The presence of opioid receptors around peripheral nerves allows for postoperative analgesia, thus encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the effectiveness of topical opioids in achieving adequate analgesia in inflamed areas. Using the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in postoperative pain management. Also, the presence of impacted teeth is a common phenomenon and in different societies, its prevalence and distribution vary significantly. The possibility of problems occurring in case of failure to diagnose and treat the impacted lower wisdom teeth on time indicates the importance of this issue. According to the results of this research, the prevalence of impacted teeth with medium hardness and difficulty in patients referring to the Faculty of Dentistry of Mod Amulet Clinic in Russia is relatively high. Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.
The patient is more likely to have pain and discomfort because of the surgically removed impacted mandibular third molars in the oral cavity. Even though the lower jaw’s third molars are frequently extracted surgically, patients’ greatest concern is pain control . The main issue arises postoperatively when the anesthetic’s effects wear off, even when intraoperative pain is effectively managed with local anesthesia (LA). The management of pain is a crucial component since postoperative pain and discomfort can make the patient’s overall treatment experience unpleasant. Most of the time, local anesthetics such as lidocaine 2% with epinephrine 1:2,000 are used during tooth extraction [2,3]. The local agent’s effects last for roughly 40 to 60 minutes, which is how long the surgery takes. The patient experiences discomfort as soon as the local anesthetic agent’s effects wear off . The patient takes analgesics after surgery to get over this. Nonsteroidal anti-inflammatory medicines (NSAIDs) including ibuprofen, aspirin, and diclofenac, as well as opioids with central action like morphine, are the most often prescribed analgesics. These medications efficiently control postoperative pain, but they each have different side effects . Systemic side effects of NSAIDs include peptic ulcers, platelet dysfunction, and renal, and hepatic dysfunction. Opioids that are -agonists, however, provide an efficient substitute for opioids without causing immediate organ damage. Opioids, however, can also have central side effects such as nausea, vomiting, dizziness, exhaustion, respiratory depression, and hypotension.
This helped researchers understand buprenorphine hydrochloride, a medication with powerful analgesic efficacy and almost no negative systemic side effects. A synthetic opioid with agonistic, antagonistic, and antihyperalgesic properties is buprenorphine hydrochloride. Buprenorphine’s pharmacological effects are reportedly 20–25 times stronger than those of morphine (a -opioid receptor agonist), with a quicker onset and longer duration of action (buprenorphine 0.3 mg is as potent as morphine 10 mg) [6,7]. Various factors such as the growth stage of the tooth and the radiographic pattern of the development and
growth of the teeth affect this frequency. Embedded teeth can
cause caries, pulp, and periodontal diseases, root resorption of
adjacent teeth, and even tumors of the mouth, jaw, and face, which
are very difficult to diagnose and treat for dentists, and how to
treat in terms of function and beauty is also difficult for patients
with It is important . The reasons for prescribing wisdom
tooth extraction are pain caused by caries, temporomandibular
joint (TMJ) pain, orthodontics and crowding, pericoronitis, and
prosthetic preparations. And its distribution has considerable
A number of 90 patients (out of 850 patients) who were
referred to the oral and maxillofacial surgery department of the
Moscow Clinic in 2021-2022 for the surgery of mandible wisdom
teeth were included in the plan . Before surgery, the degree of
hardness of the impacted tooth was evaluated and determined
according to the combination of Winter, Schiller, and Pell &
Gregory classifications based on the OPG radiographic view and
recorded in the checklist [9,10]. Then wisdom tooth surgery was
performed. The Pell & Gregory criterion is expressed as follows:
a) Pell & Gregory’s vertical classification is described in
three classes A, B, and C in terms of depth of wisdom tooth (M3)
embedment compared to the dentofacial plan of the second molar
tooth (M2). In class A, the depth of M3 embedment is at the level
of the dentofacial plan of the M2 tooth, class B, the depth of M3
embedment is between the dentofacial surface and the CEJ of the
M2 tooth, and in class C, the depth of the M3 embedment is below
the CEJ of the M2 tooth.
b) Horizontal Pell & Gregory classification, in terms of the
space between the mandible ramus and M3, is divided into three
classes 1, 2, and 3.
i. Class 1: There is enough space for M3 growth,
ii. Class 2: There is not enough space for M3 growth (M3
tooth is partially inside the ramus), and
iii. Class 3: M3 tooth is completely inside the ramus.
Schiller’s classification (which is a supplement to Winter’s
classification) determines the mesial-distal relationship and the
occlusion angle. In this classification, the hardness is grouped as
singular, horizontal, vertical, and distangular from one to four, so
that in the mesioangular type (hardness 1) the longitudinal axis of
the M3 tooth crown with the occlusal surface. The M2 tooth has an
angle between 10 and 70 degrees towards the mesial side if it has
the same angle towards the distal side . Distangular (difficulty
4) is classified. The angle is less than ten degrees mesial or distal as
vertical (difficulty 2), and an angle greater than 70 degrees mesial
or distal is considered horizontal depression (severity 3). Finally,
by using the above three classifications, technical and technical
issues and problems of surgery were predicted and investigated.
According to the degree of difficulty obtained from the vertical Pell
& Gregory classification from 1 to 3, as well as the horizontal Pell
& Gregory from 1 to 3, as well as the Schiller classification from 1
to 4, in total, the total degree of difficulty based on the Pederson
classification scale, Defined from 3 to 10.
In general, the degree of hardness of wisdom teeth is classified
Easy 3-4, medium: 5-7, and hard 8-10. Finally, the information
obtained from 90 patients (out of 850 patients) was summarized
and compared based on the gender and severity of the obstruction,
and the prevalence percentage of different obstructions was
The relationship between the variables was checked by SPSS
software with version 22 . It should be noted that chi-square
tests and one-factor analysis of variance were used in the data
A modified solution of lidocaine 2% with epinephrine 1:20,000
mixed with buprenorphine and solution B containing lidocaine
2% with epinephrine 1:2,000 were created as two solutions for a
double-blinded trial. Buprenorphine was added to lidocaine 2% at
a dosage of 1 ml of 0.3 mg in a 30 ml vial (0.01 mg/ml) . After
receiving the coin from the appropriate patient, the dental nurse
started working on the solution. The most LA that may be given
was 3 ml. In 3 ml of LA given, there was 0.03 mg of buprenorphine
(0.01 mg/ml x 3 ml).
SPSS version 20 (IBM Corp., 2011) was used for the analysis.
Armonk, New York: IBM Corp., IBM SPSS Statistics for Windows,
Version 20.0. Statistical significance was defined as a p-value of
0.05. The Wilcoxon signed-rank test was used to compare the pain
scores and the number of rescue analgesics between the test and
control groups [14,15].
The surgical method is invasive since it entails making a
mucosal incision to raise a mucoperiosteal flap that exposes
the impacted tooth underneath. Bradykinin and histamine are
two inflammatory mediators that are released in response to
tissue injury. The nociceptors are affected by these inflammatory
mediators [14,16]. Soreness, swelling in the submandibular region,
and trismus in the submasseteric region are probably the results.
Analgesics and anti-inflammatory medications, the most popular
of which are NSAIDs, are prescribed postoperatively (nonsteroidal
anti-inflammatory drugs) . Despite having an analgesic effect,
they have the potential to have negative side effects, including
renal damage and GI problems. Opioid analgesics, on the other
hand, are a mainstay of management for crippling disorders. In
low doses, they are not known to directly affect organs . On the other hand, they are known to have central effects such as nausea, vomiting, increased biliary tract pressure, dizziness, exhaustion,
respiratory depression, and hypotension when taken systemically.
Studies on the impact of opioids when combined with LA were
encouraged by the discovery of opioid receptors on peripheral
nerves, which revealed the potential for obtaining postoperative
analgesia. However, studies were done to examine the effectiveness
of a stronger opioid that is a partial agonist of the -opioid receptor
and antagonist of the -opioid receptor and shows less systemic
adverse effects due to the varied central effects associated with the
usage of morphine. When compared to morphine, buprenorphine,
a mild-receptor agonist and antagonist, induced analgesia that
lasted longer while having fewer side effects (Table1).
Women were more likely than men to have impacted wisdom
teeth among the patients who visited the Mod Amulet dental
clinic in Moscow. Mesioangular angles of incidence were most
frequently seen. Medium hardness degree was associated with the
highest likelihood of wisdom teeth impaction. According to the
classifications by Winter & Schiller and Pell & Gregory, there is a
considerable correlation between gender and the angle at which
wisdom teeth are impacted as well as their depth and connection
to the ramus. When used for intraoral block procedures, a local
anesthetic solution combined with buprenorphine efficiently
lowers postoperative pain with few adverse effects. In the first 48
hours after receiving lidocaine and buprenorphine, participants
in the current study had significantly lower mean pain scores.
However, there was no discernible distinction between the test
and control interventions in terms of how many rescue analgesics
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