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Scientific Reports Apr 2023Restorative and prosthetic considerations usually necessitates endodontic treatment of third molars in order to retain them as a functional component of the dental arch....
Restorative and prosthetic considerations usually necessitates endodontic treatment of third molars in order to retain them as a functional component of the dental arch. However, the anatomy of third molars has been described as unpredictable. To date, there has been little published work on root and canal morphology of third molars, with an adequate sample size. The aim of this study was to investigate root and canal morphology of third molars. Maxillary and mandibular third molars were gathered from dental surgeries within north Jordan. Following access cavity preparation, pulp tissue was removed and root canals stained. Teeth were subject to examination after rendering them clear by immersion in methyl salicylate, and the following features evaluated: (1) number of roots; (2) number and type of root canals; (3) number and position of lateral canals; and (4) presence of inter-canal communications. Out of the examined 592 maxillary third molars, 69.9% had three roots, 10.81% had one, 9.79% had two, 9.12% had four, and 0.34% had five roots. Most had three (52.36%) and four canals (28.2%) with less frequency of two (11.48%), one (5.91%) and five canals (2.03%). Of the 639 mandibular third molars, 89.76% had two roots, 7.35% had three, 2.5% had one, and 0.47% had four roots. Most had three (55.71%) and two canals (29.42%) with less frequency of four (13.61%), one (1.09%) and five canals (0.15%). The majority of maxillary third molars had 3 roots, while the majority of mandibular third molars had two. Overall, nearly half of the maxillary and mandibular third molars had three canals. New canal configurations, not previously described in the literature nor included in Vertucci's classifications, were identified in both maxillary and mandibular third molars.
Topics: Humans; Molar, Third; Tooth Root; Molar; Maxilla; Dental Pulp Cavity; Cone-Beam Computed Tomography
PubMed: 37106025
DOI: 10.1038/s41598-023-34134-7 -
Journal of Endodontics Jan 2021Targeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed...
INTRODUCTION
Targeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS.
METHODS
Three endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS.
RESULTS
Palatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA.
CONCLUSIONS
Palatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.
Topics: Arteries; Cone-Beam Computed Tomography; Maxilla; Microsurgery; Molar; Tooth Root
PubMed: 33091453
DOI: 10.1016/j.joen.2020.10.005 -
Journal of Anatomy Jan 2022Molar morphology is shaped by phylogenetic history and adaptive processes related to food processing. Topographic parameters of the occlusal surface, such as sharpness...
Molar morphology is shaped by phylogenetic history and adaptive processes related to food processing. Topographic parameters of the occlusal surface, such as sharpness and relief, can be especially informative regarding diet preferences of a species. The occlusal surface can however be deeply modified by wear throughout an animal's life, potentially obliterating other signals. Age being difficult to assess in wild populations, especially small rodents, experimental studies of wear through age in laboratory populations may constitute a powerful way to assess its impact on molar geometry and topography, and to validate descriptors of molar morphology that could mitigate this issue. Molar morphology was therefore quantified using 3D geometric morphometrics and topographic estimates in four groups of house mice: wild-trapped mice, lab-bred offspring of these wild mice, typical laboratory mice, and their hybrids. Three descriptors of the molar morphology were considered: the surface of the whole molar row, the surface of the first upper molar, and a truncated template of the first upper molar mimicking advanced wear. Increasing wear with age was demonstrated in the different groups, with a more pronounced effect in the wild-trapped population. The geometry of the molar row is not only modified by wear, but also by the relative position of the late developing molars on the jaw due to loading during mastication. As a consequence, the alignment of the molars is modified in wild mice, showing a qualitative difference between wild animals and their lab-bred offspring. Results obtained from the lab should thus be transferred with caution to the interpretation of differences in wild populations. Topographic estimates computed for the first upper molar seems to provide more stable parameters than those based on the whole molar row, because issues related to non-planar occlusal surface along the molar row are discarded. The truncated template was proven efficient in discarding the wear effect to focus on genetic differences, allowing an efficient characterization of the hybridization signature between wild and lab mice. Dominance of the wild phenotype for the first molar shape supports that the lab strain evolved in a context of relaxation of the selective pressures related to nutrition.
Topics: Animals; Diet; Laboratories; Mastication; Mice; Molar; Phylogeny
PubMed: 34333769
DOI: 10.1111/joa.13529 -
Scientific Reports May 2022The decision on retaining or prophylactically removing asymptomatic lower third molars is still discussed in the literature. This study aimed to verify the association...
The decision on retaining or prophylactically removing asymptomatic lower third molars is still discussed in the literature. This study aimed to verify the association between asymptomatic lower third molars and local bone conditions through periapical radiographs. Based on sample size calculations, 288 radiographs were required. Dependent variables were alveolar bone crest status and radiolucency between the distal aspect of the third molar crown and the ascending mandibular ramus. Independent variables were sex, age, Pell and Gregory and Winter's classification, angulation and distance between second and third molars, third molar side. Advanced ages (OR 1.15; CI 1.08-1.24; p < 0.001) and greater third molar angulations (OR 1.03; CI 1.01-1.04; p < 0.001) significantly increased the chance of radiographic alterations in the bone crest between second and third molars. Radiolucency distal to third molars was solely impacted by patient's age (OR 1.05; CI 1.01-1.11; p = 0.036). Older patients and lower third molars with greater angulations about adjacent second molar should be evaluated for third molar removal because of the increased chance of alveolar bone crest alterations. Older patients should also be monitored for wider radiolucent pericoronal spaces distal to lower third molars and its consequences.
Topics: Alveolar Process; Bone Diseases; Humans; Mandible; Molar; Molar, Third; Tooth Extraction
PubMed: 35606483
DOI: 10.1038/s41598-022-12729-w -
Journal of Dentistry Oct 2023This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we tried to determine the factors that affect the prognosis of pulpotomy in primary molars.
METHODS
This randomized clinical trial enrolled 158 molars of 52 children; 153 teeth were finally included and divided into three groups: ProRoot MTA (n = 50), Endocem MTA Premixed (n = 53), and Well-Root PT (n = 50). Clinical and radiographic follow-up was performed at 3, 6, and 12 months postoperatively and at the last visit post-treatment. Data were analyzed using the Fisher's exact test, Cox regression analysis, and the Kaplan-Meier survival curve method.
RESULTS
The success rates in the ProRoot MTA, Endocem MTA Premixed, and Well-Root PT were 92, 84.9 and 82%, respectively. The cumulative survival rates did not differ significantly among the materials. Among the investigated variables, only ΔF and ΔF max significantly affected the success rates. In the multivariate survival tree model, significant unfavorable survival was observed when the ΔF value was -14.4 or less (hazard ratio, 7.56; P = 0.0295).
CONCLUSIONS
Considering the clinical effectiveness of Endocem MTA Premixed and Well-Root PT and the operational convenience as a premixed type, they can be used as advantageous materials in the pulpotomy of primary molars in pediatric patients. The QLF method is a useful diagnostic method that can establish treatment plans and determine the prognosis of pulpotomy based on the ΔF value in primary molars.
CLINICAL SIGNIFICANCE
Endocem MTA Premixed and Well-Root PT can confer high success rates and are non-inferior to ProRoot MTA in pulpotomy for primary molars. We also showed that QLF technology can be applied to predict the success/failure and prognosis of pulpotomies in primary molars.
Topics: Humans; Child; Pulpotomy; Dental Cementum; Calcium Compounds; Molar
PubMed: 37660882
DOI: 10.1016/j.jdent.2023.104684 -
British Dental Journal Apr 2020The 20-year anniversary of the implementation of NICE TA1 - Guidance on the Extraction of Wisdom Teeth - arrived in March 2020. Since its implementation, impaction of...
The 20-year anniversary of the implementation of NICE TA1 - Guidance on the Extraction of Wisdom Teeth - arrived in March 2020. Since its implementation, impaction of erupted or partially erupted mandibular third molars and the associated increased caries risk in second molars has been a topic widely debated in both general practice and hospital settings. This has led to significant variation in the management observed. Radiographic examination of carious second molars with an associated impacted third molar is not routine and is commonly a coincidental finding following routine bitewing examination in an otherwise symptom-free, healthy mouth. Caries in mandibular second molars is a clear oversight in NICE guidance, with management decisions influenced by personal philosophy, clinical judgement and experience. NICE guidance is exactly that; guidance, an aid to help our and the patient's decision-making. Consideration should be given to caries risk assessment and the judicious use of radiographs as well as clinical expertise, taking account of patient values on a case-by-case basis when deciding if teeth should be kept or removed.
Topics: Dental Caries; Humans; Mandible; Molar; Molar, Third; Tooth Extraction; Tooth, Impacted
PubMed: 32277204
DOI: 10.1038/s41415-020-1433-x -
L' Orthodontie Francaise Nov 2023Delayed evolution of second molars is a rare phenomenon with an estimated prevalence in the mandible of 0 to 2.3%. Many etiologies have been proposed to explain these...
INTRODUCTION
Delayed evolution of second molars is a rare phenomenon with an estimated prevalence in the mandible of 0 to 2.3%. Many etiologies have been proposed to explain these inclusions, among which the reduction of arch perimeter, distalization of first molar, mesio-angulated position of the second molar. However, the presence and position of the third molar does not seem to be a risk factor for this inclusion.
MATERIALS AND METHODS
Several therapeutics options with surgical management have been proposed in the literature; surgical repositioning, surgical release of the crown more or less associated with orthodontic treatment, and sometimes avulsion of the second molar to allow the third molar development. There is no recommendation on this subject, the literature describing mostly retrospective studies and case reports.
CONCLUSION
This article presents the different therapeutic options in the treatment of second molar inclusions.
Topics: Humans; Retrospective Studies; Molar; Tooth, Impacted; Molar, Third; Clonal Hematopoiesis
PubMed: 37930339
DOI: 10.1684/orthodfr.2023.140 -
Oral Radiology Apr 2022To evaluate the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings...
Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans.
OBJECTIVE
To evaluate the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings on the distal surface of the second molar teeth with cone beam computerized tomography (CBCT) scans.
METHODS
All CBCT images of 189 impacted maxillary teeth belonging to 121 patients were examined by an observer. After determining the position and impaction level of the impacted maxillary third molar teeth, presence of caries, resorption and marginal bone loss in the distal of the second molar tooth were evaluated. IBM SPSS Statistics 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used for statistical analyses and calculations. Data were analysed using the Chi-square test and Fisher's exact test.
RESULTS
A statistically significant difference was found in terms of the impaction level of the impacted maxillary third molar tooth and the presence of caries in the distal surface of the second molar tooth, in terms of the impaction level of the impacted third molar tooth and the presence of marginal bone loss in the distal surface of the second molar tooth. A similar difference was found in terms of the impaction level of the impacted third molar tooth and the presence of root resorption in the distal surface of the second molar tooth.
CONCLUSION
These data on the natural history of impacted maxillary third molars may contribute to both more accurate estimates of the risk of complications associated with these teeth and determination of the prophylactic approach to asymptomatic impacted third molars.
Topics: Dental Caries Susceptibility; Humans; Molar; Molar, Third; Spiral Cone-Beam Computed Tomography; Tooth, Impacted
PubMed: 34255286
DOI: 10.1007/s11282-021-00554-2 -
Journal of Oral and Maxillofacial... Jan 2022The evidence on surgical uprighting and surgical exposure for the management of impacted mandibular second molars is limited. This systematic review evaluated the... (Review)
Review
PURPOSE
The evidence on surgical uprighting and surgical exposure for the management of impacted mandibular second molars is limited. This systematic review evaluated the efficacy of both of these surgical procedures in the management of impacted mandibular second molars.
METHODS
The authors conducted a systematic review without meta-analysis of English language articles on Pubmed and Embase databases without publication date restrictions. Additional studies were identified by searching reference lists and manually reviewing published literature in key journals. Potential included study types were cases series, cohort studies, and randomized clinical trials studying surgical uprighting or surgical exposure of impacted mandibular second molars. The outcomes studied were the positioning of the tooth in the dental arch, pulpal obliteration or calcification, infection, root resorption, and root fracture.
RESULTS
Of the 1,438 records identified, 8 were included in the review, representing a total of 433 molars. The age of study participants in the included studies ranged from 7 to 20 years. A total of 22 of 27 (81.5%) impacted mandibular second molars included in this study were reported to be successfully positioned in the dental arch after surgical exposure. A total of 374 of 408 (91.7%) mandibular second molars included in this study were successfully positioned in the dental arch after surgical uprighting. There were no reported cases of infection and root fracture of impacted mandibular second molars treated by surgical exposure. In surgical uprighting, the overall reported rates of pulpal obliteration or calcification, infection, root resorption, and root fracture were 27.1, 1.9, 14.9, and 1.0%, respectively.
CONCLUSIONS
While there are few studies comparing treatment strategies for the management of impacted mandibular second molars, surgical uprighting appears to be a successful treatment option for these patients with few reported complications.
Topics: Adolescent; Adult; Child; Humans; Mandible; Molar; Molar, Third; Root Resorption; Tooth, Impacted; Young Adult
PubMed: 34582806
DOI: 10.1016/j.joms.2021.08.160 -
Journal of the Irish Dental Association 2014Statement of the problem: Infraoccluded primary molars can be managed in general dental practice but clinicians need to understand when intervention is necessary. (Review)
Review
UNLABELLED
Statement of the problem: Infraoccluded primary molars can be managed in general dental practice but clinicians need to understand when intervention is necessary.
PURPOSE OF THE STUDY
To review the current literature on infraocclusion in primary molars, and to demonstrate diagnosis and management strategies for general dental practitioners.
METHODS AND MATERIALS
Current literature was sourced via PubMed search using multiple key words. Relevant articles are summarised within the article. Different management strategies will be illustrated using a section of cases of differing severities and age at diagnosis. All interventions, including conservative management, restorative, and surgical management will be reviewed. The importance of early diagnosis, continued monitoring, and interdisciplinary team work will be emphasised.
RESULTS
Infraocclusion of primary molars is a common clinical finding, which can be diagnosed both clinically and radiographically. The severity of infraocclusion is classified according to the relationship of the occlusal surface of the tooth relative to adjacent teeth. The age of the child at diagnosis and rate of infraocclusion play a pivotal role in case management. The majority of primary molar teeth exfoliate naturally when the permanent successor is present, however active intervention may be required in some cases. Possible management techniques include extraction, restoration, and luxation of these teeth.
CONCLUSIONS
All children in the mixed and primary dentition should be assessed for infraocclusion of primary molars, particularly mandibular molars. Accurate dental records are essential to assess the severity and monitor the rate of progression of infraocclusion so that the condition can be appropriately managed.
Topics: Age Factors; General Practice, Dental; Humans; Malocclusion; Molar; Patient Care Planning; Tooth, Deciduous
PubMed: 25272471
DOI: No ID Found