Biomedical subjects
Publications and source records attributed to T Renton.
A 20-year-old patient who presented with concerns about her large mandible was found to have a generalized mild cortical sclerosis. She was treated successfully with staged orthognathic surgery, despite the dense sclerosis of the jaws.
AIM: Historically the difficulty of third molar surgery has been judged using radiologically assessed dental factors specifically tooth morphology and position. This study investigated additional factors that have a bearing on the difficulty of extraction. STUDY DESIGN: A prospective study undertaken by three clinical assistant grade surgeons who removed 354 single mandibular third molar teeth under day case anaesthesia over the 4-year period (1994-1998). METHOD: Data relating to patient, dental and surgical variables were collected contemporaneously as the patients were treated. The difficulty of extraction was estimated by the surgeons pre-operatively using dental radiographic features and compared by the same surgeon within the actual surgical difficulty encountered at surgery. Operation time strongly related to both pre and post treatment assessments of difficulty and proved to be the best measure of surgical difficulty. RESULTS: Univariate analysis identified increased patient age, ethnic background, male gender, increased weight, bone impaction, horizontal angulation, depth of application, unfavourable root formation, proximity to inferior alveolar canal and surgeon as factors increasing operative time. Multivariate analysis showed that increasing age (P = 0.014), patient weight (P = 0.024), ethnicity (P = 0.019), application depth (P = 0.001), bone impaction (p=0.008) and unfavourable root formation (P = 0.009) were independent predictors for difficulty of extraction. CONCLUSIONS: Half of the six independent factors that predicted surgical difficulty of third molar extraction were patient variables.
The aim of this study was to investigate risk factors for temporary and permanent lingual nerve injury after extraction of mandibular third molars. It was based on a 4-year prospective study of 2134 consecutive mandibular third molar operations in 1384 consecutive day case patients. During the study period (1994-1998) data were collected prospectively on patient, dental and surgical factors and correlated with lingual nerve injury using Student's t test, xi(2) and multiple logistic regression analysis. The incidence of temporary and permanent lingual nerve injury was 1 and 0.3%, respectively, per tooth. Factors that predicted temporary and permanent lingual nerve injury by univariate analysis were age, depth of application, difficulty of operation, surgeon and surgical technique used. Independent risk factors identified by multivariate analysis for temporary lingual nerve injury were perforation of the lingual plate, exposure of the nerve and increased difficulty of operation. The predictors for permanent lingual nerve injury in order of importance were perforation of the lingual plate, surgeon, increased difficulty of operation, exposure of the nerve and increased age of the patient. Surgical factors are the main contributors to lingual nerve injury during third molar extraction, but patient and dental factors are also involved.
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OBJECTIVE: To evaluate the efficacy of single doses of intravenous diclofenac sodium (25, 50 and 75 mg) in patients with post-operative pain after third-molar surgery in a randomised, placebo-controlled study. METHODS: Two hundred and sixty-nine patients (168 females) who required the removal of their impacted third molars participated in the study, which had received prior ethical approval. Surgery was completed under general anaesthesia and, during the early post-operative period, patients received either a single intravenous dose of diclofenac (25, 50 or 75 mg) or matched placebo in random, double-blind order. Pain intensity was assessed on 10-cm visual analogue scales at fixed time points throughout a 4-h investigation period. Other efficacy variables obtained included time until rescue medication and overall assessment at 4, 6, 12 and 24 h after dosing. RESULTS: Throughout the 4-h investigation period, patients treated with diclofenac reported significantly less pain than those treated with placebo (P < 0.001). No differences were observed among the three doses of diclofenac (P = 0.22). Similar results were observed at 6, 12 and 24 h after dosing. Significant differences were also noted between the placebo group and all the diclofenac treatment groups with respect to time until rescue medication (P < 0.001) and the proportion of patients taking such medication. CONCLUSION: Single doses of i.v. diclofenac (25, 50 and 75 mg) provide significant pain relief after third-molar surgery. The efficacy of this preparation does not appear to be dose related.
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Direct referral of patients for day case surgery by general medical practitioners (without hospital assessment) has become widely accepted but few facilities exist for this form of referral from general dental practice. In order to evaluate whether direct access day surgery is applicable to dentistry, the quality of referral by GDPs and hospital consultant clinics was compared in a prospective study (1994-1997) involving 1581 patients.