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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
54 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation Radiographic bone loss: The presence of bone lossdistaltothesecondmolarof> 2 mmwasas- sessed on available digital bitewing or periapical radiographs(Fig.1b). Trea tm ent Surgicalphase All of the patients received an analgesic prior to surgery (1 g Alvedon, AstraZeneca, Mölndal, Sweden). The treatment was performed under aseptic conditions. After local anesthetic had been administered, a mucoperiosteal incision was placed using a #15 Bard-Parker blade ac- cording to the technique described by Norden- ram.12 Bone removaland sectioning ofthethird molarwere performed with a low-speed rotary instrumentunderconstantirrigationwithster- ile saline. After tooth extraction, the granula- tion tissue and follicular remnants were re- movedfromtheextractionalveolus.Correction of the anatomical architecture of the bone was performed under saline irrigation. The distal surface of the second molar was carefully scaled with hand instruments. After saline irri- gation, the flap was repositioned in order to cover the alveolus and sutured with two (occa- sionallythree) sutures (VICRYL, Ethicon, Somer- ville,N.J.,U.S.). After the surgery, the patients were ran- domly assigned to a test group or a control group by opening closed envelopes containing the group assignment. Postoperative adverse events Two patients came to the clinic before the su- ture removal because of postoperative pain. At this point, the extraction alveoli were rinsed with sterile saline and a prescriptionforstronger analgesics was given, but there was no need for theprescriptionofantibiotics. Postoperativetreatment The sutures were removed seven days after the surgery.Aftersutureremoval,thepatientsinthe control group did not receive any specific infor- mation or treatment. However, the patients in the test group were informed about the impor- tance of good oral hygiene, especially distal to the mandibular second molars; furthermore, they were instructed on how to use a special toothbrush (CompactTuft,Tepe Munhygienpro- dukter, Malmö, Sweden) to clean distal to the secondmolars. At the one-month examination, the patients in the test group were recalled by a dental hy- gienist at the Department of Periodontology, who was not aware of the aim of the study. The patients received supra- and subgingival scaling and oral hygiene reinstruction and motivation if needed. Plaque and gingival bleeding at the distal sites of the mandibular second molars werealsorecordedinthefollowingway: PI:Thepresenceorabsenceofplaquewasdeter- mined in the same manner as at the baseline ex- amination. Gingivalbleedingindex(GI):Thepresenceorab- sence of bleeding was determined after running the probe in the gingival sulcus distal to the secondmolars.13 Si x- mo nth re - e valu ati o n Atsixmonths,allofthepatientswererecalledfor acontrolvisit.Thisvisitwasperformedbyaperio- dontist(GS),whowas not aware ofthe group as- signment.Atthistime,thefollowingparameters wererecorded: PI:Thepresenceorabsenceofplaquewasdeter- mined in the same manner as at the baseline ex- amination. Rem ova l of pa rtia lly eru pte d mandi bu lar thi rd mo lars Figs. 2a & b a b Figs. 2a & b Six-month control. Clinically healthy gingival condition distal to the second molar, with a PPD of 3 mm (a). Bone-level measurements (b).