Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific International Journal of Recent Scientific Research Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019 ISSN: 0976-3031 DOI: 10.24327/IJRSR Research Article COMPARISON BETWEEN CONVENTIONAL ROTARY SURGICAL TECHNIQUE AND CHISEL MALLET TECHNIQUE FOR SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR Devesh Tiwari1, Akanksha Srivastava2 and Gaurav Kumar Saha3* 1Department of Dentistry, Hind Institute of Medical Sciences, AtariaSitapur (UP). India 2Department of Oral Medicine and Radiology, Index Institute of Dental Sciences, Indore, (MP) India 3Department of Dentistry, T.S. Misra Medical College & Hospital, Lucknow (UP) India DOI: http://dx.doi.org/10.24327/ijrsr.2019.1009.3930 ARTICLE INFO ABSTRACT Tooth impaction is a pathological situation where a tooth fails to attain its normal functional Article History: position. Impacted third molars are commonly encountered in routine dental practice. The impaction th Received 10 June, 2019 rate is higher for third molars when compared with other teeth. The mandibular third molar nd Received in revised form 2 July, 2019 impaction is said to be due to the inadequate space between the distal of the second mandibular th Accepted 26 July, 2019 molar and the anterior border of the ascending ramus of the mandible. Impacted teeth may remain th Published online 28 September, 2019 asymptomatic or may be associated with various pathologies such as caries, pericoronitis, cysts, tumors, and also root resorption of the adjacent tooth. Key Words: Rotary surgical technique, chisel-Mallet technique, Impacted Mandibular third Molar Copyright © Devesh Tiwari et al, 2019, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Kruger’s Envelop incision1 was used to expose the impacted mandibular third molar in both the groups. Exposure was Surgical removal of impacted third molars is one of the most followed by the removal of overlying bone to expose the crown common procedures carried out in oral and maxillofacial with the help of surgical rose head bur in Group I and by Chisel surgery. Surgical management of impacted third molar is & mallet in Group II. difficult because of its anatomical position, poor accessibility, and potential injuries to the surrounding vital structures, nerves, Surgical Techniques vessels soft tissues, and adjacent teeth during surgeries. The Group I-After exposure of surgical site with envelop incision factors contributing to the post‑operative morbidity are many, either no. 7/8 round bur or a straight no. 703 fissure bur is used. but the most important one is the trauma from bone cutting as The bur is used in a sweeping motion under constant irrigation, the procedure involve significant bone cutting, which is carried buccal and distal aspect of the mandibular third molar crown to out either by rotary cutting instruments or by chisel and mallet. exposed with the bur to the cervical level of the crown contour and a buccal trough or gutter is created .The buccal trough MATERIAL AND METHOD should be made in the cancellous bone. It is important that the The present study comprised of 30 patients with impacted adequate amount of trough is created to remove any bony mandibular third molar. The patients were randomly divided obstruction for exposure and the delivery of the tooth , into two equal groups especially around the distal aspect of the crown .The distolingual portion of the tooth should be exposed without Group I- Surgical procedure performed by surgical bur (15 cutting through the lingual bony plate to prevent damage to the patients) lingual nerve. Group II- Surgical Procedure performed by Chisel and Mallet (15 Patients) *Corresponding author: Gaurav Kumar Saha Department of Dentistry, T.S. Misra Medical College & Hospital, Lucknow (UP) India International Journal of Recent Scientific Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019 RESULTS To evaluate the effect of surgical Bur versus Chisel and mallet technique for removal of impacted third molar, study has been carried out over 30 patients divided in equal numbers of two groups. Group-I consisted of 15 patients and bone removal by surgical bur Group-II:-Consist of 15 patients and bone removal by chisel and mallet Table 1 Age wise Distribution Age group No. of % (in yrs) Patients 20 – 30 18 60 31 – 40 8 26.6 Fig 1Removal of Impacted mandibular third molar with conventional rotary 41 – 50 4 13.4 bur technique Total 30 100.00 Group II Age 20 – 30 year was most common with 60% of total patients The first chisel cut is a vertical “stop cut” which will prevent followed by 31 – 40 year of age with 26.6% of total patients. splitting of the bone along the buccal aspect the second molar Table 2 Sex wise Distribution .This is affected with a 3mm chisel used with the flat surface No. of facing anteriorly. The placing of the chisel is such that the cut Sex % is made parallel to the long axis of the second molar and Patients Male 21 70 immediately distal to it. The cut is made through the buccal Female 9 30 cortical bone and is carried as far toward the lower border of Total 30 100.00 the mandible as is required. The greater the depth of the wisdom tooth, the longer the “stop cut” will be necessary. Male gender was most common sex of patients 70% and females were 30%. The chisel is placed with its beveled edge downwards and a cut Table 3 Sex wise comparison of patients in two groups is made at an angle of 45degrees to the initial vertical cut, in such a way as to from a “V”. The chisel is driven through the Group I Group II buccal cortical bone and is the twisted, splitting a triangular N % N % piece of bone form the mesio-buccal aspect of the third molar. Male 10 66.6 11 73.3 Female 5 33.3 4 26.7 This should allow the application of an elevator under the Total 15 100.00 15 100.00 tooth. Having established this point of application, the distal = 0.69, p>0.05 (NS) bone must be removed to allow the tooth to be delivered. To remove this piece of bone, a 5mm. chisel is placed distal to the Statistically there was no significant difference in gender of third molar, with the beveled side upwards and the cutting edge two groups. Sex wise groups were similar. parallel to the external oblique ridge. (if it is placed parallel to Table 4 Comparison of Radiological Grading (WHARFE the internal aspect of the mandible, then the split may extend to Scale) in two groups the coronoid process). Group I Group II N 15 15 Mean WHERFE 8.56 9.80 Scale SD 1.88 2.30 t=1.41, p=0.16 (NS) The WHARFE scoring of group II was higher than group I but there was no significant difference in radiological grading in two groups. Table 5 Comparison of Operating Time in two groups Group I Group II N 15 15 Mean Time 37.26 34.33 SD 11.41 10.75 t=1.02, p=0.31 (NS) Fig 2 Removal of Impacted mandibular third molar with chisel mallet technique There was non-significant difference in operating time in two groups. 34595 | P a g e Devesh Tiwari et al., Comparison Between Conventional Rotary Surgical Technique and Chisel Mallet Technique for surgical Removal of Impacted Mandibular Third molar Table 6 Analysis of pain at different time interval from Pre- Table 10 Analysis of Mouth Opening at different time interval operative in the groups from Pre-operative in group Group-I Group – II Change from Change Mouth Pain in Pain (n=15) Pre- Mouth Opening Opening from 't' 'p' Sig. Time Interval 't' 'p' Sig. VAS Mn±SD operative (in mm) Mn±SD Pre-operative Mn±SD Mn±SD Pre- Pre-Operative 42.33±5.39 – – – – 1.53±0.68 – – – – st Operative 1 Day 25.67±7.86 -16.67±6.97 13.08 p>0.001 Sig 1st Day 1.76±0.43 +0.23±0.99 1.36 p>0.05 NS 3rd Day 20.67±5.96 -21.66±4.52 26.25 p<0.001 Sig. 3rd Day 1.50±1.65 0.03±1.71 0.11 p<0.05 NS 8th Day 24.33±5.94 -18.00±4.65 21.20 p<0.001 Sig. 8th Day 0.57±0.56 0.96±0.96 5.49 p<0.001 Sig. 10th Day 39.83±3.71 -2.5±3.16 4.41 p<0.001 Sig. 10th Day 0.06±0.25 1.46±0.68 11.78 p<0.001 Sig. 15th Day 42.73±4.33 +0.40±2.17 1.01 p=0.32 NS. th 15 Day 0 1.53±0.68 12.32 p<0.001 Sig. -ve sign shows decrease in Mouth Opening st +ve sign shows increase in Mouth Opening from Pre-operative Positive sign shows increase in pain at 1 from pre-operative. There was significant decrease in Mouth Opening at 1st day, 3rd Table 7 Analysis of pain at different time interval from Pre- day, 8th day and 10th day from pre-operative. At 15th day there operative in the groups was non-significant difference in mouth opening from pre- Group – II operative. The mouth opening first gradually decrease on 1st& 3rd post-operative day then there was continuous increase in Pain Change from th Pain in VAS (n=30) Pre-operative 't' 'p' Sig.