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1 s2.0 S1870199X17300149 Main PDF
1 s2.0 S1870199X17300149 Main PDF
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ABSTRACT RESUMEN
Objective: To determine differences between bone healing and soft Objetivo: Determinar las diferencias en la cicatrización ósea y teji-
tissues in the lower jaw of patients subjected to impacted third molar dos blandos en el maxilar inferior de pacientes sometidos a exodon-
extraction after using a high and low speed rotary devices. Material cia de terceros molares incluidos después de la utilización del ins-
and methods: Crossed clinical assay-type intervention study. trumental rotatorio de alta y baja velocidad. Material y métodos:
Under local anesthsesia, forty tooth extractions were performed Estudio de intervención tipo ensayo clínico cruzado, se efectuaron
(right and left) from 20 healthy patients. Two groups were thus 40 extracciones dentarias (derechas e izquierdas) en 20 pacientes
formed: in group 1 high speed hand-piece was used, in group 2, sanos bajo anestesia local, para lo que se formaron dos grupos: en
low speed hand-piece was employed. Index cards were used to el grupo I se utilizó la pieza de alta velocidad y en el grupo 2 la pie-
record time devoted to each patient as well as preoperative and za de baja velocidad; se registró en una ſcha el tiempo empleado
postoperative clinical data related to inƀammation, pain, opening en cada paciente y los datos clínicos preoperatorios y postoperato-
limitations, bone healing and periodontal changes in the adjacent rios con relación a la inƀamación, dolor, limitación de la apertura,
teeth. Results: When comparing high and low speed hand-pieces, cicatrización ósea y cambios periodontales a nivel de órganos den-
statistically signiſcant differences were found between pain, surgical tarios adyacentes. Resultados: Existen diferencias estadísticamen-
time and probing depth; it was observed that low speed hand-piece te signiſcativas entre dolor, tiempo quirúrgico y en la profundidad al
generated lesser aggression to soft tissues. Conclusions: Accurate sondaje entre la pieza de alta y baja velocidad siendo la pieza de
use of low speed hand-pieces allows a decrease of surgical time baja la que genera menor agresión a los tejidos blandos. Conclu-
thus providing the patients with more suitable postoperative siones: El adecuado empleo de la pieza de baja velocidad permite
evolution. una reducción del tiempo quirúrgico proporcionando una mejor evo-
lución postoperatoria a los pacientes.
Key words: (Mesh Database), osteogenesis, pain, inƀammation, third molars, osteotomy.
Palabras clave: (DeCS BIREME), osteogénesis, dolor, inƀamación, terceros molares, osteotomía.
INTRODUCTION
Extraction of impacted third molars is a very * DDS, Specialist in Stomatology and Oral Surgery, Education
Graduate, Professor, University of Cartagena.
common procedure in oral and maxillofacial surgery. §
DDS, PhD in Biomedical Sciences, Professor, University of Car-
Technique and instruments used to perform the tagena. Periodontics Specialist, Universidad Javeriana. Educa-
www.medigraphic.org.mx
procedure have changed with time, up to the use
of low-speed rotary instruments which presently is
||
tion Graduate, Universidad del Norte.
Specialist in Oral and Maxillofacial Surgery, del Bosque Univer-
sity. Graduate School Professor in Stomatology and Oral Sur-
the preferred technique since it allows for signiſcant gery, University of Cartagena.
decrease of the operating event time and greater ¶
Oral Surgery and Stomatology Residents, University of Cartagena.
comfort for both patient and clinical operator.1
Among surgeons, there is controversy with respect Received: March 2016. Accepted: August 2016.
the use of high speed hand-piece in oral surgery due to © 2016 Universidad Nacional Autónoma de México, [Facultad de
the fact that one of the most common complication with Odontología]. This is an open access article under the CC BY-NC-
the use of this technique is subcutaneous emphysema, ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
which, by itself, can exhibit benign and limited sequels, This article can be read in its full version in the following page:
but can cause events that, when left untreated and http://www.medigraphic.com/facultadodontologiaunam
suffering complications, can potentially threaten the of percentile distribution of all studied events:
patient’s life if they evolve to pneumomediatinum, inƀammation, pain, opening limitations, bone formation,
pneumoperitoneum, pneumopericardium and probing depth and level of clinical attachment.
pneumothorax. 2 To this date, there are no reports Proportion difference and t student test were used to
in dental literature about risk of suffering the determine the existence of an association between
aforementioned or other type of complication when presences of aforementioned different events with the
using low speed handpieces.2 Up to now, there have use of both hand-pieces, a detailed data description
been no scientiſc recordings revealing data on clinical was additionally undertaken.
and radiographic postoperative differences which can
be identiſed as, among others, bone formation, pain, RESULTS
inƀammation, oral opening limitations, and periodontal
changes. With the aforementioned, the present study When compared to patients operated on with low
targeted the construction of scientiſc knowledge with speed hand-piece, patients operated with high speed
alternatives to choose between use of low or high speed hand-piece required longer surgical time, and reported
rotary instruments, which will embody the possibility of relatively more postoperative pain, lockjaw (trismus)
incurring in lesser post-surgical damage in soft tissues, and inƀammation (Figures 1 and 2).
and thus achieve greater speed of bone healing. With respect to bone healing, patients operated with
high speed hand-piece experimented greater bone
MATERIAL AND METHODS healing than those operated with low speed hand-
piece. With respect to probing depth, it was shown that
A clinical assay type intervention study was
conducted: 40 surgical extractions of impacted (right
and left) lower third molars were performed, to be 6
selected they had to be class II depth B and C (Pell
& Gregory). All clinical operators were standardized
in surgical technique and clinical measurements 4
Pain
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• Oral opening: it was calculated before 24 hours,
after 24 hours and after 7 and 21 days.
• Bone formation: 12 weeks, clarifying that bone
loss was quantiſed after 72 hours by means of a 5.13
volumetric X-ray.
• Probing depth and attachment level: was taken at
24 hours, 30 days and 12 weeks. Surgical time
after three months, there were statistically signiſcant With respect to inƀammation, in the present study
differences between probing depth in second molars a substantial increase of all three measurements
operated with high and low speed hand-pieces, could be observed when using high speed hand-
patients operated with low speed hand-piece were piece. Casas del Valle Laissle3 proposed the theory
favored (Figure 3). that it could be considered that to greater surgical
time, greater would be trauma caused to tissues,
DISCUSSION Este documento
and es elaborado
therefore, por Medigraphic
more edema would be formed; this
concurred with facts observed in the present study
Age of participants ranged from 16-24 years, where it was found that when comparing it to low
average age 19.2 years. Female was predominant speed hand-piece, high speed hand-piece caused
gender with 75%. According to literature reports such procedure lengthening, and thus more inƀammation
as that of Casas del Valles Laissle3 and Olate,4 there was caused, conſrming thus the relationship between
is concordance with this percentage, which would both variables.
lead us to think that females consult the dentist more With respect to oral opening decrease, Pedersen TK
frequently with respect to dental extraction procedures, et al8 asserted the existence of an intense relationship
the most common age when these procedures are between pain and postoperative trismus (lockjaw) in
performed is between 18 and 25 years. cases of impacted third molar extraction, this research
With respect to pain, authors such as Amin and project concurs with it, this would then indicate that
Laskin5 did not ſnd a relationship between pain and pain is an important cause of onset of trismus after
surgical time, nevertheless, in this study we did ſnd this type of surgery, since patients operated on with
meaningful data, in the sense that in procedures high-speed hand-piece experienced greater pain and
conducted with high speed hand-piece longer time although this pain only ranged from moderate to mild,
was needed for the intervention and pain was said patients suffered more oral opening limitations,
moderate, differing with the mild pain elicited with low differing from patients operated on with low speed
speed hand-piece. Nevertheless, authors such as hand-piece who always experienced mild pain and did
Romero Ruiz Haug, et al 6,7 reached the conclusion not exhibit such marked trismus.
that pain is more severe in the first 12 hours after Bone formation is a time-consuming, complex
surgical extraction of impacted lower third molars, in process. It has been shown that most changes take
the present study we concur with it, since, in spite place in the crown third of the socket, since that is
of having pain ranging from moderate to mild, the the location of grater concentrations of Bundle Bone.9
maximum pain peak was 6 (moderate) experienced in Clinical studies have documented an average of 4.0 to
the 24 hours after completing the procedure. 4.5 mm horizontal bone resorption after an extraction
4 4 4
3 3 3 3 3 3 3
Probing depth
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2 2