique was developed to reduce postoperative adverse events after the extraction of impacted maxillary wisdom teeth. Hence, this study aimed to assess the occurrence of adverse events after the extraction of maxillary impacted wisdom teeth using a traditional access (TA) or a new technique (NT). Methods: Two different surgical incision designs were used for bilateral wisdom tooth extractions in 30 patients. The traditional incision was performed distal to the second molar in the center of the tuberosity, followed by a buccal releasing incision. After the tooth extraction, the wound was secured by sutures. The new technique consists of an oblique incision from the distal palatal aspect of the tuberosity towards the buccal aspect of the second molar. After the tooth extraction, cyanoacrylate glue was used on the wound. Results: Lower pain was reported by patients at the site treated with the new technique (p < 0.01). Edema, postsurgical bleeding, and hematoma were similar in both groups. The surgical time was shorter for the new technique (p < 0.01). Conclusions: The new technique applied for the extraction of impacted maxillary wisdom teeth reduced postsurgical pain and the duration of surgery. Full article

The extraction of mandibular impacted third molars is one of the most common procedures in oral surgery. One of the extraction methods consists of the preparation of a buccal bone lid to obtain access and remove the tooth. This technique aims to reduce bone loss, promote bone healing distal to the second molar, and increase the accessibility to the impacted tooth, particularly in cases of concomitant pathologies or proximity to the mandibular canal. The procedure benefits from the application of 3D printing technologies to produce cutting guides that, combined with piezosurgery, allow deeply impacted third molar extractions with excellent preoperative planning and extreme localisation precision, as well as predictable repositioning and fixation of the bone lid. The objective of this article is to present two clinical cases of the application of the bone lid technique to extract deeply impacted third molars using 3D printed guides with different designs and piezosurgery. Full article

Background: Neurosensory deficits are one of the major complications after impacted lower third molar extraction leading to an impaired patient’s quality of life. This study aimed to evaluate the incidence of neurosensory deficits after lower third molar extraction and compare it radiologically to the corresponding position of the inferior alveolar nerve. Methods: In a retrospective study, all patients who underwent impacted lower third molar extraction between January and December 2019 were compiled. Therefore, clinical data as well as preoperative radiological imaging were assessed. Results: In total, 418 patients who underwent lower third molar extractions (n = 555) were included in this study. Of these, 33 (5.9%) had short-term (i.e., within the initial 7 postoperative days) and 12 (1.3%) long-term (i.e., persisting after 12 months) neurosensory deficits documented. The inferior alveolar nerve position in relation to the tooth roots showed apical position in 27%, buccal position in 30.8%, lingual position in 35.4%, and interradicular position in 6.9%. Conclusions: A statistically significant increased incidence of neurosensory deficits occurs when the inferior alveolar nerve is directly positioned lingually to the tooth roots (p = 0.01). Full article

Wisdom tooth extraction is one of the most commonly performed procedures by oral maxillofacial surgeons. Delayed-onset infection (DOI) is a rare complication of wisdom tooth extraction, and it occurs ~1–4 weeks after the extraction. In the present study, risk factors for DOI were investigated by retrospectively analyzing the cases of 1400 mandibular wisdom tooth extractions performed at Kagawa University Hospital from April 2015 to June 2022. Inclusion criteria were patients aged >15 years with a wisdom tooth extraction per our procedure. The exclusion criteria were patients with insufficient medical records, a >30-mm lesion around the wisdom tooth shown via X-ray, colonectomy, radiotherapy treatment of the mandible, the lack of panoramic images, and lesions other than a follicular cyst. The DOI incidence was 1.1% (16 cases), and univariate analyses revealed that the development of DOI was significantly associated with the Winter classification (p = 0.003), position (p = 0.003), hypertension (p = 0.011), and hemostatic agent use (p = 0.004). A multivariate logistic regression analysis demonstrated that position (OR = B for A, 7.75; p = 0.0163), hypertension (OR = 7.60, p = 0.013), and hemostatic agent use (OR = 6.87, p = 0.0022) were significantly associated with DOI development. Hypertension, hemostatic use, and position were found to be key factors for DOI; long-term observation may thus be necessary for patients with these risk factors. Full article

Pericoronitis is characterized by inflammation of the tissues surrounding an erupting tooth and occurs most commonly in lower wisdom teeth. The extent of inflammatory phenomena can significantly affect the patient’s quality of life because of the pain, bleeding, and discomfort caused by it. The treatment of pericoronitis is carried out locally by irrigation and debridement in the early stages, but also generally by antibiotic therapy, when purulent secretion is present under the operculum and in the periodontal area. This study aims to evaluate the effect of beech bark extract (BBE) in the treatment of pericoronitis of the lower third molar. Parameters evaluated were pain, trismus, and bleeding index in a clinic study. Four groups of 20 patients were evaluated and grouped according to the irrigation solution used during the treatment: chlorhexidine 0.2% (CHX), BBE and chlorhexidine mixture solution 0.2% (1:1), and BBE and saline solution (control). The evaluation was carried out before and after the irrigation. Following the assessment of pain and trismus, a significant decrease in pain and a significant increase in mouth opening after 3 days was observed in patients treated with BBE, CHX, and BBE + CHX (p = 0.00). In the case of control patients, no significant decrease in pain (p = 0.83) was observed after 3 days, nor was there a significant increase in the opening of the oral cavity (p = 0.157). The evaluation of the inflammation index showed a significant decrease in gingival bleeding after 3 days for most patients treated with tested solutions (p < 0.05). It was concluded that irrigation with BBE was more effective in reducing pain, trismus, and bleeding compared to the other solutions (control, CHX, BBE + CHX), and this natural extract can be a choice in case of pericoronitis debut. Full article

The surgical extraction of the lower third molar is widely practiced in oral surgery. Inflammatory complications such as pain, swelling, and trismus can cause discomfort to the patients after third molar extraction. Several methods have been used to reduce these postoperative sequelae, including the use of corticosteroids, nonsteroidal anti-inflammatory drugs, analgesics, antibiotics, less traumatic surgical methods, and the use of photobiomodulation. This narrative review summarizes the current evidence on the effect of photobiomodulation on pain, facial swelling and trismus after third molar surgery. A literature search using MEDLINE (NCBI PubMed and PMC), EMBASE, Scopus, Cochrane library, Web of Science, and Google Scholar was undertaken up to October 2021. Forty-one articles met the inclusion criteria. Photobiomodulation can be considered an alternative and useful method for controlling pain following impacted wisdom tooth surgery. The effectiveness of PBM in reducing swelling and trismus is still controversial. This review highlights the lack of consensus in the literature on protocols used in PBM therapy. Full article

Dental injury to the second molar (SM) caused by the surgical extraction of the impacted third molar tends to be underestimated. The necessity of assessment of the impact of the removal of the wisdom tooth in the mandible on the second molar arose. The study group (n = 60) was the one with the second molar on the surgical side, and the control group (n = 60) was the one with the tooth on the opposite side of the alveolar arch. Before the surgery, the difficulty level was assessed according to the Pederson scale. The periodontal status of the SM was assessed by probing depth (PD), gingival index (GI), tooth mobility (TM) examination by the percussion method and resonance frequency. Measurements were taken before and after the surgery, 7 days and 8 weeks after the surgery. The study demonstrated the significant impact of the surgical removal of the wisdom tooth on the PD, GI and TM of the SM. The predicted degree of difficulty of the very difficult surgery had an influence on the increase in PD on the distal buccal and lingual surface of the SM, and on the GI in the proximity of the examined tooth. The results of the presented research confirm the necessity of the clinical assessment of the lower SM before and after the surgical removal of the impacted wisdom tooth in the mandible. Full article

This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups. Full article

The regeneration of nerve injuries after oral surgery procedures is a quite often attempted procedure in dental medicine. Despite several proposed technical approaches, there is still a lack of consensus on which should be considered the gold standard procedure, even-though in the last decades, the use of collagen-based devices allowing a tension-free direct neurorrhaphy has been used. A systematic search of multiple electronic databases and hand searching was conducted to assess the level of evidence behind the use of type I collagen devices to treat nerve injuries after oral surgery procedures. After screening, four articles (one case series and three retrospective studies) including overall 65 patients suffering from inferior alveolar (IAN)/lingual nerve (LN) injury after mandibular wisdom tooth extraction, met the inclusion criteria and could be included. The Oxford Centre for evidence-based medicine (OCEBM) scaling system was used to evaluate the quality of the included studies. Positive clinical results in terms of sensorial improvements were recorded at least 3 months after surgery, even-though the overall level of evidence is low. The use of collagen membranes to enhance nerve regeneration in oral surgery results in promising results. Nevertheless, additional clinical comparative trials with larger sample sizes are needed. Full article