Traditional Buccal Elevation Technique vs Palatal Elevation Technique for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars: A Comparative Study.

Traditional Buccal Elevation Technique vs Palatal Elevation Technique for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars: A Comparative Study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Traditional Buccal Elevation Technique vs Palatal Elevation Technique for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars: A Comparative Study. Vivek Kavila, Lochana Kilaparthi, Satish Madathanapalli, Satya Bhushan Nachu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8120082/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Buccal elevation technique was the only technique for extraction of upper third molars. However, a modified technique for removing these teeth from the palatal side was introduced in a technical report has shown some benefits in terms of ease, and lower complication rate. The purpose of this current study was to evaluate the efficacy of traditional buccal elevation technique and palatal elevation technique in the extraction of grossly decayed maxillary third molars. Methods This study was a single centre, single blinded randomised control trial comparing buccal elevation technique and a newly modified palatal elevation technique (PET) for the removal of the grossly decayed upper third molars. Results A total of 30 teeth were extracted, with 15 assigned to each technique. The parameters assessed included luxation and extraction time, as well as intraoperative and postoperative complications. Although the results were not statistically significant, the mean extraction time for the palatal elevation technique was lower than that of the buccal elevation technique. Additionally, intraoperative and postoperative complications were more frequently observed in the buccal elevation group compared to the palatal elevation group. Conclusion The results of this study suggest that the novel palatal elevation technique is an effective alternative for maxillary third molar extractions. Health sciences/Diseases/Dental diseases/Dental caries Health sciences/Health care/Dentistry/Dental treatments/Maxillofacial surgery buccal elevation palatal elevation grossly decayed maxillary third molars tuberosity fracture alveolar bone fracture Figures Figure 1 Figure 2 Figure 3 Figure 4 Scientific rationale Principal findings: Maxillary third molar extractions are one of the frequently performed procedures in oral and maxillofacial surgery. Buccal elevation technique using a straight elevator has been widely practised due to easy access and surgeon familiarity. However, grossly decayed maxillary third molars with compromised tooth structure on the buccal aspect is a common presentation and this situation makes it difficult to establish a purchase point for the elevator, therefore increasing the risk of tooth or alveolar bone fracture or inadvertent tooth displacement into the maxillary sinus., which often result in switching to more complex procedures which further compromise the quality of life of the patient subsequently. The palatal elevation technique, which involves applying the elevator from the palatal side, has been suggested as an alternative in these situations because the palatal tooth structure is usually more intact and the palatal bone provides stronger support, allowing for a better fulcrum and purchase point. However, despite its reported benefits, this technique remains underused, and there is limited literature comparing its effectiveness and safety to the conventional buccal approach. Practical implications: This study is expected to guide budding oral surgeons and clinicians in choosing the most appropriate and minimally traumatic technique for intra-alveolar extraction of grossly decayed maxillary third molars, thus minimizing the post extraction complications and therefore improving patient outcomes. Introduction Despite significant advancements in dental disease prevention and increased awareness among the public with regards to oral health, tooth extraction still remains a crucial aspect of dentistry. Conventional extraction techniques involve a combination of luxating the tooth with an elevator, and extracting it using forceps [ 1 ]. The luxation forces transferred from the dental elevator to the tooth sever the periodontal ligament, which connects the tooth to the surrounding alveolar bone resulting in an increased space between the tooth roots and the alveolar bone. This expansion enhances the range of movement of tooth within the socket thereby facilitating a systematic forceps extraction. The extraction of upper third molar is one of the most common procedures however, when compared to their counterparts these teeth present a unique set of challenges. While often considered straightforward, it can still involve certain difficulties that may complicate the management thereby affecting the patient’s quality of life. Limitations that are frequently encountered during maxillary third molar extraction include considerable anatomical variability, restricted access and visibility, and inadequate space for effective application of dental forceps. The morphology of the third maxillary molars displays significant anatomical variability. It often has three roots that may fuse together, with one or two canals typically visible. Numerous studies have been conducted to examine the extensive variations in the morphology of maxillary third molars. Also, the eruption pattern affects the varied positioning of maxillary third molars within the arch, with buccal eruption being the most commonly observed pattern. Several factors contribute to this eruption pattern. Moreover, the rearmost position of the maxillary third molars within the arch contributes to challenges like inadequate access and visibility. Besides, posterior placement of the tooth makes this area relatively prone to caries, particularly on the buccal side. In some instances, caries may extend below the cervical margin and even beneath the bone level thus damaging the mesio-buccal crown structure of the tooth. This prevents the dental elevator from being positioned correctly over the mesio-buccal aspect of the affected tooth, hindering effective tooth luxation. Furthermore, the buccal bone is often flat in this area, making it challenging to apply forceps effectively in such cases. These factors increase the risk of tooth or root fracture if forceps are applied without prior luxation using elevators, potentially leading to the need for more complex extraction procedures like chisel and mallet, trans alveolar or surgical method of extraction. Other most frequently reported complications during upper third molar extraction using the traditional buccal elevation technique include maxillary tuberosity fracture, buccal bone fracture, root displacement into the maxillary sinus, and luxation of adjacent teeth. According to Sinai Khandeparker et al. the palatal crown structure in these scenarios is intact on the mesial aspect [ 2 ]. Besides, the robust palatal bone provides a reliable purchase point for the elevator to achieve tooth luxation. A new modified technique was then introduced, in which the tooth is engaged from the palatal side using a dental elevator to achieve luxation. According to the authors, this novel technique provides a simple and efficient solution for extracting severely decayed maxillary third molars, eliminating the need for more advanced exodontia techniques as mentioned above. The aim of the study is to compare the ease and efficacy between traditional buccal elevation technique and palatal elevation technique for intra alveolar extraction of grossly decayed maxillary third molars. Objectives of the study are: To evaluate and compare the swiftness of the techniques with regard to time taken for removal and to evaluate and compare which technique is least inclined towards complications. Patients and methods This study was a comparative analysis of techniques for extracting maxillary third molars, conducted at GITAM Dental College and Hospital from September to December 2024. Patients were randomly selected from those who presented to the Oral and Maxillofacial Surgery Department for extraction of upper third molars. Approval was obtained from the Institutional Research Review Board of GITAM Dental College (No: IRRB/GDCH/2024/05–08) on 7/11/2024. The study was registered with Clinical Trials Registry India (No: CTRI/2025/03/081760). A total of 30 patients who fulfils the selection criteria were included. All the participants were informed on the objectives of the study before starting the procedure and an informed written consent was obtained. A thorough case history was taken for each patient and necessary radiographs and blood tests were performed prior to the procedure. Fifteen patients were treated by the modified technique i.e., palatal elevation technique and the other fifteen by the conventional buccal elevation technique. The criteria for inclusion are: patients within the age range of 18–60 years, patients with at least one grossly decayed maxillary third molar indicated for extraction, patients with no relevant medical history that contraindicates tooth extraction, patients with adequate inter incisal opening, patients with thick and inextensible cheeks. Exclusion criteria include: patients whose mouth opening is severely restricted with underlying conditions like oral submucous fibrosis, myofacial pain dysfunction syndrome, internal derangement of TMJ, myositis of masticatory muscles, patients taking medications affecting bone remodelling process (i.e. bisphosphonates), patients with buccally tipped maxillary third molars. Parameters observed are 1) time required to perform the extraction: from the time of application of elevator till the delivery of tooth out of the socket. 2) intra operative complications like: a) fracture of maxillary tuberosity b) fracture of alveolar bone c) fracture of root d) luxation or fracture of adjacent tooth e) escape of tooth/root into maxillary sinus f) hematoma. 3) Post-operative complications such as pain and swelling during one week follow up. Procedure: All the extractions were performed by a single surgeon under local anesthesia. Following the clinical examination, all the patients were subjected to orthopantomogram or periapical radiograph. Orthopantomogram gives a clear picture with regards to the relation of maxillary third molar roots to the maxillary tuberosity, and proximity of the roots to the maxillary sinus floor. IOPA radiographs gives a clear picture on the maxillary tuberosity, clear anatomy of the tooth root and the relation of the tooth with the maxillary sinus. Preoperative photographs and radiographs were taken to document all patients' records. The patients were seated on the dental chair and properly draped. Scrubbing was done prior to the procedure to maintain a sterile environment. A combination of posterior superior alveolar nerve block and greater palatine nerve blocks were administered using 2% lignocaine hydrochloride with adrenaline (1:80,000). Once profound anaesthetic effect is achieved the gingival soft tissues were reflected and extraction is performed. In buccal elevation technique, the elevator was engaged interdentally from the buccal aspect. Once luxation was achieved, extraction was carried out with a forceps. Palatal elevation technique (PET): A combination of posterior superior alveolar and greater palatine nerve blocks was administered. Once profound anesthesia is achieved, interdental papilla and surrounding gingiva including distal gingiva were reflected using a periosteal elevator. Reflection of distal gingiva was done to minimize the risk of maxillary tuberosity fracture. Later, the patient was asked to open his/her mouth wide followed by engaging a straight elevator along the palatal side in between the second and third molars from the opposite side of the mouth. The thumb of non-dominant hand was placed over the occlusal surface of the second molar to ensure that only the third molar was luxated, leaving the second molar unaffected. The third molar was then luxated from its socket and removed out of the socket using a maxillary third molar forceps [Figure_1]. The extraction time was measured by a stopwatch from the time of applying the elevator till the delivery of the tooth out of the oral cavity. Complication that arose during extraction, was thoroughly assessed, documented, and managed based on its type and severity. A careful visual and digital examination was done for all the cases, even those without complications. All the patients were promptly followed up and any postoperative complications like prolonged pain and swelling were recorded during the 7th day follow up. Statistical analysis: Data analysis was conducted using Microsoft Excel 2007. The study used mean, standard deviation, chi-square test and independent sample t test. Differences in proportions of qualitative parameters were compared using Chi-square analysis, while differences in means of qualitative parameters were analysed with an independent sample "t" test. Results Out of 30 patients intended for the study 18 were female (60%) and 12 were male (40%) (Figure_2). The buccal elevation technique group included 7 male and 8 female patients, while the palatal elevation technique group consisted of 5 males and 10 females. Evaluation and indexing of results: The time needed to complete the extraction by the two techniques was recorded in minutes and organized in a tabular format [Table_1]. The mean time taken by the buccal elevation group is 6.4 minutes whereas, the mean time taken by the palatal elevation group is 5.8 minutes. Intraoperative complications during the extraction: Complications that arose during the perioperative period were recorded and tabulated [Table_2]. Tuberosity fracture was noted in Case 3 and alveolar bone fracture was observed in cases 1 & 8 in the buccal elevation technique group. The palatal elevation technique group reported only one complication which is luxation of an adjacent tooth, which occurred in Case 11. Postoperative complications: Postoperatively, cases with pain or swelling during the follow up were recorded and tabulated [Table_3]. Pain was the only postoperative complication that was noted in few patients. Three patients in the buccal elevation group reported prolonged pain during the 7-day follow-up period [Figure_3]. Notably, these were the same patients who had experienced intraoperative complications earlier. In contrast, none of the patients in the palatal elevation group reported any pain during the 7-day follow-up period. Discussion Although considered as the most routinely performed procedures, proper and complication free extraction of erupted maxillary third molars depend on having a thorough understanding on the anatomy and morphology of the tooth. According to the literature, maxillary third molars possess a diversified variety of root patterns [ 3 – 6 ]. Maxillary tuberosity which is situated at the distal and inferior border of the infratemporal fossa is one of landmarks of anatomical importance that should be considered during maxillary wisdom tooth removal [ 7 ]. Tuberosity fracture is a potential complication during the extraction of upper third molar teeth. Fractures involving a large portion of bone are of major concern, as they can result in severe hemorrhage due to the close proximity of significant blood vessels, such as posterior superior alveolar artery and the pterygoid venous plexus [ 8 ]. In this study, one case in the buccal elevation technique group reported a tuberosity fracture [Figure_4]. The fractured bone segment was then carefully separated from the root, repositioned, and secured with sutures. The traditional buccal elevation technique has been the only method used for the removal of maxillary third molars for decades. Although this technique is the primary method for removing erupted maxillary third molars, it has certain limitations which include patient discomfort particularly in individuals with thick, extensible cheeks, limited visibility and accessibility, difficulty in engaging the elevator or forceps and a higher likelihood of complications despite preventive measures. Such complications often require complex procedures for the removal. PET is a modified approach for the removal of erupted maxillary third molars, introduced by Sinai Khandeparker et al. in their technical note published in 2023. According to the authors, this technique provides an advantage in cases where the third molars are severely decayed, particularly on the mesio-buccal aspect. Moreover, complication rate is less with the palatal elevation technique as observed by the authors. The authors concluded that the palatal elevation technique is quick to perform, and easy to master. The present study is the first to compare the conventional buccal elevation technique with the novel PET technique specifically for the extraction of grossly carious maxillary third molars. Females outnumbered males, accounting for 60% and 40% of the participants respectively, with a ratio of 3:2. Similar findings were reported by Khalil Alesia, Hesham S. Khalil, et al., where the highest percentage of upper third molar extractions was also observed in females [ 9 ]. Out of 30 patients, 22 reported to the department with a chief complaint of decay alone, while 8 reported of decay with accompanied pain. Dental decay associated with pain was the most common presentation in this study, aligning with the findings of Lorna McCaul et al [ 10 ]. The first parameter observed in the study was the time taken from the application of the elevator to the complete removal of the tooth from the socket. Statistical analysis using an “independent samples t-test” revealed no significant difference between the time parameter and the technique used. The t-value was 0.34369 and p-value was 0.366822 which is not statistically significant at p < 0.05. The second parameter aimed to determine which technique had a higher tendency for intraoperative complications. Statistical analysis using the chi-square test revealed no significant difference between the complications and the technique employed (p-value: 0.13533, not statistically significant at p < 0.05). Postoperative complications, including pain and swelling, were assessed on the 7th-day follow-up as the third parameter. Pain was the only complaint reported. A chi-square test was conducted to determine if there was a significant difference between postoperative complications and the technique used. The p-value was 0.067, which is not statistically significant at p < 0.05. Although the statistical analysis revealed no significant difference, the mean time taken by the palatal elevation technique was shorter compared to the buccal elevation technique. Furthermore, the buccal elevation technique recorded a higher number of complications when compared to the palatal elevation technique. This demonstrates that the buccal elevation technique is more prone to complications, making PET a potentially safer alternative. Interpretation and implications: The novel PET technique can be used as a convenient alternative to the conventional buccal elevation technique as it was found to be simple, easy to master, and has a lower incidence of perioperative and postoperative complications. Incorporating this technique into daily practice will enable dental practitioners and budding maxillofacial surgeons to efficiently manage buccally grossly decayed maxillary third molars with minimal complications. However, the buccal elevation technique is the sole option for scenarios where there is trismus and maxillary third molars that have been erupted buccally. Limitations of the study: The study's statistical significance may have been impacted by the smaller sample size, which is considered to be one of its limitations. Khandeparker et.al in his technical note stated that the palatal crown structure remains intact even if mesio buccal aspect is grossly affected by decay. However, grossly decayed crowns affecting the palatal crown structure is a limitation to effectively luxate the tooth according to the current study. Since this is a single-operator study, the surgeon's familiarity with the procedure could improve over time, potentially influencing the time taken, even though the technique is new. References Edward J, Aziz MA, Madhu Usha A, Narayanan JK. Comparing the Efficiency of Two Different Extraction Techniques in Removal of Maxillary Third Molars: A Randomized Controlled Trial. J Maxillofac Oral Surg. 2017;16(4):424–429. Sinai Khandeparker RV, Kamat RD, Shetye OA, Mandrekar P, Desai SK, Dhupar V. The Palatal Elevation Technique (PET) for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars. Cureus. 2023;15(9): e46127. Mohammadi Z, Jafarzadeh H, Shalavi S, Bandi S, Patil SG. Root and Root Canal Morphology of Human Third Molar Teeth. J Contemp Dent Pract 2015;16(4): 310–313. Sidow SJ, West LA, Liewehr FR, Loushine RJ. Root canal morphology of human maxillary and mandibular third molars. J Endod. 2000;26(11):675–8. Cosić J, Galić N, Vodanović M, Njemirovskij V, Segović S, Pavelić B et.al. An in vitro morphological investigation of the endodontic spaces of third molars. Coll Antropol. 2013;37(2):437–42. Alavi AM, Opasanon A, Ng YL, Gulabivala K. Root and canal morphology of Thai maxillary molars. Int Endod J. 2002;35(5):478–85. Cheung LK, Fung SC, Li T, Samman N. Posterior maxillary anatomy: implications for Le Fort I osteotomy. Int J Oral Maxillofac Surg. 1998;27(5):346–51. Thirumurugan K, Munzanoor RR, Prasad GA, Sankar K. Maxillary tuberosity fracture and subconjunctival hemorrhage following extraction of maxillary third molar. J Nat Sci Biol Med. 2013;4(1):242–5. Alesia K, Khalil HS. Reasons for and patterns relating to the extraction of permanent teeth in a subset of the Saudi population. Clin Cosmet Investig Dent. 2013; 5:51–6. McCaul LK, Jenkins WM, Kay EJ. The reasons for the extraction of various tooth types in Scotland: a 15-year follow up. J Dent. 2001;29(6):401–7. Tables Table_1: Time taken by Buccal Elevation Technique and Palatal Elevation Technique: Technique No. of Cases Mean time ( In minutes) t-value p-value Buccal Elevation Technique 15 6.4 minutes 0.34 .37 (p > .05) Palatal Elevation Technique 15 5.8 minutes Table_2: Intraoperative complications during the procedure: Technique Intra operative complications p-value Chi-square value Tuberosity Fracture Alveolar Bone Fracture Luxation/Fracture of Adjacent Tooth Buccal Elevation Technique 1 2 0 .14 (p>.05) 4 Palatal Elevation Technique 0 0 1 Table_3: Postoperative complications at one week follow up: Technique Postoperative complications p-value Chi-square value None Pain Buccal Elevation Technique 12 3 .06 (p>.05) 3.33 Palatal Elevation Technique 15 0 Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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15:51:15","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53759,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/79957f4c3399d88ef47d87e3.html"},{"id":96604960,"identity":"ff557cfa-3f7c-457b-9dc0-10a19e5f1334","added_by":"auto","created_at":"2025-11-24 09:16:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":298899,"visible":true,"origin":"","legend":"\u003cp\u003ePalatal Elevation Technique (PET) – A. Preoperative picture of grossly decayed 18 B. Pre-operative IOPA radiograph in relation to 18 C. Straight elevator engaged palatally between 17 and 18 from contralateral side for luxation D. Postoperative picture of extracted 18.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/29c09705a8616c67ba4c49b9.jpg"},{"id":96566218,"identity":"221fd349-03d2-4c0a-a359-6a6762df2e3a","added_by":"auto","created_at":"2025-11-23 15:51:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":114879,"visible":true,"origin":"","legend":"\u003cp\u003eBar diagram depicting gender distribution.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/73a659fa89577d0fdcae66a0.jpg"},{"id":96604259,"identity":"3ab15dbe-ee37-452f-a606-da1260a90f5f","added_by":"auto","created_at":"2025-11-24 09:13:23","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":125647,"visible":true,"origin":"","legend":"\u003cp\u003eBar diagram illustrating postoperative complications at 7 days follow up.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/14787910e07d590010f06808.jpg"},{"id":96566223,"identity":"c811f299-efc3-400d-beda-020101af0826","added_by":"auto","created_at":"2025-11-23 15:51:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":439435,"visible":true,"origin":"","legend":"\u003cp\u003eMaxillary tuberosity fracture reported in case 3 in buccal elevation technique group.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/3b9c2954ab3040927a932b8c.jpg"},{"id":97135403,"identity":"5b48ee83-e09b-4f05-babd-9bf1fa068089","added_by":"auto","created_at":"2025-12-01 09:43:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1627594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8120082/v1/811225a1-865e-4b84-a86b-fc790b09e8d0.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"Traditional Buccal Elevation Technique vs Palatal Elevation Technique for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars: A Comparative Study.","fulltext":[{"header":"Scientific rationale","content":"\u003cp\u003e\u003cstrong\u003ePrincipal findings:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaxillary third molar extractions are one of the frequently performed procedures in oral and maxillofacial surgery. Buccal elevation technique using a straight elevator has been widely practised due to easy access and surgeon familiarity. However, grossly decayed maxillary third molars with compromised tooth structure on the buccal aspect is a common presentation and this situation makes it difficult to establish a purchase point for the elevator, therefore increasing the risk of tooth or alveolar bone fracture or inadvertent tooth displacement into the maxillary sinus., which often result in switching to more complex procedures which further compromise the quality of life of the patient subsequently.\u003c/p\u003e\n\u003cp\u003eThe palatal elevation technique, which involves applying the elevator from the palatal side, has been suggested as an alternative in these situations because the palatal tooth structure is usually more intact and the palatal bone provides stronger support, allowing for a better fulcrum and purchase point. However, despite its reported benefits, this technique remains underused, and there is limited literature comparing its effectiveness and safety to the conventional buccal approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical implications:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is expected to guide budding oral surgeons and clinicians in choosing the most appropriate and minimally traumatic technique for intra-alveolar extraction of grossly decayed maxillary third molars, thus minimizing the post extraction complications and therefore improving patient outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eDespite significant advancements in dental disease prevention and increased awareness among the public with regards to oral health, tooth extraction still remains a crucial aspect of dentistry. Conventional extraction techniques involve a combination of luxating the tooth with an elevator, and extracting it using forceps [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The luxation forces transferred from the dental elevator to the tooth sever the periodontal ligament, which connects the tooth to the surrounding alveolar bone resulting in an increased space between the tooth roots and the alveolar bone. This expansion enhances the range of movement of tooth within the socket thereby facilitating a systematic forceps extraction.\u003c/p\u003e\u003cp\u003eThe extraction of upper third molar is one of the most common procedures however, when compared to their counterparts these teeth present a unique set of challenges. While often considered straightforward, it can still involve certain difficulties that may complicate the management thereby affecting the patient\u0026rsquo;s quality of life. Limitations that are frequently encountered during maxillary third molar extraction include considerable anatomical variability, restricted access and visibility, and inadequate space for effective application of dental forceps. The morphology of the third maxillary molars displays significant anatomical variability. It often has three roots that may fuse together, with one or two canals typically visible. Numerous studies have been conducted to examine the extensive variations in the morphology of maxillary third molars. Also, the eruption pattern affects the varied positioning of maxillary third molars within the arch, with buccal eruption being the most commonly observed pattern. Several factors contribute to this eruption pattern. Moreover, the rearmost position of the maxillary third molars within the arch contributes to challenges like inadequate access and visibility. Besides, posterior placement of the tooth makes this area relatively prone to caries, particularly on the buccal side. In some instances, caries may extend below the cervical margin and even beneath the bone level thus damaging the mesio-buccal crown structure of the tooth. This prevents the dental elevator from being positioned correctly over the mesio-buccal aspect of the affected tooth, hindering effective tooth luxation. Furthermore, the buccal bone is often flat in this area, making it challenging to apply forceps effectively in such cases. These factors increase the risk of tooth or root fracture if forceps are applied without prior luxation using elevators, potentially leading to the need for more complex extraction procedures like chisel and mallet, trans alveolar or surgical method of extraction. Other most frequently reported complications during upper third molar extraction using the traditional buccal elevation technique include maxillary tuberosity fracture, buccal bone fracture, root displacement into the maxillary sinus, and luxation of adjacent teeth. According to Sinai Khandeparker et al. the palatal crown structure in these scenarios is intact on the mesial aspect [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Besides, the robust palatal bone provides a reliable purchase point for the elevator to achieve tooth luxation. A new modified technique was then introduced, in which the tooth is engaged from the palatal side using a dental elevator to achieve luxation. According to the authors, this novel technique provides a simple and efficient solution for extracting severely decayed maxillary third molars, eliminating the need for more advanced exodontia techniques as mentioned above.\u003c/p\u003e\u003cp\u003eThe aim of the study is to compare the ease and efficacy between traditional buccal elevation technique and palatal elevation technique for intra alveolar extraction of grossly decayed maxillary third molars. Objectives of the study are: To evaluate and compare the swiftness of the techniques with regard to time taken for removal and to evaluate and compare which technique is least inclined towards complications.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eThis study was a comparative analysis of techniques for extracting maxillary third molars, conducted at GITAM Dental College and Hospital from September to December 2024. Patients were randomly selected from those who presented to the Oral and Maxillofacial Surgery Department for extraction of upper third molars. Approval was obtained from the Institutional Research Review Board of GITAM Dental College (No: IRRB/GDCH/2024/05\u0026ndash;08) on 7/11/2024. The study was registered with Clinical Trials Registry India (No: CTRI/2025/03/081760). A total of 30 patients who fulfils the selection criteria were included. All the participants were informed on the objectives of the study before starting the procedure and an informed written consent was obtained. A thorough case history was taken for each patient and necessary radiographs and blood tests were performed prior to the procedure. Fifteen patients were treated by the modified technique i.e., palatal elevation technique and the other fifteen by the conventional buccal elevation technique.\u003c/p\u003e\u003cp\u003eThe criteria for inclusion are: patients within the age range of 18\u0026ndash;60 years, patients with at least one grossly decayed maxillary third molar indicated for extraction, patients with no relevant medical history that contraindicates tooth extraction, patients with adequate inter incisal opening, patients with thick and inextensible cheeks. Exclusion criteria include: patients whose mouth opening is severely restricted with underlying conditions like oral submucous fibrosis, myofacial pain dysfunction syndrome, internal derangement of TMJ, myositis of masticatory muscles, patients taking medications affecting bone remodelling process (i.e. bisphosphonates), patients with buccally tipped maxillary third molars.\u003c/p\u003e\u003cp\u003eParameters observed are 1) time required to perform the extraction: from the time of application of elevator till the delivery of tooth out of the socket. 2) intra operative complications like: a) fracture of maxillary tuberosity b) fracture of alveolar bone c) fracture of root d) luxation or fracture of adjacent tooth e) escape of tooth/root into maxillary sinus f) hematoma. 3) Post-operative complications such as pain and swelling during one week follow up.\u003c/p\u003e\u003cp\u003eProcedure: All the extractions were performed by a single surgeon under local anesthesia. Following the clinical examination, all the patients were subjected to orthopantomogram or periapical radiograph. Orthopantomogram gives a clear picture with regards to the relation of maxillary third molar roots to the maxillary tuberosity, and proximity of the roots to the maxillary sinus floor. IOPA radiographs gives a clear picture on the maxillary tuberosity, clear anatomy of the tooth root and the relation of the tooth with the maxillary sinus. Preoperative photographs and radiographs were taken to document all patients' records. The patients were seated on the dental chair and properly draped. Scrubbing was done prior to the procedure to maintain a sterile environment. A combination of posterior superior alveolar nerve block and greater palatine nerve blocks were administered using 2% lignocaine hydrochloride with adrenaline (1:80,000). Once profound anaesthetic effect is achieved the gingival soft tissues were reflected and extraction is performed. In buccal elevation technique, the elevator was engaged interdentally from the buccal aspect. Once luxation was achieved, extraction was carried out with a forceps.\u003c/p\u003e\u003cp\u003ePalatal elevation technique (PET): A combination of posterior superior alveolar and greater palatine nerve blocks was administered. Once profound anesthesia is achieved, interdental papilla and surrounding gingiva including distal gingiva were reflected using a periosteal elevator. Reflection of distal gingiva was done to minimize the risk of maxillary tuberosity fracture. Later, the patient was asked to open his/her mouth wide followed by engaging a straight elevator along the palatal side in between the second and third molars from the opposite side of the mouth. The thumb of non-dominant hand was placed over the occlusal surface of the second molar to ensure that only the third molar was luxated, leaving the second molar unaffected. The third molar was then luxated from its socket and removed out of the socket using a maxillary third molar forceps [Figure_1].\u003c/p\u003e\u003cp\u003e The extraction time was measured by a stopwatch from the time of applying the elevator till the delivery of the tooth out of the oral cavity. Complication that arose during extraction, was thoroughly assessed, documented, and managed based on its type and severity. A careful visual and digital examination was done for all the cases, even those without complications. All the patients were promptly followed up and any postoperative complications like prolonged pain and swelling were recorded during the 7th day follow up.\u003c/p\u003e\u003cp\u003eStatistical analysis: Data analysis was conducted using Microsoft Excel 2007. The study used mean, standard deviation, chi-square test and independent sample t test. Differences in proportions of qualitative parameters were compared using Chi-square analysis, while differences in means of qualitative parameters were analysed with an independent sample \"t\" test.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 30 patients intended for the study 18 were female (60%) and 12 were male (40%) (Figure_2). The buccal elevation technique group included 7 male and 8 female patients, while the palatal elevation technique group consisted of 5 males and 10 females.\u003c/p\u003e\u003cp\u003eEvaluation and indexing of results:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe time needed to complete the extraction by the two techniques was recorded in minutes and organized in a tabular format [Table_1]. The mean time taken by the buccal elevation group is 6.4 minutes whereas, the mean time taken by the palatal elevation group is 5.8 minutes.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIntraoperative complications during the extraction: Complications that arose during the perioperative period were recorded and tabulated [Table_2]. Tuberosity fracture was noted in Case 3 and alveolar bone fracture was observed in cases 1 \u0026amp; 8 in the buccal elevation technique group. The palatal elevation technique group reported only one complication which is luxation of an adjacent tooth, which occurred in Case 11.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePostoperative complications: Postoperatively, cases with pain or swelling during the follow up were recorded and tabulated [Table_3]. Pain was the only postoperative complication that was noted in few patients. Three patients in the buccal elevation group reported prolonged pain during the 7-day follow-up period [Figure_3]. Notably, these were the same patients who had experienced intraoperative complications earlier. In contrast, none of the patients in the palatal elevation group reported any pain during the 7-day follow-up period.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough considered as the most routinely performed procedures, proper and complication free extraction of erupted maxillary third molars depend on having a thorough understanding on the anatomy and morphology of the tooth. According to the literature, maxillary third molars possess a diversified variety of root patterns [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Maxillary tuberosity which is situated at the distal and inferior border of the infratemporal fossa is one of landmarks of anatomical importance that should be considered during maxillary wisdom tooth removal [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Tuberosity fracture is a potential complication during the extraction of upper third molar teeth. Fractures involving a large portion of bone are of major concern, as they can result in severe hemorrhage due to the close proximity of significant blood vessels, such as posterior superior alveolar artery and the pterygoid venous plexus [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study, one case in the buccal elevation technique group reported a tuberosity fracture [Figure_4]. The fractured bone segment was then carefully separated from the root, repositioned, and secured with sutures.\u003c/p\u003e\u003cp\u003eThe traditional buccal elevation technique has been the only method used for the removal of maxillary third molars for decades. Although this technique is the primary method for removing erupted maxillary third molars, it has certain limitations which include patient discomfort particularly in individuals with thick, extensible cheeks, limited visibility and accessibility, difficulty in engaging the elevator or forceps and a higher likelihood of complications despite preventive measures. Such complications often require complex procedures for the removal. PET is a modified approach for the removal of erupted maxillary third molars, introduced by Sinai Khandeparker et al. in their technical note published in 2023. According to the authors, this technique provides an advantage in cases where the third molars are severely decayed, particularly on the mesio-buccal aspect. Moreover, complication rate is less with the palatal elevation technique as observed by the authors. The authors concluded that the palatal elevation technique is quick to perform, and easy to master.\u003c/p\u003e\u003cp\u003eThe present study is the first to compare the conventional buccal elevation technique with the novel PET technique specifically for the extraction of grossly carious maxillary third molars. Females outnumbered males, accounting for 60% and 40% of the participants respectively, with a ratio of 3:2. Similar findings were reported by Khalil Alesia, Hesham S. Khalil, et al., where the highest percentage of upper third molar extractions was also observed in females [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Out of 30 patients, 22 reported to the department with a chief complaint of decay alone, while 8 reported of decay with accompanied pain. Dental decay associated with pain was the most common presentation in this study, aligning with the findings of Lorna McCaul et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe first parameter observed in the study was the time taken from the application of the elevator to the complete removal of the tooth from the socket. Statistical analysis using an \u0026ldquo;independent samples t-test\u0026rdquo; revealed no significant difference between the time parameter and the technique used. The t-value was 0.34369 and p-value was 0.366822 which is not statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The second parameter aimed to determine which technique had a higher tendency for intraoperative complications. Statistical analysis using the chi-square test revealed no significant difference between the complications and the technique employed (p-value: 0.13533, not statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Postoperative complications, including pain and swelling, were assessed on the 7th-day follow-up as the third parameter. Pain was the only complaint reported. A chi-square test was conducted to determine if there was a significant difference between postoperative complications and the technique used. The p-value was 0.067, which is not statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eAlthough the statistical analysis revealed no significant difference, the mean time taken by the palatal elevation technique was shorter compared to the buccal elevation technique. Furthermore, the buccal elevation technique recorded a higher number of complications when compared to the palatal elevation technique. This demonstrates that the buccal elevation technique is more prone to complications, making PET a potentially safer alternative.\u003c/p\u003e\u003cp\u003eInterpretation and implications: The novel PET technique can be used as a convenient alternative to the conventional buccal elevation technique as it was found to be simple, easy to master, and has a lower incidence of perioperative and postoperative complications. Incorporating this technique into daily practice will enable dental practitioners and budding maxillofacial surgeons to efficiently manage buccally grossly decayed maxillary third molars with minimal complications. However, the buccal elevation technique is the sole option for scenarios where there is trismus and maxillary third molars that have been erupted buccally.\u003c/p\u003e\u003cp\u003eLimitations of the study:\u003c/p\u003e\u003cp\u003eThe study's statistical significance may have been impacted by the smaller sample size, which is considered to be one of its limitations. Khandeparker et.al in his technical note stated that the palatal crown structure remains intact even if mesio buccal aspect is grossly affected by decay. However, grossly decayed crowns affecting the palatal crown structure is a limitation to effectively luxate the tooth according to the current study. Since this is a single-operator study, the surgeon's familiarity with the procedure could improve over time, potentially influencing the time taken, even though the technique is new.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEdward J, Aziz MA, Madhu Usha A, Narayanan JK. Comparing the Efficiency of Two Different Extraction Techniques in Removal of Maxillary Third Molars: A Randomized Controlled Trial. J Maxillofac Oral Surg. 2017;16(4):424\u0026ndash;429.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinai Khandeparker RV, Kamat RD, Shetye OA, Mandrekar P, Desai SK, Dhupar V. The Palatal Elevation Technique (PET) for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars. Cureus. 2023;15(9): e46127.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohammadi Z, Jafarzadeh H, Shalavi S, Bandi S, Patil SG. Root and Root Canal Morphology of Human Third Molar Teeth. J Contemp Dent Pract 2015;16(4): 310\u0026ndash;313.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSidow SJ, West LA, Liewehr FR, Loushine RJ. Root canal morphology of human maxillary and mandibular third molars. J Endod. 2000;26(11):675\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCosić J, Galić N, Vodanović M, Njemirovskij V, Segović S, Pavelić B et.al. An in vitro morphological investigation of the endodontic spaces of third molars. Coll Antropol. 2013;37(2):437\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlavi AM, Opasanon A, Ng YL, Gulabivala K. Root and canal morphology of Thai maxillary molars. Int Endod J. 2002;35(5):478\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheung LK, Fung SC, Li T, Samman N. Posterior maxillary anatomy: implications for Le Fort I osteotomy. Int J Oral Maxillofac Surg. 1998;27(5):346\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThirumurugan K, Munzanoor RR, Prasad GA, Sankar K. Maxillary tuberosity fracture and subconjunctival hemorrhage following extraction of maxillary third molar. J Nat Sci Biol Med. 2013;4(1):242\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlesia K, Khalil HS. Reasons for and patterns relating to the extraction of permanent teeth in a subset of the Saudi population. Clin Cosmet Investig Dent. 2013; 5:51\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCaul LK, Jenkins WM, Kay EJ. The reasons for the extraction of various tooth types in Scotland: a 15-year follow up. J Dent. 2001;29(6):401\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable_1: Time taken by Buccal Elevation Technique and Palatal Elevation Technique:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean time ( In minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBuccal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e6.4 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e.37\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(p \u0026gt; .05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalatal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e5.8 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable_2: Intraoperative complications during the procedure:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTechnique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra operative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTuberosity Fracture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlveolar Bone Fracture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLuxation/Fracture of Adjacent Tooth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBuccal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.14\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(p\u0026gt;.05)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalatal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable_3: Postoperative complications at one week follow up:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTechnique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBuccal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.06\u003c/p\u003e\n \u003cp\u003e(p\u0026gt;.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePalatal Elevation Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"buccal elevation, palatal elevation, grossly decayed maxillary third molars, tuberosity fracture, alveolar bone fracture","lastPublishedDoi":"10.21203/rs.3.rs-8120082/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8120082/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBuccal elevation technique was the only technique for extraction of upper third molars. However, a modified technique for removing these teeth from the palatal side was introduced in a technical report has shown some benefits in terms of ease, and lower complication rate. The purpose of this current study was to evaluate the efficacy of traditional buccal elevation technique and palatal elevation technique in the extraction of grossly decayed maxillary third molars.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was a single centre, single blinded randomised control trial comparing buccal elevation technique and a newly modified palatal elevation technique (PET) for the removal of the grossly decayed upper third molars.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 30 teeth were extracted, with 15 assigned to each technique. The parameters assessed included luxation and extraction time, as well as intraoperative and postoperative complications. Although the results were not statistically significant, the mean extraction time for the palatal elevation technique was lower than that of the buccal elevation technique. Additionally, intraoperative and postoperative complications were more frequently observed in the buccal elevation group compared to the palatal elevation group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study suggest that the novel palatal elevation technique is an effective alternative for maxillary third molar extractions.\u003c/p\u003e","manuscriptTitle":"Traditional Buccal Elevation Technique vs Palatal Elevation Technique for Intra-alveolar Extraction of Grossly Decayed Maxillary Third Molars: A Comparative Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 15:51:10","doi":"10.21203/rs.3.rs-8120082/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d70ee278-b3ec-4c35-a7d9-c07438cc433c","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58148558,"name":"Health sciences/Diseases/Dental diseases/Dental caries"},{"id":58148559,"name":"Health sciences/Health care/Dentistry/Dental treatments/Maxillofacial surgery"}],"tags":[],"updatedAt":"2025-11-25T02:21:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-23 15:51:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8120082","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8120082","identity":"rs-8120082","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}