Neurosensory deficit is a well-reported complication after lower third molar surgery. It is useful to know the outcomes of the available treatments for neurosensory deficit after third molar surgery. It is more important to prevent nerve injury from third molar surgery. This thesis aims1) to evaluate the outcomes of treatments for neurosensory deficit after lower third molar surgery; 2) to investigate the effect of permanent neurosensory deficit from the patient’s perspective;3) to identify radiographic signs as predictors of inferior alveolar nerve (IAN) deficit in third molar surgery; 4)to monitor the long-term root movement and morbidities of the retained roots following coronectomy of the lower third molars. (1) A systematic search on treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery was performed. 4 surgical treatments and 2 non-surgical treatments were identified. Significant improvement in sensation was found in the majority of the subjects who received surgical or non-surgical treatment. Complete recovery was uncommon in all kinds of available treatments. (2) Forty-eight subjects (24 cases) were recruited in a prospective case-control study comparing the general and oral health-related quality of life (QoL), life satisfaction and depression symptoms of patients with persistent lingual nerve (LN)or IAN neurosensory deficit (12 months or more) after third molar surgery with those who did not have such deficit. It was found that patients with persistent neurosensory deficit after third molar surgery have significantly poorer general and oral health-related QoL, worse life satisfaction and more depression symptoms than those without such deficits. (3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatmentoutcomes. Most patients with pain wererecovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months. (3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatment outcomes. Most patients with pain were recovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months. (4) 178lower third molars with one or more of the five radiographic signs suggesting of close proximity of their roots to the IAN were analyzed. It was found that radiographic signs of “darkening of root(s)” and “displacement of inferior alveolar canal by the root(s)” were associated with increased risk of intraoperative IAN exposure. In addition, “darkening of the root(s)” or co-existing radiographic signs were associated with an increased risk of post-operative IAN deficit. (5) A phase 4 clinical trial with 612 lower third molar coronectomies was conducted to monitor the long term safety of the treatment. It was demonstrated that the technique has minimal morbidity in terms of infection, pain, dry socket or development of pathologies. Most retained roots (90.9%) migrated upward with the highest migration rate in the first 6 months, which gradually slowed down and stopped to migrate at 24months. 2.3% of the roots became exposed in the oral cavity and required removal. Re-operation to remove the exposed root did not cause any IAN deficit. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Thesis (M.S.)--University of Michigan, 1939.

published_or_final_version / abstract / Dentistry / Master / Master of Dental Surgery

At an annual cost of over three billion dollars, surgical extraction of third molars is by far the most performed surgical procedure in the United States; however, there is and has been much controversy in the literature over the last several decades about the practicality of this procedure. Presently, professionals are divided on the issue of whether or not surgical extraction is necessary for asymptomatic disease free third molars. This comprehensive literature review was performed to investigate the current evidence concerning the prophylactic removal of third molars. It was discovered that many several journals, particularly those pertaining to oral and maxillofacial surgery has been hugely instrumental in marketing this procedure to the public through research articles. Close analysis of the literature revealed a significant level of inconsistency relating to study design, sample size, and methodology. In conclusion, for the typical prophylactic third molar extraction, the risk of complications are often underestimated while the potential gains in quality of life may be exaggerated which will impede the decision making process for the clinician and patient. For an elected surgery that is performed at such a grand scale, there are too many variables still unclear in the literature, many of which present as a public health hazard. There are also many other factors, both physically and ethically, that need to be considered before a responsible decision can be made. It was also found that the imaging technology currently being used as the standard of care for the diagnosis and treatment planning of third molars does not give a clear enough picture to ensure a complication-free surgery. Furthermore, there are other non-invasive options for the management of asymptomatic third molars that are not being applied enough, which do not require sacrificing the third molars. Complications resulting from third molar surgery are one of the most common reasons responsible for lawsuits facing dentists today and can also result in a lifetime of pain and disability for the patient. Taken together, the high cost of surgery along with the risk of complications following an otherwise disease-free third molar doesn't seem to be representative of responsible dentistry. More conservative approaches along with a general shift towards evidence-based dentistry may be the answer for the proper management of third molars. Discouraging the practice of prophylactic removal of third molars could result in billions of dollars in saving, elimination of millions of days of discomfort, and prevention of permanent injury to tens of thousands of people.

Background Various analgesics are available for post-operative pain after third molar surgery. Combinations of different classes of analgesics may improve the overall efficacy of pain control as they covers different pain pathways. A great variation of combinations and dosages of analgesics have been suggested in the literature, yet it was still unclear what combination(s) and dosages were the most effective for acute post-operative dental pain. A systematic review of randomized clinical trials would help clinicians to make clinical judgment of which analgesic combination(s) would be the best for their patients for acute post-operative dental pain in terms of efficacy and safety. Aim To conduct a systematic review of randomized clinical trials to answer the clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative dental pain control?” Methods A structured systematic literature search, with predefined inclusion and exclusion criteria, of the relevant computer databases and journals was performed. The search and the evaluations of articles were done by 2 independent reviewers in 3 rounds. Studies that fulfilled the pre-set criteria were included to enter the final review. The analgesic efficacy of the analgesic combinations reported in the included studies were presented by the objective pain measurements, sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 and TOTPAR6 of various combinations were adjusted after deducting from the effect of placebos of the respective studies. The adverse effects of the different analgesic combinations were also presented. Results There were 13 studies with 2843 subjects included in the final review. Eight groups of drug combinations with 13 different dosages were reported. The efficacies of the reported analgesic combinations have SPID6 scores ranged from 1.46 to 6.44 and TOTPAR6 scores ranged from 3.24 – 10.3. Among the analgesic combinations, ibuprofen 400mg + oxycodone HCL 5mg had the highest adjusted SPID6 (6.44), and a very higher adjusted TOTPAR6 (9.31), representing its efficacy could be superior to the other different analgesic combinations reported in this study. Nausea was the most common adverse effect of the analgesic combinations, with prevalence ranged from 0-55%. Most of the common adverse effects were related to the use of opioids in the combination. Three combinations of different dosages containing ibuprofen and caffeine were reported with the lowest prevalence of adverse effect. Conclusions This systematic review of randomized clinical trials has presented the efficacy and adverse effects of the various analgesic combinations for acute post-operative dental pain control. We have identified ibuprofen 400mg with oxycodone 5mg was more effective when compared to the other 12 combinations. Nausea was the most common adverse effects in an analgesic combination containing an opioid. Ibuprofen 200mg with caffeine 100mg or 200mg has a reasonable analgesic effect with fewer side effects when compared to the other analgesic combinations. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Thesis (doctoral)--Universität Tübingen, 1935. / At head of title: Aus dem Zahnärtzlichen Institut der Universität Tübingen. "Lebenslauf": p. 25. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.

Thesis (doctoral)--Universität Tübingen, 1935. / At head of title: Aus dem Zahnärtzlichen Institut der Universität Tübingen. "Lebenslauf": p. 25. Includes bibliographical references.

Thesis (M.A.)--University of Tennessee, Knoxville, 2003. / Title from title page screen (viewed Sept. 22, 2003). Thesis advisor: Dr. Richard Jantz. Document formatted into pages (vii, 56 p. : ill.). Vita. Includes bibliographical references (p. 51-55).

Thesis (doctoral)--Ludwig-Maximilians-Universität, Munich, 1932.