Acute Inflammation After Wisdom Tooth Removal

Study Overview
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Brief Summary
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Third molar (wisdom teeth) extraction is one of the most frequent intervention in dentistry. Nevertheless, little is known about the level of general body inflammation of subjects with impacted or semi-impacted third molars. Moreover, The possible effects of surgical removal of wisdom teeth on the overall health are not known. Thus, a study in which 40 subjects has been designed. Twenty subjects were affected by bilateral wisdom tooth pathology necessitating for extraction of both teeth. Control group comprised 20 subjects with absence of wisdom teeth or completely erupted wisdom teeth without pathology associated to or history of previous extraction of both wisdom teeth. In both groups a medical and dental examination will be performed at the baseline and 3 months after baseline for the control group or after the second third molar extraction in the control group. Blood will be also withdrawn to assess systemic inflammation and other systemic parameters. Parameter were evaluated via high sensitive c reactive protein (CRP), lipids, fibrinogen, oxidative stress and endothelial function analysis.

Detailed Description
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Third molar extraction is one of the most frequent intervention in dentistry. Nevertheless, little is known about the systemic aspect of subjects with impacted or semi-impacted third molars and the possible effects of surgical removal on their systemic parameters. A case-control study of 40 subjects has been designed to evaluate i) the overall systemic inflammation and metabolism of subjects with bilateral third molars compared to subjects with no third molars and ii) the effect of bilateral removal in the immediate and medium postsurgical period. Systemic parameters are evaluated via high sensitive c reactive protein (CRP), lipids, fibrinogen, oxidative stress and endothelial function analysis.

Official Title
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Systemic Inflammation After Wisdom Tooth Removal: a Case-control Study

Conditions
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Tooth Impacted

Intervention / Treatment
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* Procedure: Wisdom tooth removal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: cases: bilateral wisdom tooth pathology. control: agenesia/previous extraction/no symptoms of the lower third molars. Exclusion Criteria: younger than 18 years and older than 65 years; pregnant or lactating females; females using contraceptive methods; suffering from any systemic illness; undergoing any pharmacological treatment within 30 days prior to the inclusion patients affected by periodontal disease (radiographic diagnosis of vertical bone defects or bone resorption equal to 20% of the root length); patients with periapical and periradicular radiolucent areas X-ray detectable; patients unable to participate to study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Case-control intervention trial: cases are treated for pathology. Controls do not have pathology.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cases: wisdom tooth pathology<br>Subjects affected by bilateral wisdom tooth pathology, undergoing surgical removal | Procedure: Wisdom tooth removal<br>* After inferior dental and buccal nerve anesthesia a triangular full thickness flap with releasing incision on the mesio-buccal aspect of the second molar is designed. Ostectomy is then performed and tooth is sectioned and gently elevated. Once all the tooth components are extracted, the socket is carefully inspected and flap is sutured with interrupted sutures.<br>|
| No Intervention: Controls: no wisdom tooth pathology<br>Subjects showing agenesia/previous extraction/no symptoms of the lower third molars. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in C-reactive protein (CRP) | High-Sensitive plasmatic C-reactive protein | baseline, 24 and three months after the second extraction | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in plasma malondialdehyde (MDA) | plasma malondialdehyde | baseline, 24 and three months after the second extraction | 
| Changes in lipoperoxides (LOOH) | lipoperoxides levels in plasma | baseline, 24 and three months after the second extraction | 
| Changes in ferric-reducing antioxidant power (FRAP) | FRAP levels in plasma | baseline, 24 and three months after the second extraction | 
| Changes in endothelial flow-mediated dilation (FMD) calculated as maximal percentual increase in diameter of the blood vessel above baseline | Endothelium-dependent response of the brachial artery in response to increased blood flow by high resolution ultrasound with a 7.5 MHz linear array transducer | baseline, 24 and three months after the second extraction | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Systemic inflammation, Third molar, Wisdom tooth, C-reactive protein