Yiu Yan Leung

Safety of coronectomy versus excision of wisdom teeth: A randomized controlled trial

OBJECTIVE The objective of this study was to compare the surgical complications and neurosensory disturbances of coronectomy and total excision of lower wisdom teeth with roots in close proximity to the inferior dental nerve (IDN). STUDY DESIGN A randomized controlled trial was conducted to compare the surgical complications and IDN deficit of coronectomy and total removal of wisdom teeth. Patients with specific radiographic signs of close proximity of wisdom teeth roots to the IDN were randomized. RESULTS A total of 231 patients underwent surgery for 349 lower wisdom teeth (171 coronectomies, 178 controls); 16 coronectomies failed and were removed in total. Nine patients in the control group presented with IDN deficit, compared with 1 in coronectomy group (P = .023). Pain and dry socket incidence was significantly lower in the coronectomy group, and there were no statistical differences in infection rate between the 2 groups. Reoperation of one coronectomy case was performed owing to persistent root exposure. CONCLUSION There are fewer complications in terms of IDN deficit, pain, and dry socket after coronectomy, but the infection rate is similar to that of total excision.

Coronectomy of the Lower Third Molar Is Safe Within the First 3 Years

PURPOSE There is no long-term evaluation on the safety of coronectomy of the lower third molar. The aim of this study was to investigate the 3-year morbidity of coronectomy of the lower third molars and to monitor the behavior and migration pattern of the retained roots after coronectomy. MATERIALS AND METHODS This was a prospective cohort study. Patients with lower third molars with specific radiographic sign(s) showing proximity of the roots to the inferior alveolar nerve who underwent coronectomy in a previous randomized clinical trial were reviewed postoperatively in the first week and the third, sixth, 12th, 24th, and 36th months. The morbidities of infection, pain, root eruption, reoperation to remove the root, and the development of any pathology were recorded. The pattern of any root migration was analyzed. RESULTS Ninety-eight patients (35 men and 63 women; mean age, 25.7 yrs; standard deviation, 7.9 yrs) with 135 coronectomies completed the 36-month review. None presented with infection or pain from the postoperative third month onward. Root eruption causing sensitivity occurred in 3% (4/135) of the sample and the erupted roots were removed. None of the reoperated cases presented with a postoperative inferior alveolar nerve deficit. No pathology developed in any of the retained roots after coronectomy. Root migration was noted in most cases in the first 12 months, and all roots stopped migrating from the 24th month onward. The mean root migration at 36 months was 2.8 mm (standard deviation, 1.4 mm). CONCLUSIONS This study confirms that retained roots after coronectomy in the lower third molars produce no complications in terms of infection, pain, or the development of pathologies within the first 3 years. Root eruption can occur in a very small percentage of patients and may require reoperation to remove the root.

Correlation of Radiographic Signs, Inferior Dental Nerve Exposure, and Deficit in Third Molar Surgery

PURPOSE To identify the specific radiographic signs on orthopantomograms that are positive predictors of intraoperative inferior dental nerve (IDN) exposure and postoperative IDN deficit in lower third molar surgery. MATERIALS AND METHODS A prospective clinical cohort of patients with lower third molars with specific radiographic signs showing a close proximity of the roots to the IDN who underwent total excision at our center from June 2006 to June 2008 were recruited as the study group. The prevalence of intraoperative IDN exposure and postoperative IDN deficit were recorded. The correlations between the various radiographic signs and the prevalence of IDN exposure and deficit were analyzed. The prevalence of IDN deficit in the sample was compared with an age-, gender-, and operator experience-matched control group of patients who had undergone lower third molar surgery without any of the radiographic signs present. RESULTS Patients with a total of 178 lower third molars with 1 or more of the specific radiographic signs present were recruited as the study group. The prevalence of IDN deficit in the study group (5.1%) was significantly greater than that in the control group (0.56%; P = .01). In the study group, darkening of root and displacement of the inferior dental canal by the root were radiographic signs significantly related to IDN exposure (P = .001 and P = .019, respectively). Darkening of the root was the only sign significantly related to a postoperative IDN deficit (P = .016). When 2 or more radiographic signs were present, the risk of a postoperative IDN deficit was significantly increased (P = .001). CONCLUSIONS Darkening of the root and displacement of the inferior dental canal by the root were positive predictors of intraoperative IDN exposure. Darkening of the root or the presence of 2 or more radiographic signs were positive predictors of a postoperative IDN deficit.

The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis.

Objectives To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?”. Materials and Methods A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review. Results Fourteen studies with 3521 subjects, with 10 groups (17 dosages) of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 – 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31). Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects. Conclusion This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study.

A Double-Blind Randomized Crossover Study to Evaluate the Timing of Pregabalin for Third Molar Surgery Under Local Anesthesia

PURPOSE This double-blind randomized crossover study compared the analgesic efficacy of pre- and postoperative administration of oral pregabalin 75 mg using a postsurgical dental pain model. MATERIALS AND METHODS Patients requiring third molar surgery in 2 separate stages under local anesthesia were recruited. They were given pregabalin 75 mg either 1 hour before or after their first surgical extraction. They then received the same dose of pregabalin at their second surgical extraction, but those who received it before surgery received it postsurgery, and vice versa. Postoperative analgesic effects were assessed at postoperative hours 2, 4, 8, 12, 24, 48, and 72. Time to first analgesic, analgesic consumption and adverse events were also evaluated. RESULTS Forty patients were recruited, and 34 completed the study. The area under curves for numerical rating scale pain scores 1 to 24 hours were significantly lower at rest but not during mouth opening for patients receiving postoperative pregabalin (P < .048). Pain relief was similar for the period of 24 to 72 hours. No significant difference was found in time to first analgesic, total analgesic consumption, and side effects between preoperative and postoperative groups. No difference in the incidence of adverse events was noticed in relation to the timing of pregabalin administration. CONCLUSIONS Postoperative administration of oral pregabalin 75 mg appears to offer better analgesic efficacy than preoperative administration after third molar surgery under local anesthesia.

Long-term morbidities of coronectomy on lower third molar.

OBJECTIVE To monitor the long-term morbidity of retained roots up to 5 years following lower third molars coronectomy with close proximity to the inferior alveolar nerve (IAN). STUDY DESIGN A prospective study on long-term morbidities after lower third molar coronectomy. RESULTS This study included 612 lower third molar coronectomies in 458 patients. The prevalence of IAN injury was 0.16% (1/612) and was temporary. Long-term postoperative infection occurred in 1 case at 6 months following surgery and another at 12 months. No infection was found after 12 months. The incidence rates of pain at 6 months, 12 months, 24 months after surgery were 0.50% (3/596), 0.38% (2/529), 0.49% (2/411), respectively. Root exposure was noted in 2.3% of cases (14/612). Reoperation to remove the exposed root did not cause any IAN deficit. CONCLUSIONS Lower third molar coronectomy is safe in the long term.

Surgical ciliated cysts may mimic radicular cysts or residual cysts of maxilla: report of 3 cases.

Surgical ciliated cysts, or postoperative maxillary cysts, are benign cystic lesions induced after a surgical procedure in the maxillofacial area. It is a cystic lesion in the maxillary region that develops after radical sinus surgery to treat maxillary sinusitis. It is frequently reported in he Japanese literature, and most cases are related to revious Caldwell-Luc surgeries to treat maxillary sinustis. There are case reports of surgical ciliated cysts that eveloped after midface and bimaxillary orthognathic urgery, alveolar bone grafting, and maxillofacial trauma. It is believed that some cells of the respiratory ining are trapped during a surgical procedure or rauma. Subsequent cystic change of the trapped lining nd enlargement of the cyst from the osmotic difference ause destruction of adjacent bone and structures. As he cyst expands, it may affect the adjacent teeth. The linical scenario may be identical to a radicular cyst if a nonvital” tooth is involved. We present 3 cases of surgical ciliated cysts where the atients had previously undergone maxillary sinus sureries and later presented with cystic lesions in the axillary region similar to radicular cysts or residual ysts.

Trigeminal Neurosensory Deficit and Patient Reported Outcome Measures: The Effect on Life Satisfaction and Depression Symptoms

Objectives To investigate the effect of persistent neurosensory disturbance of the lingual nerve (LN) or inferior alveolar nerve (IAN) on life satisfaction and depression symptoms. Methods This study recruited patients with persistent LN or IAN deficit as a consequence of lower third molar surgery for 12 months or more to form the study group. A control group was formed by matching age and gender of recruited subjects in the study group with patients without the neurosensory complications. Life satisfaction was assessed with Satisfaction With Life Scale (SWLS) and depression symptoms were assessed with 20-item Center for Epidemiological Studies Depression scale (CESD-20). Results Fourty-eight participants (24 cases and 24 controls) were recruited. Patients with LN or IAN deficits after lower third molar surgery were less satisfied with their lives when compared to the control group (p<0.001). They were presenting with more depression symptoms (p = 0.001). 45.8% of the study group subjects had a CESD-20 score of 16 or above. Older patients presented with more depression symptoms among the subjects with neurosensory disturbance after lower third molar surgery (p = 0.02). Conclusions Individuals with permanent trigeminal neurosensory deficit after lower third molar surgery have worse life satisfaction and more depressive symptoms when compared to those who did not suffer from the surgical complication.

Trigeminal Neurosensory Deficit and Patient Reported Outcome Measures: The Effect on Quality of Life

Objectives To investigate the effect of persistent neurosensory disturbance of the lingual nerve (LN) or inferior alveolar nerve (IAN) on general health and oral health- related quality of life (QoL). Methods The study design was a case-control study. Patients with persistent neurosensory deficit of LN or IAN after lower third molar surgery (for 12 months or more) were the study group. The control group was an age and gender matched sample of patients who had dental extractions or lower third molar surgeries without trigeminal neurosensory deficit. The outcome variables were the general health and oral health-related QoL. General health-related QoL was assessed using the 36-item Short Form Health Survey (SF-36) and oral health-related QoL using the 14-item Short Form Oral Health Impact Profile (OHIP-14). Differences in SF-36 scores and OHIP-14 scores between the groups were compared. Results Forty-eight subjects (24 cases and 24 controls) were recruited. When compared to the control group, patients with neurosensory deficits had poorer Mental-Health Component Scores (MCS) (p = 0.005), General Health (p = 0.023), Vitality (p = 0.048), Social Functioning (p = 0.003), Role-emotion (p = 0.008) and Mental Health (p = 0.022). The OHIP-14 scores were also significantly worse in this patients with neurosensory deficits compared with the control group (p = 0.002). When compared within the study group, older patient with neurosensory deficit was found to correlate with worse Physical Health Component Scores (PCS) (p = 0.02) and OHIP-14 scores (p = 0.02), while more severe visualized analog scaling rating of numbness was correlated with a worse PCS (p = 0.034). Conclusions Patients with persistent LN or IAN deficit after lower third molar surgery have poorer health-related QoL and poorer oral health-related QoL than those without such deficits.

Risk factors of neurosensory disturbance following orthognathic surgery.

Objectives To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery. Materials and Methods A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo neurosensory tests with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed. Results 238 patients with 476 sides were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients and surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery. Conclusion The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery.