• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.3
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• pp.163-171
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• 2023

Background: Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. Methods: This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Results: Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) Conclusion: The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.217-225
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• 2001

Any fracture passing through the socket of a teeth is compounded intraorally, even if the fracture is not displaced and the tooth is firm in its socket. Before the advent of antibiotic therapy the danger of infection in a compounded fracture posed severe problems in treatment. Infection is reduced by antibiotic therapy but prolonged use of antibiotics is not justified in an attempt to save a tooth which might eventually be sacrificed. There is still controversy in the management of third molar in mandibualr angle fracture, particulary in regard to their retention or removal at the time of fracture treatment. So we surveyed the 159 patients who were treated with open reduction of mandibular angle fracture containing third molar in fracture line, and compared with the postoperative infection rate depending on time intervals between injury and operation, eruption state of third molar, non-extraction or extraction of third molar related to eruption state, non-extraction or extraction of third molar related to condiition of third molar and its surrounding periodontium and were to propose treatment guidline of third molar in mandibular angle fracture The results obtained were as follows : 1. There were no statistical significance between the time from injury to operation and postoperative infection. 2. There were no statistical significance between eruption state of third molar and postoperative infection. 3. In case of retention of the third molar, there were no statistical significance between eruption state of third molar and postoperative infection, but in case of extraction, postoperative infection was high rate in complete impacted cases. 4. There were no statistical significance between non-extraction or extraction of third molar and postoperative infection depending on condition of third molar. There are no difference in infection rate statistically according to the time from injury to operation, eruption state and condition of third molar, but retention of third molar revealed lowered infection rate in completely impacted cases. By terms of the manegement of third molar, we should extract or preserve third molar in the line of the mandibular angle fracture according to possibility of infection.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.379-388
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• 2019

Background: In dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar. Methods: We recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use. Results: In this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05). Conclusion: The postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.4
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• pp.215-220
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• 2016

In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed $Garr{\acute{e}^{\prime}s$ sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.3
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• pp.121-128
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• 2015

Background: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Methods: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. Results: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Conclusions: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.1
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• pp.27-34
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• 2024

Objectives: Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don't have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. Materials and Methods: A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). Results: There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. Conclusion: The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.5
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• pp.328-334
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• 2020

Objectives: This study aimed to validate the effectiveness of a recently proposed difficulty index for removal of impacted mandibular third molars based on extraction time and suggest a modified difficulty index including the presence of pathologic conditions associated with third molars. Materials and Methods: This retrospective study enrolled 65 male patients younger than 25 years with third molars. Extraction time was calculated from start of the incision to the last suture. The difficulty scores for third molars were based on spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points) using cone-beam computed tomography. The difficulty index was defined as follows: I (3-4 points), II (5-7 points), III (8-10 points), and IV (11-12 points). The modified difficulty score was calculated by adding one point to the difficulty score if the third molar was associated with a pathologic condition. Two modified difficulty indices, based on the presence of pathologic conditions, were as follows: the half-level up difficulty index (HDI) and the one-level up difficulty index (ODI) from the recently proposed difficulty index. Results: The correlations between extraction time and difficulty index and or modified difficulty indices were significant (P<0.001). The correlation coefficient between extraction time and difficulty index was 0.584. The correlation coefficients between extraction time and HDI and ODI were 0.728 and 0.764, respectively. Conclusion: Extraction time of impacted third molars exhibited a moderate correlation with difficulty index and was strongly correlated with the modified indices. Considering the clinical implications, the difficulty index of surgical extraction should take into consideration the pathologic conditions associated with third molars.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.203-212
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• 2020

Background: This research evaluated the numbness produced by lignocaine at an equal or higher concentration than that of 4% articaine through a single point of injection for maxillary third molar surgery. This randomized double-blind study was conducted to compare the anesthetic efficiency of 4% lignocaine with that of 4% articaine in impacted maxillary third molar surgery using a single buccal infiltration alone. Methods: The study participants were 30 healthy patients requiring the bilateral surgical removal of symmetrically-positioned maxillary third molars. Using a split-mouth design, each patient randomly received buccal infiltration of 1.7 ml of 4% lignocaine and 1.7 ml of 4% articaine during two separate appointments. After 15 minutes of anesthetic injection, surgery was performed by the same surgeon using a consistent technique on both sides. Pinprick test pain scores of the buccal and palatal gingiva of the maxillary third molar after 10 minutes and 15 minutes latencies, pain scores during the surgery, the need for supplemental anesthesia, and patients' satisfaction with anesthetic efficiency were recorded. Surgery performed without supplemental anesthesia was categorized as successful. Results: The success rates of 4% lignocaine and 4% articaine (83.34% vs. 86.67%, P = 1.00) were not significantly different. Only 5 cases (4 cases in the articaine group and 1 case in the lignocaine group) reported mild pain and pressure sensation (NRS ≤ 1) on probing at the palatal side after 15 minutes of latency (P = 0.25). The pain scores of maxillary third molar surgery in the two groups were not significantly different (P > 0.05). Moreover, the statistical analysis confirmed the comparable patient satisfaction of two study groups (P = 0.284). Conclusion: This study provides evidence that single buccal infiltrations of 4% lignocaine and 4% articaine have comparable anesthetic efficacy and success rates for impacted maxillary third molar surgery. Both 4% lignocaine and 4% articaine can produce effective palatal anesthesia and pain control using buccal infiltration alone after 15 minutes of latency.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.121-127
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• 2017

Background: There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. Method: This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. Results: The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P<0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. Conclusion: We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.

• The korean journal of orthodontics
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• v.17 no.2
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• pp.321-333
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• 1987

The purpose of this study was to observe the changes of the lower 3rd molars following the extraction of the lower 2nd molars by Lateral Cephalograms and Orthopantomograms. The subjects consisted of twenty malocclusion, 7 males 13 females, were 19 year 5 month old at the removal of the lower 2nd molars, 19 year 1 month old at the end of the orthodontic supervision after the removal of the lower 2nd molars (mean age) The obtained results were as follows, 1 It is recommended to extract the lower 2nd molars when the lower 3rd molars are Nolla's Stage 4 or 5 2 With the pre-extraction variables obtained by factor analysis, it was possible to predict the long axis of the lower 3rd molars after 2nd molar extraction. 3 There were no impacted 3rd molars.