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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.

Objective Osteoradionecrosis (ORN) of the jaw is one of the most significant complications of radiotherapy (RT) for head and neck cancer (HNC), and is primarily attributable to tooth extraction. The objective of this study was to assess the efficacy of advanced platelet-rich fibrin (A-PRF) in preventing ORN after tooth extraction in patients with post-irradiated HNC and other postoperative complications. Methods The study population comprised 30 patients who previously underwent radiotherapy for HNC and subsequently underwent tooth extraction, with a total of 134 extractions performed. Extraction sockets were randomly assigned to receive either A-PRF ( n  = 67 [experimental group]); or clot maintenance alone ( n  = 67 [control group]). Patients were clinically evaluated at 7, 14, 30, 60, 90, and 120 days postoperatively to assess pain and healing of the surgical site. The intensity of postoperative pain was quantified using a visual analog scale. Patients were clinically evaluated for up to 120 days to diagnose ORN. Other postoperative complications, including edema, bleeding, tissue color, consistency, and suppuration, were also evaluated. Results In terms of pain and healing, there was no statistically significant difference between the two groups. No ORN or other surgical complications were observed. The use of A-PRF demonstrated no statistically significant differences compared with the control group in most of the parameters evaluated. Conclusion A-PRF yielded no additional benefits and did not influence the healing process in the short or medium term. RBR- 3 tdk22p Date of registration:  02/14/2022.

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 ).

Aim To compare the anesthetic effects of combined block anesthesia of inferior alveolar nerve, lingual nerve and buccal nerve guided by 3D printed indicator (IGT) with Halstead Technique (HT) in the extraction of mandibular third molars. Materials and methods A total of 210 patients with impacted mandibular third molars who were admitted to the outpatient department of oral and maxillofacial surgery of Zhongshan People's Hospital from 2022.10 to 2023.3 were randomly divided into IGT group and HT group, with 105 patients in each group. The onset time, anesthesia effect, and incidence of complications were compared between the two groups of patients. Result There was no statistical difference between the IGT group and the HT group in terms of anesthesia success rate ( P  = 0.180), anesthesia onset time ( P  = 0.213), and anesthesia effect ( P  = 0.933). In terms of anesthesia safety the incidence of anesthesia risk factors in the IGT group was 1.9%, and the incidence of anesthesia risk factors in the HT group was 8.6%. There was a statistically significant difference ( P  = 0.030) between the two groups. Conclusion The Combined block anesthesia of inferior alveolar nerve, lingual nerve and buccal nerve guided by 3D printed indicator can obtain good anesthetic effect in the extraction of mandibular third molars. Compared with the Halstead Technique, it is safer. Trial registration (retrospectively registered) The trail was registered at the Chinese Clinical Trial Registry (ChiCTR2400087941,07/08/2024). Clinical relevance Impacted mandibular third molar is a common clinical disease. When extracting the mandibular third molar, it is usually necessary to perform inferior alveolar nerve block. However, the current mainstream inferior alveolar nerve block has certain limitations. This study aims to introduce a method of inferior alveolar nerve block guided by a 3D printed indicator and compare it with traditional anesthesia technique, providing a new approach for dentists in this field.

Background The aim of this prospective randomized controlled trial was to compare the effects of orthodontic and traditional extraction methods on nerve injury following the extraction of impacted third molars close to the inferior alveolar nerve and to demonstrate the impact of factors such as gender, age, systemic diseases, the side of the third molar, its position, and classification on nerve recovery. Methods Patients with impacted third molars close to the inferior alveolar nerve and an indication for impacted third molar extraction were included in the study. The patients were divided into two groups according to the surgical approach to be applied. Results Preoperative 2-point discrimination (2PD) test values, as well as postoperative 2PD test and visual analog scales (VAS) values on the 7th day, 14th day, and 1st, 3rd, and 6th months, were compared. In the traditional extraction group, the results of the 2PD test were statistically significantly higher on the 7th day, 14th day, 1 month, and 3 months compared to the orthodontic extraction group ( P  < 0.05). Sex, age, systemic disease, M3 side, position, and classification had no statistically significant effect on nerve recovery ( P  > 0.05). Conclusions The orthodontic extraction was found to be safer than traditional extraction in terms of nerve injury for high-risk M3s. Clinical trial registration This study was registered on www.clinicaltrials.govin13/02/2024 . Clinical trial number: NCT06270784.

Background Among the post-surgical complications of lower wisdom teeth surgery, swelling is considered by patients one of the most impairing, with both social and biological influences and impacting patients' quality of life. Aim of the study was to evaluate the swelling following the osteotomy when performed with drilling burs versus piezo-electric instruments in the mandibular impacted third molar extraction, using a facial reconstruction software. Materials and methods A randomized, split-mouth, single-blind study was conducted on patients, ranging between 18 and 40 years of age, requiring lower third molars extraction and referred at the Oral Surgery Unit of the School of Dentistry of the University of Messina. Twenty-two patients were recruited during an 8 months period according to the following criteria: good general health conditions; bilateral, symmetrical, impacted third molars; no use of medication that would influence or alter wound healing; no temporomandibular joint disorder history; no smoking. All patients underwent bilateral surgical removal. For each patient, a facial scan was obtained prior to the surgical procedures. The two extractions were conducted performing, in a randomized way, osteotomy with rotatory burs or use of piezo surgical instruments. Facial scans were repeated at 3 and 7 days after the surgical procedures. Volumetric differences were calculated via superimposition using a dedicated software. The data obtained were processed using paired t-test. Results The results obtained from our study showed no significant differences between two groups regarding post-operative swelling. To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters. Conclusions The 3D digital analysis, in the evaluation of facial swelling, is a technique of simple application, objective, reproducible, reliable, decreasing the variables of error. Based on these data, it is possible to conclude that piezo surgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the post-operative swelling, it does not show an advantage over classical rotary instruments. Trial registration Registered on ClinicalTrials.gov (ID: NCT05488028, on 04/08/2022). Approved by Ethical Committee of Messina: (ID 01–2020, on 27/04/2020).

Objectives To evaluate the clinical efficacy of an autonomous robotic system in reducing bone resection volume and operative time for impacted teeth extraction in children, compared to conventional surgical techniques. Methods A single-blinded randomized controlled trial enrolled 10 pediatric patients impacted teeth. Each participant received robotic surgery (test group) and conventional surgery (control group) on contralateral quadrants. Primary outcomes were bone resection volume ratio (measured via pre-/post-op CBCT segmentation) and operative time. Secondary outcomes included nerve injury incidence and healing outcomes. Differences were analyzed via paired t-tests and generalized estimating equations. Results In this RCT of 10 children with impacted teeth, robotic surgery reduced total operative time by 35% (30.7 ± 6.3 vs. 39.3 ± 4.2 min, p  < 0.05) and bone resection time by 65% (8.6 ± 3.3 vs. 24.2 ± 4.8 min, p  < 0.001), while eliminating nerve injuries (0 vs. 1 case). Volumetric analysis confirmed 42% less bone resection (56.8 ± 9.2% vs. 98.4 ± 13.2%, p  < 0.001) through automated segmentation and Boolean subtraction. Conclusion This first RCT on autonomous robotic surgery for pediatric impacted teeth confirms its minimal invasiveness, and operative efficiency. The system significantly reduces bone loss while ensuring anatomical safety in complex pediatric cases. Clinical significance As the pioneering autonomous robotic platform validated through RCT for pediatric oral surgery, this technology offers a clinically viable solution to minimize surgical trauma and operative risks in children, addressing critical challenges in dentoalveolar procedures. Registry Chinese Clinical Trial Registry, TRN: ChiCTR2400092822, Registration date: 25 November 2024.

Summary This study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis. Purpose To describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT). Methods This retrospective cohort study collected clinical and CBCT data from 176 patients. The study group ( n  = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected ( n  = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher’s exact, Mann–Whitney U , and t -tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ − , and bisphosphonate and denosumab patients/sites. Significance was set at p  ≤ 0.05. Results From the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features ( p  > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis. Conclusion Osteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.

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

Previous findings indicated that the laser photobiomodulation is more effective than the control or placebo in preserving the alveolar socket. This study aimed to compare two different lasers regarding their effectiveness in aiding alveolar socket preservation. Twenty extraction sockets were selected then divided into two equal groups. Group A was exposed to 650 nm Diode laser, and Group B to 810 nm Diode laser following the same protocol and parameters after a standard alveolar socket preservation procedure with collagen plug. Radiographic analysis with cone beam computed tomography was done to compare the alveolar bone surface area immediately after extraction and three months post-operatively, while bone samples collected before implant drilling were histologically examined for newly formed bone evaluation and histomorphometric analysis in terms of percentage of new bone surface area, percentage of unmineralized bone and finally, immunohistochemical analysis of Osteocalcin reaction surface area as well as optical density. Radiographically, infrared (810 nm) Diode effect on alveolar bone surface area has significantly exceeded the red laser, while histologically, red (650 nm) Diode has demonstrated statistical significance regarding all parameters; newly formed bone surface area percentage, unmineralized bone area percentage and finally Osteocalcin bone marker reaction surface area percentage and optical density. Under the specified conditions and laser parameters, photobiomodulation using the 810 nm Diode got the upper hand radiographically, yet histologically, the red 650 nm Diode managed to dominate all histological parameters when both employed as an adjunct to alveolar socket preservation procedures.