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      Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar

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          Abstract

          The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.

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          Most cited references 78

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          Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog.

          Different approaches were advocated to preserve or improve the dimension and contour of the ridge following tooth extraction. In some of studies, socket 'flapless extraction' apparently had a successful outcome. The objective of the present experiment was to compare hard tissue healing following tooth extraction with or without the prior elevation of mucosal full-thickness flaps. Five mongrel dogs were used. The two second mandibular premolars ((2)P(2)) were hemi-sected. The mesial roots were retained. By random selection the distal root in one side was removed after the elevation of full-thickness flaps while on the contralateral side, root extraction was performed in a flapless procedure. The soft tissue wound was closed with interrupted sutures. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined in the microscope. The data showed that the removal of a single tooth (root) during healing caused a marked change in the edentulous ridge. In the apical and middle portions of the socket site minor dimensional alterations occurred while in the coronal portion of the ridge the reduction of the hard tissue volume was substantial. Similar amounts of hard tissue loss occurred during healing irrespective of the procedure used to remove the tooth was, i.e. flapless or following flap elevation. Tooth loss (extraction) resulted in marked alterations of the ridge. The size of the alveolar process was reduced. The procedure used for tooth extraction - flapless or following flap elevation - apparently did not influence the more long-term outcome of healing.
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            Processing of collagen based biomaterials and the resulting materials properties

            Collagen, the most abundant extracellular matrix protein in animal kingdom belongs to a family of fibrous proteins, which transfer load in tissues and which provide a highly biocompatible environment for cells. This high biocompatibility makes collagen a perfect biomaterial for implantable medical products and scaffolds for in vitro testing systems. To manufacture collagen based solutions, porous sponges, membranes and threads for surgical and dental purposes or cell culture matrices, collagen rich tissues as skin and tendon of mammals are intensively processed by physical and chemical means. Other tissues such as pericardium and intestine are more gently decellularized while maintaining their complex collagenous architectures. Tissue processing technologies are organized as a series of steps, which are combined in different ways to manufacture structurally versatile materials with varying properties in strength, stability against temperature and enzymatic degradation and cellular response. Complex structures are achieved by combined technologies. Different drying techniques are performed with sterilisation steps and the preparation of porous structures simultaneously. Chemical crosslinking is combined with casting steps as spinning, moulding or additive manufacturing techniques. Important progress is expected by using collagen based bio-inks, which can be formed into 3D structures and combined with live cells. This review will give an overview of the technological principles of processing collagen rich tissues down to collagen hydrolysates and the methods to rebuild differently shaped products. The effects of the processing steps on the final materials properties are discussed especially with regard to the thermal and the physical properties and the susceptibility to enzymatic degradation. These properties are key features for biological and clinical application, handling and metabolization.
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              Marginal flap versus paramarginal flap in impacted third molar surgery: a prospective study.

              A clinical prospective study was carried out to compare 2 flap designs-marginal and paramarginal-that are used during impacted third molar surgery. Twenty-seven healthy patients (ages 17 to 31 years) who underwent surgical removal of 4 impacted third molars, including 54 lower and 54 upper, were included. A marginal flap was used in 1 randomly chosen half of the jaw, and a paramarginal flap was used in the other half. The influence of these flaps on wound healing, periodontal pocket depth of the adjacent second molar, pain, trismus, and swelling was studied. Wound dehiscences developed in 8 paramarginal flap cases, whereas none occurred with the use of a marginal flap. The buccal and distal probing depths of the adjacent second molar were significantly bigger in marginal flaps at 5 and 10 days after surgery. However, the probing depth was similar with the use of both techniques at 3 months. Pain, trismus, and swelling were similar with both techniques. We found no advantages to the use of a paramarginal flap instead of a traditional marginal flap for removing impacted third molars.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                tcrm
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                22 March 2021
                2021
                : 17
                : 235-247
                Affiliations
                [1 ]Shanxi Medical University School and Hospital of Stomatology , Taiyuan, 030001, People’s Republic of China
                [2 ]Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials , Taiyuan, 030001, People’s Republic of China
                Author notes
                Correspondence: Xing Wang; Xiuyun Ren Shanxi Medical University School and Hospital of Stomatology , Taiyuan, 030001, People’s Republic of China Email tt1984621@163.com; rxy611@163.com
                [*]

                These authors contributed equally to this work

                Article
                298147
                10.2147/TCRM.S298147
                7997553
                33790564
                © 2021 Zhang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 2, References: 80, Pages: 13
                Funding
                Funded by: Shanxi Province Key Research and Development Program;
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                Funded by: Scientific and Technological Innovation Programs of Higher Education Institutions in Shanxi;
                Funded by: Graduate Education Innovation Project of Shanxi Province;
                This work was supported by Shanxi Province Key Research and Development Program (201903D321148), National Natural Science Foundation of China (81801004 and 82071155), Scientific and Technological Innovation Programs of Higher Education Institutions in Shanxi (2019L0438 and 2020L0209), Graduate Education Innovation Project of Shanxi Province (2020YJJG118 and J2020111).
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