Giuseppe Monaco

Evaluation of Antibiotic Prophylaxis in Reducing Postoperative Infection After Mandibular Third Molar Extraction in Young Patients

PURPOSE This study evaluated the influence of antibiotic prophylaxis on postoperative complications after inferior third molar removal in young patients. PATIENTS AND METHODS We extracted 59 mandibular third molars from 59 patients with a mean age of 15 years (range, 12-19 years). The patients were included in the study when radiographs at the time of surgery showed that only the crown of the tooth germ was formed. Patients were randomized into 2 groups, the test group and the control group. The test group received 2-g amoxicillin tablets 1 hour before surgery, and the control group received no antibiotic therapy. The test group included 32 patients, 20 of whom were female and 12 were male; the mean age was 15 years. The control group included 27 patients, 12 of whom were female and 15 were male; the mean age was 15 years. Postoperative complications such as pain, swelling, wound infection, and fever were recorded by use of a questionnaire completed by the patient for the week after the extraction. Suture removal and questionnaire evaluation were performed by a surgeon who did not know the preoperative regimen. RESULTS The mean operating time was 34 minutes in the control group and 31 minutes in the test group. This difference was not significant. In the test group there was a statistically significant reduction of postoperative pain in the 7 days after the extraction, and the patients had a consistent minor consumption of analgesics. Swelling was always present in the control and test groups in the postoperative week, but in the test group it was a minor sequela and was absent in 2 patients. Wound infection was a sequela reported in 4 patients in the control group and in 1 patient in the test group; this difference was statistically significant (P < .01). Fever was present in 2 patients in the control group and in 1 patient in the test group; this difference was not statistically significant. CONCLUSIONS A statistically significant difference was found between patients receiving preoperative amoxicillin and the control group in the incidence of postoperative pain, fever, and wound infection. Another important finding was the statistically minor consumption of analgesics in the test group in the postoperative week.

Mandibular third molar removal in young patients: an evaluation of 2 different flap designs.

PURPOSE To evaluate the influence of 2 different flap designs on periodontal healing and postoperative complications, after inferior third molar removal in young patients. PATIENTS AND METHODS Twenty-four mandibular third molars were extracted from 12 patients with an average age of 16 years. Patients were included in the study when radiographs at the time of surgery showed that only the crown of the germ was formed. Each patient underwent 2 extractions, using a triangular flap on one side and an envelope flap on the other. Periodontal probing was recorded at the preoperative visit, and 7 days, 3 months, and 6 months after extraction. Postoperative complications were recorded using a questionnaire completed by the patient for the week after the extraction. RESULTS The examination performed 7 days after the extraction demonstrated a deeper probing depth in all teeth examined. This increase was statistically greater (P < .05) for the first and second molars when an envelope flap was used. After 3 months, the probing depths returned to preoperative values. No significant differences were seen between the 2 flap designs when postoperative complications were considered. The average operating time was 30.66 minutes with the triangular flap, versus 35.66 minutes with the envelope flap. This difference was not significant. After 6 months, the 2 flap designs resulted in no difference in periodontal healing or complications, but 30% of the surgical extractions resulted in a debilitating postoperative period for the patients treated. CONCLUSIONS Although we observed statistically significant differences in probing depth between triangular and envelope flaps 7 days after the extraction of third molars with no root development, this was not important from a clinical perspective, because periodontal healing at 3 and 6 months was comparable. We believe that this is also the case with the extraction of third molars with fully formed roots. Another important finding was the presence of a debilitating postoperative period in most of the patients who underwent extraction, contrary to the beliefs of many surgeons.

What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study.

PURPOSE Coronectomy has been proposed for impacted third molars in close proximity to the inferior alveolar nerve (IAN) to avoid neurologic injury. Immediate (up to 1 month) and late (2 to 36 months) postoperative complications were investigated. MATERIALS AND METHODS A prospective cohort study was performed on healthy patients treated in the dental clinic of the Department of Oral Surgery, University of Bologna. The predictor variables examined were experience of the surgeon (<10 vs ≥10 yr), length of surgery, type of mandibular third molar inclusion, and patient age. To assess the rate of postoperative complications, outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate and need for a second surgery also were investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables. RESULTS The study involved 94 healthy patients (mean age, 28.99 ± 8.9 yr; range, 17 to 56 yr; 37 men and 57 women) who had 116 third mandibular molars treated with coronectomy. During the 3-year follow-up period, 28 patients (29 coronectomy procedures) dropped out of the study. There was no case of neurologic injury to the inferior alveolar nerve (IAN) or to the lingual nerve (LN). In total, 30 complications were observed (25 within 1 month; 5 at 2 to 12 months). Surgeons with less than 10 years of training exposed patients to a greater risk of complications (hazard ratio = 2.069; 95% confidence interval, 1.004-4.263). An overall success rate of 74% at 6 months was estimated, and a second surgery was needed in 6% of cases. Of the retained roots analyzed, 80% showed postoperative root migration. CONCLUSIONS In this study, coronectomy of mandibular third molars did not result in temporary or permanent injury to the IAN or LN. Coronectomy showed a low rate of postoperative complications. However, within the first year, a second surgery was needed in 6% of coronectomy procedures to remove migrated root fragments. Additional studies with larger patient samples are recommended to further investigate differences in postoperative complications in relation to patient age.

Piezosurgery or Conventional Rotatory Instruments for Inferior Third Molar Extractions

PURPOSE The purpose of this study was to compare the discomfort and surgical outcomes of a piezosurgery device with those of rotatory instruments in lower third molar extraction. MATERIALS AND METHODS A split-mouth, randomized, unblinded clinical study was designed; the 2 molars had to have the same extraction difficulty score. The test side was extracted using a piezosurgery technique and the control side was extracted using a conventional handpiece. The primary endpoint was patient discomfort evaluated with the Postoperative Symptom Severity (PoSSe) scale, which was administered to each patient; secondary endpoints were pain, trismus, swelling, and surgical time evaluation. Paired-samples t test and repeated-measures analysis of variance were used to compare outcomes within patients. RESULTS Ten consecutive patients (6 female, 4 male; mean age, 22.4 ± 2.3 yr) were recruited. The total score on the PoSSe scale was significantly lower for piezosurgery compared with the conventional rotating handpiece (24.7 ± 10.3 vs 36.0 ± 7.6; t = -4.27; P = .002). Moreover, postoperative swelling 1 week after surgery was significantly lower for piezosurgery than for the conventional rotating handpiece (2.75 ± 0.23 vs 3.1 ± 0.39 cm; t = -2.63; P = .027). CONCLUSIONS Piezosurgery was associated with less postoperative discomfort and yielded better results for swelling. Piezosurgery seems to be a good technique in daily surgical practice, especially if applied in the critical steps in which safety and respect for soft tissue, bone, and nerves are necessary.

Coronectomy of mandibular third molars: A clinical protocol to avoid inferior alveolar nerve injury.

Coronectomy is a surgical procedure for the treatment of mandibular third molars in close proximity to the mandibular canal. Unfortunately, often the surgical protocol is not described step by step and it is difficult for the clinician to assess the key factors that are important for the success of this procedure. The aim of this paper is to propose and describe a standardized surgical protocol to improve the success of the technique. The treatment approach, for the most common types of third molars impaction is analysed. Each step of the surgical procedure is described in details and a new type of crown section is proposed. The presented protocol is proposed in order to define a clinical practitioners guide that could help the surgeon who approaches coronectomy for the first times.

A Laboratory Based Investigation of a New Elastic Toothbrush Head

Purpose. To demonstrate the noninferiority of a new toothbrush head with retractile bristles compared to traditional toothbrush heads on dental models. Methods. The new toothbrush head, mounted on manual and electrical handles, presents retractile bristle groups that can singularly retract over its entire length and offer calibrated resistance. Fourteen gypsum models of dental arches, twelve with and two without anatomical impairments, were spread with a “plaque simulator.” Each arch was brushed twice with each of the four toothbrushes, one minute by the same operator, blinded to the study. The plaque index (PI) was recorded at the end of each brushing session. GLM for repeated measures analysed the data. Results. On all the casts, the manual prototype and the electric prototype, removed 11% and 14% more “plaque simulator” compared to the standard toothbrush. In presence of dental anomalies, the prototypes removed 13% and 16% more plaque, respectively, compared to standard toothbrushes (P = 0.04). In both situations, the 95% confidence intervals of PI did not include −10% (the minimal margin of clinical relevance). Conclusions. The prototype is more effective in removing plaque from the casts with anomalies. The noninferiority of the prototype with respect to the standard toothbrushes was demonstrated.

Coronectomia: analisi della letteratura e illustrazione del protocollo chirurgico

ObjeCtives. t he present work aims to critically evaluate the results obtained by different authors in published studies about the coronectomy of mandibular third molars.

Delayed onset infections after lower third molar germectomy could be related to the space distal to the second molar

The onset of delayed infection after lower third molar germectomy is influenced by the amount of distal space. This retrospective study aimed to determine whether the incidence of delayed onset infection is related to the space distal to the second molar. The ratio between the distal space and the crown width, measured according to the Ganss protocol on panoramic radiographs, was obtained for 218 surgical germectomies performed for orthodontic reasons in 134 patients. A delayed onset infection occurred following 20 germectomies at between 2 and 8 weeks after surgery; purulent exudates from the alveolus and swelling were present. In 16 of the 20 cases of infection, a Ganss ratio of <0.5 showed the almost complete absence of space distal to the second molar. This study found that the distal space was significantly and inversely correlated with delayed onset infection (P=0.004). From a clinical point of view, it is important for the surgeon to be aware that a higher Ganss ratio may indicate that a delayed onset infection is less likely to occur and that a lower Ganss ratio could indicate a greater likelihood of this type of infection, so that the patient can be properly informed.

Influence of secondary wound healing after mandibular third molar coronectomy.

Our aim was to describe the postoperative morbidity related to secondary wound healing after coronectomy. Ten of 116 patients treated by coronectomy healed by second intention as a result of failed sutures. We made a retrospective analysis after two years to evaluate the postoperative morbidity related to secondary wound healing. The complete closure of the alveolus of the 10 surgical sites was recorded three months after coronectomy. No patients had postoperative infections, dry socket, or pulpitis. All patients were free of symptoms, the retained roots were completely included, and were not detectable with a periodontal probe. The importance of primary wound closure after coronectomy has been stressed as a critical point to avoid postoperative infection of the root. We found that secondary wound healing after coronectomy was not associated with a high postoperative infection rate, but further randomised clinical studies are necessary to confirm the need for primary closure and its relations to the long-term success of the coronectomy.