Postoperative customary outcomes and complications after extraction of impacted mandibular third molars and influence of surgery on the adjacent second molar

  • Tian Zhang Zhejiang University School of Medicine, Second Affiliated Hospital, Department of Oral and Maxillofacial Surgery, Hangzhou, China
  • Chen Liu Capital Medical University, Beijing Stomatological Hospital, Department of Wangfujing General Dentistry, Beijing, China
Keywords: molar;, oral surgical procedures;, piezosurgery;, tooth extraction;, tooth, impacted;, treatment outcome.

Abstract


Background/Aim. Extraction of impacted mandibular third molars (IMTMs) may be difficult due to a hidden position, anatomical structure, and limited operating space. Therefore, searching for an effective and safe extraction method has always been the focus of research. The aim of this study was to examine postoperative customary outcomes and complications after the extraction of IMTMs and the possible influence of surgery on the adjacent second molar. Methods. A total of 86 patients with IMTMs, admitted from March 2022 to March 2024, were randomized into two equal groups: the control group (CG) and the study group (SG), each consisting of 43 patients. Traditional IMTM extraction was performed for CG, while piezosurgery was conducted for SG. Clinical indicators, customary outcomes (pain degree, swelling degree, and degree of mouth opening limitation), and complications were compared between the two groups. Results. The pain factor levels and periodontal status of the adjacent second molar were observed pre- and postoperatively. In SG, the operation time was shorter and intraoperative blood loss was less than in CG (p < 0.05). After surgery, the Visual Analogue Scale scores were higher in both groups than preoperatively, but they were lower in SG than in CG (p < 0.05). The degrees of swelling and mouth opening limitation were lower in SG than in CG (p < 0.05). SG had a lower percentage of complications than CG on the 30th day postoperatively (p < 0.05). Conclusion. For IMTM extraction, patients receiving piezosurgery have satisfactory short-term healing outcomes, accompanied by good long-term outcomes of the adjacent second molar.

References

Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cun-ningham LL, Van Sickels JE. Third molar surgery: Past, pre-sent, and the future. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132(5): 523–31.

Gulnahar Y, Alpan AL. Comparison of postoperative morbidi-ty between piezoelectric surgery and conventional rotary in-struments in mandibular third molar surgery: a split-mouth clinical study. Med Oral Patol Oral Cir Bucal 2021; 26(3): e269–75.

Del Rey YC, Rikvold PD, Johnsen KK, Schlafer S. A fast and reli-able method for semi-automated planimetric quantification of dental plaque in clinical trials. J Clin Periodontol 2023; 50(3): 331–8.

Suryavanshi VG, Tale RK, Aasole AG, Barge AK, Sanikop S, Go-pashetti P. Assessment of IL-8 Levels in Saliva of Healthy and Chronic Periodontitis Individuals. J Pharm Bioallied Sci 2024; 16(Suppl 1): S825–7.

P SM, S S. Effectiveness of Microneedling Technique Using Olive Oil on the Severity of Gingival Inflammation and Plaque Accumulation: A Randomised Controlled Trial. Cure-us 2024; 16(4): e59415.

Canullo L, Rakic M, Corvino E, Burton M, Krumbeck JA, Chittoor Prem A, et al. Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integra-tion: a proof-of-concept randomized study. BMC Oral Health 2023; 23(1): 27.

Chen YW, Chi LY, Lee OK. Associations between aging and second molar diseases in patients having adjacent impacted third molar extraction. J Formos Med Assoc 2021; 120(1 Pt 2): 380–7.

Patel PS, Shah JS, Dudhia BB, Butala PB, Jani YV, Macwan RS. Comparison of panoramic radiograph and cone beam comput-ed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation. Indian J Dent Res 2020; 31(1): 91–102.

Mann A, Scott JF. Coronectomy of mandibular third molars: a systematic literature review and case studies. Aust Dent J 2021; 66(2): 136–49.

Jiang S, Zhou B, Li Z, Gao J, Wang P. Comparison of the effects of two extraction methods on the alveolar ridge preservation of Maxillary Anterior Teeth. Pak J Med Sci 2023; 39(2): 549–52.

Wang L, Liu Y, Wang S, Li J, Sun Y, Wang J, et al. Research on ultrasonic bone cutting mechanism based on extended finite element method. Biomech Model Mechan 2024; 23(3): 861–77.

Yang Y, Bao DY, Ni C, Li Z. Three-dimensional positional re-lationship between impacted mandibular third molars and the mandibular canal. BMC Oral Health 2023; 23(1): 831.

Kaposvári I, Körmöczi K, Csurgay K, Horváth F, Ashourioun AH, Buglyó A, et al. Delayed-onset infections after lower third mo-lar surgery: A Hungarian case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132(6): 641–7.

Cicciù M, Stacchi C, Fiorillo L, Cervino G, Troiano G, Vercellotti T, et al. Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instru-ments: a systematic review, meta-analysis, and trial sequential analysis. Int J Oral Maxillofac Surg 2021; 50(1): 121–31.

Hamad SA. Outcomes of coronectomy and total odontectomy of impacted mandibular third molars. Int Dent J 2024; 74(2): 195–8.

Zhang Y, Chen X, Zhou Z, Hao Y, Li H, Cheng Y, et al. Effects of impacted lower third molar extraction on periodontal tissue of the adjacent second molar. Ther Clin Risk Manag 2021; 17: 235–47.

Miguel DCN, Oliveira RDS, Panzarella FK. Postoperative Complications After Extraction of impacted mandibular third molars: A clinical observational study on dental position and risks. J Int Soc Prev Community Dent 2025; 15(2): 155–72.

Genç BGÇ, Orhan K, Or S. A clinical comparison of Er: YAG Laser, piezosurgery, and conventional bur methods in the impacted third molar surgery. Photobiomodul Photomed Laser Surg 2023; 41(6): 283–90.

Caputo A, Rubino E, Marcianò A, Peditto M, Bellocchio AM, Nu-cera R, et al. Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial. BMC Oral Health 2023; 23(1): 233.

Steel BJ, Surendran KSB, Braithwaite C, Mehta D, Keith DJW. Current thinking in lower third molar surgery. Br J Oral Max-illofac Surg 2022; 60(3): 257–65.

Civak T, Ustun T, Yilmaz HN, Gursoy B. Postoperative evalua-tion of Er: YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. J Crani-omaxillofac Surg 2021; 49(1): 64–9.

Nogueira DGM, Leão JC, Sales PHDH, Silva PGB, Gomes ACA. Piezoelectric surgery is effective in reducing pain, swell-ing, and trismus after removal of impacted lower third molars: A meta-analysis. J Oral Maxillofac Surg 2023; 81(4): 483–98.

Nehme W, Fares Y, Abou-Abbas L. Piezo-surgery technique and intramuscular dexamethasone injection to reduce postop-erative pain after impacted mandibular third molar surgery: A randomized clinical trial. BMC Oral Health 2021; 21(1): 393.

Alraqibah MA, Rao JKD, Alharbi BM. Periotome versus piezo-tome as an aid for atraumatic extraction: A randomized con-trolled trial. J Korean Assoc Oral Maxillofac Surg 2022; 48(6): 356–62.

Costa SM, Ribeiro BC, Gonçalves AS, Araújo LM, Toledo GL, Amaral MB. Double blind randomized clinical trial comparing minimally-invasive envelope flap and conventional envelope flap on impacted lower third molar surgery. Med Oral Patol Oral Cir Bucal 2022; 27(6): e518–24.

Wu L, Wang S. Effect of Ultrasonic Osteotome on therapeu-tic efficacy and safety of spinal surgery: A system review and meta-analysis. Comput Math Methods Med 2022; 2022: 9548142.

Blagova B, Krastev D, Malinova L. Conventional drilling versus ultrasound and laser osteotomy in mandibular third molar sur-gery: A comparative study. Lasers Surg Med 2023; 55(10): 862–70.

Bernabeu-Mira JC, Peñarrocha-Oltra D, Peñarrocha-Diago M. Coronectomy of impacted mandibular third molars: A clinical and radiological retrospective case series study with 2-9 years of follow-up. Med Oral Patol Oral Cir Bucal 2024; 29(2): e180–6.

Published
2025/10/29
Section
Original Paper