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1.  The association between orthodontic treatment with removal of premolars and the angulation of developing mandibular third molars over time 
The Angle orthodontist  2012;83(3):376-380.
To assess changes in mandibular third molar angulation during orthodontic treatment in subjects having either first or second premolars or neither removed.
Materials and Methods
In a retrospective study approved by the institutional review board, right and left mandibular third molar angulations were compared to the vertical axis of adjacent second molars before and at the end of orthodontic treatment. The sample included 25 subjects with first premolars removed, 25 subjects with second premolars removed, and 24 subjects with no premolars removed. A decrease in angulation over time of at least 5°, so that the third molar became more vertical, was considered clinically favorable. Data were assessed by a linear mixed effect model and a proportional odds model with significance set at P <.05.
Prior to treatment, the average mandibular third molar angulation did not differ significantly among the three study groups (P = .97). The average change during treatment was not significantly affected by group (P = .59), but a higher proportion of mandibular third molars were more vertical by at least 5° in the second premolar extraction group compared to the other two groups at the completion of treatment.
Although creating space for third molars to erupt and function has intuitive appeal, clinicians should not assume that third molars will move upright to a vertical position even if premolar removal is performed as part of an orthodontic treatment plan.
PMCID: PMC3634897  PMID: 23043244
Premolar; Third molar
2.  Third Molars and Periodontal Pathology in Middle Aged and Older Americans 
Assess the association between the visible presence of 3rd molars and the severity of periodontal pathology on teeth more anterior in the mouth.
Subjects and Methods
This analysis included dentate participants 52 to 74 years old from the Dental Atherosclerosis Risk in Communities (DARIC) Study who underwent an oral examination which included periodontal probing depths (PD) on all visible teeth including 3rd molars.
PD ≥4mm and clinical attachment level (CAL) ≥3mm were indicator variables for periodontal pathology. Explanatory variables were the presence or absence of visible 3rd molars. Covariates included: gender, ethnicity, age, income level, education, and smoking status.
Outcome variables for periodontal pathology were: mean PD, the extent (% probing sites) PD≥4mm, and the extent (% probing sites) CAL>3mm. Outcomes between subjects with visible 3rd molars and no visible 3rd molars were compared by descriptive statistics and Chi-square tests with significance set at 0.05. Multivariable modeling was performed using SAS Proc GLM to calculate least squared means adjusting for study outcome variables and covariates.
The DARIC sample consisted of 6,793 subjects; 80% were Caucasian and 19% African American. Most subjects (53%) were 62 to 74 years old and female (54%). Thirty percent of ARIC subjects, 2,035, had at least one visible 3rd molar. Having a visible 3rd molar was significantly associated with being: male, African American, less than the mean age of 62.4 years, and higher income or never smoking (all P<0.01).
Greater mean PD on 1st/2nd molars, the extent PD≥4mm on 1st/2nd molars, and the extent CAL≥3mm on 1st/2nd molars, were all significantly associated with having a visible 3rd molar in unadjusted and adjusted models.
In these middle-aged and older Americans, having a visible 3rd molar was significantly associated with more severe periodontal disease on teeth more anterior in the mouth as compared to subjects with no visible 3rd molars
PMCID: PMC3926700  PMID: 19925977
3.  Cryotherapy and Topical Minocycline as Adjunctive Measures to Control Pain After Third Molar Surgery: An Exploratory Study 
To assess the impact of cryotherapy or topical minocycline on patients’ perceptions of recovery from pain after third molar surgery in an exploratory comparative-effectiveness study.
Patients and Methods
Subjects aged at least 14 years who were having all 4 third molars removed were enrolled in 3 separate institutional review board–approved studies. Study groups included subjects treated with a passively applied cold wrap for 24 hours postoperatively, subjects treated with topical minocycline during surgery, and subjects enrolled in a nonconcurrent comparison group who had received neither topical minocycline nor directed cryotherapy. Third molar surgery was performed in all cases by trained surgeons using the same protocol. An exact Kruskal-Wallis test was used to compare the distributions of the worst and average pain scores and a Fisher exact test to compare verbal responses from Gracely pain scales among the 3 groups for postsurgical days (PSDs) 1 to 3.
This study comprised 51 cryotherapy subjects (2005–2009), 63 minocycline subjects (2003–2004), and 92 comparison-group subjects (2002–2006) who were treated at academic centers and in community practices across the United States (N = 206). Demographic descriptors were similar among all groups. For PSDs 1 through 3 (unadjusted), the highest scores for worst pain (6–7 [out of 7] on Likert-type scale) were reported less frequently in each of the study groups than in subjects in the comparison group, although the numbers of subjects reporting the highest scores were few. The distribution of pain outcomes was significantly different among the 3 groups for worst pain and affective words on PSD 1 (P = .04 for both). However, the small number of subjects who reported the highest pain scores precluded adequate multivariate statistical analyses for all outcomes on PSD 1 to 3.
Data from this exploratory study suggest that adjunctive therapy to decrease postoperative pain—cryotherapy or topical minocycline—might be effective at moderating the patient’s highest pain levels after third molar surgery. The topic should be studied further in a multicenter, prospective, randomized trial.
PMCID: PMC3589520  PMID: 21802812
4.  Recovery Following Sedation with Midazolam or Diazepam Alone or in Combination with Fentanyl for Outpatient Surgery 
Anesthesia Progress  1986;33(5):230-234.
Midazolam is a new water-soluble benzodiazepine with a much shorter pharmacologic half-life than diazepam. Despite this shorter pharmacologic half-life, several reports indicate that patients do not recover more rapidly after sedation with midazolam than with diazepam. The purpose of this study was to compare recovery of patients sedated with either midazolam or diazepam alone or in combination with fentanyl using the digit symbol substitution test (DSST) and Trieger test. Patients were randomly divided into treatment groups and recovery tests were administered to the patients prior to sedation and at 60, 120, and 180 minutes after achieving a standardized sedative endpoint. Patients who received midazolam alone had significantly fewer numbers of correct reponses on the DSST than patients who received midazolam plus fentanyl or diazepam with or without fentanyl. When midazolam was combined with fentanyl there was no significant difference between results obtained on the DSST when compared with either diazepam group. Comparisons between all groups using dots missed or millimeter deviation on the Trieger test showed no statistical difference between any groups. These data indicate that midazolam as a single IV agent has a slightly prolonged recovery phase compared to diazepam. The addition of fentanyl to the sedation regimen allows reduction in the midazolam dose resulting in a recovery time comparable to that of diazepam.
PMCID: PMC2177484  PMID: 3465258

Results 1-4 (4)