INTRODUCTION: Antimicrobial resistance (AMR) poses a critical global health threat, with millions of deaths attributed to it annually. Antibiotic stewardship to combat AMR is the responsibility of all healthcare professionals. Despite evidence suggesting that it is unnecessary, dentists routinely prescribe prophylactic antibiotics following third molar (3M) surgeries. METHOD: This mixed-methods study examined the behavioural barriers influencing antibiotic prescribing practices within the Division of Oral and Maxillofacial Surgery at the National University Centre for Oral Health Singapore. This study used the capability, opportunity and motivation for behavioural change or COM-B framework to implement interventions targeting the behavioural barriers. RESULTS: Pre- and post-intervention data over 6 months showed a significant reduction in antibiotic prescriptions from 84.45% to 20.89%, following the implementation of COM-B strategies (P<0.001). Qualitative feedback from focus group discussions highlighted a positive shift in clinicians' attitudes towards antibiotic reduction, acknowledging the minimal infection risk associated with non-prescribing practices. Notably, complication rates remained stable throughout the study period, indicating no adverse effects from reduced antibiotic usage. CONCLUSION These findings demonstrated that the COM-B model can be successfully applied to modify deeply ingrained prescription habits, and underscored the effectiveness of a structured behavioural change intervention in enhancing compliance with antibiotic stewardship guidelines. The study advocates continuation of initiatives to sustain this positive trend and mitigate AMR in clinical practice.
Humans ; Molar, Third/surgery* ; Anti-Bacterial Agents/therapeutic use* ; Singapore ; Antimicrobial Stewardship/methods* ; Practice Patterns, Dentists'/statistics & numerical data* ; Antibiotic Prophylaxis ; Female ; Attitude of Health Personnel ; Male ; Tooth Extraction ; Adult ; Focus Groups ; Practice Patterns, Physicians'

OBJECTIVE: To evaluate the clinical and radiographic efficacy of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis compared with natural healing, and to preliminarily propose the surgical indication. METHODS: A retrospective analysis was conducted on clinical data from patients with mandibular molars with severe periodontitis either receiving micro crestal flap-alveolar ridge preservation (MCF-ARP group) or undergoing natural healing in department of periodontology, Peking University School and Hospital of Stomatology from September 2013 to June 2021. Cone-beam computed tomography scannings performed before/immediately after extraction (as baseline) and repeated before implantation (after the extraction socket healing) were used to measure the ridge width, height and volumetric changes of the sockets, and the proportion of guided bone regeneration (GBR) during implant therapy were compared between the two groups. RESULTS: Between baseline and healing, significant differences in changes of MCF-ARP group [(8.34±2.81) mm] and natural healing group [(3.82±3.58) mm] in the distances from mandibular canal to center of the tooth socket were recorded (P < 0.001). The ridge width at 1 mm below the most coronal aspect of the crest increased by (3.50±4.88) mm in the MCF-ARP group but decreased by (0.16±5.70) mm in the natural healing group, respectively (P=0.019). After healing, the MCF-ARP group showed the distances from mandibular canal to center of the tooth socket >8 mm in all the cases, with 97.1% exceeding 10 mm. Natural healing group displayed 23.1% of the cases with center bone height < 8 mm and 61.5% exceeding 10 mm. Volume changes at the buccal and lingual aspect as well as the total socket were significantly greater in the MCF-ARP group compared with natural healing group (P < 0.001).At the time of implantation, GBR was performed in 5 out of 68 subjects (8.3%) in the MCF-ARP group, whereas 8 out of 26 subjects (30.8%) in the natural healing group required GBR, reflecting significant difference (P=0.003). CONCLUSION In the sites of mandibular molars with severe periodontitis, when the distances from mandibular canal to center of the tooth socket was not enough (less than 7 mm), clinicians could consider performing the micro crestal flap-alveolar ridge preservation to achieve augmentation for alveolar ridge and reduce the proportion of guided bone regeneration during implant therapy to reduce the difficulty and risk of injuries during implant therapy.
Humans ; Tooth Extraction ; Retrospective Studies ; Surgical Flaps ; Molar/surgery* ; Mandible/surgery* ; Female ; Periodontitis/surgery* ; Male ; Adult ; Middle Aged ; Cone-Beam Computed Tomography ; Alveolar Ridge Augmentation/methods* ; Alveolar Process/surgery* ; Tooth Socket/diagnostic imaging* ; Dental Implantation, Endosseous/methods*

OBJECTIVE: To investigate the clinical application effect of the along-axis extraction method in the extraction of impacted mandibular third molars (IMTM) and to compare the biomechanical characteristics of different root extraction techniques through three-dimensional finite element analysis. METHODS: A total of 68 patients requiring IMTM extraction were enrolled and randomly divided into two groups: the experimental group underwent the along-axis extraction method, while the control group underwent the traditional buccal bone removal and root extraction method. The duration of the procedure, intraoperative and postoperative complications were recorded. Three-dimensional finite element analysis further revealed the stress distribution in the tooth root, jawbone, periodontal ligament, and mandibular canal during different root extraction methods. RESULTS: The duration of root extraction, pain score and swelling on the first postoperative day in the control group were (7.87±3.90) min, 4.62±1.90 and (11.37±5.12) mm, respectively, which were significantly higher than those in the experimental group [(5.74±2.37) min, 3.87±1.19 and (7.22±3.39) mm, respectively]. The root fracture rate and lingual bone plate fracture rate in the control group were significantly higher than those in the experimental group (P < 0.05). The results of finite element analysis showed that the control group ' s lingual al-veolar bone had the higher peak equivalent stress, and lingual bone plate fracture was prone to occur. The periodontal ligament of the experimental group had the higher equivalent stress value, making it more likely to rip and more likely to cause root displacement. When subjected to force, the experimental group' s instantaneous root displacement was higher, but the control group ' s root displacement was more pronounced in the lingual direction. CONCLUSION This study suggests that the along-axis extraction me-thod can not only effectively shorten the operative time but also reduce postoperative complications after extraction of impacted mandibular third molars, and enhance the safety of the operation and the patient' s comfort. Three-dimensional finite element analysis shows the biomechanical characteristics of various root extraction techniques visually, serves as a valuable guide for choosing and refining clinical surgical techniques, and confirms that extracting a tooth' s root along its long axis yields better clinical results.
Humans ; Finite Element Analysis ; Tooth, Impacted/surgery* ; Tooth Extraction/methods* ; Molar, Third/surgery* ; Mandible/surgery* ; Imaging, Three-Dimensional ; Female ; Adult ; Biomechanical Phenomena ; Male ; Tooth Root/surgery* ; Young Adult ; Adolescent

OBJECTIVE: To analyze the clinical characteristics and risk factors of patients with oral bleeding. METHODS: A retrospective study was performed on patients with oral bleeding in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2019 to December 2022. The distribution of the patients ' gender, age, cause of bleeding, systemic condition, treatment methods and risk factors of hemostasis methods, and number of visits were analyzed. RESULTS: A total of 4 764 patients with oral bleeding were enrolled, including 2 660 males (55.84%) and 2 104 females (44.16%), with an average age of 40.7 years. The most common causes of oral bleeding were bleeding after tooth extraction (3 080 cases, 64.65%), followed by gingival bleeding (1 386 cases, 29.09%), bleeding after outpatient surgery (194 cases, 4.07%), maxillofacial mass bleeding (33 cases, 0.69%), postoperative bleeding of inpatient (24 cases, 0.50%), and bleeding from other causes (47 cases, 0.99%). Simple hemostatic methods were applied in 1 867 cases (39.19%) while 2 897 cases (60.81%) used complex methods, among which iodine strip tamponade and suture were the most commonly used methods of hemostasis. Logistic regression analysis showed that the male patients had a higher proportion of complex methods than the female patients; gingival bleeding were often stopped by simple hemostatic methods while complex methods were more likely to be applied in the patients with bleeding after tooth extraction. The patients with hypertension and coagulation disorders were more likely to visit the hospital for repeated bleeding. Gender and age did not affect the number of visits. CONCLUSION Oral bleeding was one of the common diseases in oral emergency. The common causes were bleeding after tooth extraction and gingival bleeding. Most patients could be treated by compression, local suture and packing of iodine strips while some cases with severe bleeding needed further treatment to stop bleeding. A minority of patients with oral bleeding could induce systemic complications, which should be paid full attention by clinicians.
Humans ; Male ; Female ; Retrospective Studies ; Adult ; Risk Factors ; Middle Aged ; Tooth Extraction/adverse effects* ; Oral Hemorrhage/epidemiology* ; Young Adult ; Adolescent ; Aged ; Child ; Hemostatic Techniques ; Emergencies ; Postoperative Hemorrhage ; Aged, 80 and over ; Child, Preschool ; Gingival Hemorrhage/etiology*

In May 2023, the Chinese Stomatological Association promulgated the group standard of "Clinical Practice Specifications for Permanent Tooth Extraction". These specifications were formulated after repeated discussions and revisions guided by relevant literature and the opinions of well-known experts in the field across the country. However, the content of the group standard is not elaborated and is limited to its writing form and requirements. As a consequence, medical workers might not easily understand and comprehend its content and knowledge points, which also limits its dissemination and wide use in primary medical units. This study aims to sort out and interpret the content of the 2023 edition of the "Clinical Practice Specification for Permanent Tooth Extraction" to help medical staff understand and apply it in clinical practice.
Tooth Extraction/standards* ; Humans ; China ; Dentition, Permanent ; Practice Guidelines as Topic

OBJECTIVES: To compare the clinical effects of concentrated growth factor (CGF) membrane and Bio-Gide ^® collagen membrane, combined with Bio-Oss ^® sticky bone respectively in alveolar ridge preservation (ARP) of maxillary anterior teeth. METHODS: Thirty patients who needed alveolar ridge preservation after maxillary anterior tooth extraction were selected and randomly assigned to the Bio-Gide group and the CGF group. In both groups, the extraction sockets were tightly filled with the Bio-Oss^® sticky bone. In the Bio-Gide group used Bio-Gide^® collagen membrane to cover the upper edge of the Bio-Oss^® sticky bone and closed the wound. The CGF group, the CGF membrane was covered on the upper edge of the Bio-Oss^® sticky bone and the wound was closed. The soft tissue wound healing status at 10 days after ARP, the changes in alveolar ridge height and width immediately after ARP and at 6 months after ARP, and the doctor-patient satisfaction at 6 months after ARP were compared and evaluated between the two groups. RESULTS: At 6 months after ARP, there was no statistically significant difference in the changes of alveolar bone width and height between the two groups (P>0.05). However, the CGF group showed better performance in soft tissue healing after ARP and doctor-patient satisfaction, and the differences were statistically significant (P<0.05). CONCLUSIONS Compared with the Bio-Gide^® collagen membrane, the combined application of CGF membrane and Bio-Oss^® sticky bone can lead to better soft tissue healing after ARP of maxillary anterior teeth and higher doctor-patient satisfaction, showing obvious advantages in ARP of maxillary anterior teeth.
Humans ; Maxilla/surgery* ; Tooth Extraction ; Alveolar Process/surgery* ; Membranes, Artificial ; Alveolar Ridge Augmentation/methods* ; Intercellular Signaling Peptides and Proteins/therapeutic use* ; Minerals/therapeutic use* ; Collagen ; Wound Healing ; Tooth Socket/surgery* ; Bone Substitutes/therapeutic use* ; Male ; Female ; Middle Aged ; Alveolar Bone Loss/prevention & control* ; Adult

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.
Humans ; Tooth Extraction/adverse effects* ; Mandible/surgery* ; Tooth Root ; Mandibular Nerve/anatomy & histology* ; Postoperative Complications/prevention & control* ; Intraoperative Complications ; Mandibular Nerve Injuries/etiology*

Dental trauma is a common oral condition in children. For single-type trauma to young permanent teeth, timely treatment often results in a high survival rate for both the teeth and the pulp. However, in cases of complex dental trauma or when supernumerary teeth are impacted near the apex of the injured tooth, the prognosis is less predictable. This article reports a case of root fracture in an immature maxillary permanent central incisor combined with impacted supernumerary tooth in the apical region. After supernumerary tooth extraction and pulp revascularization therapy, the case demonstrated a good treatment outcome over a nearly 10-year follow-up period.
Child ; Humans ; Incisor/injuries* ; Maxilla ; Tooth Extraction ; Tooth Fractures/complications* ; Tooth Root/injuries* ; Tooth, Impacted/surgery* ; Tooth, Supernumerary/surgery*

OBJECTIVES: This study aimed to establish a new treatment of the mandibular second molars with external root resorption caused by impacted teeth to preserve the affected teeth and their vital pulps. METHODS: For mandibular second molars clinically diagnosed as external root resorption caused by impacted teeth, debridement and removal of the root at the resorption site via micro-apical surgery and direct capping of the pulp with bioactive material on the surface of the root amputation via vital pulp therapy were performed immediately after the impacted teeth were extracted. RESULTS: The external root resorption of the affected tooth was ceased. It was asymptomatic with intact crown, normal pulp, periapical alveolar bone reconstruction, normal periodontal ligament, continuous bone sclerosis, and no periapical translucency in radiographic examination at the 1-year postoperative follow-up, thus showing good prognosis. CONCLUSIONS Simultaneous combination of micro-apical surgery and vital pulp therapy after extraction of impacted teeth could successfully preserve mandibular second molars with ERR caused by impacted teeth and their vital pulps.
Humans ; Tooth, Impacted/surgery* ; Molar ; Mandible ; Dental Pulp ; Root Canal Therapy ; Root Resorption/etiology* ; Tooth Extraction

OBJECTIVE: To evaluate the relevant indicators affecting difficulty in the extraction of impacted mandibular third molars and score difficulty of different operation and risk indicators, so as to build an intuitive and accurate scale to help operators make more accurate analysis and prediction of difficulty before the operation. METHODS: Based on literature and the clinical review, the difficulty indicators of tooth extraction were summarized. Firstly, 10 doctors from Peking University School and Hospital of Stomatology who had been engaged in alveolar surgery for a long time established an expert nominal group, and then rated whether the summarized indicators needed to be retained in the form of face-to-face questionnaires. A level 1 and 2 item frame for evaluating difficulty in the tooth extraction was formed after discussion; Then Delphi method was used to send a questionnaire to 30 experts by e-mail. After two rounds of scoring and modification, the scale of difficulty in the extraction of impacted mandibular third molars was formed. RESULTS: The recycling rate of two rounds of questionnaires was 100.0%, which showed that the experts were very enthusiastic about the study; The authority coefficients (Cr) of the two rounds of Delphi expert consultation were both 0.92, which showed that the results were representative and authoritative. After two rounds of grading and revision, the variable coefficient (CV) decreased and the Kendall's concordance coefficient (W) increased, which were statistically significant: In the first round, the CV was 0.24 and W was 0.56 (P < 0.001), and in the second, the CV was 0.19 and W was 0.72 (P < 0.001), which indicated that there was a good convergence among the expert opinions. Finally, a scale of difficulty in the tooth extraction containing 12 items at level A and 37 items at level B was formed, including operation difficulty indicators, risk difficulty indicators and common difficulty indicators. CONCLUSION Based on comprehensive literature retrieval, the study has put forward the concept that difficulty in the extraction of impacted mandibular third molars is composed of operation difficulty and risk difficulty. Using Delphi method, the long-term clinical experience and professional knowledge of experts are transformed into quantitative indicators as a scoring scale. The scale has certain representativeness and authority.
Delphi Technique ; Humans ; Mandible/surgery* ; Molar, Third/surgery* ; Tooth Extraction ; Tooth, Impacted/surgery*