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ObjectivesThis study investigated and compared the effectiveness of a phytotherapeutic drug composed of herbal extracts on postsurgical discomfort after mandibular third molar surgery.Materials and methodsEighty-two patients requiring the surgical removal of a mandibular third molar were randomly assigned to receive placebo (group 1), ibuprofen (group 2), and a phytotherapeutic drug (composed of baicalin, 190 mg; bromelain, 50 mg; escin, 30 mg) (group 3). Drugs were administered after tooth extraction twice a day for 5 days. The primary outcome, pain, was evaluated using a visual analogue scale at 2 h, 6 h, 12 h, 24 h, 48 h, and 7 and 10 days after surgery. The secondary outcomes were the changes in maximum mouth opening and facial contours (mm) between baseline and at 24 h, 72 h, and 7 and 10 days after surgery.ResultsCompared to the baseline, all treatments demonstrated an improvement in the primary and secondary outcomes. Moreover, compared to groups 1 and 2, patients in group 3 yielded a significant reduction of the postoperative pain score at 12 h (p < 0.001), 24 h (p = 0.010), and 48 h (p = 0.048) after surgery. The mean reduction of the swelling and trismus was similar between groups.ConclusionsThe results of this study suggest that a postoperative administration of a phytotherapeutic drug was found to be effective in postoperative pain management after the surgical removal of impacted mandibular third molars.Clinical relevanceThe phytotherapeutic drug composed of herbal extract determined a decrease in the severity of postoperative pain compared to ibuprofen and placebo.

Objective With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. Methods This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. Results The experimental group can significantly reduce the localization time of palatally impacted teeth ( P  < 0.001), with total surgery times of 18.15 ± 4.88 min and 22.00 ± 7.71 min for the experimental and control groups, respectively ( P  = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain ( P  < 0.05), swelling ( P  < 0.001), and patient satisfaction ( P  < 0.001) compared to the control group. Conclusion Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Photobiomodulation is a safe option for controlling pain, edema, and trismus when applied postoperatively in third molar surgery. However, administration prior to surgery has been under-explored. This study aims to explore the effectiveness of pre-emptive photobiomodulation in reducing postoperative edema in impacted lower third molar extractions. Two groups of healthy individuals undergoing tooth extraction will be randomly assigned: Control group receiving pre-emptive corticosteroid and simulated photobiomodulation, and Photobiomodulation Group receiving intraoral low-intensity laser and extraoral LED cluster application. The primary outcome will be postoperative edema after 48 h. The secondary outcomes will be pain, trismus dysphagia, and analgesic intake (paracetamol). These outcomes will be assessed at baseline as well as two and seven days after surgery. Adverse effects will be recorded. Data will be presented as means ± SD and a p-value < 0.05 will be indicative of statistical significance.

Purpose This study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures. Methods A prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p  < 0.05. Results In the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant ( p  = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury. Conclusion The precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery. Graphical Abstract

Background One of the most frequent dental operations is the surgical extraction of an impacted third molar. The study aimed to evaluate the impact of the intra-socket application of 0.8% Hyaluronic Acid (HA) gel on hard & soft tissue healing after surgical removal of the impacted 3rd molar. Objective Materials and methods This randomized controlled clinical study included thirty patients aged from 21–36 years who were scheduled for surgical removal of impacted mandibular third molar. 0.8% hyaluronic acid gel (HA group) was applied immediately after surgery in the intra-socket of 15 patients, and nothing (No HA group) was applied to the socket of the other 15 patients. Soft tissue healing was assessed after extraction on the third, seventh, and fourteenth day. Bone healing was assessed 2 months post-extraction by measuring bone density and socket length from cone beam computerized tomography. Results The soft tissue healing index was significantly better (very good or excellent) in the HA group compared with no HA group after fourteen days postoperative ( p  < .001). Also, the percentage increase of bone density in the HA group was statistically significantly higher after two months than in the no HA group (( p  < .001). Conclusion Hyaluronic acid 0.8% gel application improves soft tissue healing and bone density healing following surgical extraction of the mandibular third molar. It could be considered a valuable material for improving bone healing and soft tissue. Trial registration The trial is retrospectively registered at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202407576478340 on 30/07/2024.

Background Anxiety during oral surgery adversely affects patients’ compliance with treatment and patient–doctor cooperation. Therefore, various treatment protocols have been developed to reduce anxiety. This study aimed to evaluate the effects of music and white noise on patients’ anxiety and pain during surgery for impacted third molars. Methods According to the Consolidated Standards of Reporting Trials statement, this single-blind, randomized, controlled trial with parallel groups involved 66 patients who met the eligibility criteria and were randomly assigned to one of three groups. Group 1 listened to preselected songs played against a pre-prepared standard “white noise” through noise-isolating headphones that block ambient noise during the procedure. Group 2 listened only to music through noise-isolating headphones during the procedure. Group 3 listened to natural ambient noise during the procedure. All surgical procedures were performed in a standard operating room. All patients completed the State-Trait Anxiety Inventory-State (STAI-S) form and indicated their anxiety on a Visual Analog Scale (VAS) preoperatively and postoperatively. They also indicated the pressure/pain level they felt during the procedure on a VAS. The primary predictor variable was the music and white noise intervention. The primary outcome variables were the STAI-S and VAS scores. Sex was included as a covariate. Results Anxiety VAS scores were significantly lower postoperatively than preoperatively in Groups 1 ( p  < 0.001), 2 ( p  < 0.001), and 3 ( p  = 0.002). Similarly, STAI-S scores were significantly lower postoperatively than preoperatively in Groups 1 ( p  < 0.001), 2 ( p  < 0.001), and 3 ( p  = 0.012). The change in STAI-S scores ( p  = 0.053) did not differ significantly between groups. Conclusion Although not statistically significant, listening to music alone or with white noise reduced the anxiety experienced by patients during the procedure and increased their comfort. As a simple, inexpensive, and non-invasive method, listening to self-selected music in the preoperative and perioperative periods could benefit patients.

ObjectivesThis prospective study introduced a digitally designed sectioning guide and evaluated its feasibility for the extraction of horizontally impacted lower third molars.Materials and methodsThis study included 38 horizontally impacted lower third molars, randomly divided into experimental and control groups. The teeth were extracted using a 3D-printed titanium surgical guide in the experimental group; free-hand extractions were performed in the control group. The surgical duration, tooth sectioning duration, cortical bone perforation, and postoperative complications, including pain, swelling, trismus, dry socket, infection, and hemorrhage, were evaluated.ResultsAlthough not statistically significant, guided surgery tended to reduce the number of tooth sectioning steps compared to free-hand extractions. There were no cases of cortical bone perforation in the experimental group. Although the surgical duration was greater in the experimental group (p < 0.05), there were no differences in postoperative pain, swelling, and trismus. There were no cases of postoperative infection and hemorrhage in either group.Conclusions3D-printed titanium surgical guides had superior accuracy and safety compared to free-hand surgery. Further studies with larger sample sizes are required to verify these findings.Clinical relevanceThe template improved the safety of tooth sectioning during impacted lower third molar surgery and resulted in a more predictable extraction. The narrow sectioning groove could fit comfortably with hypertrophic soft tissues in the posterior mandible.

Background-objective(s) This randomized, split-mouth study aimed to compare postoperative complications following the surgical extraction of impacted lower third molars using piezosurgery versus conventional rotary instruments. Materials and methods Twenty-one patients, aged 18–35 years, with bilaterally and symmetrically impacted lower third molars, were randomly assigned to undergo extraction using piezosurgery on one side and conventional rotary instruments on the other. Results The piezosurgery method required a longer operation time. However, it resulted in quicker resolution of postoperative swelling by the 7th day compared to the conventional method, where swelling persisted longer. Mandibular angle-tragus measurements were significantly higher with the conventional method on the 1st, 3rd, and 7th postoperative days. Although mouth opening decreased significantly after piezosurgery, it returned to preoperative levels by the 7th day, outperforming the conventional method. Postoperative pain was notably higher with the conventional method during the first four days but showed no significant difference from the 5th day onward. Alveolar bone healing was significantly better with piezosurgery at the 3rd and 6th months. Temporary paresthesia occurred in one patient from the conventional group, resolving within four weeks. Neither method resulted in alveolar osteitis. Conclusion(s) Within the study's limitations, piezosurgery demonstrated a reduction in postoperative discomfort, suggesting its advantage in enhancing patient recovery following lower third molar extractions. Clinical significance Piezosurgery, when used appropriately, can reduce postoperative complications compared to conventional methods. Clinicians should be aware of its indications, benefits, and potential challenges. Trial registration This study was registered as a clinical trial to the ClinicalTrials.gov, and the registration ID is NCT06262841 ( https://clinicaltrials.gov/study/NCT06262841 ).

To explore and evaluate the application of a surgical guide in the extraction of impacted mesiodentes. Patients with impacted mesiodentes approachable from the labial side of the maxilla were randomly divided into three groups. The surgical guide for group I was made using cone beam computed tomography (CBCT) and dental cast, whereas the surgical guide for group II was only made using CBCT data. Group I and group II were first evaluated to determine whether guide use could accurately locate the cementoenamel junction (CEJ) of the mesiodentes, and the impacted mesiodentes were extracted with the help of the surgical guide. Group III underwent an operation without a guide. For all patients, the preoperative design time, tooth searching time, operation time, complications, and costs were measured. The guides for group I and group II could locate the CEJ of the mesiodentes accurately, with good application effect during the operation. Group I and group II required additional preoperative design time compared with group III. However, the tooth searching time and operation time in groups I and II were significantly reduced compared with those in group III. Group I and group II showed no intraoperative complications, and two cases in group III showed imprecision during localization. The overall cost for group III was higher than that of group I or group II. But group I and group II required extra visits and costs. Despite some limitations, the surgical guide assisted with mesiodentes extraction and can improve the quality of the operation quality as well as reducing its economic burden, difficulty, and duration. Through proper design, we can create a high-quality surgical guide using only CBCT data. The surgical guide can be used as an important assistive tool in alveolar surgery.

Objectives The aim of this study was to compare leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation (PBM) applications, which have been repeatedly reported to be superior to control groups, in terms of pain, soft tissue and bone healing in tooth extraction sockets. Materials and methods This double-blind, randomized clinical study was completed with 34 patients, who had an indication for extraction of their bilaterally impacted teeth. The right and left teeth of the patients were randomly divided into L-PRF and PBM groups. L-PRF group was treated with the blood product centrifuged for 12 min at 2700 rpm, and the PBM group was treated with a diode laser at different points for 60 s with a wavelength of 940 nm in repeated sessions. Postoperative pain was evaluated using Visual Analogue Scale (VAS), soft tissue healing with Landry Index (LI), tissue healing in the distal region of mandibular second molar by probing depth measurement, and bone healing via panoramic x-ray using the Image J program. Results No statistically significant difference was found for any variable compared between the groups. Conclusion L-PRF and PBM applications provide similar support in the healing of extraction sockets. Nevertheless, the advantages and disadvantages of both methods determine their usage areas. Clinical relevance While L-PRF is advantageous in the early healing of extraction sockets, PBM may be preferred in terms of bone trabeculation in the long term.