Indications of the extraction of symptomatic impacted third molars. A systematic review

Background: A literature review was made to determine when third molar (3M) extraction is recommended in symptomatic patients and when it is not recommended. Material and methods: A Medline (PubMed) and EMBASE search was made for articles related to indications for the extraction of 3Ms, published in the last 10 years and up until September 2018. Results: The electronic search yielded 175 articles. After eliminating duplicates, a total of 173 articles were subjected to review of the title and abstract. Only 19 studies were finally included in the systematic review. There was a well documented increase in morbidity associated to impacted 3Ms (non-restorable caries, fracture, infection, periodontal disease, repeated pericoronitis, cysts and tumors), and in the presence of disease, extraction was considered to be indicated. The extraction of 3Ms with signs and/or symptoms of periodontal disease improved periodontal health at the distal surface of the second molar. Postoperative quality of life of patients with symptomatic 3Ms and with disease improved after surgical extraction. Conclusions: Extraction is indicated in the presence of disease associated to an impacted 3M, whether symptomatic or not. In contrast, extraction is not indicated in the absence of infection or other associated disease conditions

Diagnosis and indications for the extraction of third molars - The SECIB clinical practice guideline.

Background: The removal of third molars (3Ms) is the most frequent surgical procedure in the field of Oral Surgery. As a result, the Spanish Society of Oral Surgery (SECIB) aims to create a Clinical Practice Guideline (CPG) that offers evidence-based recommendations for optimal clinical practice. Specifically, the CPG will focus on providing guidance regarding the indications and criteria for clinical and radiological diagnosis of patients with 3Ms. Material and methods: This CPG was developed by the SECIB, following the methodological guidelines described in the methodological manual for the "Development of Clinical Practice Guidelines in the National Health System". Several PICO questions related to the diagnosis and indications for the extraction of 3Ms were formulated. The leading experts carried out the evaluation of the evidence and the formulation of specific recommendations. Results: A total of 17 PICO questions were evaluated, addressing the indications, prognosis, diagnosis, and cost-benefit relationship of 3M extraction. Conclusions: The present Clinical Practice Guideline provides evidence-based recommendations on the diagnosis and indications for 3M extraction. These evidence-based recommendations can assist healthcare professionals and the general population in making informed decisions regarding the management of 3Ms

A comparison of mandibular and maxillary alveolar osteogenesis over six weeks: a radiological examination

INTRODUCTION : Insufficient information exists on comparing radiological differences in bone density of the regeneration rate in the alveolar bone of the maxilla and mandible following the creation of similar defects in both. METHODS : Alveolar bone defects were created from five healthy Chacma baboons. Standardized x-ray images were acquired over time and the densities of the selected defect areas were measured pre-operatively, directly post-operatively and at three- and six weeks post-operatively. Differences in densities were statistically tested using ANOVA. RESULTS : The maxilla was significantly more radiologically dense (p = 0.026) than the mandible pre- operatively. No differences were obtained between the maxilla and mandible directly postoperatively and three- and six weeks post-operatively respectively; i.e. densities were not significantly different at the different time points after the defects had been created (three weeks: t = 1.08, p = 0.30; six weeks: t = 1.35, p = 0.19; three to six weeks: t = 1.20, p =0.25). The increase in density in the mandible was 106% (8.9±7.6%/time versus 4.3 ± 2.7%/time) over three weeks, 28% (15.0 ± 8.1%/time versus 11.7 ± 8.0%/time) over six weeks and 56% (12.5 ± 9.7%/time versus 8.0 ± 6.9%/time) over three-to-six weeks and was higher than in the maxilla over the same intervals. CONCLUSIONS : Radiological examination with its standardized gray-scale analysis can be used to determine the difference in bone density of the maxilla and mandible. Although not statistically significant, the mandible healed at a faster rate than the maxilla, especially observed during the first three weeks after the defects were created.http://www.head-face-med.com/hb201