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Extraction-site alveolar remodeling is a major concern due to negative volumetric hard and soft tissue changes that inevitably limit rehabilitation options and diminish esthetic outcomes. Surgical techniques employed to minimize alveolar dimensional changes are not always predictable. Utilizing a socket shield with an immediate surgical implant procedure helps maintain a thin portion of the root in the vestibular area and thus minimizes bone resorption, especially at the coronal cortical aspect. This case series assesses the dimensional changes in peri-alveolar structures via superimposition of the preoperative and 6-month postoperative 3D digital quantification of soft tissue. Fifty patients with 50 sites fulfilled the inclusion criteria. Implant survival was 100%, with no incidence of complications. Tissue changes were as follows: -0.85 mm at the mesial papilla, -0.95 mm at the distal papilla, -0.7 mm at both the vertical and horizontal central margins, -0.21 mm at a distance 4 mm from the margin, and -0.64 mm at the palatal central margin. The buccal contour was clinically convex in all cases. The site with highest frequency of > 1 mm of dimensional loss was the distal papilla (42% of sites), and the site with the lowest frequency was the point 4 mm from the midfacial margin (0% of sites).

Background: Type 2 diabetes mellitus (T2DM) causes severe bone loss after tooth extraction as a hyperglycemic environment causes aberrant bone homeostasis. Artesunate (ART) is known to possess anti-inflammation and osteogenic properties. However, its osteogenesis property in alveolar bone remains unclear. This study aimed to explore the osteogenic and immunoregulatory effects of artesunate-loaded thermosensitive chitosan hydrogel (ART-loaded TCH) on maxilla tooth extraction in T2DM rats., Methods: T2DM rats were induced by a high-fat diet and streptozotocin. Different concentrations of ART-loaded TCH were applied in tooth extraction sockets. Bone loss and the expression of osteogenic regulatory factors (OPG, ALP, RANK) were evaluated. The immunoregulatory effects of ART-loaded TCH were observed through detecting the infiltration of T lymphocytes and their cytokines. The underlying mechanisms were explored., Results: Results showed that the 150 mg/ml ART-loaded TCH group significantly ameliorated maxilla bone height and bone mineral density when compared with the T2DM group (p < 0.05). It also improved the expression of OPG, ALP, and RANK. Although the alteration of CD4 + T, CD8 + T, and CD4 + :CD8 + T ratio has no significant difference among groups, the release of Th1 and Th2 in the 150 mg/ml ART-loaded TCH group has been significantly regulated than in the T2DM group (p < 0.05). Besides, ART-loaded TCH treatment inhibited the expression of p38 MAPK and ERK1 in T2DM maxilla., Conclusions: Therefore, the results indicated that 150 mg/ml ART-loaded TCH could be an effective method to prevent bone loss in T2DM tooth extraction rats by modulating the immunoregulation of Th1 and Th2 and the MAPK signaling pathway., (© 2024. The Author(s).)

The socket shield technique has been proposed as a surgical method to prevent the collapse of the buccal plate following tooth extraction, leading to excellent soft tissue stability and long-term esthetic outcomes. Despite its success, this technique is still not without potential risks. One of the most common complications is internal exposure of the socket shield, which can present as inner soft tissue inflammation with or without exposure of a portion of the shield. This case series discusses this complication's etiology, diagnosis, treatment, management, and prevention. Data from 10 patients with 12 internally exposed sites are presented.

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.

Purpose: To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars., Material and Methods: A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique., Results: A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020)., Conclusion: The results obtained support concomitant molar extraction with BSSO as a feasible option., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author., Material and Methods: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented., Results: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods., Conclusions: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure.

Objective: Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery., Materials and Methods: Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023., Results: Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively., Conclusions: The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports., Clinical Relevance: The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To explore the effect of extracting the completely impacted teeth by minimally invasive surgery with preserving the buccal bone plate., Methods: Eighty-six cases were selected and randomly divided into 2 groups. In the experimental group, a fenestration was made with a ball drill to expose the buccal and lingual margin of crown, and the buccal bone plate was preserved. T-shaped crown cuttings were performed, minimally invasive extraction was conducted.In the control group, the distal and buccal bone plates were removed with a ball drill, the distal and buccal crowns were exposed, and T-shaped crown was cut. The other procedures were the same. The degree of swelling, restricted mouth opening and VAS pain score after operation were observed, the levels of C-reactive protein and anti-hemolytic streptoglobulin were detected by laboratory tests, and the periodontal probing depth(PD), bleeding index (BI), and clinical attachment loss(CAL) of the adjacent second molar were examined 1 month after surgery. SPSS 25.0 software package was used for data analysis., Results: The swelling degree of the two groups was significantly relieved in the experimental group than in the control group (P＜0.05), and there was no significant difference in the degree of mouth opening limitation and pain (P＞0.05). The level of C-reactive protein in the control group was significantly higher than that in the observation group (P＜0.05). There was no significantly difference in the level of anti-hemolytic streptococcus between the 2 groups (P＞0.05). One month after operation, the PD and CAL in the control group were significantly higher than those in the experimental group(P＜0.05). There was no significant difference between the 2 groups in BI(P＞0.05)., Conclusions: The patients who preserve the buccal bone plate by minimally invasive extraction of impacted mandibular teeth have less reaction and better wound healing.

Purpose: To evaluation the effect of modified triangular flap-secondary healing (MTF-S) on the treatment of mandibular impacted wisdom teeth with full or partial bone impaction., Methods: A total of 207 patients with mandibular impacted wisdom teeth were selected in Shaoxing Stomatological Hospital from June 2022 to June 2023. Among them, 86 patients had completely impacted wisdom teeth (group A), and 121 patients had partially impacted wisdom teeth (group B). All patients had bilateral impacted wisdom teeth. One of the wisdom teeth was removed first and was sutured with triangular flap-primary healing (TF-P). The other wisdom tooth was removed two weeks later and was sutured with MTF-S. Patients in groups A and B were divided into two subgroups based on suture methods, with TF-P used for group A1 and B1, and MTF-S used for groups A2 and B2. Perioperative indicators, including surgical time, root loss rate, and completeness of extraction sockets were recorded; Postoperative complications of four groups, including pain, swelling, and limited mouth opening were compared. SPSS 22.0 software package was used for statistical analysis., Results: The surgical time of group A1, A2, B1 and B2 was (17.69±3.28), (18.22±3.06), (12.37±3.72) and (12.64±4.13) minutes, respectively. The surgical time of group A1 and A2 was significantly longer than that of group B1 and B2 (P＜0.05). Seven days after surgery, the VAS scores of group A1, A2, B1 and B2 were (1.17±0.34), (0.93±0.29), (0.48±0.15) and (0.76±0.21), respectively. The VAS scores of group B1 and B2 were lower than those of group A1 and A2, and group A2 was lower than group A1 and B2 was higher than group B1 group(P＜0.05). On the 1st day, 3rd day, and 7th day after surgery, the swelling degree in group A1 was greater than that in group B1, and the swelling degree in group B1 was greater than that in group A2 and B2(P＜0.05); while the limitation of mouth opening mouth in group A2 and B2 was lower than that in group A1 and B1, and the limitation of opening mouth in group B2 was lower than that in group A2(P＜0.05)., Conclusions: Compared with partially impacted wisdom teeth, the extraction of completely impacted wisdom teeth has a longer surgical time. For completely impacted wisdom teeth, MTF-S is beneficial for reducing postoperative pain, swelling and mouth opening limitations. For partially impacted wisdom teeth, MTF-S is beneficial for reducing postoperative swelling and mouth opening limitations, but the effect is not significant in reducing patient pain.

Objectives: To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone., Material and Methods: This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year., Results: The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively., Conclusion: The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization.", Clinical Trial Registration: NCT05381467., (© 2023 Wiley Periodicals LLC.)

This study aimed to compare the effectiveness of platelet-rich fibrin clot (PRF) and conventional oroantral communication (OAC) repair techniques following tooth extractions from the maxilla. The study involved 22 patients, divided into 2 groups: a study group treated with PRF and a control group undergoing conventional OAC repair. The primary outcome measured was the effectiveness of OAC closure, with pain intensity and postoperative complications as secondary outcomes. Cone-beam computed tomography (CBCT) was used to evaluate post-extraction bone regeneration. Pain was assessed using the Visual Analogue Scale (VAS) on days 0, 1, 7, and 14 postoperatively. The results showed that the PRF group experienced a significant decrease in pain within the first 24 hours and after 7 days (P < .0001; P < .05). In contrast, complications were reported in 45.45% of patients in the conventional repair group and 18.18% in the A-PRF group. Three months postsurgery, CBCT revealed appreciable bone healing in both groups, with no significant difference (P > .05). In conclusion, the study suggests that A-PRF treatment for OACs resulted in fewer complications and quicker pain reduction than traditional repair methods, making it a promising alternative for managing OACs. However, future studies are needed to confirm these findings and establish the full therapeutic potential of PRF.

Background: Alveolar ridge preservation (ARP) is a technique that aims to maintain bone volume and minimize resorption after tooth extraction., Objective: This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) versus hyaluronic acid (HA) in combination with xenografts for ARP., Methods: This randomized controlled trial included 36 patients (20 females and 16 males) who required implant placement in the upper arch. The patients were randomly allocated to one of three groups (n = 12 each): I-PRF with xenografts, HA with xenografts, or xenografts alone. All patients underwent ARP, and the extraction sockets were sealed with a free gingival graft harvested from the palate, a total of 36 implants were inserted. Cone-beam CT scans were performed before and 4 months postoperatively to measure radiographic bone gain as the primary outcome. Clinical parameters, including soft tissue thickness and clinical bone width, were evaluated preoperatively, and at 4 months and 1 year postoperatively. Additionally, histological assessment of core bone biopsies was performed 4 months postoperatively using histomorphometric analysis to determine the percentages of newly formed bone, mature bone, and residual grafts., Results: Regarding the radiographic bone gain 4 months postoperative the HA group exhibited the highest value (9.78 ± 0.87), which was significantly greater than the values observed in the I-PRF and control groups (8.60 ± 1.27 and 7.99 ± 0.89, respectively) (one-way ANOVA, p = 0.007). Crestal bone loss was significantly higher in the control group (-0.98 ± 0.18) than in the I-PRF group (-0.53 ± 0.11) and HA group (-0.33 ± 0.15) groups (one-way ANOVA, p < 0.001). In the histomorphometric analysis, the mean area fraction of newly formed bone trabeculae was significantly higher in the HA group (56.66 ± 7.35) than in the I-PRF group (28.74 ± 5.15) and the control group (24.05 ± 3.64) (repeated measures ANOVA, p < 0.001). Additionally, the mean area fraction of residual graft material was higher in the I-PRF group (6.76 ± 2.59), followed by the control group (2.71 ± 1.24), while the HA group had the lowest value (2.63 ± 1.27) (Repeated measures ANOVA, p < 0.001)., Conclusion: The combination of HA with xenografts yielded better radiographic and histological outcomes in terms of new bone formation and degree of bone maturation than the I-PRF and control groups. Furthermore, I-PRF improved soft tissue thickness. Please note that clinical trial registration was not completed prior to participant recruitment and randomization. The registration link for this trial is https://clinicaltrials.gov/ct2/show/NCT05781529., (© 2023 Wiley Periodicals LLC.)

Background: The aim of our study is to evaluate the postoperative complications after the extraction of impacted third molar teeth and to investigate the effects of these complications on the quality of life of patients., Methods: Demographic, clinical, and radiological evaluations were conducted, covering factors like age, gender, and tooth position. Clinical measurements, pain and edema assessments, and quality of life evaluations through OHIP-14 scores were performed. Preoperative and postoperative mouth opening, trismus, alveolitis and dehiscence were evaluated., Results: A total of 100 patients were included in our study. No significant gender-based differences were found in measurements, pain, or swelling. There was no statistically significant difference between the preoperative and postoperative results of difference A-C, difference B-E, difference A-D, and difference mouth opening. Procedure duration correlated positively with age, alveolar osteitis, trismus, and swelling. Postoperative quality of life, assessed by OHIP-14, demonstrated a negative correlation with age and trismus. It was observed that the gender and the tooth positions of the patients had no effect on the severity of postoperative pain and edema., Conclusions: As the age of the patients increases and the duration of the procedure increases, the rate of postoperative complications increases and it is concluded that the quality of life decreases significantly., (© 2024. The Author(s).)

Objective: To investigate the clinical application of an ultrasonic bone knife (UBK) combined with a dental electric motor (DEM) in the extraction of mandibular middle and low impacted teeth., Methods: From January 2022 to May 2023,200 patients with wisdom teeth were randomly divided into three groups: experimental group A (UBK combined with DEM), experimental group B (UBK combined with high-speed turbine mobile phone (HSTMP)), and the control group (bone chisel split crown (BCSC)). The operation time, psychological state during operation, pain, swelling, limitation of mouth opening and other complications on the first, second and third days after operation were recorded., Results: The operation time of experimental group A (EAG) (12.95 ± 2.12) minutes was shorter than that of experimental group B (EBG) (17.06 ± 2.25) minutes and the control group (CG) (23.43 ± 2.18) minutes, and the difference was statistically significant (P < 0.05). The psychological state of the EAG was significantly lower than that of the EBG and CG (P < 0.05). The postoperative pain, swelling, limitation of mouth opening and complications in the EAG were significantly lower than those in the EBG and CG (P < 0.05)., Conclusion: UBK combined with DEM in the extraction of mandibular middle and low obstructed teeth has good results, good prognosis, high safety, short operation time, better psychological status of patients, low postoperative pain, swelling, mouth opening restriction and complication rate, and is currently the preferred extraction method., (© 2024. The Author(s).)

Searching for third molars atraumatic removal method remains a challenge in oral surgery. Method of partial removal of impacted tooth leaving a non-extracted root in the wound becomes more popular recently. Determining medical indications for this method, as well as searching for standards for its implementation is important. The paper presents a review on latest technique of performing a coronectomy, and the long-term results of this method. However, the technique of incomplete tooth extraction is highly controversial in terms of harm to the patient's health. There are also uncertain medical indications for this method and the legal treatment consequences.

This chapter will discuss the orthodontic perspective of extractions of compromised first permanent molars (cFPMs) due to hypomineralisation. The context behind the diagnosis of a poor prognosis of cFPM that would support the planning of extractions will be presented. In addition, the ideal timing for interceptive extraction of cFPM as well as the favorable and unfavorable orthodontic scenarios for extractions in the permanent dentition will be discussed., (© 2024 S. Karger AG, Basel.)

Background: Dental extraction or tooth extraction is a common clinical radical treatment surgery., Objective: To explore the efficacy and safety of remimazolam in tooth extraction surgery in a randomized, single-blind, multi-center clinical trial., Method: Patients who underwent tooth extraction surgery at Jinan Stomatological Hospital from April 2022 to March 2023 were selected as the research subjects, and they were divided into a control group and an observation group using the random arrangement table method. The patients in the control group were anesthetized with midazolam, and the patients in the observation group were anesthetized with remimazolam. Collect the general demographic data of the patients, use the propensity score matching method (PSM) to balance the baseline data of the two groups, and use t-test, chi-square test, and analysis of variance to compare the hemodynamics, anesthesia maintenance period indicators, and alertness/Sedation scores and occurrence of adverse reactions., Result: PSM matching was performed according to a 1:1 ratio, and 40 patients were included in the observation and control groups. There was no statistical significance in the baseline data of the two groups. Compared with T0, the hemodynamic indexes of both groups of patients increased at T1, T2, T3, T4, and T5 (P< 0.05), but the indexes at T0 and T2 were the same. The same (P> 0.05), and the indicators of the observation group at T1, T3, T4, and T5 were higher than those of the control group (P< 0.05); the administration time of the two groups of patients was the same (P> 0.05), but the observation group The recovery time and onset of effect were shorter than those in the control group (P< 0.05); at T0, the clinical behavior scores of the two groups of patients were the same (P> 0.05), and at T1, the scores of the observation group were lower than those of the control group (P< 0.05); at T0 and T1, the alertness/sedation scores of the patients in the observation group were lower than those in the control group, but at T2, the scores of the patients in the observation group were higher than those in the control group (P< 0.05); the total clinical adverse reactions of the patients in the observation group were The incidence rate (5.00%) was lower than that of the control group (30.00%) (P< 0.05)., Conclusion: The use of remimazolam during tooth extraction can stabilize the patient's hemodynamics, shorten the recovery and onset time, stabilize the patient's behavior, have an excellent soothing effect, have fewer adverse reactions, and be safer, so it is worthy of use.

The two presented cases of socket shield technique were done following a split mouth protocol in two patients, each received an immediate implant inserted conventionally on maxillary one side and another implant inserted applying the socket shield technique on the contralateral side. The outcomes including soft and hard tissue changes were compared clinically and radiographically. The four implants were followed for 5 years, and the outcomes were successful.

We conducted this study to assess the effect of ultrasound osteotome on surgical site wound infection and pain following removal of mandibular wisdom teeth. A computerised search of Embase, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for publicly available randomised controlled trials (RCTs) on the clinical effects of applying ultrasound osteotome to extract mandibular wisdom teeth was conducted from the inception of the databases to September 2023. Two researchers independently screened the retrieved results for literature screening, quality assessment and data extraction. RevMan 5.4 software was applied for data analysis. A total of 17 RCTs were included in this study, including 848 cases in the ultrasound osteotome group and 842 cases in the control group. The analysis revealed, compared with the control group, the ultrasound osteotome group showed a significantly lower incidence of postoperative wound infection (1.42% vs. 5.46%, odds ratio [OR]: 0.30, 95% confidence intervals [CI]: 0.17-0.53, p < 0.0001), fewer postoperative complications (6.35% vs. 22.12%, OR: 0.23, 95% CI: 0.17-0.32, p < 0.00001), shorter operative time (standardised mean differences [SMD]: -1.30, 95% CI: -1.97 to -0.64, p = 0.0001) and lower wound pain scores (SMD: -2.26 95% CI -2.80 to -1.73, p < 0.00001). Strong evidence suggests that ultrasound osteotome applied to extract mandibular wisdom teeth is more advantageous in terms of lower postoperative wound infection, less wound pain, fewer postoperative complications and shorter operative time compared with conventional treatment methods, but large-scale, multicentre RCTs are still needed to obtain more accurate results., (© 2024 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied., Material and Methods: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibular impacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553)., Results: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times., Conclusions: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.

Background: During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support instead of the DA., Purpose: This study compared the occurrence of postoperative preauricular and masticatory muscle pain symptoms (PMMPS) between the device and DAs providing mandibular support, using two outcome measures. Secondary aims identify predictors of outcome and providers' opinions of the device., Study Design, Setting, Sample: In this multisite, single-blind, two-arm parallel randomized trial, participants without preoperative PMMPS had surgical removal of third molars, with sedation and bite blocks were randomly assigned to manual support or the device., Exposure Variable: The exposed group was randomly assigned to the device and the nonexposed group to manual support., Main Outcome Variable(s): The primary outcome was patient-reported PMMPS. Two secondary outcomes were pain assessed with the temporomandibular disorder Pain Screener and providers' views on the device. Outcomes were assessed at 1-, 3-, and 6-month postsurgery., Covariates: The covariates are baseline demographics (eg, sex), clinical characteristics (eg, eruption status), and third molar surgeries., Analyses: For occurrence of pain, generalized estimating equations assessed differences between groups. Logistic regression analysis assessed predictors of pain at 1 month, per the Screener. The level for statistical significance was 5%., Results: Enrollment was 86 and 83 participants in the device and DA groups, respectively. The average age was 20.8 years; the majority were female (65%) and Caucasian (66%). The retention rate was ≥95.9%. The groups did not differ significantly for occurrence of pain using the primary and secondary outcome measures at any follow-up (P ≥ .46). Fully impacted molars were associated with occurrence of pain (odds ratio = 3.44; 95% confidence interval 1.49-7.92; P = .004)., Conclusion and Relevance: Occurrence of pain using the primary and secondary outcome measures did not differ significantly between groups at any follow-up and was associated with removal of fully impacted third molars. Four out of five surgeons reported wanting to use the device on a regular basis when performing this procedure in sedated patients., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Blood-derived materials have been used recently to accelerate orthodontic tooth movement, but there are conflicting reports on their effectiveness., Objective: To evaluate the potential effect of local injection of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on the rate of orthodontic tooth movement., Trial Design: A single-center, three-arm, parallel-group randomized controlled trial., Materials and Methods: The sample consisted of 60 patients aged between 18 and 25 years (mean age: 21.1 ± 2.2 years) with Class II division 1 malocclusion requiring anterior retraction. Using a computer-generated list of random numbers, patients were assigned to three groups of canine retraction: (i) assisted with PRP injection (PRP group), (ii) assisted with i-PRF group, and (iii) conventional treatment with no injections (Cont. group). In the interventional groups, injections were done immediately and at 8 weeks after the onset of canine. Transpalatal arches (TPAs) were used to reinforce anchorage. The upper canines were distalized on 0.019 × 0.025-inch stainless archwires using coil springs with a force of 150 g. The primary outcome was the amount of canine retraction, whereas the secondary outcomes were canine rotation and anchoring loss. Assessment was done at five-time points: the beginning of tooth movement (T0) and at 4, 8, 12, and 16 weeks following T0 on three-dimensional superimposed digital models., Results: Sixty patients were randomized and included in this study (20 patients in each group), there were no dropouts. The rate of canine retraction was faster in the experimental groups. The PRP group showed a significantly slower movement in the second and fourth months than the i-PRF group while in the first and third months, there were nonsignificant differences between the two experimental groups., Limitations: Blinding was not possible during the clinical stage of this trial., Conclusions: PRP and i-PRF were found to be effective in accelerating orthodontic tooth movement during canine retraction. However, the effect of i-PRF was longer than that of PRP., Trial Registration: ClinicalTrials.gov (ID: NCT05335824)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: This study compared whether there is a difference in treatment time (TT) and efficiency when appointments are held once a month or at 2-week intervals in patients with Class II malocclusion treated with 2-premolar extractions METHODS: The patients of this retrospective sample were treated with the same orthodontic mechanics and divided into 2 groups according to frequencies of orthodontic appointments. Group 1 consisted of 18 patients (10 males, 8 females), with an initial mean age of 14.38 ± 1.38 years and appointments once a month. Group 2 consisted of 19 patients (9 males, 10 females), with an initial mean age of 14.12 ± 1.38 years and biweekly appointments. Edgewise fixed appliances with a slot size of 0.022 × 0.028 mm were used, and the anterior teeth were retracted en-masse with a rectangular wire and elastic chains. The Peer Assessment Rating and Objective Grading System indexes were measured in the dental models at the beginning and the end of treatment. Efficiency was assessed by dividing the percentage of improvement of each occlusal index concerning the multiplication of TT and the number of appointments., Results: Both groups presented similar Peer Assessment Rating and Objective Grading System indexes at the end of treatment. Groups 1 and 2 presented different TTs (28.06 and 22.05 months, respectively); however, there were no differences regarding the efficiency of both protocols., Conclusions: Patients with Class II malocclusion treated with 2-maxillary premolars had significantly shorter treatment times when seen on biweekly appointments than those with monthly appointments; however, there was no difference in efficiency between protocols., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar ridge preservation can be applied to minimize dimensional changes with a new socket grafting material, an autogenous dentin graft, produced by mechanically and chemically processing natural teeth. This study assessed the safety and efficacy of using autogenous dentin biomaterial in alveolar ridge preservation., Materials and Methods: Patients with nonrestorable maxillary anterior teeth bounded by natural sound teeth were included in this study. After a detailed clinical and tomographic examination, eligible participants were randomly allocated into two groups. The control group had spontaneous healing of extraction sockets. The study group had their extraction sockets filled with autogenous dentin biomaterial after processing their extracted retained roots with the KometaBio device. Standardized cone beam computed tomography (CBCT) scans were repeated four months later. A full-thickness mucoperiosteal flap reflection was achieved under local anesthesia to get core biopsies for histomorphometric analysis, and dental implants were placed at the same session., Results: A total of 32 eligible patients were included in this study ( n = 16 in each group). Both groups had significantly higher facial soft tissue thickness after four months than baseline ( p < 0.05). However, the study group showed statistically significant lesser dimensional changes than the control group according to the standardized CBCT scans. Furthermore, core biopsies confirmed an excellent remodeling of the autogenous dentin biomaterial in the study group. In comparison, only new thin bone trabeculae-filled sockets were in the control group., Conclusion: Autogenous dentin graft can be safely and successfully used for alveolar ridge preservation. Optimal graft remodeling histologically, better ridge dimensional stability, and uneventful wound healing support its clinical application. This trial is registered with TCTR20220615002., Competing Interests: All authors declare no conflicts of interest/competing interests in this study., (Copyright © 2023 Afnan Abdulkareem Hussain et al.)

The aim of this study was to evaluate the impact of mini-screw placement on the alveolar ridge using a split-mouth design. Twelve beagles underwent bilateral extraction of their lateral teeth. In the immediate group, a mini-screw was unilaterally placed approximately 3-4 mm below the alveolar crest of the extraction site on the experimental side. The delayed group received mini-screws six weeks after tooth extraction. On average, the dogs were sacrificed after 11 weeks, and the maxillary bones were excised and scanned using cone-beam computed tomography (CBCT). Histopathological examinations were conducted to assess inflammation and bone formation scores. The results showed that in the immediate group, bone height was significantly greater on the intervention side compared to the control side (p < 0.05), whereas there was no significant difference in the delayed group. In both groups, there was a significant increase in bone density around the mini-screws compared to the control sides (p < 0.05). Mini-screw insertion led to a significant enhancement of bone growth in both groups (p < 0.05), with no notable differences between the two groups. The mini-screws did not have any impact on bone inflammation or width. Overall, both immediate and delayed mini-screw placement in the extraction socket positively influenced bone dimensions, density, and histological properties. However, immediate insertion was more effective than delayed placement in preserving vertical bone height, despite delayed insertion resulting in higher bone density., (© 2023. The Author(s).)

For immediate implants in the anterior region, the socket-shield technique has received much attention in recent years. However, this technique is technically sensitive and root preparation is difficult. It is also difficult to obtain the ideal three-dimensional position for implant placement in the anterior region. This paper reports a clinical case in which socket-shield preparation and implant cavity preparation were performed with the aid of a dual guide in implant surgery. The dual guide surgical preparation technique was used to reduce the difficulty of socket-shield preparation and to achieve restoration-orientated implant placement with satisfactory clinical results., Competing Interests: Declaration of Competing Interest Disclosures: The authors declare that they have no competing interests., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Tooth extraction is a common surgical procedure where the invasiveness of the surgery can affect the nature of the dentoalveolar remodelling which follows. However, there is very little biomechanical data relating the loading applied during tooth extraction to the outcomes of the procedure. The purpose of this pilot study is to present a novel ex vivo experimental method for measuring tooth extraction mechanics and to explore preliminary metrics for predicting extraction success., Methods: A custom experimental apparatus was developed in-house to extract central incisors from ex vivo swine mandible samples. Twenty-five (n = 25) incisors were extracted at different rates in displacement- and force-control, along with an intermittent ramp-hold scheme for a total of five schemes. Peak forces and extraction success were recorded for each test. Video analysis assisted in determining the instantaneous stiffnesses of the dental complex during continuous extractions, which were compared using the K-means clustering algorithm., Findings: Tooth extraction forces ranged from 102 N to 309 N, with higher-rate tests tending towards higher peak forces (141 N - 308 N) than the lower-rate tests (102 N-204 N) for displacement- and force-controlled schemes. The K-means algorithm clearly identified load rates among tests, indicating that higher-rate loading increased system stiffness relative to the lower-rate tests., Interpretation: The developed experimental method demonstrated a desirable degree of control. The preliminary results suggest the influence of load rate on the mechanical response of the dental complex and extraction outcome. Future work will further investigate the biomechanics of tooth extraction and relate them to tissue damage to improve future tooth extraction procedures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment., Materials and Methods: Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies., Results: Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected., Conclusions: HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth., Clinical Relevance: HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation., (© 2023. The Author(s).)

Background: Many techniques have been proposed to address post-extraction ridge resorption, which often represents a concern, especially in the esthetic region., Purpose: The purpose of the present, prospective, multicenter, single cohort study was to investigate, up to 1 year of function, the effectiveness of a protocol for alveolar ridge preservation involving implants with laser-microgrooved surface immediately placed in fresh extraction sockets., Materials and Methods: Twenty eight patients candidate to tooth extraction in the esthetic zone (site 15-25 and 35-45) were treated by immediate placement of a single laser-microgrooved implants with the adjunct of a highly porous anorganic porcine bone mineral matrix and a collagen wound dressing. Peri-implant marginal bone level (MBL) was evaluated at time of loading, 3 and 12 months after loading. Gingival index, plaque index, probing depth, and bleeding on probing were measured at 3, 6, and 12 months after loading. Dimensional changes at implant sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Implant aesthetic score (IAS) as well as patients' post-operative quality of life were also evaluated at 12 months. Comparisons between data relative to thick and thin gingival phenotypes were made using Student's t-test or Mann-Whitney test, as appropriate. The significance level was set at p = 0.05., Results: No patient dropped out, and 28 implants were evaluated at 12 months post-loading. The overall MBL was found to be 0.92 ± 1.11 mm. Volumetric analysis of superimposed models showed an alveolar bone tissue displacement at the buccal aspect of -0.57 ± 0.52 mm in thin phenotypes and -0.46 ± 0.31 mm in thick phenotypes (p = 0.58, unpaired Student's t-test). No signs of soft tissue recession or esthetically unpleasant buccal gingiva were reported., Conclusions: The clinical protocol herein employed showed benefits in maintaining marginal bone levels and soft tissue contour around post-extraction implants in the esthetic zone., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Objectives: In this prospective, double-blinded, randomized split-mouth study, the local hemostatic effect of platelet-rich fibrin (PRF) inserted into the extraction socket in patients taking factor Xa (FXa) inhibitors (apixaban, rivaroxaban, edoxaban) was compared to a hemostatic gelatine sponge (GS) as the "therapeutic gold standard" without withdrawal of oral anticoagulant therapy., Materials and Methods: Single-tooth extraction was conducted under local anesthesia in n = 21 patients using a split-mouth design (42 teeth). Using a double-blind approach, the extraction socket on one side of the jaw was filled with PRF and on the other with a GS. Bleeding was assessed immediately after surgery, in 30 min, 1 h, 1.5 h, and on follow-up appointments in 24 h and on the 7th day., Results: In 67% of cases, mild postoperative oozing could be stopped 30-90 min after tooth extraction via gauze pressure without any delayed bleeding. Concerning bleeding events, there was no difference among the PRF and GS groups and no significant difference among rivaroxaban, apixaban, and edoxaban (all p > 0.15)., Conclusion: PRF and GS are reliable hemostatic methods in postextraction sockets of patients taking FXa inhibitors., Clinical Relevance: Consequently, there is no need to discontinue FXa inhibitors because of a single-tooth removal, eliminating the risk of thrombus formation., (© 2023. The Author(s).)

Objectives: To evaluate the effect of hyperlipidemia on the healing of bone defects., Materials and Methods: Apolipoprotein E (ApoE)-deficient mice and wild-type (WT) C57BL/6J mice were fed with an atherogenic high-fat diet (HFD) or a standard chow diet (as control) for 6 weeks. Blood samples were collected to evaluate serum lipid levels. Closed bone defects and open tooth extraction wounds were then created in the mandibles of these animals. One or two weeks after surgery, animals were euthanized. Micro-CT analysis and histomorphometric analysis were conducted to evaluate the healing of bone defects and the alveolar ridge resorption., Results: Bone regeneration of closed bone defects was considerably delayed in the hyperlipidemic Apoe-/- mice and WT mice. No obvious difference was detected in the new bone formation of the tooth extraction wounds. The HFD-fed mice showed more prominent reduction in the lingual alveolar ridge height of the tooth extraction wounds when compared with the control group., Conclusions: Hyperlipidemia results in delayed bone regeneration in large closed bone defects. Although tooth extraction wounds are small and normally regenerated in a hyperlipidemic microenvironment, the prominent reduction in the alveolar ridge height is also a challenge for future restoration of the dentition., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP., Methods: MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339)., Results: A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups., Conclusion: Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Previous studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients' perceptions of the injection of autologous platelet-rich fibrin (i-PRF)., Objectives: To investigate patients' perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines., Methods: Twenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients' perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman's Test was the selected test for detecting variables' changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented., Results: Pain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals., Conclusions: Injecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards., Trial's Registration: ClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018)., (© 2023. The Author(s).)

Technical advances in such fields as optical magnification (eg, loupes, microscopes), microsurgical instruments, bone and soft-tissue grafting materials, and digital dentistry have paved the way for dentists to be able to provide all the necessary specialties for a state-of-art single-tooth replacement treatment under one roof in their clinics, without having to involve a technical laboratory. This case report demonstrates a routine complete chairside digital workflow using minimally invasive and microscopic techniques in every stage of treatment, from tooth extraction and socket preservation, to implant insertion and soft-tissue management, to delivery of the final chairside digital zirconia full-anatomic supraconstruction. In addition to describing the intent of minimally invasive tooth extraction and socket preservation, this article illustrates how to perform a vestibular split rolling flap procedure and discusses its benefits. The goal of this digitally driven single-implant treatment was to achieve restoration as close as possible to the original condition.

Aim: The purpose of the current study was to determine the effectiveness of topical ozone gel application in the management of postextraction wound healing., Materials and Methods: The current study involved a total of 40 participants. The patients were randomly placed into two groups with sample size estimated as n = 20 in each group. Group A: Control: patients received only saline irrigation and group B: patients receiving topical ozone gel. The surgical procedure was standardized for all groups, and local anesthesia was used during the procedure. After the removal of the mandibular third molar, the control group irrigated the socket with saline, whereas in the study group, the socket was filled with ozone gel. On the first, third, fifth, and seventh postoperative days, a single examiner evaluated each participant for postoperative mouth opening, discomfort, and patient satisfaction. The t -test was used to analyze quantitative data, whereas the Fisher exact test was employed to analyze qualitative data. Statistical significance was defined as a p value less than 0.05., Results: On comparison of patient satisfaction, in the ozone gel group, 13 patients were very satisfied but in the control group, 8 patients were very satisfied. On comparison of pain intensity, on the 5th day, the complete absence of pain patients was more in the ozone gel group (12 patients) compared with the control group (4 patients). There was a statistically significant difference found between these two groups ( p < 0.001). On comparison of mouth opening, on the 3rd and 5th day, mouth opening was better in the ozone gel group (29.22 ± 1.28 and 34.06 ± 0.09) compared with the control group (27.38 ± 1.03 and 31.14 ± 0.82), respectively. And there was a statistically significant difference found between these two groups ( p < 0.001) on both the days., Conclusion: The current study came to the conclusion that using ozone gel significantly improves postoperative pain, mouth opening range, and promotes faster wound healing., Clinical Significance: The primary goals of postoperative care for exodontia patients have always been pain management and infection control. The most frequent postoperative consequences are pain and edema. Hence, ozone therapy can be used as an effective topical agent to manage postextraction pain and swelling in healthy patients without the need for excess medications. How to cite this article: Varghese LJ, Lahiri B, Penumatsa NV, et al . Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study. J Contemp Dent Pract 2023;24(11):887-890.

Background: To compare the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars with different degree of impaction., Material and Methods: Systematic reviews and meta-analyses evaluating the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars were included. An electronic search was performed in PubMed, EMBASE, and the Cochrane Database of Systematic reviews. AMSTAR 2 tool was used to evaluate the confidence in results from the included reviews. Descriptive analyses were performed., Results: Six reviews were included. A significant benefit of different antibiotics to the prevention of site infection after extraction of third molars was reported. Amoxicillin/amoxicillin clavulanic acid could significantly reduce the rate of surgical site infection versus placebo. Chlorhexidine gel could significantly reduce the frequency of alveolar osteitis versus placebo., Conclusions: Based on the limited evidence, there is a significant benefit of prophylactic therapy while the comparative effect of different types of prophylactic regimes are controversial.

Purpose: Mandibular second molar (M2M) impaction is a serious eruption disorder. The purpose of this systematic review was to analyze the therapeutic approaches for M2M impaction. The objective of the meta-analysis was to summarize the success of the surgical, surgical-orthodontic, and orthodontic treatment., Methods: A PRISMA-guided search strategy was conducted by 2 authors in 5 databases up to January 2023. Randomized and nonrandomized clinical trials were considered. Case reports, case series with<5 patients, and reviews were excluded. Methodological quality was assessed using Newcastle-Ottawa scale and Cochrane Collaboration tool for nonrandomized and randomized clinical trials, respectively. Outcomes were as follows: 1) treatment success rate defined by the repositioning of impacted M2M in the dental arch with normal functional occlusal relationship and periodontal health; 2) time-to-repositioning as time-to-event analysis; and 3) complications. Meta-analysis examined treatment success differences with 3 approaches: orthodontic (uprighting maneuvers/traction), surgical (surgical procedures/strategic extractions), and surgical-orthodontic (combined surgical and orthodontic procedures) as the exposure variable. The quantitative analysis also compared the success rate using third molar removal as the secondary predictor variable. The χ 2 test determined the statistical heterogeneity (I2); a cut-off of 70% was used to select the common or random effects model. Odds ratio (OR) and 95% confidence interval (CI) were recorded., Results: A total of 1,102 articles were retrieved. After full-text reading, 16 articles were included and 1008 M2Ms were analyzed. Nine studies had fair quality, 6 studies had good quality, and 1 had unclear risk of bias. Managing impacted M2Ms showed a moderate to high success rate (66.7 to 100%). Significant differences favoring surgical treatment over orthodontic treatment were observed for M2M uprighting (OR = 4.97; CI: 1.49 to 16.51; P = .01).No differences were detected comparing surgical and surgical-orthodontic treatment (OR = 1.00; CI: 0.03 to 37.44; P = .99), or orthodontic and surgical-orthodontic treatment(OR = 4.14; CI: 0.43 to 40.14; P = .22).Third molar removal showed no significant correlation with M2M uprighting (OR = 1.98; CI: 0.24 to 16.03; P = .5)., Conclusion: Despite study limitations, both orthodontic and surgical management of impacted M2M can be effective suggesting that clinicians are able to choose best treatment for most cases., (Copyright © 2023. Published by Elsevier Inc.)

Tooth loss or extraction is associated with significant reduction in alveolar ridge volume, extensively expressed in the anterior zone, and immediate implant placement is insufficient to overcome this problem. The proposed approach combined immediate implant placement with buccal tissue enhancement by applying a crosslinked collagen matrix hydrated with crosslinked hyaluronic acid (xHyA). All 10 cases presented with a retained but narrow buccal socket wall, so immediate implant placement with the "tunneled sandwich" technique was performed after tooth extraction. The tunneled sandwich technique helped create a subperiosteal pouch for insertion of the collagen matrix buccal to the alveolar bone crest. The implants healed transmucosally by receiving either a gingiva former or an immediate temporary restoration. Ten sites in 10 patients demonstrated stable, noninflamed peri-implant conditions and suitable ridge volume at the implant neck and achieved high pink esthetic scores 6 months after implant loading. The tunneled sandwich technique is a suitable method to preserve buccal volume, which biologically and esthetically contributes to favorable long-term results.

Successful rehabilitation of the anterior maxilla remains a challenge, primarily due to postextraction ridge collapse, which can lead to gingival recession and a nonesthetic appearance. The socket shield technique presents a viable alternative for immediate dental implant placement in the esthetic zone. This pilot study aimed to evaluate the survival, complication rates, and marginal bone loss around body-shift implants placed in fresh extraction sockets with the socket shield technique to replace maxillary incisors. After socket shield preparation, 14 hopeless incisors were extracted and immediately replaced by a body-shift implant (Inverta, Southern Implants) at baseline. Patients were followed up for 12 to 39 months (mean: 18.1 ± 8.2 months). The average age was 52.3 ± 16.9 years, and the survival rate was 100%. One socket shield presented minimal internal exposure that was successfully treated with a connective tissue graft. The mean PES score was 12.9 ± 1.2. Mean interproximal marginal bone loss was -0.4 ± 0.5 mm. Body-shift implants can be a promising alternative for immediate tooth replacement combined with the socket shield technique. The superior esthetic outcomes remained stable, suggesting that the extra space created by the narrow cervical portion of the implant is beneficial for preserving the alveolar bone and limiting internal shield exposure.

Purpose: To evaluate the peri-implant outcomes of customized healing abutments (CstHA) placed on dental implants inserted in fresh tooth extraction sockets., Materials and Methods: The study was registered on PROSPERO: CRD42022304320. A systematic search in PubMed, Scopus, and Web of Science was conducted between April 2022 and October 2022 to identify clinical studies involving immediate implant surgery associated with CstHA placement. The Joanna Briggs Institute Critical Appraisal and RoB2 tool were performed for the risk of bias analysis., Results: A total of 12 studies were included, most of them with low risk of bias. Four studies compared CstHA vs conventional healing abutments (CnvtHA), two compared CstHA vs cover screw and collagen matrix (CMa), and six were clinical case series. For the CstHA vs CnvtHA comparison, favorable results were observed for CstHA considering papilla maintenance and probing depth, yet the mean marginal bone level was statistically similar between CstHA and CnvtHA. CstHA showed advantages when compared to CMa for total bone volume, papilla height, and midfacial mucosa maintenance. Significantly less horizonal bone loss was reported when using CstHA compared with CMa. Horizontal and vertical bone loss was observed in a few (or no) sites in the case series using CstHA., Conclusions: CstHA provides favorable peri-implant response because in general it does not result in a significant loss of soft and hard tissues.

Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The literature identified variations in socket seal surgery, each with limitations. This case series aimed to observe the outcome of using autologous dental root (ADR) for socket sealing on socket preservation (SP). A total of 9 patients with 15 extraction sockets were documented. After flapless extraction, the xenograft or alloplastic grafts were placed in the sockets. Autologous dental roots were prepared extraorally and applied to seal the socket entrance. All SP sites healed uneventfully. Cone-beam computed tomography (CBCT) scan was performed after 4-6 months of healing to evaluate ridge dimensions. The preserved alveolar ridge profiles were verified on CBCT scans and during implant surgery. Implants were placed successfully with a reduced need for guided bone regeneration. Histological biopsy specimens were examined in 3 cases. The histological examination demonstrated vital bone formation and osseointegration of graft particles. All patients completed the final restorations and were monitored for 15.56 ± 9.08 months after functional loading. The favorable clinical outcomes support the use of ADR for SP procedures. It was not only accepted to patients but also easy to perform with low complication rates. The ADR technique is thus a feasible method for socket seal surgery.

The aim of this study is to assess the relationship between somatosensory functional changes and inferior alveolar nerve (IAN) exposure after impacted mandibular third molars (M3M) removal. We recruited 35 patients who underwent impacted M3M extraction near the IAN. The M3Ms were extracted by combined endoscopy, piezosurgery, and contra-angle high-speed turbine handpiece. All IAN canal perforations and exposed regions were recorded and measured by endoscopy after extraction and on cone-beam computed tomography (CBCT) images before extraction. The patients were followed up 1, 7, and 35 days after surgery. A standardized quantitative sensory testing (QST) battery was performed on the lower lip skin. All of 35 cases had exposed IAN on CBCT images, 5 of which had no exposed IAN under endoscopy. For the other 30 cases, the endoscopy-measured IAN length and width were shorter than the CBCT measurements (P < 0.001). The warm and mechanical detection thresholds (MDT) on the operation side were significantly higher than the contralateral side after surgery (P < 0.05). Thermal sensory limen, MDT, and cold pain threshold were strongly correlated with the exposed IAN length and MDT also with the exposed IAN width one day after surgery. In conclusion, it was found that not all exposed IAN in CBCT images were real exposure after surgery. The intraoperative exposed IAN endoscopic measurements were smaller than by CBCT and strongly correlated with some QST parameters., (© 2023. The Author(s).)

Partial extraction therapy (PET) is a group of surgical techniques that preserve the periodontium and peri-implant tissues during restorative and implant therapy by conserving a portion of the patient's own root structure to maintain the blood supply, derived from the periodontal ligament complex. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). Although their clinical success and benefits have been demonstrated, several studies report possible complications. The focus of this article is to highlight management strategies for the most common complications associated with PET, including internal root fragment exposure, external root fragment exposure, and root fragment mobility.

Purpose: Iodoform gauze is commonly used to treat patients with localized alveolitis; however, saliva can easily dilute the iodoform concentration. This study aimed to compare the efficacies of platelet-rich fibrin (PRF) and iodoform gauze in treating localized alveolitis., Methods: This prospective randomized controlled trial enrolled patients with localized alveolitis who received treatment at our hospital from January 2018 to July 2021. They were randomly assigned to the control (treated with iodoform gauze) or experimental (treated with PRF) groups. Treatment method was the predictor variable. The primary outcome variable was clinical efficacy, defined as symptom resolution 1 week after treatment. Secondary outcome variables included granulation tissue (GT) quantitative score, analgesic drug dosage, and pain score determined using a visual analog scale (VAS). Patient demographics were used as covariates. Data analysis was performed by carrying out the χ 2 and Mann-Whitney rank sum tests; P values <.05 indicated statistical significance., Results: This study included 60 patients, equally and randomly divided into the control and PRF groups (n = 30 each). There were no significant differences in demographic characteristics of patients between the 2 groups. One week after treatment, the PRF group showed a higher healing rate (93.3% vs 60.0%) and better GT quantitative score (3.13 ± 0.63 vs 1.70 ± 0.75) than the control group (P < .05). Moreover, the number of analgesic tablets consumed within 1 week postoperatively was lesser in the PRF group than in the control group (3.93 ± 1.53 vs 9.67 ± 3.16, P < .05). The PRF group exhibited significantly lower VAS pain scores than those of the control group on the 3rd day (1.10 ± 1.03 vs 4.17 ± 1.49) and 7th day (0.30 ± 0.60 vs 1.73 ± 1.44, P < .05) postoperatively., Conclusions: Compared with iodoform gauze, PRF is associated with higher healing rate, faster promotion of GT growth in the extraction socket, better relief of alveolar pain, and lower intake of analgesic drugs when treating localized alveolitis., (Copyright © 2023 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to assess the efficacy of simvastatin in bone regeneration in extraction sockets of mandibular third molars using cone beam computed tomography (CBCT) at 6th post-operative month., Methods: This is a prospective randomized split-mouth study involving 15 patients who underwent surgical extraction of bilaterally impacted mandibular third molars with similar morphology on the same day. The efficacy of drug was analyzed by implanting 10 mg of simvastatin into the socket (study site) and observations were made over 6 months to compare the healing with the control site., Results: The study results demonstrated a statistically significant difference in bone regeneration: mean gray value of 429.133 in study site compared with mean gray value of 310.153 in the control site., Conclusion: These values demonstrate significant change in bone regeneration in simvastatin site as compared to that of control site., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: This study evaluated  the effects of advanced platelet-rich fibrin (A-PRF +) on the healing of upper third molar post-extraction sockets., Methods: Sixteen patients who underwent extractions of the upper third molars (18 and 28) were included in this randomized split-mouth study. The alveoli on the test side were filled with A-PRF + , while the control side was maintained with blood clot. The side that received treatment was randomly defined. Alveolar bone regeneration was evaluated by CBCT scans to assess healing stage, bone density, and fractal analysis 1 week and 90 days post-extraction. Additionally, pain, edema, bleeding, and soft tissue alveolar repair were evaluated by clinical analyses 3, 7, 14, 30, and 90 days after the surgical procedure using a visual analog scale., Results: There were no clinical differences regarding treatments in any experimental period. In the tomographic evaluation, at 7 days, the alveoli treated with A-PRF + presented a suggestive sign of higher bone density than the control alveoli, which was not confirmed 90 days after the surgical procedure., Conclusion: Thus, the use of A-PRF + does not demonstrate a clinical advantage in the repair of post-extraction sockets of upper third molars., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)