Comparative Evaluation of the Post-operative Complication following Mandibular Third Molar Surgery when using Chlorhexidine vs. Ozonated Water as an Intra-operative Irrigant: A Double-blinded Randomised Controlled Trial
Main Article Content
Keywords
impaction, Chlorhexidine, Ozonated water, Dental, Quality of life
Abstract
Introduction: One of the most common dental procedures is the surgical extraction of impacted mandibular third molars. Pain, oedema, trismus, wound infections, and alveolar osteitis are the most common morbidity-inducing complications
Objective: To evaluate the incidence of post-operative complications following third molar surgical removal, when using cold saline, ozonated water or chlorhexidine as an intra-operative irrigant.
Methods: A total of 132 patients participated in the study. Random allocation was done into one of three groups; saline irrigation, ozonated water irrigation or chlorhexidine solution irrigation. Only mandibular third molars were used in this study
Results: Chlorhexidine was found to be the most effective of the three. There were statistically significant effects of chlorhexidine on the incidence of alveolar osteitis and pain.
Conclusion: This study provided strong evidence that chlorhexidine is the optimal irrigating solution for intraoperative and postoperative third molar procedures.
References
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4. Castagnola R, Lajolo C, Minciacchi I, Getella G, Foti R, Marigo L, et al. Efficacy of three different irrigation techniques in the removal of smear layer and organisms debris from root canal microscopic study. Giornale Italiano di Endodonzia. 2014 doi: 101016/gien 201409001
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6. Sayadizadeh M, Shojaeipour R, Aminizadeh M, Horri A, Estabragh SR, Aminizadeh M, et al. Comparing a combination of saline and chlorhexidine with saline as root canal irrigation solutions in pulpectomy of the primary molars in 6-9-year-old children: A double-blind clinical trial. JDMT. 2019;8:174–82
7. Gloria JCR, Douglas-de-Oliveira W, e Silva LDA, Falci SGM, dos Santos CRR. Influence of ozonized water on pain, edema and trismus during impacted third molar surgery: A randomized, triple blind clinical trial. BMC Oral Health. 2020;20:47–50
8. Gharminia H, Hoppenreys JJM, Xi J, Fennis JP, Maal JJ, Berge SJ, Meyer GJ. Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molar: A multicenter randomized trial. Clin Oral Invest. 2017;21:71–83
1. 9.M, S, O.R, H & M, T “Prevalence of impacted teeth in adult population,” International Journal of Dentistry and Oral Science, Volume 2, Issue Special Issue 8, 2020, Pages 89-93, https://www.scopus.com/record/display.uri?eid=2-s2.0-85107827061&origin=inward&txGid=57b74ff21765ed1063b5214b9595f1b7.
9. Krishnan, S, Periasamy, S & M, A “Evaluating the incidence of distal caries in mandibular second molars due to mesioangularly impacted mandibular third molars,” International Journal of Dentistry and Oral Science, (Volume 2, Issue Special Issue 4, 2019, Article number 0012, Pages 63-68):, https://www.scopus.com/record/display.uri?eid=2-s2.0-85108113443&origin=inward&txGid=dc310ef09e4e8a755741255f791e64a6.
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11. Santhanam, A 2021, “Prevalence Of Impacted Maxillary Canines And Its Association With Other Dental Anomalies,” International Journal of Dentistry and Oral Science, https://doi.org/10.19070/2377-8075-21000347.
12. Mp, SK 2021, “Prevalence and Patterns of Impacted Maxillary third Molar in a Private Dental Institution,” International Journal of Dentistry and Oral Science, 3820–3826, https://doi.org/10.19070/2377-8075-21000783.
13. Kanitkar R, Balihallimath L. Comparison of effect of ozonated water with normal saline as an irrigant on post-operative pain, swelling and trismus following the surgical extraction of impacted mandibular third molar. Paripex-Ind J Res. 2017;6:105–12
14. Menon, V & Muthusekhar, MR “Effectiveness of anti-inflammatory properties of combination of bromelain,trypsin and rutoside with combination of diclofenac and serratiopeptidase following surgical removal of impacted mandibular third molar-a randomised double blinded clinical tria,” International Journal of Dentistry and Oral Science, (Volume 8, Issue 9, 2021, Pages4217-4221)
15. Marimuthu, M 2021, “Dental Impactions Performed Under General Anaesthesia - A Retrospective Study On The Frequency and Implications,” International Journal of Dentistry and Oral Science, https://doi.org/10.19070/2377-8075-21000355.
16. Lone PK, Jamwal R, Lone BA. Comparison of two different irrigating solutions; 3% hydrogen peroxide and 0.12% chlorhexidine in pericoronitis of partially erupted mandibular third molars. Int J Contemp Med Res. 2016;3:3353–6
17. Bhat, S, Periasamy, S & M, A “Incidence of residual periodontal defects distal to second molar due to a mesioangular mandibular impacted third molar,” International Journal of Dentistry and Oral Science, Volume 8, Issue 7, 2021, Pages 3119-3123.
18. Muthusekhar, “Prevalence Of Dry Socket In Surgically Removed Impacted Teeth,” International Journal of Dentistry and Oral Science, 1547–1550, https://doi.org/10.19070/2377-8075-21000307.
19. Rathod D, Mulay S. Evaluation of efficacy of Nd: YAG laser, ozonated water, and ultrasonic irrigation with 3% sodium hypochlorite for disinfection of root canal: An in vivo study. Endodontology. 2018;30:135–9
20. Muthusekhar. 2021, “Prevalence Of Dry Socket In Surgically Removed Impacted Teeth,” International Journal of Dentistry and Oral Science, 1547–1550, https://doi.org/10.19070/2377-8075-21000307.
21. Madhulaxmi & Koshy, SJ “Comparison of the clinical efficacy of two different extraction techniques in the removal of impacted maxillary third molar,” International Journal of Dentistry and Oral Science, Volume 8, Issue 4, 2021, Pages 2172-2175, https://www.scopus.com/record/display.uri?eid=2-s2.0-85104200657&origin=inward&txGid=ef577b73cd1a1d8ca52d05b5cf002d80.
22. Ganapathy, D 2021, “Psychological Aspect Of Patients Undergoing Dental Extraction,” International Journal of Dentistry and Oral Science, 1409–1412, https://doi.org/10.19070/2377-8075-21000280.
23. Shah U, Haren P, Hiren P, Byal B, Dewan H. Efficacy of chlorhexidine versus betadine as an irrigating agent during removal of bilateral impacted lower third molars. Pak Oral Dent J. 2014;34:264–8
24. Anisuzzaman MM, Bhuiyan MSR, Ahmed GI, Abdullah MK, Kafi AH, Khan S. The efficacy of normal saline versus distilled water as irrigating solution in surgical removal of mandibular third molar tooth. Bangladesh Dent Coll J. 2013;4:1–5
25. Tolstunov L. Influence of immediate post-extraction socket irrigation on development of alveolar osteitis after mandibular third molar removal: A prospective split-mouth study, preliminary report. Br Dent J. 2012;213:597–602
26. Malik T, Kaura S, Kakria P. Dental ozone: A boon for dentistry. Indian J Dent Sci. 2020;12:49–52
27. Jacob, B, Nivedhitha, MS, Ranjan, M, Ranganath, A & Siddique, R 2021, “The Antimicrobial Effect of Pomegranate Peel Extract versus Chlorhexidine in High Caries Risk Individuals Using Quantitative Real-Time Polymerase Chain Reaction: A Randomized Triple-Blind Controlled Clinical Trial,” International Journal of Dentistry, 20211–14, https://doi.org/10.1155/2021/5563945.
28. Suh Y, Patel S, Kaitlyn R, Gandhi J, Joshi G, Smith NL, et al. Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res. 2019;9:163–7
29. Chaudhary M, Singh M, Singh S, Singh SP, Kaur G. Primary and secondary closure technique following removal of impacted mandibular third molars: A comparative study. Nat J Maxillofac Surg. 2012;3:10–5
30. Prabu, D 2020, “Submucosal Dexamethasone Vs Intramuscular Dexamethasone in Surgical Extraction of Third Molars- A Retrospective Study R,” International Journal of Dentistry and Oral Science, 1222–1225, https://doi.org/10.19070/2377-8075-20000241.
31. Rn, B 2020, “Evaluation Of Suturing In Closed Extraction,” International Journal of Dentistry and Oral Science, 1132–1135, https://doi.org/10.19070/2377-8075-20000224.
32. K, G, O.R, H & D, P “Comparison and evaluation of different antibiotics prescribed to elderly patients post extractionComparison and evaluation of different antibiotics prescribed to elderly patients post extraction,” International Journal of Dentistry and Oral Science, (Volume 2, Issue Special issue 5, 2020, Pages 107-111):, https://www.scopus.com/record/display.uri?eid=2-s2.0-85114104543&origin=inward&txGid=65e2df7355197265a380dd7afd26d316.
2. Khiavi RK, Pomallahverdi M, Pourallahverdi A, Khiani SG, Oskonei SG, Mokhtari H. Pain control following impacted third molar surgery with bupivacaine irrigation of tooth socket: A prospective study. J Dent Res Dent Clin Dent Prosp. 2010;4:105–10
3. Jadhao VA, Rao A, Hande P, Mahajan M, Raktade PP, Gedam R, et al. The efficiency of three irrigating solutions after surgical removal of impacted mandibular third molars. J Contemp Dent Pract. 2018;19:1147–81
4. Castagnola R, Lajolo C, Minciacchi I, Getella G, Foti R, Marigo L, et al. Efficacy of three different irrigation techniques in the removal of smear layer and organisms debris from root canal microscopic study. Giornale Italiano di Endodonzia. 2014 doi: 101016/gien 201409001
5. Sabe-Alarab M, Al-Essa H, Jaber F, Saleh H. Role of povidone-iodine (PV-I) in surgical extraction of impacted lower third molars.: Hemostyptic and anti-edema? Int J Appl Dent Sci. 2019;5:306–9
6. Sayadizadeh M, Shojaeipour R, Aminizadeh M, Horri A, Estabragh SR, Aminizadeh M, et al. Comparing a combination of saline and chlorhexidine with saline as root canal irrigation solutions in pulpectomy of the primary molars in 6-9-year-old children: A double-blind clinical trial. JDMT. 2019;8:174–82
7. Gloria JCR, Douglas-de-Oliveira W, e Silva LDA, Falci SGM, dos Santos CRR. Influence of ozonized water on pain, edema and trismus during impacted third molar surgery: A randomized, triple blind clinical trial. BMC Oral Health. 2020;20:47–50
8. Gharminia H, Hoppenreys JJM, Xi J, Fennis JP, Maal JJ, Berge SJ, Meyer GJ. Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molar: A multicenter randomized trial. Clin Oral Invest. 2017;21:71–83
1. 9.M, S, O.R, H & M, T “Prevalence of impacted teeth in adult population,” International Journal of Dentistry and Oral Science, Volume 2, Issue Special Issue 8, 2020, Pages 89-93, https://www.scopus.com/record/display.uri?eid=2-s2.0-85107827061&origin=inward&txGid=57b74ff21765ed1063b5214b9595f1b7.
9. Krishnan, S, Periasamy, S & M, A “Evaluating the incidence of distal caries in mandibular second molars due to mesioangularly impacted mandibular third molars,” International Journal of Dentistry and Oral Science, (Volume 2, Issue Special Issue 4, 2019, Article number 0012, Pages 63-68):, https://www.scopus.com/record/display.uri?eid=2-s2.0-85108113443&origin=inward&txGid=dc310ef09e4e8a755741255f791e64a6.
10. Osborn TP, Frederikson G, Jr, Small JA, Torgerson JS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985;43:767–9
11. Santhanam, A 2021, “Prevalence Of Impacted Maxillary Canines And Its Association With Other Dental Anomalies,” International Journal of Dentistry and Oral Science, https://doi.org/10.19070/2377-8075-21000347.
12. Mp, SK 2021, “Prevalence and Patterns of Impacted Maxillary third Molar in a Private Dental Institution,” International Journal of Dentistry and Oral Science, 3820–3826, https://doi.org/10.19070/2377-8075-21000783.
13. Kanitkar R, Balihallimath L. Comparison of effect of ozonated water with normal saline as an irrigant on post-operative pain, swelling and trismus following the surgical extraction of impacted mandibular third molar. Paripex-Ind J Res. 2017;6:105–12
14. Menon, V & Muthusekhar, MR “Effectiveness of anti-inflammatory properties of combination of bromelain,trypsin and rutoside with combination of diclofenac and serratiopeptidase following surgical removal of impacted mandibular third molar-a randomised double blinded clinical tria,” International Journal of Dentistry and Oral Science, (Volume 8, Issue 9, 2021, Pages4217-4221)
15. Marimuthu, M 2021, “Dental Impactions Performed Under General Anaesthesia - A Retrospective Study On The Frequency and Implications,” International Journal of Dentistry and Oral Science, https://doi.org/10.19070/2377-8075-21000355.
16. Lone PK, Jamwal R, Lone BA. Comparison of two different irrigating solutions; 3% hydrogen peroxide and 0.12% chlorhexidine in pericoronitis of partially erupted mandibular third molars. Int J Contemp Med Res. 2016;3:3353–6
17. Bhat, S, Periasamy, S & M, A “Incidence of residual periodontal defects distal to second molar due to a mesioangular mandibular impacted third molar,” International Journal of Dentistry and Oral Science, Volume 8, Issue 7, 2021, Pages 3119-3123.
18. Muthusekhar, “Prevalence Of Dry Socket In Surgically Removed Impacted Teeth,” International Journal of Dentistry and Oral Science, 1547–1550, https://doi.org/10.19070/2377-8075-21000307.
19. Rathod D, Mulay S. Evaluation of efficacy of Nd: YAG laser, ozonated water, and ultrasonic irrigation with 3% sodium hypochlorite for disinfection of root canal: An in vivo study. Endodontology. 2018;30:135–9
20. Muthusekhar. 2021, “Prevalence Of Dry Socket In Surgically Removed Impacted Teeth,” International Journal of Dentistry and Oral Science, 1547–1550, https://doi.org/10.19070/2377-8075-21000307.
21. Madhulaxmi & Koshy, SJ “Comparison of the clinical efficacy of two different extraction techniques in the removal of impacted maxillary third molar,” International Journal of Dentistry and Oral Science, Volume 8, Issue 4, 2021, Pages 2172-2175, https://www.scopus.com/record/display.uri?eid=2-s2.0-85104200657&origin=inward&txGid=ef577b73cd1a1d8ca52d05b5cf002d80.
22. Ganapathy, D 2021, “Psychological Aspect Of Patients Undergoing Dental Extraction,” International Journal of Dentistry and Oral Science, 1409–1412, https://doi.org/10.19070/2377-8075-21000280.
23. Shah U, Haren P, Hiren P, Byal B, Dewan H. Efficacy of chlorhexidine versus betadine as an irrigating agent during removal of bilateral impacted lower third molars. Pak Oral Dent J. 2014;34:264–8
24. Anisuzzaman MM, Bhuiyan MSR, Ahmed GI, Abdullah MK, Kafi AH, Khan S. The efficacy of normal saline versus distilled water as irrigating solution in surgical removal of mandibular third molar tooth. Bangladesh Dent Coll J. 2013;4:1–5
25. Tolstunov L. Influence of immediate post-extraction socket irrigation on development of alveolar osteitis after mandibular third molar removal: A prospective split-mouth study, preliminary report. Br Dent J. 2012;213:597–602
26. Malik T, Kaura S, Kakria P. Dental ozone: A boon for dentistry. Indian J Dent Sci. 2020;12:49–52
27. Jacob, B, Nivedhitha, MS, Ranjan, M, Ranganath, A & Siddique, R 2021, “The Antimicrobial Effect of Pomegranate Peel Extract versus Chlorhexidine in High Caries Risk Individuals Using Quantitative Real-Time Polymerase Chain Reaction: A Randomized Triple-Blind Controlled Clinical Trial,” International Journal of Dentistry, 20211–14, https://doi.org/10.1155/2021/5563945.
28. Suh Y, Patel S, Kaitlyn R, Gandhi J, Joshi G, Smith NL, et al. Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res. 2019;9:163–7
29. Chaudhary M, Singh M, Singh S, Singh SP, Kaur G. Primary and secondary closure technique following removal of impacted mandibular third molars: A comparative study. Nat J Maxillofac Surg. 2012;3:10–5
30. Prabu, D 2020, “Submucosal Dexamethasone Vs Intramuscular Dexamethasone in Surgical Extraction of Third Molars- A Retrospective Study R,” International Journal of Dentistry and Oral Science, 1222–1225, https://doi.org/10.19070/2377-8075-20000241.
31. Rn, B 2020, “Evaluation Of Suturing In Closed Extraction,” International Journal of Dentistry and Oral Science, 1132–1135, https://doi.org/10.19070/2377-8075-20000224.
32. K, G, O.R, H & D, P “Comparison and evaluation of different antibiotics prescribed to elderly patients post extractionComparison and evaluation of different antibiotics prescribed to elderly patients post extraction,” International Journal of Dentistry and Oral Science, (Volume 2, Issue Special issue 5, 2020, Pages 107-111):, https://www.scopus.com/record/display.uri?eid=2-s2.0-85114104543&origin=inward&txGid=65e2df7355197265a380dd7afd26d316.
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Published
May 13, 2023
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Sabari Nathan Rajamoorthy, Hemavathy O.R Muralidoss, Murugesan Krishnan, Vinod Krishna Krishnamurthy, & Killampalli Y V Saytanarayana. (2023). Comparative Evaluation of the Post-operative Complication following Mandibular Third Molar Surgery when using Chlorhexidine vs. Ozonated Water as an Intra-operative Irrigant: A Double-blinded Randomised Controlled Trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(10), 383–391. https://doi.org/10.47750/jptcp.2023.30.10.042
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