Abstract: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 s… Show more
“…The inclusion criteria of the patients were as follows: (1) healthy status without any underlying disease, (2) impacted mandibular third molar which is horizontal (80 to 100°) with less than half of the third molar crown above the CEJ of the adjacent second molar and contacted with the inferior mandibular canal on computed tomography (Fig. 1 ) [ 8 , 9 ], and (3) facial MRI within 48 h after surgical extraction of their mandibular third molar. The exclusion criteria were as follows: (1) simultaneous extraction of impacted maxillary third molar with incision, ostectomy, or odontomy, (2) poor oral hygiene control, and (3) uncontrolled systemic diseases.…”
Section: Methodsmentioning
confidence: 99%
“… Fig. 1 Assessment of the impacted third molar position in computed tomography according to a previous study [ 8 ]. The spatial relationship was classified based on the angle measured between the long axis of the impacted third molar and the adjacent second molar (yellow lines and an asterisk mark).…”
Section: Methodsmentioning
confidence: 99%
“…Surgical extraction of the mandibular third molar was performed with operculectomy. After operculectomy, the extraction was performed through odontomy on the exposed third molar with or without additional mesial incision [ 8 ]. Patients were instructed to take oral antibiotics (625 mg, amoxicillin, Ilsung Pharmaceutical, Korea) and NSAID (500 mg, dexibuprofen, Samil Pharmaceutical, Korea) thrice daily for 5 days and daily mouth rinse with a chlorhexidine solution.…”
Purpose
Several investigations have been performed for a postoperative edema after extraction, but the results have been controversial due to low objectivity or poorly reproducible assessments of the edema. The aim of this study was to suggest a classification and patterns of postoperative edema according to the anatomical division associated with extraction of mandibular third molar as a qualitative evaluation method.
Methods
This study was conducted forty-four mandibular third molars extracted and MRI was taken within 48 h after extraction. The postoperative edema space was classified by MRI (one anatomic component—buccinator muscle—and four fascial spaces—supra-periosteum space, buccal space, parapharyngeal space, and lingual space), and evaluated independently by two examiners. The inter-examiner reliability was calculated using Kappa statistics.
Results
The evaluation of buccinator muscle edema showed good agreement and the fascial spaces showed constant high agreement. The incidence of postoperative edema was high in the following order: supra-periosteum space (75.00%), buccinator muscle (68.18%), parapharyngeal space (54.55%), buccal space (40.91%), and lingual space (25.00%).
Conclusion
Postoperative edema could be assessed clearly by each space, which showed a different tendency between the anatomic and fascial spaces.
“…The inclusion criteria of the patients were as follows: (1) healthy status without any underlying disease, (2) impacted mandibular third molar which is horizontal (80 to 100°) with less than half of the third molar crown above the CEJ of the adjacent second molar and contacted with the inferior mandibular canal on computed tomography (Fig. 1 ) [ 8 , 9 ], and (3) facial MRI within 48 h after surgical extraction of their mandibular third molar. The exclusion criteria were as follows: (1) simultaneous extraction of impacted maxillary third molar with incision, ostectomy, or odontomy, (2) poor oral hygiene control, and (3) uncontrolled systemic diseases.…”
Section: Methodsmentioning
confidence: 99%
“… Fig. 1 Assessment of the impacted third molar position in computed tomography according to a previous study [ 8 ]. The spatial relationship was classified based on the angle measured between the long axis of the impacted third molar and the adjacent second molar (yellow lines and an asterisk mark).…”
Section: Methodsmentioning
confidence: 99%
“…Surgical extraction of the mandibular third molar was performed with operculectomy. After operculectomy, the extraction was performed through odontomy on the exposed third molar with or without additional mesial incision [ 8 ]. Patients were instructed to take oral antibiotics (625 mg, amoxicillin, Ilsung Pharmaceutical, Korea) and NSAID (500 mg, dexibuprofen, Samil Pharmaceutical, Korea) thrice daily for 5 days and daily mouth rinse with a chlorhexidine solution.…”
Purpose
Several investigations have been performed for a postoperative edema after extraction, but the results have been controversial due to low objectivity or poorly reproducible assessments of the edema. The aim of this study was to suggest a classification and patterns of postoperative edema according to the anatomical division associated with extraction of mandibular third molar as a qualitative evaluation method.
Methods
This study was conducted forty-four mandibular third molars extracted and MRI was taken within 48 h after extraction. The postoperative edema space was classified by MRI (one anatomic component—buccinator muscle—and four fascial spaces—supra-periosteum space, buccal space, parapharyngeal space, and lingual space), and evaluated independently by two examiners. The inter-examiner reliability was calculated using Kappa statistics.
Results
The evaluation of buccinator muscle edema showed good agreement and the fascial spaces showed constant high agreement. The incidence of postoperative edema was high in the following order: supra-periosteum space (75.00%), buccinator muscle (68.18%), parapharyngeal space (54.55%), buccal space (40.91%), and lingual space (25.00%).
Conclusion
Postoperative edema could be assessed clearly by each space, which showed a different tendency between the anatomic and fascial spaces.
“…The classification of impaction status for M3M is mainly based on local anatomy and radiographs (11). Several classification systems have been proposed for evaluating the difficulty index for impacted M3M (12,13). All these classifications illustrate the relationship between radiological anatomy and surgical difficulty.…”
Section: Introductionmentioning
confidence: 99%
“…Additionally, operation time has also been shown to be a predictor of postoperative symptoms and is used as a proxy measure for extraction difficulty (7,16). Recent research has shown that the relationship between the M3M position, operation time, and surgical difficulty may be influenced by radiological factors such as the P-G level classification (12). These findings suggest a possible association between operation time and PoSS.…”
Background: To investigate the association between operation time and serious postoperative symptom severity (PoSS) in patients following the surgical removal of mandibular third molar (M3M), independent of the degree of impaction. Methods: A retrospective hospital-based observational study was carried out at the Stomatology Hospital of Tianjin Medical University. The operation time was recorded and divided by quartiles (Q1-Q4). The primary outcome was PoSS. Clinical, demographic and radiologic variables were also recorded. A descriptive bivariate analysis was performed. Associations were analyzed using the adjusted multivariate logistic regression. The association between time and impaction status was also tested. Potential nonlinear associations were evaluated with the restricted cubic spline. P values of <0.05 were considered as statistically significant. Results: A total of 321 patients met our inclusion criteria (114 men and 207 women). The mean operation time was 16.0 minutes (range, 1.1 to 40.5 minutes). The odds ratio (OR) and 95% confidence interval (CI) were determined after multivariate adjustments for the risk of serious PoSS per 5-min incremental increase in operation time (OR 1.201, 95% CI, 1.005-1.434). The multivariable-adjusted ORs (95% CI) of PoSS across the categories of operation time were as follows: 1.00 (reference), 1.765 (0.770-4.045), 2.567 (1.047-6.293), and 3.085 (1.180-8.064) (P for trend =0.027). The test of interaction effect was not significant (all P for interaction >0.05). No evidence of a nonlinear association was observed (P for nonlinearity =0.117). Conclusions: Operation time was significantly and positively associated with a high risk of serious PoSS independent of impaction status in patients who underwent the surgical removal of M3M.
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