• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.207-213
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• 1998

Purpose : This study attempted to relate the incidence of fractures at the mandibular angle with the presence and state of eruption of lower third molars, and to find out the real risk factors for angle fractures in the states of lower third molars. Materials and Methods : Medical records and radiographs of 395 patients with mandibular fractures were retrospectively reviewed. The presence and states of third molars were assessed for each patients and related to the occurrence of angle and other mandibular fractures. Results : Of 395 patients with mandibular fractures, 142 had angle fractures. The incidence of angle fractures was found to be significantly greater when partial erupted lower third molars were present and it had a definite role for risk factors for angle fractures. But there were no clear relationship between the incidence of angle fracrtures and states of without, fully erupted lower third molars. Furthermore, the states of patial and unerupted lower third molar had an effect on bony segment displacement. Conclusions : This study provides clinical evidence to suggest that patial erupted third molar teeth weaken the mandibular angle both quantitatively and qualitatively.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.1
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• pp.3-10
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• 2015

Objectives: We retrospectively evaluated the impact of mandibular third molars on the occurrence of angle and condyle fractures. Materials and Methods: This was a retrospective investigation using patient records and radiographs. The sample set consisted of 440 patients with mandibular fractures. Eruption space, depth and angulation of the third molar were measured. Results: Of the 144 angle fracture patients, 130 patients had third molars and 14 patients did not. The ratio of angle fractures when a third molar was present (1.26 : 1) was greater than when no third molar was present (0.19 : 1; odds ratio, 6.58; P<0.001). Of the 141 condyle fractures patients, the third molar was present in 84 patients and absent in 57 patients. The ratio of condyle fractures when a third molar was present (0.56 : 1) was lower than when no third molar was present (1.90 : 1; odds ratio, 0.30; P<0.001). Conclusion: The increased ratio of angle fractures with third molars and the ratio of condyle fractures without a third molar were statistically significant. The occurrence of angle and condyle fractures was more affected by the continuity of the cortical bone at the angle than by the depth of a third molar. These results demonstrate that a third molar can be a determining factor in angle and condyle fractures.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.3
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• pp.103-106
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• 2018

Objectives: The goal of the study was to investigate the clinical effects of amoxicillin-clavulanic acid (500+125 mg) with metronidazole 400 mg administered three times daily (Group I) versus azithromycin 500 mg administered once daily and with metronidazole 400 mg three times daily (Group II) for the prevention of postoperative infection following mandibular third molar surgical removal. Materials and Methods: The study design was a single-center prospective study. Patients who reported to the Department of Oral and Maxillofacial Surgery between February 2015 and January 2017 for removal of mandibular third molar were screened, and 108 patients were chosen. One surgeon carried out all procedures. Patients were prescribed antibiotics until the two groups contained a similar number of cases. Results: Our data showed that Group II had fewer incidences of surgical site infection, but with no statistical significance. Conclusion: Although both treatments are used routinely after removal of the mandibular third molar, neither is significantly better than the other.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.213-221
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• 2020

Background: Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. Methods: The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. Results: The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. Conclusion: Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.370-375
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• 1999

To evaluate the efficacy of antibiotic administration in the impacted mandibular third molar extraction the author investigated 107 patients requiring extraction of the lower third molar who visited at the Department of oral and maxillofacial Surgery, Chosun Dental Hospital and were healthy without medical problems and had no signs and symptoms of infection around the lower third molar. The patients were divided into 4 groups according to the method of antibiotics administration: 13 patients without antibiotics administration(group 1), 30 patients with only intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure(group 2), 39 patients with intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure and oral administration of follow-up dosages of $Augmentin^{(R)}$ for 1 day(group 3), and 25 patients with intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure and oral administration of follow-up dosages of $Augmentin^{(R)}$ for 3 day(group 4). Infection rates after extraction were calculated and compared according to gender, the age of the patients, the level of impaction, and also compared between four groups. The results were as follows. 1. The overall infection rate was 8.4%. 2. The infection rate was higher in male(11.9%) than in female(4.2%), but there were statistically no significant differences between them. 3. Infection rate was lower in patients under age 30(7.2%) than in patients over age 30(12.5%), but there were statistically no significant between them. 4. Infection rate was higher in patients with complete bony impacted tooth(11.1%) than in patients with partial bony impacted tooth(6.5%), but there were statistically no significant differences between them. 5. Infection rate was 7.7% in group 1, 10.0% in group 2, 10.3% in group 3, 4.0% in group 4 and there were statistically no significant differences between groups. In summary, it is more important to extract the impacted lower third molar under aseptic condition and to minimize the injury of tissue if possible than to administer the preventive antibiotics in reducing the infection rate in healthy patients without medical problems who had no signs and symptoms of infection around the lower third molar.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.69-76
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• 2015

Background: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. Methods: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. Results: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. Conclusions: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.575-582
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• 2021

Background: The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth. Methods: Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated. Results: In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics. Conclusion: Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.29.1-29.10
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• 2019

Background: Reduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments. Methods: To address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient's satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar's tests. Results: The pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient's satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant. Conclusion: Due to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.

• 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.