Epidermoid cyst in the right mandible: a case report and literature review / 口腔疾病防治

Objective@#To discuss the possible etiology, pathogenesis, clinical features, diagnosis and treatment of epidermoid cysts of the jaw and to provide a reference for clinical diagnosis and treatment.@*Methods@#A case of an epidermoid cyst in the right mandible with retained deciduous teeth and succedaneous impacted teeth was reviewed and analyzed in combination with the relevant literature.@*Results@#A patient presented with a mass in the right mandible that had persisted for 1 month after being found at imaging examination. Tooth 83 was retained, and tooth 43 was unerupted. Swelling was characterized by no obvious tenderness, fluctuation, or table tennis sensation and was observed in the lingual alveoli of teeth 83, 44, and 45. Imaging revealed a low-density shadow in the apex of teeth 83, 44, 45, and 46, approximately 1.9 cm × 2.6 cm × 1.6 cm in size, which wrapped around the dental crown of tooth 43. Preliminary diagnoses were as follows: right mandibular mass thought to be a dentigerous cyst; impacted tooth 43; and retained primary tooth 83. The mass in the right mandible was removed, and teeth 43 and 83 were extracted under intravenous and inhalation anesthesia. During the operation, the mass was observed to have a thin cyst wall and contained bean-like residue. Histopathological examination indicated an epidermoid cyst in the right mandible. At the 1-week follow-up examination, the patient reported no discomfort, and the surgical area showed good recovery. According to the literature, epidermoid cysts are benign cysts originating from ectopic ectodermal tissue that can occur throughout the body but rarely in the oral cavity and are even extremely rarer in the jaw. Epidermoid cysts of the jaw, which have no specific clinical manifestations, can be confused with odontogenic cysts such as dentigerous cysts and odontogenic tumors. Dental pulp tests and other techniques can serve as a reference for clinicians. The diagnosis is confirmed via histopathology. Surgical removal is a common treatment, with a good prognosis and a low recurrence rate.@*Conclusion@#The principle of treatment for an epidermoid cyst of the jaw is similar to that for a jaw cyst. The prognosis is good when the cyst is removed completely.

Clinical analysis of orthodontic traction of impacted upper incisors / 口腔疾病防治

Objective@#To study the effect of orthodontic traction on the roots and periodontal soft and hard tissues of buried obstructed upper incisors.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From January 2018 to December 2022, 40 patients who underwent orthodontic traction on impacted upper incisors were selected; those whose contralateral homonymous apical foramen was not developed were placed in group A (23 cases), and those whose contralateral homonymous apical foramen was developed were placed in group B (17 cases). Software was used to measure the root length of the impacted upper incisors in groups A and B on cone beam CT (CBCT) images before and after traction and compare the changes in alveolar bone (alveolar bone width, labral bone plate thickness, and horizontal height of alveolar bone) and keratinized gingival width between each impacted upper incisor and the corresponding contralateral tooth immediately and one year after traction@*Results@#The root length of the impacted upper incisors increased after traction compared to before traction (P<0.05). The width of the alveolar bone at the completion of traction in group A was similar to that of the contralateral homonymous tooth (P>0.05), whereas the width of the alveolar bone at the completion of traction in group B did not reach that of the contralateral homonymous tooth, with a significant difference in width (P<0.05). Neither the labial bone plate height or width in group A or B reached that of the contralateral homonymous tooth after traction (P<0.05). The keratinized gingival width on the affected side was also significantly smaller than that on the contralateral side (P<0.05), but it was increased significantly in group A at the one-year follow-up visit (P<0.05).@*Conclusion@#Tooth traction is conducive to impacted upper incisor root growth, alveolar bone reconstruction and keratinized gingival growth but cannot produce complete symmetry with respect to the contralateral side.

Research progress on valgus impacted proximal humeral fractures / 中国修复重建外科杂志

OBJECTIVE@#To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF).@*METHODS@#The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized.@*RESULTS@#PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option.@*CONCLUSION@#Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.

Relación entre la compresión maxilar y potencial impactación del canino superior: Scoping review

El canino maxilar permanente corresponde al segundo diente más frecuentemente impactado en el arco dental. La etiología de esta patología aún no está totalmente definida, sin embargo, investigadores plantean la deficiencia del ancho del hueso maxilar como una posible causa. Objetivo: Investigar la evidencia que asocia menores dimensiones transversales del maxilar a la ocurrencia de la impactación de caninos superiores y esclarecer la posible relación. Materiales y métodos: Se realizó una revisión sistemática exploratoria a partir de una búsqueda amplia de la literatura en bases de datos PubMed, Cochrane, EBSCO y Multibuscador UNAB. Los artículos fueron recopilados, identificados y filtrados según el diagrama de flujo de declaración PRISMA. Resultados: La búsqueda identificó 755 estudios, de los cuales 14 fueron incluidos. Los estudios varían en diseño, edad de estudio y métodos de diagnóstico. La mitad de los estudios reporta una asociación positiva entre compresión maxilar e impactación canina superior, mientras que la otra mitad una asociación negativa. Conclusiones: No hay evidencia suficiente para poder asociar compresión maxilar con impactación de caninos superiores. Estudios con métodos de diagnóstico rigurosos son necesarios para una mejor comprensión. No obstante, se enfatiza la importancia de un diagnóstico precoz, para garantizar mejores resultados y pronóstico más favorable.

The permanent maxillary canine is the second most frequently impacted tooth in the dental arch. The etiology of this disease is not completely defined, yet some researchers propose the deficiency of the width from the maxilla as a possible cause. Objective: To investigate available evidence correlating smaller transverse maxilla dimensions with the occurrence of potential impaction of upper canines and clarify the possible relation. Materials and methods: A systematic exploratory review was carried out based on comprehensive search of the literature in databases such as PubMed, Cochrane, EBSCO and UNAB multi search engine. The articles were compiled, identified and filtered systematically according to the PRISMA flow diagram. Results: Our search identified 755 studies, 14 of which were included. These studies vary in design, patients age, and methods for detection. Half of the studies show a positive correlation between maxillary compression and potential upper canine impaction, whereas the other half show a negative correlation. Conclusions: There is not enough evidence to link maxillary compression to upper canine impaction. Studies with rigorous diagnostic methods for detection are necessary for a better understanding of this relation. Nonetheless, the importance of early diagnosis must be emphasized to guarantee better results and a more favorable prognosis.

Cirurgia de aproveitamento de dente incluso associada a odontoma: relato de caso / Surgery to use an impacted tooth associated with odontoma: case report / Cirugía para uso de diente incluido asociado a odontoma: reporte de caso

Introdução: Odontoma é o tipo mais comum de tumor odontogênico, contudo são lesões assintomáticas, de crescimento lento e indolor, descobertos geralmente em consultas de rotina, e que muito comumente são causadores de impactação dentária. Esse trabalho tem por objetivo relatar o caso clínico de uma criança que apresentava um odontoma composto na pré-maxila, ocasionando a impactação de seu incisivo central e comprometimento estético. Relato de caso: Paciente de 12 anos, em preparo para tratamento ortodôntico, no qual na etapa de exames de imagem, foi percebido um odontoma composto na região anterior da maxila o qual impedia a irrupção do dente 21, onde para que se conseguisse o melhor aproveitamento estético e funcional, foi indicado a remoção do tumor com 43 estruturas semelhantes a dentes e o tracionamento do dente associado. Conclusão: O tratamento do odontoma não costuma ter recidivas, permitindo o aproveitamento de possíveis dentes associados e manutenção de estruturas nobres adjacentes. Possibilitando também, o tracionamento do dente impactado ao arco dental, restituindo saúde e estética... (AU)

Introduction: Odontoma is the most common type of odontogenic tumor. They are asymptomatic, slow-growing lesions of unknown etiopathogenesis. They have a density similar to teeth, surrounded by a thin radiolucent halo. Objective: To report a clinical case of traction surgery of an impacted tooth associated with compound odontoma, and a brief literature review. Case report: Patient presented composite odontoma in the anterior region of the maxilla, preventing the eruption of tooth 21. The lesion was noticed during the preparation of the orthodontic treatment and for the success of such procedure, the treatment consisted of the excision of the lesion composed of 43 similar structures to teeth and the preparation of the traction of the maxillary central incisor. Conclusion: The removal of the odontoma was extremely relevant, with this, the impacted tooth was exposed, allowing the placement of the orthodontic button for its traction. Positioning the missing tooth in the dental arch, restoring health and aesthetics... (AU)

Introducción: El odontoma es el tipo más común de tumor odontogénico. Son lesiones asintomáticas, de crecimiento lento y de etiopatogenia desconocida. Tienen una densidad similar a los dientes, rodeados de un fino halo radiotransparente. Objetivo: Reportar un caso clínico de cirugía de tracción de un diente retenido asociado a odontoma compuesto, y una breve revisión de la literatura. Reporte de caso: Paciente presentó odontoma compuesto en la región anterior del maxilar, impidiendo la erupción del diente 21. La lesión fue notada durante la preparación del tratamiento de ortodoncia y para el éxito de dicho procedimiento, el tratamiento consistió en la escisión de la lesión. compuesto por 43 estructuras similares a los dientes y la preparación de la tracción del incisivo central maxilar. Conclusión: La remoción del odontoma fue de suma relevancia, con esto se logró exponer el diente impactado, permitiendo la colocación del botón de ortodoncia para su tracción. Posicionamiento del diente faltante en la arcada dentaria, restaurando la salud y la estética... (AU)

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Complicaciones en la extracción de terceros molares mandibulares incluídos, retenidos e impactados. Revisión de la literatura / Complications in the extraction of impacted, and retained third molars. Literature Review

La literatura científica sostiene que los terceros molares muy a menudo son lo que contemplan varías complicaciones al momento del procedimiento quirúrgico, debido no solo a su erupción sino también a sus diferentes características que suceden como anatomía, forma, posición de su erupción, etc. Para ello el estudio complementario Integral antes de pasar al acto quirúrgico es la primera opción que se hace. Para que un correcto tratamiento post-quirúrgico sea efectivo tanto antibiótico farmacológico, biomateriales integrales, etc. Objetivo: Establecer por medio de una revisión de la literatura cuáles son las acciones o procedimientos quirúrgicos ejecutándose que pueden evitar las complicaciones más prevalentes en la extracción de terceros molares mandibulares incluídos, retenidos e impactados. Materiales y métodos: Se plantea un estudio de tipo descriptivo y de análisis respectivamente con 2 tipos de bases electrónicas: PubMed y SciELO tomando como sustentación artículos que contemplen meta-análisis, revisiones sistemáticas, revisiones literarias, etc. Resultados: Se confirmó que el mejor procedimiento ante quizás una posible: hemorragia, fracturas, laceraciones, etc. es el buen manejo quirúrgico farmacológico durante la cirugía y posterior a esta. Conclusión: Con esta revisión de la literatura se llega a la idea de que un correcto diagnóstico, manejo estricto farmacológico y el conocimiento de las complicaciones que pueden suscitarse durante y posterior en las extracciones dentales son acciones correctas que se utilizan muy comúnmente durante el procedimiento quirúrgico, lo que evita sus respectivas dificultades.

After the various articles compiled by different authors, is becomes clear that the third molars are very often what contemplate various complications at the time of the surgical procedure, due not only to their eruption but also to their different characteristics that occur such as anatomy, shape, position of its eruption, etc. For this reason, the comprehensive complementary study before proceeding to the surgical act is the first option that is made. For a correct post-surgical treatment to be effective both antibiotic-pharmacological, integral biomaterials, etc. Purpose: To establish through a review of the literatura which are the actions or surgical procedures being performed that can avoid the most prevalent complications in the extraction of included, retained and impacted mandibular third molars. Materials and methods: A descriptive and analytical study is proposed, respectively, with 2 types of electronic databases: PubMed and SciELO, taking as support articles that include meta-analyses, systematic reviews, literary reviews, etc. Results: It was confirmed that the best procedure for perhaps a possible one: hemorrhage, fractures, lacerations, etc. It is good pharmacological surgical management during and after surgery. Conclusion: With this review of the literature, the idea is reached that a correct diagnosis, strict pharmacological management and knowledge of the complications that can arise during and after dental extractions are correct actions that are very commonly used during the surgical procedure. , which avoids their respective difficulties.

Caracterización epidemiológica, clínica y cefalométrica del brote anormal de los terceros molares / Epidemiological, clinical and cephalometric characterization of the abnormal eruption of third molars

Introducción: El brote de los terceros molares es un proceso que no está del todo explicado, pero durante su erupción puede provocar diferentes accidentes o complicaciones. Objetivo: Caracterizar el brote anormal de los terceros molares según variables epidemiológicas, clínicas y cefalométricas. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente «Mártires del Moncada», de Santiago de Cuba, desde noviembre de 2019 a febrero de 2020. La población estuvo conformada por jóvenes de 18 a 25 años de edad; la muestra fue seleccionada por muestreo aleatorio simple. Se tuvieron en cuenta las siguientes variables: sexo, color de la piel, brote anormal y otras variables cefalométricas. Resultados: De los 84 dientes incluidos en el estudio, se detectaron 66 terceros molares con brote anormal (78,6 %). El promedio asociado al brote de estos molares de espacio óseo superior insuficiente fue igual para los superiores con medias de 25,9 mm; el de angulación inadecuada resultó obtuso en el superior izquierdo con 128,3º y agudo en los inferiores derechos con 58,8º; asimismo el mayor diámetro mesiodistal inadecuado fue el de los inferiores derechos con 15,7 mm. Conclusiones: El brote anormal de los terceros molares se caracteriza por afectar, de forma importante, a féminas y a individuos mestizos. Su observación se singulariza, fundamentalmente, en molares inferiores con espacios óseos posteriores reducidos, mesioangulaciones y diámetros mesiodistales considerables.

Introduction: eruption of the third molars is a process that is not fully explained in the literature; however it is known that their eruption can cause different complications. Objective: to characterize the abnormal eruption of third molars according to epidemiological, clinical and cephalometric variables. Methods: an observational, descriptive and cross-sectional study was carried out at "Mártires del Moncada" Provincial Teaching Dental Clinic, in Santiago de Cuba, from November 2019 to February 2020. The population consisted of young people aged 18-25 years; the sample was selected by simple random sampling. Gender, skin color, abnormal eruption and other cephalometric variables were taken into account. Results: sixty-six third molars with abnormal eruption were detected from the 84 teeth included in the study (78.6%). The average associated with the eruption of these molars with insufficient upper bone space was the same for the upper ones with means of 25.9 mm; the average with inadequate angulation was obtuse in the upper left third molar with 128.3º and the acute one in the lower right third molars with 58.8º; the lower right third molars likewise had the largest inadequate mesiodistal diameter with 15.7 mm. Conclusions: the abnormal eruption of third molars is characterized by significantly affecting females and mixed-race individuals. Its observation is singled out, fundamentally, in lower molars with reduced posterior bone spaces, mesioangulations and considerable mesiodistal diameters.

Has the literature thoroughly categorized the lower third molars? A new classification of the various lower third molar root forms for a better understanding of their morphology / ¿La literatura ha categorizado minuciosamente los terceros molares inferiores? Una nueva clasificación de las diversas formas radiculares del tercer molar inferior para una mejor comprensión de su morfología

SUMMARY: Impacted lower third molars (IL3M) have different root shapes and numbers. This study aimed to create a classification for IL3M root forms, that should aid in understanding roots morphology. A retrospective cross-sectional study on patients had IL3M at the university clinics between 2017 and 2019. Panoramic radiographs were retrieved to classify the roots into fused roots (FR): one or two roots connected from furcation to apices, and separated roots (SR): two or more roots not connected from furcation to apical third, and each type has different forms. Statistical analysis was done by Chi-Square test. Five-hundred patients, males (54.6 %) and females (45.4 %) were included. SR were in 591 teeth (75.5 %), and FR in 192 teeth (24.5 %). Statistically significant associations emerged between SR and males (60 %) and between FR and females (66 %) (p = .000). SR forms were straight (45.8 %), joined roots (28.2 %), one straight and one curved (13.3 %), roots curved distal (9.1 %), roots curved mesial (2.5 %), and more than two roots (0.3 %). FR forms were straight (87.5 %), curved distal (9.4 %), S-shaped (2.1 %), and curved mesial (1 %). The common angulations of IL3M with SR were vertical (39 %) followed by mesioangular (25.7 %), while FR were mostly vertical (39.1 %) or horizontal (23.9 %). The classification is applicable on panoramic radiographs, and complements Winter and Pell & Gregory to provide a better description of IL3M status by adding root morphology to the angulation, occlusal, and ramus relationship.

Los terceros molares inferiores impactados (3MII) tienen diferentes formas y números de raíces. Este estudio tuvo como objetivo crear una clasificación para las formas de raíz 3MII, que debería ayudar a comprender la morfología de las raíces. Realizamos un estudio transversal retrospectivo de pacientes con 3MII en las clínicas universitarias entre 2017 y 2019. Se recuperaron radiografías panorámicas para clasificar las raíces en raíces fusionadas (RF): una o dos raíces conectadas desde la zona de furca a los ápices y raíces separadas (RS): dos o más raíces no conectadas desde la bifurcación al tercio apical, y cada tipo con formas diferentes. El análisis estadístico se realizó mediante la prueba Chi-Cuadrado. Se incluyeron 500 pacientes, hombres (54,6 %) y mujeres (45,4 %). RS se observó en 591 dientes (75,5 %) y RF en 192 dientes (24,5 %). Surgieron asociaciones estadísticamente significativas entre RS y hombres (60 %) y entre RF y mujeres (66 %) (p = .000). Las formas de RS eran rectas (45,8 %), raíces unidas (28,2 %), una recta y una curva (13,3 %), raíces curvas distales (9,1 %), raíces curvas mesiales (2,5 %) y más de dos raíces (0,3 %).). Las formas RF eran rectas (87,5 %), curvas distales (9,4 %), en forma de S (2,1 %) y curvas mesiales (1 %). Las angulaciones comunes de 3MII con RS fueron verticales (39 %), seguidas de mesioangular (25,7 %), mientras que RF fueron mayoritariamente verticales (39,1 %) u horizontales (23,9 %). La clasificación es aplicable en radiografías panorámicas y complementa a Winter y Pell & Gregory para proporcionar una mejor descripción del estado de 3MII al agregar la morfología de la raíz a la relación de angulación, oclusal y rama.

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare ef?cacy and safety of ?exible and rigid esophagoscopy in esophageal foreign body removal. It is a prospective study done in E.N.T department in KIMS Methods: MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. This prospective cohort study includes 50 patients Results: who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for Conclusion: removal of impacted esophageal foreign body

Predictive value of proximal and distal ureteral diameter ratio for impacted stones in the middle and upper ureter / 中华泌尿外科杂志

Objective:To evaluate the predictive value of proximal ureteral diameter (D1)to distal ureteral diameter (D2)ratio (DDR) for impacted stones in the middle and upper ureter.Methods:The clinical data of 173 patients with middle and upper ureteral calculi admitted to the Third Hospital of Shanxi Medical University from January 2014 to November 2021 were retrospectively analyzed. There were 75 males and 98 females, with the median age of 56.0 (51.0, 62.0) years old and median body mass index of 26.1 (24.8, 27.2) kg/m 2. The imaging data of the patients were analyzed. The impacted stones were defined as the inability of the contrast agent to pass through the site of obstruction when intravenous urography or CT urography was performed, resulting in the inability of the ureter to visualize normally in parts below the site of obstruction. D1 was defined as the proximal ureteral diameter at the lower pole of the kidney on horizontal CT images. D2 was defined as the ureteral diameter 3 cm from the calculi. The stone diameter, stone CT value, D1, D2, and DDR were compared between impacted stone group and non-impacted stone group. Univariate logistic regression analysis was used to analyze the different indicators. Random number table was used to divide the training set and validation set according to the ratio of 7∶3. Through least absolute shrinkage and selection operator(LASSO) regression analysis, the independent influencing factors were obtained and the nomogram model was established (Model 1). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to verify the predictive efficacy of the model, and the other three effective models (Model 2-4) were constructed by stepwise multivariate logistic regression. The deLong test was used to compare whether there was a significant difference in the AUC between Model 1 and the other three models, and the net benefit of patients was analyzed by clinical decision curve analysis(DCA). Results:In this study, 64 cases (37.0%) were impacted ureteral calculi and 109 cases (63.0%) were non-impacted ureteral calculi, and there were significant differences in diameter[7.8(6.2, 8.8)mm vs. 6.3(5.2, 8.1)mm] , CT value[878.5(763.8, 940.5)HU vs.764.0 (613.0, 854.0) HU], D1[11.1(8.9, 14.9) mm vs. 9.1(7.1, 10.8) mm], D2[4.1(3.1, 4.9) mm vs. 5.0(4.1, 5.9) mm] and DDR[3.1(2.3, 3.9) vs. 1.8(1.4, 2.4)] between the two groups( P < 0.05). The results of univariate logistic regression analysis showed that stone diameter ( OR = 1.333, P < 0.001), CT value ( OR = 1.002, P=0.002), D1 ( OR = 1.146, P<0.001), D2 ( OR = 0.652, P < 0.001) and DDR ( OR = 2.995, P<0.001) were the influencing factors of impacted stones. The training set and validation set included 122 cases and 51 cases, respectively, without significant differences in their image characteristics and outcomes ( P > 0.05). The results of LASSO regression analysis showed that λ corresponding to the simplest result in the optimal range was 0.0908, and three variables were included at this time, and the influencing factors of impacted stones were stone diameter (coefficient 0.0700, OR = 1.073), CT value (coefficient 0.0003, OR = 1.001) and DDR (coefficient 0.5960, OR = 1.815). Moreover, Model 1 was established. According to the model fitting results, ROC curves were plotted, and the AUC of Model 1 was 0.862, and the AUCs of Model 2-4 were 0.859, 0.762, and 0.793, respectively. After deLong test, there was no significant difference between Model 1 and Model 2 ( Z = 0.248, P = 0.804). The AUC of Model 1 was superior to that of Model 3 ( Z = 2.888, P = 0.004) and Model 4 ( Z = 2.321, P = 0.020). The DCA suggested that Model 1 could improve the net benefit rate by up to approximately 21% of patients. Conclusions:DDR is the influencing factor of impacted ureteral calculi, and the model constructed by DDR, stone CT value and stone diameter can effectively predict the probability of impacted ureteral calculi in the middle and upper ureter.

Research progress in the design of surgical flaps for impacted mandibular third molars / 中国基层医药

The incidence of impacted mandibular third molars is high. Many complications occur after extraction of impacted third molars, such as bleeding, pain, swelling, and dry grooves, which affect quality of life. To reduce postoperative complications, various skin flap designs have emerged with time. This paper summarizes the current research progress in designing impacted mandibular third molar flaps, providing a reference for clinical work.

Clinical application of a digital positioning guide template during the extraction of maxillary wholly impacted supernumerary teeth / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of positioning guide templates for maxillary wholly impacted supernumerary teeth to provide technological solutions for clinical applications. @*Methods @#After approval by the hospital ethics committee and informed consent given by the patients. Data from 136 patients with maxillary wholly impacted supernumerary teeth from January 2016 to April 2022 were analyzed retrospectively. The patients were divided into two groups according to the usage of the positioning guide template. The experimental group included patients using the positioning guide template (71 cases), and the control group did not use the positioning guide template (65 cases). The operation time and complications were statistically analyzed to evaluate the clinical efficacy after surgery. @*Results @# All operations were successfully completed. The average operation time in the experimental group was (21.5 ± 3.4) min, significantly shorter than that in the control group (27.2 ± 4.9) min. There were statistically significant differences between the experimental and control groups (t = 7.599, P<0.001). One week after the operation, there were no complications in the experimental group, and there were 2 cases of adjacent tooth injury and 3 cases of gingival numbness in the control group.@* Conclusion @# A digital positioning guide template can effectively shorten the time of maxillary wholly impacted supernumerary teeth extraction and is an effective means to assist clinical maxillary wholly impacted supernumerary teeth extraction.

Comparison of panoramic radiography and cone-beam computed tomography images for detecting external root resorption of mandibular second molar associated with third molar impaction / 口腔医学

Objective@# To compare the diagnostic performance between panoramic radiography(PR)and cone beam computed tomography(CBCT)in the assessment of external root resorption(ERR)of mandibular second molars associated with impacted third molars. @*Methods@# A total number of 832 patients with 1 074 mesially and horizontally impacted mandibular third molars treated at our institution from January 2019 to December 2020 were retrospectively analyzed. Presence of ERR on the adjacent second molar was investigated with PR and CBCT. Factors affecting the diagnostic accuracy of PR were determined. @*Results@# The overall incidence of ERR in second molars was 33.15%(356/1 074)as detected by CBCT images. The accuracy of PR was 66.39%. Multivariate Logistic regression analyses further revealed that middle and Class Ⅲ impaction, crown contact or overlap with the root of adjacent tooth were risk factors for inaccurate diagnosis of PR(P<0.05). @*Conclusion@#The accuracy of detection on ERR of mandibular second molar associated with impacted third molar using panoramic radiography is lower. CBCT is recommended for this clinical scenario.

Comprehensive orthodontic treatment of impacted teeth / 口腔疾病防治

@#Impacted teeth are a kind of complex malocclusion, and their incidence differs among different races, sexes and dental positions. The causes of impacted teeth include systemic factors and local factors, such as endocrine disorders, malnutrition, and acute and chronic infectious diseases. Local factors can cause abnormal tooth development or eruption during the process from tooth development to tooth eruption, such as damaged permanent tooth embryos caused by local inflammation or trauma, insufficient eruption space caused by premature loss of deciduous teeth, and eruption disorders caused by local lesions for example hyperplasia or odontoma. The clinical manifestation of impacted teeth is the absence of a permanent tooth in a normal position. We can use cone beam CT (CBCT) to locate the impacted teeth. Comprehensive orthodontic treatment includes surgical-assisted eruption, extraction of retained deciduous teeth or supernumerary teeth, removal of lesions such as odontomas and cysts, and expansion of the orthodontic space. When the dysfunctional local soft and hard tissues are removed during a surgical operation, the tooth still cannot sprout smoothly, and it needs to be assisted by orthodontic traction-guided eruption or extracted and autotransplantation. A clear diagnosis, evaluation of the difficulty of treatment and appropriate treatment are the keys to improving the success rate of treatment. In this paper, the epidemiology, etiology, diagnosis and corresponding treatment methods of impacted teeth will be reviewed, and the orthodontic treatment of impacted teeth will be comprehensively described to provide a reference for clinicians about the treatment of impacted teeth.

Combined micro-apical surgery and vital pulp therapy in mandibular second molars with external root resorption caused by impacted teeth / 华西口腔医学杂志

OBJECTIVES@#This study aimed to establish a new treatment of the mandibular second molars with external root resorption caused by impacted teeth to preserve the affected teeth and their vital pulps.@*METHODS@#For mandibular second molars clinically diagnosed as external root resorption caused by impacted teeth, debridement and removal of the root at the resorption site via micro-apical surgery and direct capping of the pulp with bioactive material on the surface of the root amputation via vital pulp therapy were performed immediately after the impacted teeth were extracted.@*RESULTS@#The external root resorption of the affected tooth was ceased. It was asymptomatic with intact crown, normal pulp, periapical alveolar bone reconstruction, normal periodontal ligament, continuous bone sclerosis, and no periapical translucency in radiographic examination at the 1-year postoperative follow-up, thus showing good prognosis.@*CONCLUSIONS@#Simultaneous combination of micro-apical surgery and vital pulp therapy after extraction of impacted teeth could successfully preserve mandibular second molars with ERR caused by impacted teeth and their vital pulps.

Effect of dental follicles in minimally invasive open-eruption technique of labially impacted maxillary central incisors / 华西口腔医学杂志

OBJECTIVES@#To summarize the open-eruption technique of impacted anterior maxillary teeth, this study reports a technically improved operation on surgical exposure based on dental follicles and evaluates post-treatment periodontal health considering the effect of dental follicles.@*METHODS@#Patients who underwent open-eruption technique with unilateral labially impacted maxillary central incisors were selected. The impacted teeth were assigned to the experimental group, and the contralateral unimpacted maxillary central incisors were assigned to the control group. In the surgical exposure, the new technique makes use of dental follicles to manage the soft tissue, so as to preserve soft tissue for better aesthetic results and healthier periodontal tissue. Tooth length, root length, alveolar bone loss, and alveolar bone thickness were recorded after the therapy.@*RESULTS@#A total of 17 patients with unilateral maxillary central incisor impaction were successfully treated. The tooth length and root length of the two groups showed a statistically significant difference between the impacted and homonym teeth, with a shorter length in the impacted tooth (P<0.05). More labial alveolar bone loss was found in the experimental group compared with that in the control group (P<0.05). The outcomes of the cementoenamel junction width, pa- latal alveolar bone loss, and alveolar bone thickness did not indicate statistical significance between the experimental and control groups (P>0.05).@*CONCLUSIONS@#In the surgical exposure, the new technique uses dental follicles to manage the soft tissue and preserve it for better aesthetic results and healthier periodontal tissues.

Atypical traumatic bone cyst involving impacted lower third molar: report of case / Cisto ósseo traumático atípico envolvendo terceiro molar inferior impactado: relato de caso

ABSTRACT The traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a "pseudocyst" because of the lack of an epithelial lining. This lesion is particularly asymptomatic and, therefore, is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma. The objective of this paper is to report one case of atypical traumatic bone cyst involving impacted lower third molar, addressing its clinical and radiographic characteristics, differential diagnosis, treatment through surgical exploration and case follow-up.

RESUMO O cisto ósseo traumático é uma lesão não neoplásica incomum dos maxilares, considerada um "pseudocisto" devido à ausência de um revestimento epitelial. Esta lesão é particularmente assintomática e, portanto, é diagnosticada pelo exame radiográfico odontológico de rotina como uma radioluscência unilocular com bordas recortadas, principalmente na região mandibular posterior. A etiopatogenia exata da lesão permanece incerta, embora esteja frequentemente associada a trauma. O objetivo deste trabalho é relatar um caso de cisto ósseo traumático atípico envolvendo terceiro molar inferior impactado abordando suas características clínicas, radiográficas, diagnóstico diferencial, tratamento por meio de exploração cirúrgica e proservação do caso.

Quistes Dentígeros Asociados a Sacos Foliculares Patológicos de Terceros Molares Incluidos

Establecer la frecuencia y características de quistes dentígeros asociados a sacos foliculares de terceros molares incluidos, extraídos en las clínicas de cirugía oral de la Facultad de Odontología de la Universidad Nacional de Colombia. Estudio cuantitativo, se realizó el análisis histopatológico de 30 sacos foliculares de terceros molares incluidos con col oración de hematoxilina-eosina. Se analizaron 30 biopsias de sacos foliculares de terceros molares superiores e inferiores correspondientes a 21 pacientes con edades comprendidas entre los 17 a 36 años (media: 25,3). De los sacos estudiados 25 (83,3 %) se diagnosticaron como quiste dentígero y 5 (16,7 %) como saco folicular, siendo más frecuente el diagnóstico de quiste dentígero en la zona mandibular. El saco folicular asociado al tercer molar incluido tiene alta capacidad de desarrollar patolo gía odontogénica quística, siendo la más frecuente el quiste dentígero con predilección a la ubicación anatómica en la mandíbula.

To establish the frequency and characteristics of dentigerous cysts associated with follicular sacs of impacted third molars extracted in the oral surgery clinics at the School of Dentistry at Universidad Nacional de Colombia. Quantitative study, a histopathological analysis of 30 follicular sacs of impacted third molars with hematoxylin-eosin staining was performed. 30 biopsies of follicular sacs of upper and lower third molars corresponding to 21 patients aged between 17 and 36 years (mean: 25.3) were analyzed. Of the sacs studied 25 (83.3%) were diagnosed as dentigerous cysts and 5 (16.7%) as follicular sacs, with the diagnosis of dentigerous cysts being more frequent in the mandibular area. The follicular sac associated with impacted third molars has a high capacity to develop cystic odontogenic pathology, being the most frequent the dentigerous cyst with a predilection for the anatomical location in the mandible.

Directrices para el diagnóstico y tratamiento de Molares Retenidos / Guidelines for diagnosis and treatment of impacted molars

Los terceros molares son piezas dentarias correspondientes a la dentición permanente y se encuentran por detrás de los segundos molares. Erupcionan entre los 18 y 27 años aproximadamente, tienen variedad de formas, anomalías y disposición diversa. Normalmente se encuentran total o parcialmente retenidos en el hueso maxilar. La retención es muy frecuente y afecta aproximadamente al 75% de la población. La causa principal es por la falta de espacio dentro de la boca. La patología derivada de la retención de un tercer molar puede generar diferentes alteraciones: abscesos, sinusitis, reabsorción de las raíces de los dientes adyacentes, caries del molar retenido y/o del segundo molar, úlceras en la mucosa contigua, podrían generar quistes, ameloblastomas y ulceraciones leucoqueratósicas que pueden degenerar en carcinomas, alteraciones nerviosas o vasomotoras: dolores faciales, trismus, y parálisis facial ipsilateral. Las extracciones profilácticas de terceros molares asintomáticos están justificadas cuando los terceros molares se encuentran bajo prótesis removible que puede estimular su erupción, molares semierupcionados que pueden generar pericoronitis, caries o problemas periodontales; pacientes que van a ser sometidos a radioterapia; cuando el diente incluido interfiera en una cirugía ortognática. Si el molar retenido presenta sintomatología por parte del paciente está aconsejada su extracción quirúrgica.

The third molars are dental pieces corresponding to the permanent dentition and are located behind the second molars. They erupt between the ages of 18 and 27 approximately, have a variety of shapes, anomalies, and diverse dispositions. They are normally fully or partially retained in the maxillary bone. Retention is very frequent and affects approximately 75% of the population. The main cause is due to the lack of space inside the mouth. The pathology derived from the retention of a third molar can generate different alterations: abscesses, sinusitis, resorption of the roots of adjacent teeth, caries of the retained molar and/or second molar, ulcers in the contiguous mucosa, could generate cysts, ameloblastomas and leukokeratotic ulcerations that can degenerate into carcinomas, nervous or vasomotor disorders: facial pain, trismus, and ipsilateral facial paralysis. Prophylactic extractions of asymptomatic third molars are justified when the third molars are under removable prosthesis that can stimulate their eruption, semi-erupted molars that can generate pericoronitis, caries or periodontal problems; patients who are going to undergo radiotherapy; when the included tooth interferes with orthognathic surgery. If the retained molar presents symptoms on the part of the patient, its surgical extraction is recommended.