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BMC Oral Health Nov 2023To observe the three-dimensional positional relationship between impacted mandibular third molars (IMTMs) and mandibular canal close contacts using cone beam computed...
OBJECTIVE
To observe the three-dimensional positional relationship between impacted mandibular third molars (IMTMs) and mandibular canal close contacts using cone beam computed tomography (CBCT).
METHODS
A total of 101 patients with IMTMs were selected who met the diagnostic criteria for 142 teeth (no bone wall imaging area between IMTMs and the mandibular canal, a high-density bone cortical imaging area only, or a ≦1 mm bone imaging area). The parameters of the rotating CBCT anode were set as follows: 110 kV, 40-50 mA; the focal point and exposure field were set as 0.3 mmh and a high-resolution zoom, respectively; the exposure time and image layer thickness were set as 5.4 s and 0.25 mm. Three-dimensional reconstruction was performed, and the position of the mandibular canal through the IMTM area was observed continuously from the coronal, horizontal and sagittal planes.
RESULTS
We found that the mandibular canal was interrupted below the third molar (TM) in 85 cases, accounting for 59.86% of all cases. The mandibular canal was located below the buccal and lingual curvatures in 33 and 19 cases, respectively, accounting for 23.23% and 19%. In addition, a small number of mandibular canals were also located on the buccal side of the mandibular molars (2.82%). We also found one case of direct insertion of the mandibular third molar (MTM) into the mandibular canal. In addition, the mandibular canal passed through the IMTM region with 125 close contacts at the roots (88.03%); 14 mandibular canals were in contact with all teeth and 3 were in contact with the crown.
CONCLUSION
The use of CBCT can provide a dynamic and comprehensive understanding of the three-dimensional positional relationship of the mandibular alveolar nerve canal passing through the IMTM area, providing a high clinical reference value when extracting IMTMs and reducing the risk of injury to the inferior alveolar nerve.
Topics: Humans; Molar, Third; Mandibular Canal; Molar; Mandible; Tooth, Impacted; Cone-Beam Computed Tomography; Mandibular Nerve
PubMed: 37924035
DOI: 10.1186/s12903-023-03548-0 -
Stomatologija 2020Evaluate the influence of different wound closure methods in terms of pain, swelling, trismus, infection and healing time after third molar extraction. (Review)
Review
OBJECTIVE
Evaluate the influence of different wound closure methods in terms of pain, swelling, trismus, infection and healing time after third molar extraction.
MATERIAL AND METHODS
A literature analysis was performed according to PRISMA guidelines in search of clinical trials published between 2015 and 2020. Databases were searched using different combinations of the following keywords: mandibular impacted OR retained wisdom teeth OR third molar removal OR extraction AND surgical removal AND discomfort OR pain OR trismus OR swelling AND drain OR drainage. The literature search resulted in a total of 364 publications. Finally, 12 study articles were used in the present review, following a selection based on the preestablished eligibility criteria.
RESULTS
The significant difference between various wound closure ways and postoperative pain, swelling and trismus has been found in 8 of 12 analyzed articles. Three of five established beneficial effect of drain application. In other articles, examining different wound closure methodologies, significant benefits were found by using buccally based triangular, buccal mucosal-advancement, and modified envelope flap. Suture-less anterior releasing incision and secondary wound closure also could be favorable after removing impacted third molars.
CONCLUSION
There was no significant effect of a rubber drain on swelling, pain, trismus, or wound infections after removal of the asymptomatic impacted third molar(s). Secondary wound closure was found to ensure lower pain, swelling and trismus ratio with comparison to primary wound closure.
Topics: Humans; Mandible; Molar, Third; Pain, Postoperative; Tooth Extraction; Tooth, Impacted; Trismus
PubMed: 33847282
DOI: No ID Found -
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 -
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 -
Forensic Science International May 2023Reliability, or repeatability, of permanent tooth staging techniques is usually expressed as Cohen's Kappa. This single value obscures information about the quantity and...
Reliability, or repeatability, of permanent tooth staging techniques is usually expressed as Cohen's Kappa. This single value obscures information about the quantity and allocation of disagreements. In this study we assess and compare intra-observer reliability of permanent tooth staging techniques described by Nolla, Moorrees et al. and Demirjian et al. The sample was panoramic radiographs of healthy dental patients made up of 100 males and 100 females aged 6-15 years. All permanent teeth on the left side (excluding third molars) were scored twice. Weighted Kappa and percentage agreement were calculated. Results show Kappa values for all teeth combined as 0.918, 0.922 and 0.938 for Demirjian (number of teeth N = 2682), Nolla (N = 2698) and Moorrees (N = 2674) respectively. A comparison of Kappa values between upper and lower teeth showed marginally higher values for upper incisors and lower molar for all three scoring methods. Small differences in Kappa values were noted between tooth types with the upper first molar having smaller values than other teeth. Percentage agreement ranged from 81 % (Moorrees), 86 % (Nolla) to 87 % (Demirjian). Tooth stage differences between first and second assessments were not more than one stage. Our findings show that Demirjian scoring is marginally more reliable than Nolla or Moorrees. We suggest that (1) data for reliability are tabulated in full to show the quantity and allocation of disagreement between first and second readings, and (2) that the reliability sample is sufficiently large with a wide age range to include multiple different tooth stages.
Topics: Male; Female; Humans; Reproducibility of Results; Age Determination by Teeth; Dentition, Permanent; Tooth; Molar, Third; Molar; Radiography, Panoramic
PubMed: 37011430
DOI: 10.1016/j.forsciint.2023.111654