Year : 2022

Volume : Volume 13

Issue : Issue 5

Address for correspondence :
: Sudhir Kumar
Sudhirk1417@gmail.com

Abstract

Introduction: One of the most common surgical procedures advocated by many of the oral and maxillofacial surgeons and many general dentists is extraction of impacted third molar due to insufficient anatomical space to accommodate normal eruption. The removal of these teeth is usually correlated with moderate-to-severe post-operative pain, swelling, and trismus whereas complications such as infection, dry socket, trigeminal nerve injuries, and, rarely, it may cause fracture of the mandible which is less common to occur. Due to the anatomical constraints during the osteotomy (bone removal) procedure, it is important to choose an apt surgical method and instruments. Although the conventional rotary bur technique requires short operator time than piezoelectric technique during osteotomy, it causes marginal osteonecrosis
due to high temperature. Dental anxiety is an upsurge during tooth extraction due to the unpleasant notion and a longer surgical operator time which stimulates the adrenal cortex and increased secretion of cortisol. Hence, a reduced noise and vibration environment produced by the piezoelectric unit can help reduce such stress and hence be more psychologically comfortable for the patient. Materials and Methods:
About 50 healthy adult individuals reporting to the department were taken into this study who were in need of prophylactic removal of the lower third molar impactions with ideal conditions were considered. Inclusion criterion is Healthy individuals above 20 years of age and individuals having vertical, mesioangular, and horizontal impactions based on radiographic interpretations. Exclusion criterion includes
individuals with systemic diseases that could possibly interferes healing, individuals who were not willing to provide consent, those under antibiotic regime in the past 6 weeks or who require antibiotic prophylaxis before extraction, patients with acute infections at the site of impacted teeth. As soon as the individuals reported to the department, the study protocol was explained and written consent was obtained
from the participants. Study participants were randomly allotted into two groups so that the surgery difficulty level will remain the same in both the groups. After obtaining adequate local anesthesia using inferior alveolar, long buccal, and lingual nerve blocks under strict aseptic conditions, surgical procedures were followed in both the groups as per the protocol. Hand piece and foot pedal were the common components
of the rotary device, and it was attached to the power plug. The rotary speed used was set at the range around 35,000 rpm. Seven hundred and two and 703 rotary burs were used. Results: The comparison of all the study participants according to mean age. Mean age of study individuals in the piezosurgery group was 28.60 ± 2.69, which was slightly less than the mean age of the rotary group at 30.52 ± 3.15. No
statistically significant difference was observed in mean age between the groups. Comparison of the study individuals based on the type of their impaction. There was no statistical difference for the type of impaction among the groups. The time taken for removal of impacted tooth using the piezoelectric device was 48.35 ± 15.39 and for rotary technique, it was 34.43 ± 11.31, which is less than for the piezoelectric
device. Statistically significant difference was found for time taken for the procedure between the groups. Patient satisfaction was estimated using a grading scale. The results for satisfaction of the procedure were almost same in both the groups and were without any statistically significant difference. Mouth opening was measured in millimeters, which showed a statistically significant difference (P < 0.01) measured
on the 3rd day, 5th day, and 7th day between the piezoelectric and rotary bur groups. Mouth opening was significantly better in the piezoelectric group as compared with the rotary bur group until the 7th post-operative day. Conclusion: The piezosurgery technique has proved to be a better alternative to rotary surgical technique in terms of its post-operative outcomes of pain, edema, and trismus in spite of the increased surgery duration in piezosurgery technique. Salivary cortisol level seems to be a reliable indicator of intraoperative stress; therefore, it is suggested that further scientific research is needed to study the nature of salivary cortisol response in transalveolar extraction of lower third molars.

Keywords: Osteotomy, Piezoelectric, Transalveolar extraction