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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
58 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation Rem ova l of pa rtia lly eru pte d mandi bu lar thi rd mo lars group, who received the dental hygienist treat- ment at one month after the extraction, pre- sented with a lower number of sites with plaque and sulcular gingival bleeding com- pared with the control group, but the differ- ences did not reach statistical significance. At the six-month evaluation, both groups had a clinically relevant PPD reduction distalto the second molars, and only one patient (in the control group) presented with a PPD of 6 mm. Thus, no additional surgical periodontal treat- ment was needed, except in one patient. In this respect, it should be underlined that, after the extraction of the third molars, meticulous de- bridement distaltothe second molarswas per- formed, together with removal of the granula- tion tissue. In a literature review, Aloy-Prósper et al. also concluded that debridement of the distal radicular surface of the second molars, together with oral hygiene control, reduced PPD values after the extraction of third molars.19 Leung et al., in their clinical study, concludedthat plaque controlprevented resid- ual pockets at periodontally involved second molars six months after the removal of the ad- jacent third molar.10 In our study, no bone loss distal to the sec- ond molarswas recorded. In a studyevaluating the adjunctive effect of guided tissue regener- ation in conjunctionwith surgicalremovalofan impacted third molar, Karapataki et al. con- cluded that an intrabony defect distal to the second molars would depend on the existing amount of periodontal ligament of the second molar and whether this was affected by perio- dontal disease before surgery.20 Thus, un- diagnosed periodontal lesions and the pres- ence of bacteria on the root surface of second molars might affect wound healing in the area and develop into a persistent intrabony defect. These defects require surgical treatment at a later time.21 In our study, the periodontal con- dition distal to the second molars in all of the patients (except one inthe controlgroup) atthe six-month evaluation did not require additional periodontal surgical treatment. Kan et al. investigated the periodontal con- dition distal to mandibular second molars 6–36 months after routine surgical extraction of adjacent impacted third molars in 158 sub- jects under 40 years of age.11 Three possible risk indicators were associated with localized increased PPD: third molar mesio-angular im- paction; pre-extraction signs of bone loss; and inadequate post-extraction local plaque con- trol.11 In our study, the majority of the patients (76%) were under 30 years of age, without compromised general condition, only three were smokers and none had periodontal dis- ease, except at the distal sites of their second molars. Furthermore, 79% of the subjects had bone loss distal to the second molars not ex- ceeding one-third ofthe root length and no pa- tient presented with bone loss exceeding two- thirds of the root length. All of these factors could have had a positive effect on the healing pattern. The moderate bone loss distal to the secondmolarsatbaselinecouldalsohavehada positive effect on the soft-tissue healing, pre- venting concavity in the gingiva, which could have been a retaining factorfor plaque. In the interpretation of similar studies, it is important to distinguish between those re- porting results on totally impacted and on par- tiallyeruptedthird molars. Moss et al. reported results from 7,000 subjects (mean age of 62) and found that the PPD at the first or second molars was significantly higher when partially erupted third molars were present, compared with totally impacted third molars.2 Similarly, in 52- to 74-year-old patients in the Dental Figs. 4a &b a b Figs. 4a & b Radiographic images before and six months after the extraction of tooth # 38. The bone healing distal to tooth # 37 is noticeable.