Distal probing depth and attachment level of lower second molars following surgical extraction of lower third molars: A literature review

Abstract

A review of the literature is made to evaluate factors that influence probing depth and attachment level on the distal aspect of the lower second molar (L2M) following extraction of a lower third molar (L3M). The PubMed database was searched for studies published between 1997 and March 2009 using the following keywords: mandibular third molar, distal periodontal defect, distal probing depth, distal attachment level, flap design. Randomized prospective studies, with a minimum follow-up of three months for which the full text could be obtained, and that indicated the attachment level and/or probing depth on the distal surface of the L2M in both the preoperative and postoperative periods were included. In the studies obtained, flap design had no influence on distal probing depth or distal attachment level of the L2M following extraction of an L3M. Curettage of the distal radicular surface of the L2M, together with oral hygiene control by the dentist, reduced probing depth values. Various authors recommend bone regeneration techniques in patients with a distal periodontal defect prior to extraction. The placing of membranes (resorbable or nonresorbable) is not justified; however, the use of demineralized bone powder or platelet-rich plasma gel reduces the distal probing depth and attachment level of the L2M.

Effect of Surgical Intervention for Removal of Mandibular Third Molar on Periodontal Healing of Adjacent Mandibular Second Molar: A Systematic Review and Bayesian Network Meta‐Analysis

“…Nevertheless, results of these studies advocated the fact that selection of flap design does not seem to have a significant effect on the health of M2M periodontal tissues. These conclusions were in agreement with those of the overviews conducted by Karaca et al 15 and Aloy‐Prosper et al 13 Contrary to the findings of Buti et al, 47 Ramírez et al 18 in their review found insufficient evidence to recommend the use of mechanical debridement of second molars after the extraction of third molars. Aloy‐Prosper et al 13 in their review concluded that curettage of the distal radicular surface of the M2M, together with oral hygiene control, reduced PD values.…”

“…Management of impacted M3M poses another relevant challenge for the clinician because surgical removal of wisdom teeth has been associated with the risk of having persistent or developing new periodontal defects at the distal aspect of the mandibular second molar (M2M) 9–13 . To reduce the risk of developing periodontal defects, different treatment strategies have been proposed, consisting of adjunctive systematic debridement of M2M distal root surface, specific access flap designs, soft‐tissue suturing, regenerative procedures, and bone grafting techniques, for their potential benefits in periodontal healing distally to M2M compared to conventional M3Ms extractions 2 , 14 , 15 …”

“…Scientific evidence pertaining to management of M3M removal and postextraction healing has been summarized previously in different reviews, mainly being limited to qualitative evaluation 8,12,13,15‐19 . To date, it is still unclear whether any of the proposed treatment approaches result in better periodontal healing at the distal surface of the M2M.…”

Clinical Evaluation of Use of Platelet Rich Plasma in Bone Healing

“…The possibility to concentrate growth factors in a surgical wound seems to allow activation of cellular events, providing a final gain in quality and time of healing. The use of PRP has been shown to be a useful tool in aiding periodontal and bone regeneration in vivo because of the high content of growth factors [16]. Results showed that PRGF contains a pool of growth factors that significantly stimulated the proliferation of tenocytes and induced the paracrine secretion of both VEGF and HGF.…”

“…Some investigators have reported significant improvements in tissue healing and bone formation using PRP [1,4,7,8,11,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] whereas others did not observe improvements [2,5,13,14,[32][33][34][35][36]. Some have given no conclusion regarding effect of PRP application in maxillofacial region than periodontal defects [37].…”