Coronectomy for lower third molar surgery

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This review of coronectomy versus extraction of third molars in patients at increased risk of inferior alveolar nerve (IAN) injuries included 42 observational studies. The findings indicate lower a reduction in the odds of IAN sensory loss in favour of coronectomy and an increase in the odds of surgical reintervention.

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Third molar surgery and antibiotic use

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This review of antibiotic prophylactic treatments in relation to the risk of developing dry socket (DS) and site-specific infection (SSI) after lower third molar extraction included 16 RCTs. Antibiotic did reduce the risk of DS and SSI in health patients but the number needed to treat (NNT) was high so the use should be considered only after a careful assessment of an individual patient’s risk.

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Alveolar osteitis and oral contraceptive use

Anti-epileptic drugs can influence the effectiveness of contraceptive drugs

This review assessing the risk of alveolar osteitis (AO) in in oral contraceptive users included 17 mainly observational studies. The findings showed an increased risk of developing AO in female oral contraceptive (OCP) users, RR = 1.98 (95%CI:1.42 to 2.76) compared to female non-OCP users

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Alveolar osteitis – local management interventions

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This Cochrane review update looked at local interventions used for the prevention and treatment of alveolar osteitis (dry socket) following tooth extraction. 49 RCTs were included providing moderate certainty evidence for chlorhexidine rinses and gel for probably reduction in dry sockets.

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Platelet-rich fibrin to reduce post-operative complications of lower third molar removal

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This review of platelet-rich fibrin (PRF) to reducedpostoperative complications following lower third molar surgery included 6 RCTs.
The findings are consistent to other reviews finding that PRF derivative may lead to improvements in postoperative outcomes from third molar surgery but the amount of evidence is limited.

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Platelet-rich fibrin and third molar post extraction problems

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This review of the effectiveness of leukocyte-and platelet-rich fibrin (L-PRF) and advanced-platelet-rich fibrin (A-PRF) in mandibular third molar extraction included 10 RCTs. While the findings suggest some benefits the studies are small and limited in number so the findings should be interpreted cautiously.

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Alveolar osteitis: Are warm saline mouthwashes effective for prevention?

Unequal measures

This review of the effectiveness of warm saltwater mouthwashes in preventing incidence of dry socket following tooth extraction included 8 RCTs. Only one of the included studies was considered to be at low risk of bias with the findings indicting that saltwater was more effective than no moutwash but less effective than chlorhexidine.

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Third molar extraction– effect of preoperative oral corticosteroids on pain, swelling and trismus

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Four RCTs involving a total of 212 patients were included in this review of a single pre-operative dose of oral corticosteroids in reducing pain,swelling & trismus after surgical removal of lower third molars. While the findings suggested there was little benefit to the patients none of the studies were small and none of them were at low risk of bias.

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Tooth extraction: Do antibiotics prevent complications?

The authors sought to review available literature relating to SSRI withdrawal syndromes

This Cochrane review update of the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions included 23 studies. There was very-low certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction compared to placebo.

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Third molars: Which surgical technique for removal?

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This Cochrane review upate compares the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. While the review includes 25 new trials the quality of the studies was variable with many having biases that could have influenced the findings so no meaningful conclusions could be drawn.

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