***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve r and omized crossover , within-patient , controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline ( Aureomycin 3 % , Lederle ) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted m and ibular third molars . The teeth were removed on two separate occasions ; on one side drain was inserted in the socket , and on the other side no drain treatment was used for control . The influence on postoperative pain , swelling , and mouth opening ability was investigated . The results indicated a statistically significant reduction ( P = 0.02 ) in the incidence of postoperative inflammatory complications , defined as postoperative alveolitis , from 35 % in the no-drain group to 4 % in the drain group . No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction . There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method . It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain , swelling , and mouth opening reduction after impacted m and ibular third-molar surgery The purpose of this study was to compare the effects of flap design on the postoperative sequelae of pain , swelling , trismus and wound dehiscence after surgical removal of bilateral impacted m and ibular third molars ( M3 ) . 20 patients aged 20 - 30 years who required removal of bilateral impacted M3 were included in the study . Maximum interincisal opening and facial measurements were recorded preoperatively . Bayonet flap was used on one side and envelope flap on the other side for the removal of impacted M3 . The effect of flap design on pain , swelling , trismus and wound dehiscence was evaluated postoperatively . Pain and wound dehiscence were significantly greater in the envelope flap group compared with the bayonet flap group ( P<0.05 ) . No significant difference in postoperative swelling and trismus was found in either group ( P>0.05 ) . The bayonet flap was superior to the envelope flap for postoperative pain and wound dehiscence . There was no difference in postoperative swelling and trismus between the two groups INTRODUCTION A major concern of patients who need surgery for impacted third molars is the occurrence of pain and swelling . The damage done during the incision and retraction of soft tissue to expose the impacted teeth , contribute to the above-mentioned . AIMS AND OBJECTIVES The study was done to prove a hypothesis that an alternative surgical flap ( ASF ) is effective in limiting pain and swelling when compared to the st and ard reverse L-flap ( RLF ) . METHOD A prospect i ve r and omized cross-over study was done , which included 33 healthy patients . Patients with mirror-image impacted m and ibular third molars were selected . Evaluation of pain and swelling was done by Visual Analogue Scale ( VAS ) , implemented for the first seven days after surgery . RESULTS The results indicated on average that patients experience less pain with the ASF , although this was not statistically significant . The patients also indicated that they experienced a significant reduction ( p < 0.05 ) in swelling for days one through three , compared to the RLF . CONCLUSIONS The hypothesis that the ASF will result in less swelling , has been proven . It is therefore recommended that surgeons use this flap method for removal of impacted third molars to enhance post-operative patient comfort This study sought to evaluate the influence of flap design ( that is , modified triangular flap or buccal envelope flap ) on alveolar osteitis ( AO ) and on healing following the surgical removal of an impacted m and ibular third molar . A double-blind split-mouth clinical trial examined 17 patients who were c and i date s for extraction of a bilaterally impacted m and ibular third molar with the same difficulty index ;  a modified triangular flap was placed on one side and a buccal envelope flap ( control ) was placed on the other side .  AO and healing were assessed at three and seven days after surgery . Data were analyzed with the McNemar and Wilcoxon signed-rank tests . The modified triangular flap decreased the incidence of AO and expedited healing at seven days postsurgery . In addition , statistically significant differences were observed in terms of both AO and postoperative healing The aim of the study is to compare the prevalence of post-operative inferior dental nerve ( IDN ) deficit after coronectomy with total removal of wisdom teeth showing specific radiographic signs of close proximity to IDN . A r and omized clinical trial comparing total removal and coronectomy of wisdom tooth was conducted . Analyses of the correlations of IDN deficit and various radiographic signs of wisdom tooth roots showing close proximity to IDN were performed . Two radiographic signs were found to be positive predictors ofintra-operative IDN exposure . Specific radiographic signs or the presence of two or more radiographic signs are positive predictors of post-operative IDN deficit . The study concluded that darkening of the wisdom tooth root and presence of two or more specific signs in radiographs significantly increased the risk of IDN deficit in lower wisdom tooth surgery . Coronectomy can significantly reduce the prevalence of an IDN deficit in patients with lower wisdom teeth showing radiographic signs of close proximity to IDN . It also carries less surgical morbidities when compared with total removal of lower wisdom tooth PURPOSE Lingual nerve damage is one of the main complications of  m and ibular third molar removal .  In literature , the series published are heterogeneous so we have decided to study the importance of the lingual protection only during germectomies ( wisdom teeth without root formation ) . METHODS We conducted a r and omized prospect i ve study in 300 germectomies , operated by the same skilled surgeon . These 300 third molar removals  have been divided in two groups , one with lingual nerve protection and one without . RESULTS Lingual nerve injuries following germectomies , with or without lingual protection was 0 % . CONCLUSION In germectomies , one can avoid lingual protection Our aim was to compare the use of a conventional rotary h and piece and a Piezosurgical unit for extraction of lower third molars . We studied 40 patients , who were allocated alternately to have the third molar removed with either the h and piece or the Piezosurgical unit .  Pain , trismus , and oedema were evaluated at baseline and then postoperatively , together with paraesthesiae , on postoperative days 1 , 3 , 5 , 7 , and 15 . Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards . More patients complained of pain in the conventional group , they also required more analgesics , and they developed trismus more often than in the Piezosurgery group . There was also significantly more postoperative swelling in the conventional group . Patients were also evaluated using the subjective Postoperative Symptom Severity ( PoSSe ) scale . Our results suggest that apart from some inherent limitations with the Piezotome , it is a valuable alternative for extraction of third molars PURPOSE To compare the effect of total and partial wound closure techniques on immediate postoperative tissue reactions and complications after m and ibular third molar surgery . PATIENTS AND METHODS This prospect i ve , r and omized , controlled study was carried out at the Department of Oral and Maxillofacial Surgery , National Hospital , Abuja , Nigeria . Patients were r and omly allocated to partial ( group I ) and total ( group II ) wound closure groups . Data were collected on pain , trismus , swelling , and complications experienced by the patients . Data analysis was carried out with SPSS software for Windows ( version 13.0 ; SPSS , Chicago , IL ) and GenStat ( Discovery Edition , 2005 ; VSN International Ltd , Hemel Hempstead , UK ) . RESULTS We studied 82 patients , consisting of 54 female and 28 male patients , with m and ibular third molar teeth impaction . There were 40 patients ( 48.8 % ) in group I and 42 patients ( 51.2 % ) in group II . A statistically significant reduction in facial swelling ( P = .001 ) was found in group I compared with group II , but no difference was recorded for pain and trismus . Group I presented with significant postoperative reactionary bleeding ( P = .007 ) , but no difference was recorded between the 2 groups regarding dry socket and socket infection . CONCLUSION The partial wound closure technique after third molar surgery was considered to be associated with more postoperative morbidity , in view of the distressing nature of reactionary bleeding that was found to be associated with it . However , patients should be adequately informed about the possibility of attendant facial swelling each time the technique of total wound closure is used PURPOSE The purpose of this study was to investigate and compare , in a r and omized and controlled clinical trial , the use of ultrasound bone surgery devices and the use of rotary instruments in lower third molar extraction s. MATERIAL S AND METHODS We selected 26 patients ( 12 women and 14 men ) for this study ; the mean age was 31.2 years ( range , 24 - 45 years ) . A r and omized clinical trial was planned . Patients in the control group received treatment with the conventional rotary instruments ; patients in the test group received treatment with the ultrasound bone surgery tools . Twenty-six third molars were allocated to the test and control groups according to a computer-generated r and omization list . All the surgical procedures were performed by the same surgeon . Pain , trismus , cheek swelling , and number of analgesics taken were evaluated at baseline ( before surgery ) and at the first- , third- , fifth- , and seventh-day visits . RESULTS Pain levels ( evaluated on a visual analog scale ) were higher in the control group when compared with the ultrasonic group ; however , no statistically significant differences were found . On the contrary , the number of analgesics taken in the test group was significantly lower when compared with the control group . The occurrence of trismus was significantly higher in the control group when compared with the test group . The clinical values of cheek swelling were higher in the rotary group when compared with the ultrasound group at the fifth-day visit . CONCLUSION This study showed that the use of ultrasound bone surgery for third molar extraction significantly reduced the occurrence of postsurgical trismus , the occurrence of swelling , and the number of analgesics taken after surgery OBJECTIVE To investigate the influence of flap design on  postoperative trismus , pain , and swelling .  STUDY DESIGN Thirty-two patients with bilateral symmetrically impacted m and ibular third molars participated in a r and omized prospect i ve split mouth study . Two flap design s were used : a buccal envelope flap and a modified triangular flap .  Postoperative pain was recorded using a st and ardized  visual analog scale . Postoperative swelling was evaluated using laser scans of models of the patient 's cheek taken before and two days after surgery , with the scan area being calculated using MatLab software . RESULTS There were no statistical differences between the flap design s in terms of severity of postoperative pain or trismus . A statistically significant difference was observed in postoperative swelling at 2 days , with the modified triangular flap design being associated with increased swelling . The envelope flap design was associated with a higher incidence of alveolar osteitis . CONCLUSION The flap design s used in this study did not adversely affect patients in terms of postoperative pain and trismus , and although greater extraoral swelling was seen with the modified triangular flap design , the clinical relevance is debatable A double blind controlled r and omised trial suggested that irrigation of third molar sockets with bupivacaine 0.75 % produces significant reduction in pain scored on the first post-operative morning ( p less than 0.01 ) . However , this technique produces no significant reduction in opiate or oral analgesic consumption This study was carried out because a great deal of uncertainty exists as to he effect of the surgical removal of the fully impacted third molar on the periodontal status of the second molar . The objectives were to determine the effect of surgical removal of the third molar on the periodontal status of the second molar ; the influence of flap design on these results ; the influence of the initial height of the alveolar bone on the distal of the second molar on subsequent changes in attachment level . The study included 30 patients with bilateral m and ibular impactions . A split-mouth experimental design was used , with one side of the m and ible being r and omly allocated to one of two flap design groups . Plaque level , gingival inflammation , probing depth and attachment level measurements around the second molar were taken at baseline and then at monthly intervals for a period of 6 months . Alveolar bone height was measured from panoramic radiographs . Six months postsurgically , both flap design groups exhibited a statistically significant loss of attachment level on the distal surface of the second molar with no difference between the two flap groups . The initial height of the alveolar bone on the distal of the second molar had no influence on the loss of attachment . It was concluded that the surgical removal of the fully impacted m and ibular third molar led to the loss of attachment on the distal of the second molar ; flap design had no influence on the degree of attachment loss ; the initial height of the alveolar bone on the distal of the second molar had no influence on the loss of attachment Fifty-two consecutive healthy patients with bilateral , similarly impacted m and ibular third molars were studied . For each patient , both third molars were removed at the same operation by the same experienced operator . On one side , the lingual split method by chisel was used ; on the other , the buccal approach with surgical bur . St and ard preoperative and postoperative drug regimens were used . Pain , facial swelling ( visual analogue scales ) , and lingual and labial 
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We found no data for use of a retractor on other primary outcomes or adverse effects ( including fracture of the m and ible).Due to the small number of studies , the different comparisons evaluated , the variable outcomes reported and the paucity of useful data for all primary outcomes we were not able to draw any conclusions concerning bone removal in third molar surgery .
We found no data for any of the other primary outcomes .There was insufficient evidence ( low to very low quality ) that any wound closure technique ( primary versus secondary ) was superior to another for the outcomes of alveolar osteitis , postoperative infection or maximum mouth opening achieved after seven days , or reactionary bleeding .