M. Mercedes Gallas Torreira

Trismus and Pain After Removal of Impacted Lower Third Molars

Abstract Purpose : This study evaluated trismus and pain after removal of impacted lower third molars and investigated whether these responses were related to difficulty of surgery. Patients and Methods : A consecutive series of 104 patients, all of whom underwent removal of an impacted lower third molar under local surgery, was studied. Difficulty of surgery was evaluated on a modified version of the Parant scale: I, extraction with forceps only; II, extraction by ostectomy; III, extraction by ostectomy and coronal section; IV, complex procedures. Trismus was evaluated in terms of maximum interincisal distance (MID) 1 and 5 days after surgery. Pain was evaluated on the basis of reported analgesic use 1 and 5 days after surgery. Results : Among group I subjects, mean day 1 MID did not differ significantly (P > .05) from mean presurgery MID, whereas mean day 1 MID in groups II, III, and IV was significantly lower than before surgery. In groups II, III, and IV, mean day 5 MID remained lower than before surgery. The proportion of group I patients using analgesics was significantly lower on both days 1 and 5 than the proportion of patients using analgesics in groups II, III, and IV. In all groups, the proportion of patients using analgesics dropped significantly between days 1 and 5. Conclusion : Trismus is less severe after simple (forceps-only, grade I) extractions than after surgical extractions (grades II to IV). However, trismus severity after surgical extraction does not depend on difficulty of surgery. Pain, as revealed by reported analgesic use, is likewise less severe after simple extractions. Regardless of extraction type, pain declines between days 1 and 5 postsurgery.

Periosteal distraction as bone regenerative alternative

The use of endoseus implants is frequently limited by insufficient bone in the reception area as a result of trauma, tooth loss, poor surgical technique or periodontal disease. Several methods have been described to solve problems related to bone atrophy: regeneration with bone grafts, Guided Bone Regeneration (GBR) and Osteogenic Distraction (OD). OD is a technique that induces the formation of hard and soft tissue through a progressive elongation of a gap created by osteotomy. The periosteum plays an active role in osteogenic distraction. Therefore, it is possible to produce the formation of new bone through Osteogenetic Periosteal Distraction (OPD) without having to perform an osteotomy. The goal of this revision is to clarify the matter, revising the used devices, techniques and comparing the results. The bibliographic revision of OPD was performed by searching on PUBMED and SCOPUS for the articles published until December 2013. We included a total of 17 articles that complied with the requirements. Several experimental studies in animals have shown the formation of bone by OPD, however, there is not a clear protocol to develop the intervention due to the diversity of devices, animal models, anatomical regions or variables in the surgical technique in regards to latency periods, activation frequency and consolidation periods. OPD is efficient for the creation of new bone between the remnant bone and the periosteal tissue, although the amount of variables do not allow for the establishment of a predictable result.