Archive | Wisdom Teeth

Using Fibrin Glue to Help Lingual Nerve Repair

An interesting article titled “Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report,” was written by Nicholas P. Theberge and Vincent B. Ziccardi and appears in the 2016 Journal of Oral and Maxilofacial Surgery (vol. 74, pp. 1899 e1-e4). The article describes a report of a case of a woman in her 20s who had an impacted wisdom tooth removed and developed left lingual nerve numbness and pain. She later had surgery with fibrin glue to help correct the lingual nerve injury. The article reports that most lingual nerve injuries after wisdom teeth removal occurs in 0.4% to 22% of cases. Such an injury can be detrimental to patients and lead to drooling, tongue biting, self-induced thermal injuries, and changes in speech, swallowing, and taste perception. Lingual nerve deficit has been reported to have the highest incidence in distally impacted lower wisdom teeth, followed by horizontal, mesial, and vertical impactions. When an injury to the lingual nerve occurs full recovery occurs in most patients (58%) within the first 6 months and in 72% patients after 2 years. The article later describes the specific surgery done on the woman. The nerve was freed with […]

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Collagen Treatment After Wisdom Teeth Removal

An interesting article titled “Effects of Collagen Resorbable Membrane Placement After the Surgical Extraction of Impacted Lower Third Molars,” appears in the 2015 Journal of Oral and Maxilofacial Surgery (vol. 73, pp. 1457-1464) written by Isidoro Cortell-Ballester and et. al. The article explores the use of resorbable collagen membranes (RMs) in the healing of a bone defect on the distal side of a lower second molar (L2M) after surgical extraction of an impacted lower wisdom tooth. In recent years, various clinical studies have been carried out to evaluate the efficacy of guided tissue regeneration in the treatment of intraosseous defects and deep periodontal pockets on the distal aspect of lower second molars after surgical extraction of impacted wisdom teeth. Nonresorbable expanded tetrafluoroethylene membranes, resorbable polylactic acid and resorbable collagen membranes (RMs), bone graft substitutes, and platelet-rich plasma (PRP) have been used. The authors carried out a randomized, double-blinded clinical trial on guided tissue regeneration of intraosseous defects and deep periodontal pockets on the distal surface of L2Ms after surgical extraction of horizontal or mesioangular impacted wisdom teeth. The sample size was calculated at 25 patients per group to detect differences in the bone level variable of 2 mm at 6 […]

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Treating with Platelet Rich Fibrin After Wisdom Teeth Removal

An interesting article titled “Evaluation of Treatment Outcome After Impacted Mandibular Third Molar Surgery With the Use of Autologous Platelet-Rich Fibrin: A Randomized Controlled Clinical Study,” appears in the Journal of Oral and Maxilofacial Surgery written by Nilima Kumar and et al. (vol 73, pp. 1042-1049). The article sets out to explore the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing near the second molar, and progress of bone regeneration in upper wisdom teeth extraction sockets. Clinicians have identified a subpopulation of patients having wisdom teeth removed that are at ‘‘high risk’’ for periodontal defects after wisdom teeth removal (such as greater than 26 years old, pre-existing periodontal defects [attachment level, >3 mm; probing depth, >5 mm]; and horizontal or mesioangular impaction). The authors studied a patient sample that consisted of 31 patients with mesioangular or horizontal upper impacted wisdom teeth. Patients in the study were randomized by the closed-envelope method and divided into 2 groups. In one group, 16 patients had a impacted mandibular wisdom tooth surgically removed and PRF was placed into the extraction socket followed by flap approximation. The control group  had 15 patients treated with surgical removal of the impacted mandibular wisdom […]

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Bleeding After Dental Extractions in Patients on Warfarin

An interesting article titled “Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated With Warfarin” written by Anthony Febbo and et al. appears in the 2016 Journal or Oral and Maxilofacial Surgery (vol. 74, pp. 1518-1523). The article sought to explore the risk of bleeding in patients on warfarin after dental extraction. Warfarin is the most common anticoagulant used in Australia which can be used to prevent life-threatening thromboembolic events, such as stroke and deep vein thrombosis from occuring in patients at risk. Varying viewing points exisist as how to best handle these patients when a tooth or teeth need to be extracted. Some options include stopping the anticoagulant before extraction or continuing to use it while local hemostatic techniques are used. However ceasing the anticoagulant could be deadly so it is not generally used. The therapeutic effect of warfarin is measured as prothrombin time and communicated as the international normalized ratio (INR) with most patients between a value of 2 and 3 for INR. Prior studies have shown a rate of bleeding after dental extraction of approximately 2 to 8% for patients on warfarin but this includes specialistic centers with highly trained dentists or oral surgeons. The authors sought to […]

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Dental Extraction Complications in Patients on Double Antiplatelet Therapy

An interesting article titled “Hemorrhagic Complications of Dental Extractions in 181 Patients Undergoing Double Antiplatelet Therapy” written by Olga Olmos-Carrasco and et al. appears in the 2015 Journal of Oral and Maxilofacial Surgery (vol. 73, pp. 203-210). The study sought to explore if dental extractions can be done safely on patients with double antiplatelet therapy. Double antiplatelet therapy is the combination of 100 mg per day of acetylsalicylic acid and a second antiplatelet agent. This type of therapy is done to prevent blood cells from forming a clot in certain types of patients who have a history of coronary artery disease, or have had a heart attack or stroke. A total of 181 patients with a mean age of roughly 67 were included in the study.  Most of the patients (76.8%) were male. A total of 217 teeth were extracted in the study which was conducted in Madrid. During the course of extraction, a total of 165 patients  had light hemorrhage which lasted less than 30 minutes. In 15 patients (8.3%) the hemorrhage continued for more than 30 minutes. After 24 hours, 162 patients reported an absence of bleeding, while 15 patients (8.3%) had light hemorrhage, and 4 patients (2.2%) […]

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