Discussion
bleeding, postoperative swelling, swelling, pain, hematoma, trismus
BLEEDING, SEQUELAE, HAND SWELLING, HEMATOMA, TRISMUS, COMPLICATIONS
Third molar surgery can be complicated. Clinicians' priority is to promote optimal treatment outcomes while maintaining the integrity of the noble structures.In oral surgery, conventional instrumentation for bone removal is performed with rotary handpieces. In recent years, piezo surgery has gained popularity. It has been considered safe and effective and uses micro vibrations with ultrasonic frequency [It promotes bone healing as it does not produce high temperatures [However, the operating time is longer compared to the use of rotary instruments [It is necessary to differentiate true complications from sequelae that are part of the postoperative course such as pain, swelling, trismus, moderate bleeding, and hematoma. These complaints are typically present in 35% of cases during the first postoperative day, 25% at 7 days, and 4% at 14 days [The incidence of complications depends on the difficulty of treatment, the severity of inclusion, and the age of the patient [Some authors have shown that pain and swelling are directly proportional to the difficulty of the procedure and the treatment time [In this split-mouth study, postoperative swelling was evaluated with facial 3d scan by comparing two different surgical techniques (piezo surgery vs. rotary instruments) in the extraction of impacted third molars.According to Winter and Pell and Gregory's classifications, included third molars were evaluated.Only patients with the same classification for third molars were enrolled.A homogeneous sample of patients and teeth was selected as age, position and anatomy may influence the postoperative course.Post-surgical facial swelling is difficult to accurately quantify because measurements are made on an irregular surface.Several papers have assessed postoperative swelling, after lower third molar surgery, by face measurements with manual techniques, obtained with a tape measure [However, this technique is operator-dependent and for that reason not objective.To date, there is no accurate and reliable measurement method in the literature for evaluating facial swelling after third molar surgery.In this study, innovative, digital measurements were used that allowed us to obtain reliable data for objective comparison.The Bellus 3D application, for scanning patients' faces, and the dental application software for obtaining the results, showed ease of use.The results obtained from our study showed no significant differences between two groups regarding postoperative swelling which contradict with other reports in the literature [We argue that this may be related to the reduced number of patients.To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters, on the other hand, the use of the application and software has financial implications.Consequently, this study is added to others in a constant effort to obtain increasingly reliable data. The main limitation of our study is represented by the small sample size. However, while image acquisition through the Bellus 3D app can be considered a very simple and straightforward procedure, image processing to evaluate swelling requires a well-versed operator and may present a steep learning curve. Moreover, every surgical procedure was performed by a single experienced oral surgeon, so results may vary together with operator skills.