Periodontal status of mandibular second molar after extraction of impacted mandibular third molars- a prospective clinical trial

Abstract

Mandibular third molar (M3) extraction is the common surgical procedures carried out; however, one of the complications is development of periodontal disease in adjacent second molars (M2). Hence the purpose of this study was to evaluate the effect of extraction of M3 on the periodontal status of M2. Materials and Methods Study included 120 sites with mandibular M2 adjacent to the impacted M3. Plaque index(PI), gingival index(GI), probing pocket depths(PD), clinical attachment levels(CAL), Gingival recession(GR) and alveolar bone height(ABH) before and 9-12 months after surgical extraction of M3 were assessed. Patients perception was assessed using dichotomous rating. Four types of impactions(IMP) were included along with surgical cofactors like degree of impaction, flap design, bone removal, tooth sectioning. Results At baseline mesioangular and horizontal IMP showed greater PPD and CAL. After extraction of M3 there was significant decrease in PPD & CAL. 14% cases showed significant increase gingival recession at the distobuccal of M2. Although 10.9% of patients had an alveolar bony defect(ABD) distal to the M2, there was considerable improvement in ABH from baseline. The ABDs are mostly associated with mesioangular and horizontal IMP. Conclusion Extraction of impacted M3 proves to be beneficial on periodontal status of M2. However, occasionally, mesioangular and horizontal IMP are likely to develop ABD distal to M2 and hence can be followed by regenerative procedures to prevent the formation of ABD.

Keywords

• Alveolar bone defect
• impacted tooth
• mandibular third molar
• mandibular second molar
• tooth extraction

References

1. 1. Lima CJ, Silva LC, Melo MR, Santos JA, Santos TS. Evaluation of the agreement by examiners according to classifications of M3. Med Oral Patol Oral Cir Bucal 2012;17:281–316.
2. 2. Lieblich SE, Dym H, Fenton D. Dentoalveolar Surgery. J Oral Maxillofac Surg. 2017;75:50-73.
3. 3. Santosh P. Impacted Mandibular M3: Review of Literature and a Proposal of a Combined Clinical and Radiological Classification. Ann Med Health Sci Res 2015;5: 229-34.
4. 4. Zhang Y, Chen X, Zhou Z, Hao Y, Li H, Cheng Y, Ren X, Wang X. Effects of Impacted Lower M3 Extraction on Periodontal Tissue of the Adjacent M2. Ther Clin Risk Manag. 2021;17:235-247.
5. 5. Lytle JJ. Etiology and indications for the management of impacted teeth. Northwest Dent 1995;74:23–32.
6. 6. Blakey GH, Marciani RD, Haug RH, Phillips C, Offenbacher S, Pabla T, et al. Periodontal pathology associated with asymptomatic M3. J Oral Maxillofac Surg 2002;60:1227–33.
7. 7. Petsos H, Korte J, Eickholz P, Hoffmann T, Borchard R. Surgical removal of M3 and periodontal tissues of adjacent M2. J Clin Periodontol 2016;43:453–60.
8. 8. Coleman M, McCormick A, Laskin DM. The incidence of periodontal defects distal to the maxillary M2 after impacted M3 extraction. J Oral Maxillofac Surg 2011;69:319–21.

9. 9. Dodson TB. Management of mandibular M3 extraction sites to prevent periodontal defects. J Oral Maxillofac Surg 2004;62:1213–24.
10. 10. Sammartino G, Tia M, Bucci T, Wang HL. Prevention of Mandibular M3 Extraction‐Associated Periodontal Defects: A Comparative Study. J Periodontol 2009;80:389-96.
11. 11. Dodson TB. Management of mandibular M3 extraction sites to prevent periodontal defects. J Oral Maxillofac Surg 2004;62:1213–24.
12. 12. Silness J, Loe H. Periodontal disease in pregnancy. Ii. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121–35.
13. 13. Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533–51.
14. 14. Montero J, Mazzaglia G. Effect of removing an impacted mandibular M3 on the periodontal status of the mandibular M2. J Oral Maxillofac Surg 2011;69:2691–97.
15. 15. White RP, Jr, Fisher EL, Phillips C, Tucker M, Moss KL, Offenbacher S. Visible M3 as risk indicator for increased periodontal probing depth. J Oral Maxillofac Surg 2011;69:92–103.
16. 16. Stephens RJ, App GR, Foreman DW. Periodontal evaluation of two mucoperiosteal flaps used in removing impacted mandibular M3. J Oral Maxillofac Surg 1983;41:719–24.
17. 17. Ash MM. M3 as periodontal problems. Dent Clin North Am 1964;45: 51–61.
18. 18. Chin Quee TA, Gosselin D, Millar EP, Stamm JW. Surgical removal of the fully impacted mandibular M3. The influence of flap design and alveolar bone height on the periodontal status of the M2. J Periodontol 1985;56:625–30.
19. 19. Archer W. Oral and maxillofacial surgery. Philadelphia: Saunders; 1975.
20. 20. Faria AI, Gallas-Torreira M, Lopez-Raton M. Mandibular M2 periodontal healing after impacted M3 extraction in young adults. J Oral Maxillofac Surg 2012;70:2732–2741.
21. 21. Ylipaavalniemi P, Turtola L, Rytomaa I, Helminen S, Jauhiainen L. Effect of position of wisdom teeth on the visible plaque index and gingival bleeding index. Proc Finn Dent Soc 1982;78:47–49.
22. 22. Giglio JA, Gunsolley JC, Laskin DM, Short K. Effect of removing M3 on plaque and gingival indices. J Oral Maxillofac Surg 1994;52:584–87.
23. 23. Kruger GO. Oral & Maxillofacial Surgery. St Louis (MO): Mosby; 1984
24. 24. Kugelberg CF, Ahlstro¨m U, Ericson A, Hugoson A, Kvint S. Periodontal healing after impacted lower M3 surgery in adolescents and adults. A prospective study. Int J Oral Maxillofac Surg. 1991;20:18–24.
25. 25. Krausz AA, Machtei EE, Peled M. Effects of lower M3 extraction on attachment level and alveolar bone height of the adjacent M2. Int J Oral Maxillofac Surg 2005;34:756–60.
26. 26. Kaldahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK. Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. J Periodontol 1996;67:93–102.
27. 27. Dodson TB. Is there a role for reconstructive techniques to prevent periodontal defects after M3 surgery? J Oral Maxillofac Surg 2005;63:891–96.
28. 28. Peng KY, Tseng YC, Shen EC, Chiu SC, Fu E, Huang YW. Mandibular M2 periodontal status after M3 extraction. J Periodontol. 2001;72:1647-51.
29. 29. Prósper AA, Mira GB, Morón LC, Diago PM. Distal probing depth and attachment level of lower M2 following surgical extraction of lower M3: a literature review. Med Oral Patol Oral Cir Bucal. 2010;15:755-59.
30. 30. Faria AI, Gallas-Torreira M, López-Ratón M, Crespo-Vázquez E, Rodríguez-Núñez I, López-Castro G. Radiological infrabony defects after impacted mandibular M3 extractions in young adults. J Oral Maxillofac Surg. 2013;71:2020-28.
31. 31. Kugelberg CF, Ahlstrom U, Ericson S, Hugoson A, Kvint S. Periodontal healing after impacted lower M3 surgery in adolescents and adults. A prospective study. Int J Oral Maxillofac Surg. 1991a;20:18–24.
32. 32. Aniko-Włodarczyk M, Jaroń A, Preuss O, Grzywacz A, Trybek G. Evaluation of the Effect of Surgical Extraction of an Impacted Mandibular M3 on the Periodontal Status of the M2-Prospective Study. J Clin Med. 2021 16;10(12):2655.
33. 33. Passarelli, PC, Lajolo, C, Pasquantonio, G, et al. Influence of mandibular M3 surgical extraction on the periodontal status of adjacent M2. J Periodontol. 2019; 90: 847– 855.