Effect Of Different Pathological Conditions On Postoperative Response To Extraction Of Mandibular Third Molar

Objective:Mandibular third molar(M3M)obstruction may have many potential risks,including pericoronitis,caries,pulpitis,periapical inflammation,external root resorption of the mandibular second molar and odontogenic cysts,etc.There is no controversy about extracting symptomatic third molars,but postoperative symtoms like pain,swelling,restricted mouth opening can occur after mandibular third molar extraction.During this period,patients may feel painful and uncomfortable,and their normal life including speaking,eating and work is critically affected.Medical imaging plays an important role in the diagnosis and treatment of diseases.With the continuous development of Artificial Intelligence(AI)in medical imaging,its application in the field of oral and maxillofacial medical imaging has been growing year by year.Most scholars currently study the effects of patient age,gender,oral hygiene,surgical design,and postoperative care on postoperative complication response,and for specific patients,most oral surgeons can predict the incidence of facial swelling based on personal experience.However the inaccuracy of swelling prediction always affects the quality of medical care and subsequent treatment planning.Also whether pathological changes such as pericoronitis,caries,and pulpitis have an effect on the postoperative complication has rarely been studied,and the effect of predicting the response to M3 M extraction by AI in different pathological conditions has been even less studied.Therefore,the purpose of this experiment was to confirmin the pathological diagnosis of wisdom tooth-related diseases by combining clinical manifestations and imaging,to investigate the potential relationship between pathological conditions and postoperative non-infectious complications,to explore the risk factors leading to postoperative pain,swelling,and mouth opening restriction,and to provide some clinical basis for later AI prediction of postoperative response to extraction of mandibular third molars under different pathological conditions by means of panoramic radiograph.Methods:A total of 155 patients who visited the Department of Oral and Maxillofacial Surgery in Hospital of Stomotology,Shanxi Medical University between June,2022 and November,2022 and met the criteria,included among these pericoronitis group(n=26),carious group(n=18),pulpitis group(n=16),periapical group(n=12),external root resorption of the mandibular second molar group(n=21),and no indication group(n=62)were recruited for this experiment.the patients were informed about the possible complications and risks after wisdom tooth extraction before surgery,and informed consent was obtained from all patients.Basic information about the patients was collected preoperatively,and the pathology of the affected tooth was determined by clinical diagnosis and panoramic radiograph diagnosis.The patients were reviewed at the24 th hour,3rd day,7th day,and 10 th day of the postoperative period to record the number of painkillers taken by the patients,the number of days of pain,the size and time of swelling,and the visual analogue scale(VAS)of pain and to assess the effect of pathologic conditions on the postoperative response to M3 M.Results:The results showed that the pericoronitis group took more pain medication,had longer pain duration,and higher pain VAS scores at the 24 th hour after extraction compared to the unindicated group,all differences were statistically significant(P<0.05);The apical periapical group had a higher number of pain medications,a longer duration of pain,and higher pain VAS scores at the 24 th hour,the 3rd day,the 7th day,and the10 th day after extraction,and the differences were all statistically significant(P<0.05);the external root resorption group of the second molar had a higher number of pain medications,a longer duration of pain,higher pain VAS scores at the 24 th hour,the 7th day,and the 10 th day after extraction,had more restriction in opening the mouth on the1 st day,and had a longer period of time that interfered with normal life,all of which were statistically significant differences(P<0.05);No significant difference in the caries and pulpitis groups compared to the no indication group(P>0.05).A multifactorial logistic regression analysis of pain and swelling in patients after M3 M extraction in different pathology groups showed that the degree of swelling in the external root resorption of the mandibular second molar [OR=6.491,95% CI(1.210-34.814)] was statistically significant(p<0.05)Conclusion:1.Pericoronitis of the mandibular third molar was significantly correlated with its level of pain at the 24 th hour after extraction,with no significant effect on swelling or mouth opening;2.Periapical inflammation of the mandibular third molar and external root resorption of the mandibular second molar were significantly correlated with the postoperative pain response time;3.External root resorption of the mandibular second molar was one of the risk factors for swelling reaction after extraction the mandibular third molar;4.Neither pulpitis nor caries of the mandibular third molar had a significant effect on the postoperative reaction to extraction of the mandibular third molar.