Procedure
allergy, ®, tooth
STERILE, SEPARATION, ALLERGY, ADVERSE EVENT
After enrollment, all patients underwent professional oral hygiene. A pre-surgical cone beam computed tomography (CBCT; X-Mind® Trium, Acteon®, Mérignac, FR) was performed to assess M3M surgical intervention risk according to Daugela et al. (Fig. A pre-surgical evaluation with CBCT scan was performed to assess the presumptive surgical risk for each M3MAll patients enrolled in the study were treated by a single certified oral and maxillofacial surgeon (AG), unaware of randomization. During test side surgery, patients received, in a randomized manner, a pre-operative single dose of prednisone 25 mg (Deltacortene 25 mg, Bruno Farmaceutici, Roma, IT; PG – prednisone group) or placebo (CG – control group) per os, 1 h before third molar extraction.Surgeries were performed four weeks apart.A single dose of antibiotic prophylaxis was administered 1 h before surgery: 2 g of amoxicillin or 600 mg of clindamycin in case of allergy. Immediately before surgery, the patient rinsed with a 0.20% chlorhexidine gluconate solution (Curasept, Curaden HealthCare, Italy) for one minute. Preoperative antibiotic prophylaxis and the use of local antiseptics for all patients aimed to reduce the bacterial load as much as possible near surgery.Local anesthesia with mepivacaine 2%/epinephrine 1:100.000 (Optocain, Molteni Dental, Italy) was performed to obtain inferior alveolar, lingual, and buccal nerves block. Ten minutes after anesthesia, the surgery started with the elevation of a mucoperiosteal modified-triangular flap. Osteotomy was performed with a straight low-speed handpiece and round bur (Komet Dental, Lemgo, Germany) to expose M3M, and the tooth was sectioned using a highspeed handpiece and fissure bur (Komet Dental, Lemgo, Germany) under continuous irrigation with sterile saline solution. When required, the root separation was performed, and the M3M was subsequently removed. The surgical site was revised and irrigated with physiological saline solution, and then the flap was repositioned and sutured using a 3–0 resorbable suture (Vicryl, Ethicon, United States). Figures Surgical sequence of M3M (3.8) removal. All surgical procedures were performed by the same experienced oral surgeon following a strict scheduleSurgical sequence of M3M (4.8) removal. All surgical procedures were performed by the same experienced oral surgeon following a strict scheduleAn independent operator recorded the time (in minutes) for each surgical M3M removal.Time of surgery was considered from the start of incision to the end of suturing.Each patient received the same post-operative instructions: paracetamol 1 g three times a day for two days starting immediately after surgery; rinsing with 0.2% chlorhexidine mouthwash for at least 1 min twice a day for one week, starting the day after surgery. The follow-up visits were scheduled two (T1) and seven (T2) days after surgery. Any other drug intake or adverse event after surgery was recorded. The summarized study protocol is presented in Fig. Flow chart of study procedures