Magister Scientiae Dentium - MSc(Dent) / Aim: A clinical trial to determine the post-operative outcomes of a PRF-treated socket versus a conventionally treated socket following surgical removal of third molar teeth. Introduction: Third molar surgery is a procedure many have to endure and which often results in prolonged healing time with consequential absence from work and school. This has motivated clinicians to seek methods to enhance the healing process and in effect, reduce the healing time. Research on the use of PRF in enhancing wound healing in maxillofacial and oral surgery have shown varying results. Therefore, this study was conceived to ascertain the effect PRF has on the post-operative sequelae of third molar teeth. Materials and Methods: This was a split mouth, prospective, single blinded, randomized control trial. The study sample was made up of 26 patients (N=26) who met the inclusion criteria. Four of the patients experienced neurosensory fallout of an associated nerve and were subsequently excluded from the sample. This resulted in the total sample size of twenty-two patients (n=22). Symmetrically impacted maxillary and mandibular third molars were removed under general anaesthesia. Patients were treated in a within subject design: when one side of a patient was treated with PRF, the other side was conventionally treated and acted as a control. The allocation of the side treated with PRF was 'random'. Patients were followed-up on Day 2 and Day 7, respectively. Pain scores were recorded on a visual analogue scale (VAS) using 0 to 10 pain score. Swelling, wound dehiscence, development of alveolar osteitis, wound infection and post-operative bleeding were compared between the intervention and control side. Results: Twenty-two patients (females = 13 and males = nine) b

<p>To compare the use of a piezoelectric with a standard surgical handpiece in third molar surgery. Thirty patients requiring removal of third molars were included in the study. Panoramic radiographs were used to assess the third molars. The patients were randomly subdivided and the split-mouth technique applied. In split-mouth design, divisions of the mouth, such as right (upper and lower) and left (upper and lower) quadrants constitute the experimental units, which are randomly assigned to two treatment groups. Each patient serves as his or her own control, which increases statistical efficiency (Siddiqi et al. 2010). Each side was operated with either a piezoelectric or a conventional handpiece. All aspects of preoperative care, general anaesthesia, surgery and postoperative care were standardized for the groups.</p>

<p>To compare the use of a piezoelectric with a standard surgical handpiece in third molar surgery. Thirty patients requiring removal of third molars were included in the study. Panoramic radiographs were used to assess the third molars. The patients were randomly subdivided and the split-mouth technique applied. In split-mouth design, divisions of the mouth, such as right (upper and lower) and left (upper and lower) quadrants constitute the experimental units, which are randomly assigned to two treatment groups. Each patient serves as his or her own control, which increases statistical efficiency (Siddiqi et al. 2010). Each side was operated with either a piezoelectric or a conventional handpiece. All aspects of preoperative care, general anaesthesia, surgery and postoperative care were standardized for the groups.</p>

Third molar (M3) impaction is commonly observed in dental practice. While the causes of impaction are still not clearly understood, they appear to be multifactorial. Currently, an insufficient amount of space in the jaw distal to the second molar - the retromolar (RM) region - is considered to be the most significant of these putative risk factors. However, M3 eruption is not always guaranteed by space availability in the RM region, and other factors such as delayed M3 mineralization, tooth crown size, and dental arch size are suspected to increase impaction risk. Because studies have traditionally focused on mandibular M3s and been limited to two-dimensional (2D) radiographs, this study is the first to investigate the causes of M3 impaction in both jaws, using 3D imaging, with precision and accuracy not previously possible using standard 2D dental imaging modalities. This study tests the hypothesis that not only a reduced amount of space in the RM region is observed when M3 impaction is present but also delayed M3 mineralization, larger molar and premolar crowns, and shorter dental arches. Research ethics permission (BIO#11-202) was obtained to use existing retrospective cone beam computed tomography (CBCT) images of over 500 patients aged 8 to 24 years taken and curated at the College of Dentistry, University of Saskatchewan. Anatomical landmarks were defined and a proprietary software package, Xoran-CAT (Imaging Sciences International, Philadelphia, USA) was used to measure RM regions, molar and premolar crowns, and dental arch dimensions, as well as to score M3 mineralization status. Results were assessed using independent sample t-tests. When M3 impaction was present, both short RM regions and delayed M3 mineralization occurred in both jaws, indicating that both of these are risk factors for impaction. In the presence of M3 impaction, narrower dental arches were observed only in the maxilla, while larger premolar and molar crowns were seen only in the mandible. The observation of these last risk factors in distinct jaws when M3 impaction was present, suggests that these are secondary factors in the determination of the M3 impaction condition, and that standards of M3 impaction differ between upper and lower jaws.

Magister Chirurgiae Dentium - MChD / To compare the use of a piezoelectric with a standard surgical handpiece in third molar surgery. Thirty patients requiring removal of third molars were included in the study. Panoramic radiographs were used to assess the third molars. The patients were randomly subdivided and the split-mouth technique applied. In split-mouth design, divisions of the mouth, such as right (upper and lower) and left (upper and lower) quadrants constitute the experimental units, which are randomly assigned to two treatment groups. Each patient serves as his or her own control, which increases statistical efficiency (Siddiqi et al. 2010). Each side was operated with either a piezoelectric or a conventional handpiece. All aspects of preoperative care, general anaesthesia, surgery and postoperative care were standardized for the groups. / South Africa

Magister Chirurgiae Dentium - MChD / This study compares the CMN to the steel scalpel by assessing incision time, incisional blood loss, postoperative pain, wound healing, and the incidence of lingual and long buccal nerve injury. Twenty standardised cases were included in an analytical prospective case series. Each case had one side cut with CMN and the other side with steel scalpel. Third molar surgery is the most commonly performed procedure by maxillo-facial and oral surgeons, and is associated with expected but transient sequelae such as pain, swelling and trismus. Modalities to reduce the severity of these sequelae are desirable. Several studies report that the use of conventional electrosurgical instruments and the Colorado Microdissection Needle (CMN) resulted in significant reductions in cutting time, incisional blood loss, postoperative pain, with no evidence of increased incidence of wound complications such as dehiscence and infection.

Magister Chirurgiae Dentium - MChD / Aim: To assess the change in the quality of life of patients while on the third molar surgery waiting list. Introduction: A large number of patients routinely present at the Tygerberg Oral Health Centre for removal of symptomatic impacted third molars. This results in many patients being placed on a surgical waiting list. In addition, many patients who have been placed on this waiting list return for adjunctive interventions, indicating a possible decrease in Quality of Life (QoL) over the waiting period. Numerous studies document post-surgery changes in QoL in patients that have had third molars removed. Many other studies detail QoL changes in patients awaiting orthopaedic and general surgery procedures. However, no study could be found that dealt with changes in QoL while awaiting third molar surgery. Materials and Methods: This is a prospective questionnaire-based study. It compares QoL at the beginning and the end of the waiting period for the removal of impacted third molars in order to determine whether a change in QoL occurs during the waiting period. The study sample was made up of 48 patients who met the inclusion criteria. Results: The present study shows that patients presenting with symptomatic impacted third molars have a decreased QoL at baseline, which further deteriorates over the waiting period. Although the overall change is negative, it is not statistically significant. This suggests that the null hypothesis cannot be excluded, and that it is therefore acceptable for patients to be managed on a waiting list. Conclusion: Third molar surgery results in a greater decrease in mental than physical wellbeing. The results in this study regarding a negative change in QoL was found not to be statistically significant. Only three out of 48 patients required emergency intervention. It can thus be concluded that placing patients on a waiting list for third molar surgery is acceptable.

O objetivo do presente estudo foi avaliar a eficácia da analgesia preemptiva na cirurgia de extração de terceiros molares inclusos. Nesse estudo duplo cego, randomizado e pareado, os pacientes foram submetidos à extração de terceiros molares inferiores bilaterais em dois tempos distintos. Em uma das duas cirurgias, no pré-operatório os pacientes fizeram uso de Cetoprofeno 150 mg via oral a cada 12 horas durante dois dias antes e, após a cirurgia, continuaram a medicação por mais três dias. Em outra cirurgia, fizeram uso de um comprimido placebo no pré-operatório a cada 12 horas durante dois dias antes e, após a cirurgia, fizeram uso de Cetoprofeno 150 mg a cada 12 horas por três dias. O analgésico de resgate utilizado foi o Paracetamol 750 mg via oral. A dor pós-operatória foi avaliada por meio de Escala Visual Analógica, Escala Nominal e quantidade de consumo de analgésicos de resgate. Os resultados não mostraram diferença significante entre o controle e cetoprofeno preemptivo na redução da dor pós-operatória e no consumo de analgésicos de resgate. Concluiu-se que neste modelo experimental, a analgesia preemptiva não se mostrou eficaz na redução da dor pós-operatória. / The aim of this study was to evaluate the effectiveness of the preemptive analgesia in the third molar surgery. In this double blind study, randomized and paired, the patients were submitted to the extraction of the third molar bilateral inferiors in two distinct times. In one of the two surgeries, during the two-day preoperative the patients made useof150 mg of ketoprofenoralevery12 hours and, after the surgery, they kept taking this medication for three days. In the other surgery, a placebo pill was used in the preoperative, also every 12 hours, for two days and, after the surgery, ketoprofen 150 mg was used every 12 hours for three days. The rescue analgesic used was the paracetamol 750 mg oral. Postoperative pain was evaluated by making use of the Analogical Visual Scale, the Nominal Scale and the amount of rescue analgesic consumption. The results did not show significant difference between the control and the preemptive ketoprofen in the reduction of postoperative pain and in the rescue analgesic consumption. We can conclude that in this experimental model, the preemptive analgesia did not prove to be efficient in the reduction of postoperative pain.

O Objetivo do presente estudo foi avaliar a relação entre ansiedade odontológica e cortisol salivar por meio de escalas e o nível de cortisol salivar em pacientes submetidos à exodontia dos terceiros molares inferiores. O estudo envolveu 15 pacientes com idade entre 18 e 29 anos, do gênero masculino e ASA I (saudável), submetidos à exodontia dos terceiros molares inferiores bilateralmente sob anestesia local. Foram coletados dados subjetivos por meio de escalas (Escala de Ansiedade Dental de Corah, Escala Visual Análoga de ansiedade e dor, Inventário de Ansiedade Traço-Estado de Spielberger, Escala Verbal e Escala Visual Numérica de ansiedade e dor) e objetivo por meio da coleta de cortisol salivar. Os dados obtidos revelaram correlação entre ansiedade odontológica e dor detectada por meio da escala visual numérica, que evidenciou diferença estatística significante na redução quando comparado os períodos de 3 minutos após a anestesia e 2 horas após o início da segunda cirurgia. O cortisol salivar no período de 2 horas após o início da primeira e segunda cirurgia expôs alteração da curva do ritmo circadiano elevando-a, contudo sem diferença estatística. As cirurgias para extração de terceiros molares inferiores foram capazes de alterar a curva do cortisol mesmo em pacientes com baixo nível de ansiedade. A experiência interfere na resposta do paciente frente à ansiedade e dor, se de forma positiva, reduzindoas de modo significante. / The objective of this study was to evaluate the relationship between dental anxiety and salivary cortisol using scales and salivary cortisol levels in patients undergoing extraction of third molars. The study involved 15 patients aged between 18 and 29 years, male and ASA I (healthy), undergoing extraction of third molars bilaterally under local anesthesia. Data were collected by means of subjective scales (Corahs Dental Anxiety Scale (DAS), Anxiety Visual Analogue Scale (VAS) of anxiety and pain, Spilberger State-trait Anxiety Inventory (STAI), Verbal Scale and Visual Numeric Scale of anxiety and pain) and objective by collecting salivary cortisol. These data revealed a correlation between dental anxiety and pain detected by visual numerical scale, showing statistically significant difference in reduction compared periods of 3 minutes after anesthesia and 2 hours after starting the second operation. The salivary cortisol within 2 hours after the onset of first and second operation curve exhibited alteration of circadian rhythm raising it, however no statistical difference. Surgeries for extraction of third molars were able to change the curve of cortisol even in patients with low anxiety levels. The experience interferes with the patient\'s response against the anxiety and pain, in a positive way, reducing them so significant.

Objective: This study aimed to evaluate the prevalence, the eruption status and angulation of third molars in orthodontically untreated subjects. Material and methods: Five hundred panoramic radiographs of individuals from the Bauru region of both sexes, aged between 18 and 50 years, untreated orthodontically, with all teeth present until the second permanent molar were retrospectively selected. It was evaluated the presence of the third molars, their eruption status and their angulation using Dolphin software. The comparison of the prevalence and eruption status between the maxillary and mandibular teeth was performed by the chi-square test and the comparison of the angulations between the eruption status by the oneway ANOVA and Tukey tests. Results: The prevalence of maxillary third molars is 72.8% and of mandibular ones is 70.3%. There was a statistically significant difference between the eruption status in the maxillary and mandibular third molars. Most of maxillary third molars were erupted (63.19%), 29.94% unerupted, but considered with favorable angulation for eruption. The mandibular third molars had a higher prevalence of impaction than the maxillary molars (21.05% vs 3.85%). Conclusion: The prevalence of maxillary third molars is 72.8% and of mandibular ones is 70.3%. The maxillary third molars were more erupted than the mandibular ones, which were more impacted and partially erupted than the maxillary ones. The impacted mandibular third molars were more mesially angulated than the other eruption status. / Objetivo: O objetivo deste estudo foi avaliar a prevalência, o estado de erupção e a angulação de terceiros molares em indivíduos submetidos a tratamento ortodôntico. Material e métodos: Foram selecionadas retrospectivamente 500 radiografias panorâmicas de indivíduos da região de Bauru, de ambos os sexos, com idade entre 18 e 50 anos, não tratados ortodonticamente, com todos os dentes presentes até segundos molares permanentes. Avaliou-se a presença dos terceiros molares, seu status de erupção e sua angulação com auxílio do software Dolphin. A comparação da prevalência e do status de erupção entre os dentes superiores e inferiores foi realizada pelo teste qui-quadrado e a comparação das angulações entre os status de erupção, pelo teste ANOVA a um critério de seleção e teste de Tukey. Resultados: A prevalência dos terceiros molares superiores é de 72,8% e dos inferior é de 70,3%. Houve uma diferença estatisticamente significante entre o status de erupção nos terceiros molares superiores e inferiores. A maioria dos terceiros molares superiores se apresentaram erupcionados (63,19%), 29,94% não erupcionados, mas considerados com angulação favorável para erupção. Os terceiros molares inferiores apresentaram maior prevalência de impactação do que os superiores (21,05% vs 3,85%). Conclusões: A prevalência da presença dos terceiros molares superiores é de 72,8% e dos inferiores é de 70,3%. Os terceiros molares superiores mostraram-se mais irrompidos do que os inferiores, que se mostraram mais impactados e parcialmente irrompidos que os superiores. Os terceiros molares inferiores impactados se apresentaram mais mesialmente angulados do que os demais status de erupção.