Is there a role for reconstructive techniques to prevent periodontal defects after third molar surgery?
OBJECTIVE
Among patients at high risk for second molar (M2) periodontal defects after third molar (M3) removal, does active treatment at the time of extraction, when compared with no treatment, alter the risk of postextraction M2 periodontal defects?


METHODS
We used a prospective cohort study design and a sample composed of subjects at high risk for developing M2 periodontal defects after M3 extraction, that is, age > or = 26 years, pre-existing periodontal defects (attachment level [AL] > or = 3 mm), and mesioangular or horizontal M3 impaction. The predictor variable was treatment status of the M3 extraction site. The M3 extraction sites were reconstructed with demineralized bone powder (DBP), bioresorbable guided tissue regeneration (GTR) therapy, or no treatment. The outcome variable was ALs measured at the M2 distobuccal line angle preoperatively and 26 weeks after extraction. Appropriate univariate, bivariate, and multivariate statistics were computed, and statistical significance was set at a value P < .05.


RESULTS
The cohort was composed of 12 subjects contributing 18 high-risk M3s. Twenty-six weeks after M3 removal, the ALs for GTR-treated (3.0 +/- 1.2 mm), DBP-treated (1.4 +/- 0.5 mm), and control (3.8 +/- 0.9) M3 sites were statistically significantly different ( P = .002). Tukey post-hoc comparisons revealed a statistically significant difference between control and DBP ALs ( P = .001) and GTR-treated and DBP-treated ALs ( P = .037). There was no statistically significant difference in ALs between control and GTR-treated M3s ( P = .35).


CONCLUSIONS
The results of this study suggest that subjects at high risk for developing M2 periodontal defects after M3 removal may benefit from the use of DBP placed at the time of M3 extraction to enhance periodontal healing.
Dodson
Thomas B
TB
Department of Oral and Maxillofacial Surgery, Massatusetts General Hospital, Boston, MA 02114, USA. tbdodson@partners.org
D000328:Adult; D016301:Alveolar Bone Loss / Q000209:etiology / Q000517:prevention & control*; D001857:Bone Matrix / Q000637:transplantation; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D015999:Multivariate Analysis; D019647:Oral Surgical Procedures; D017622:Periodontal Attachment Loss / Q000517:prevention & control; D011446:Prospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome