Third molar surgery and antibiotics to prevent infection

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This review and infection of dry socket after third molar surgery identified 58 RCTs of whihc 34 contributed to a meta-analyses. The findings indicated that metronidazle and amoxicillin did reduce infection but the findings were of low certainty.

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Intraosseous injection or inferior alveolar nerve block for third molar surgery?

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This review comparing the anaesthetic efficacy of intraosseous injection(IO) and conventional inferior alveolar nerve block (INAB) in mandibular third molar surgery included 4 small RCTs. The findings suggest no significant difference between IO and INAB techniques.

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Ibuprofen prior to lower third molar removal

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This review of the effect of pre-emptive ibuprofen on post-operative pain after lower third molar surgery included 5 RCTs. Only one of the included studies was at low risk of bias so there is insufficient evidence to support the routine use of pre-emptive ibuprofen to reduce post-operative pain after lower third molar removal

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Third molar surgery – Er:Yag lasers and post-operative problems

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This review of the effectiveness of Er:YAG lasers in reducing pain, oedema and trismus compared to rotary instruments for the removal of impacted lower third molars included 6 small studies only one of which was at low risk of bias. The findings suggest a reduction in swelling and a small reduction in pain however the findings should be viewed cautiously because of the limited amount and quality of the evidence.

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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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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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Third molar surgery – Lingual or buccal-based flaps?

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This review of postoperative discomfort, operative time, and wound healing in the short-term follow-up following surgical extraction of lower third molars with lingual- or buccal-based flaps included 7 RCTs. The quality of the included studies was limited and few differences were seen between the type of flaps.

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Third molar surgery: Does low-level laser therapy reduce post-operative morbidity?

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This review of whether low-level laser therapy (LLLT) is effective in reducing postoperative morbidity in patients undergoing surgical removal of mandibular third molars included 17 RCTs. The findings suggest a reduction in post-operative swelling but not pain or trismus.

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Tooth extraction: Do antibiotics prevent complications?

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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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