Periodontal Regenerative Therapy for Preventing Bone Defects Distal to Mandibular Second Molars After Surgical Removal of Impacted Third Molars: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up

“…The results of the present prospective case series indicate that the use of an alloplastic grafting material, consisting of β-TCP and CS, resulted in significant bone gain and effectively prevented periodontal defect on the distal aspect of M2, when used for treating osseous defects after the surgical removal of mesioangular or horizontal M3s in patients older than 26 years. Our results are in accordance with the findings of recent systematic reviews and meta-analyses showing that regenerative periodontal therapy is effective in preventing the distal periodontal defect of M2 after M3 extraction with regard to clinical attachment level gain, PD reduction, and BG, without increasing the risk of postoperative complications [ 2 , 3 ].…”

“…Although barrier membranes seem to be more effective than bone grafting in such clinical scenarios [ 2 , 3 ], the use of resorbable or non-resorbable membranes has several drawbacks. Non-resorbable titanium reinforced membranes are associated with soft-tissue complications, as wound dehiscence and exposure of the membrane to the oral cavity will require early membrane removal, resulting in impaired periodontal regeneration.…”

“…The presence of third molars is common in humans, and M3s are frequently found to be fully or semi- impacted in the bone [ 1 ]. The presence of a M3 that failed to erupt or is partially erupted may cause a plethora of problems, and indications for M3s removal include acute or chronic infection, pain, caries, prevention or repair of periodontal defects, pathology associated with cystic degeneration and/or neoplastic transformation of the dental follicle, and facilitation of orthodontic treatment [ 2 , 3 ]. The literature also suggests that even for asymptomatic and disease-free impacted or semi-impacted M3s in young adults, there is an accumulative high risk for extraction in the future [ 4 ].…”

“…Although after the extraction of a M3 the socket is generally healed spontaneously by formation of new bone, several clinical parameters may affect the level of bony healing, and surgical removal of third molars has been associated with the risk of having persistent or developing new periodontal defects on the distal aspect of the adjacent M2 [ 5 ]. One of the most important factors seems to be the age of the patient at the time of M3 removal and younger patients (age < 25) have a higher probability of uneventful healing [ 2 , 3 ].…”

“…Moreover, the positioning of a partially or fully impacted M3, as well as the periodontal status distally to the root of the M2 and the presence of bone between the M2 and the M3 are important parameters. A partially impacted M3 exposed to the oral environment is more prone to chronic infection, which may cause severe periodontal attachment loss on the distal aspect of the M2 [ 2 ]. Similarly, deeply impacted M3s in direct contact to the adjacent molar may lead to incomplete osseous healing and periodontal defects after their surgical extraction.…”