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.

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.

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.

Enucleación de quiste dentígero, asociado al incisivo lateral retenido, y tracción ortodóntica de canino superior retenido / Enucleation of tooth cyst, associated with retained lateral incisor, and orthodontic traction of retained upper canine

Introducción: Un inconveniente de la erupción dental permanente es la retención dentaria. Un diente retenido no ha completado su erupción y no ha llegado a su posición normal en el maxilar. Los dientes retenidos pueden estar dentro del maxilar asintomáticos u ocasionando migración dentaria, persistencia de dientes deciduos, alteraciones en la oclusión y estética, formación de quiste dentígero y tumores. Objetivo: Describir la enucleación de quiste dentígero, asociado al incisivo lateral, y tracción ortodóntica de canino superior retenido. Presentación de caso: Paciente femenino de 19 años de edad, con persistencia de dientes 52 y 53. Tomográficamente se aprecia un incisivo lateral superior derecho retenido en posición horizontal, asociado a una imagen radiolúcida de dimensiones de 11,2 mm x 20,1 mm y un canino retenido en posición vertical. Se realizó la exodoncia a colgajo del incisivo lateral y enucleación del quiste. Respecto al canino, se colocó el botón de ortodoncia para posterior tracción. El diagnóstico histopatológico definitivo fue quiste dentígero. Conclusiones: Las lesiones asociadas a dientes retenidos pueden tener varios diagnósticos diferenciales. El especialista deberá conocer las características clínicas y radiográficas de cada uno de ellos y proyectar el plan de tratamiento de acuerdo a los criterios de ubicación, tamaño de la lesión, edad, estado sistémico, entre otros. El conocimiento de la técnica quirúrgica y el diagnóstico histopatológico evita complicaciones(AU)

Introduction: A drawback of permanent tooth eruption is tooth retention. A retained tooth has not completed its eruption and has not reached its normal position in the jaw. Retained teeth may be within the jaw asymptomatic or causing tooth migration, persistence of deciduous teeth, alterations in occlusion and aesthetics, formation of tooth cyst and tumors. Objective: Describe the enucleation of dentiger cyst, associated with the lateral incisor, and orthodontic traction of retained upper canine. Case presentation: Female patient, 19 years old, with persistence of teeth 52 and 53. Tomographically there is a right upper lateral incisor retained in a horizontal position, associated with a radiolucent image of dimensions of 11.2 mm x 20.1 mm and a canine retained in an upright position. Exodontics were performed at the flap of the lateral incisor and enucleation of the cyst. Regarding the canine, the orthodontic button was placed for subsequent traction. The definitive histopathological diagnosis was tooth cyst. Conclusions: Lesions associated with retained teeth may have several differential diagnoses. The specialist must know the clinical and radiographic characteristics of each of them and project the treatment plan according to the criteria of location, size of the lesion, age, systemic status, among others. Knowledge of surgical technique and histopathological diagnosis avoids complications(AU)

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.

Evaluation of the clinical effects of impacted lower third molar tooth on adjacent oral tissues / Avaliação dos efeitos clínicos do terceiro molar inferior impactado nos tecidos orais adjacentes

Objective: Impacted tooth develops when the tooth fails to erupt into its anatomical functional position. The aim of this prospective study was to find out common clinical effects of impacted lower molar on adjacent tissues and to evaluate the relationship between signs and symptoms of impacted tooth as regards gender and age respectively. Material and Methods: Data for this study were obtained using a well-structured questionnaire at the Teem Dental Hospital Warri, Nigeria. The data included age, sex, and clinical features of patients with confirmed diagnosis of impacted lower third molar following clinical examination and radiographic investigation. Data were analysed and chi-square was employed. Results: A total of 131 patients were examined, 57 (44.5%) were males and 74 (56.5%) were females within the ages of 10-40 years. Patients within the ages of 21-25 years had the highest frequency (32.1%) of impacted lower third molar. It was observed that impacted tooth had a gender predilection towards females than males. Inflamed gingivae around lower 3rd molar 60(45.8%) and pain on the lower third molar 72(55.0%) were most predominantly associated with impacted third molar teeth. No significant association was observed between age (0.909) and gender (0.461) against symptoms of impacted tooth but significant association (0.001) between age and sign was observed. Conclusion: The most commonly associated effect of impacted third molar is inflammation of the adjacent gingivae alongside pain around the lower third molar. Prevalence of impacted molar tooth was gender based with age being a predilection factor in its signs of presentation. (AU)

Objetivo: O dente impactado se desenvolve quando o dente não consegue irromper em sua posição anatômica funcional. O objetivo deste estudo prospectivo foi identificar os efeitos clínicos comuns do molar inferior impactado nos tecidos adjacentes e avaliar a relação entre os sinais e sintomas do dente impactado em relação ao sexo e idade, respectivamente. Material e Métodos: Os dados para este estudo foram obtidos por meio de um questionário bem estruturado no Teem Dental Hospital Warri, Nigéria. Os dados incluíram idade, sexo e características clínicas de pacientes com diagnóstico confirmado de terceiro molar inferior impactado após exame clínico e investigação radiográfica. Os dados foram analisados e o teste qui-quadrado foi empregado. Resultados: Foram examinados 131 pacientes, 57 (44,5%) do sexo masculino e 74 (56,5%) do sexo feminino na faixa etária de 10 a 40 anos. Pacientes com idades entre 21 a 25 anos tiveram a maior frequência (32,1%) de terceiros molares inferiores impactados. Observou-se que o dente impactado teve uma predileção de gênero para o sexo feminino em relação ao masculino. Gengiva inflamada ao redor do 3º molar inferior 60 (45,8%) e dor no terceiro molar inferior 72 (55,0%) foram predominantemente associadas a terceiros molares impactados. Não foi observada associação significativa entre idade (0,909) e sexo (0,461) diante sintomas de dente impactado, mas foi observada associação significativa (0,001) entre idade e sinal. Conclusão: O efeito mais comumente associado ao terceiro molar impactado é a inflamação da gengiva adjacente associada à dor ao redor do terceiro molar inferior. A prevalência de dente molar impactado foi baseada no gênero, sendo a idade um fator de predileção em seus sinais de apresentação.(AU)

Coronectomia em terceiro molar superior: relato de caso / Maxillary third upper molar coronectomy: case report

Introdução: A extração de terceiros molares é um dos procedimentos mais realizados em cirurgias orais. As indicações para esse procedimento estão ligadas à doença cárie, doença periodontal, pericoronite, entre outras. Objetivo: O objetivo deste artigo é apresentar um relato de caso e discussão com a técnica aplicada a um terceiro molar superior com risco de comunicação oroantral, demonstrando os benefícios deste procedimento. Relato de Caso: Paciente sexo masculino, 49 anos, ausência de comorbidades, encaminhado para remoção de terceiro molar superior por dificuldade de higienização e acúmulo de placa bacteriana, ao exame tomográfico, apresentou proximidades das raízes com o seio maxilar, onde foi optado pela contra indicação de extração devido a grande chance de comunicação oroantral e sugerido coronectomia para resolução do caso. Conclusão: A coronectomia é uma técnica bastante difundida nos casos em que o terceiro molar está intimamente relacionado ao nervo alveolar inferior, com chances de parestesia. Não há relatos na literatura dessa técnica aplicada ao terceiro molar superior... (AU)

Introduction: Extraction of third molars is one of the most commonly performed procedures in oral surgeries. The indications for this procedure are linked to caries disease, periodontal disease, pericoronitis, among others. Case Report: Male patient, 49 years old, absent from comorbidities, referred for removal of the upper third molar due to difficulty in cleaning and bacterial plaque accumulation, on tomographic examination, proximity of the roots to the maxillary sinus, where it was opted for the contraindication of extraction due to great chance of oroantral communication and suggested coronectomy to resolve the case. Objective: The purpose of this article is to present a case report and discussion with the technique applied to a maxillary third molar at risk of oroantral communication, demonstrating the benefits of this procedure. Conclusion: Coronectomy is a widespread technique in cases where the third molar is closely related to the lower alveolar nerve, with chances of paresthesia. There are no reports in the literature of this technique applied to the upper third molar... (AU)

Terceiro molar superior impactado invertido: relato de caso / Invert impacted superior third molar: case report

Introdução: A impactação invertida dos dentes é raro, correspondendo a menos de 1% dos casos de terceiros molares impactados na maxila. O elemento dentário afetado pode permanecer por longos períodos sem apresentar sintomatologia, entretanto, podem provocar problemas dentários e desenvolvimento de patologias dos maxilares. O tratamento cirúrgico é proposto em casos em que o folículo dentário se apresentar patologicamente afetado, ou necessidade estética, funcional e/ou comportamental. Relato de caso: Paciente do sexo feminino, leucoderma, 35 anos, ASA I, procurou atendimento na Clínica Escola de Odontologia da Universidade Estadual da Paraíba, UEPB, Campus VIII em Araruna/ PB, queixando-se da presença de quadros de sintomatologia dolorosa na região direita da maxila. Por meio da avaliação clínico-radiográfica concluiu-se que a impactação invertida do elemento 18 era responsável por originar os episódios de dor. Devido a isto e com a finalidade de prevenir o desencadeamento de complicações futuras, optou-se, pela remoção cirúrgica do dente. Considerações finais: A exodontia de dentes invertidos - quando indicada - se configura como uma técnica cirúrgica eficiente. Assim, uma vez optada pela intervenção cirúrgica, o profissional deve realizar um planejamento minucioso da técnica operatória... (AU)

Introduction: Inverted impaction of teeth is rare, corresponding to less than 1% of cases of third molars impacted on the maxilla. The affected dental element can remain for long periods without presenting symptoms, however, they can cause dental problems and the development of pathologies of the jaws. Surgical treatment is proposed in cases where the dental follicle is pathologically affected, or has an aesthetic, functional and/or behavioral need. Case report: Female patient, leucoderma, 35 years old, ASA I, sought care at the Dental School Clinic of the State University of Paraíba, UEPB, Campus VIII in Araruna/PB, complaining of the presence of painful symptoms in the right region of the maxilla. Through clinical-radiographic evaluation, it was concluded that the inverted impaction of element 18 was responsible for causing episodes of pain. Because of this and in order to prevent the triggering of future complications, we opted for surgical removal of the tooth. Final considerations: The extraction of inverted teeth - when indicated - is an efficient surgical technique. Thus, once opted for surgical intervention, the professional must carry out a thorough planning of the operative technique... (AU)

Coronectomia: alternativa à exodontia de terceiros molares inferiores / Coronectomy: an alternative to third lower molar extraction

Objetivo: relatar um caso clínico de coronectomia com acompanhamento pós-operatório de 15 meses. Relatode caso: a coronectomia é uma alternativa de tratamento para terceiros molares inferiores (3MI) impactadosque apresentam proximidade com o canal mandibular, minimizando o risco de morbidade neurossensorial.A técnica consiste em remover apenas a coroa dentária (na junção amelocementária) com retençãointencional das raízes e da polpa, evitando o dano direto ou indireto ao nervo alveolar inferior (NAI). Oprocedimento foi realizado em paciente adulto do gênero masculino com 3MI impactados. A radiografia panorâmicamostrava o escurecimento dos ápices radiculares, sugerindo íntima relação das raízes com o canalmandibular. No acompanhamento pós-operatório imediato, o paciente retornou sem sintomatologia dolorosa,sem edema facial significativo, apresentando boa cicatrização e sem relato de perda de sensibilidade nemde disfunção mastigatória. No acompanhamento radiográfico, foi verificada neoformação óssea adjacenteaos remanescentes radiculares. Considerações finais: a coronectomia mostrou-se um procedimento simples,eficaz e seguro para diminuir o risco de injúria ao NAI durante o tratamento dos 3MI.(AU)

Objective: to report a case of coronectomy with follow-up of 15 months. Case report: coronectomy is an alternative treatment for impacted lower third molars (3ML) which are close to the mandibular canal, minimizing the risk of sensorineural morbidity. The technique consists of removing only the dental crown (at the cementoenamel junction) with intentional retention of the roots and pulp, avoiding direct or indirect damage to the inferior alveolar nerve (IAN). The procedure was performed on an adult male patient with impacted 3ML. Panoramic radiograph showed darkening of the roots, suggesting a close relationship between the roots and the mandibular canal. At immediate postoperative follow-up, the patient returned with no painful symptoms, no significant facial edema, good healing, and no loss of sensation or masticatory dysfunction. Radiographic follow-up showed bone neoformation adjacent to the root remnants. Final considerations: coronectomy has been shown to be a simple, effective and safe procedure to decrease the risk of injury to IAN during 3MI treatment.(AU)

Compound odontoma causing impaction of primary tooth in a 4-year-old child: case report / Impacção de dente decíduo por presença de odontoma composto em criança de 4 anos: relato de caso

Objetivo: relatar um caso raro de impacção de um incisivo decíduo inferior pela presença de odontoma composto, bem como descrever a sua abordagem clínica. Relato de caso: paciente do sexo masculino, com 4 anos de idade, apresentava ausência do incisivo lateral decíduo inferior esquerdo. O exame radiográfico mostrou impacção do incisivo não erupcionado próximo a estruturas radiopacas sugestivas de odontoma composto. O paciente foi acompanhado por dois anos, momento em que se realizou abordagem cirúrgica do caso. Após a cirurgia, a hipótese de diagnóstico de odontoma composto foi confirmada e com o acompanhamento ocorreu a erupção dos incisivos centrais permanentes inferiores. O paciente foi encaminhado para tratamento ortodôntico. Considerações finais: esse relato de caso aborda um caso raro de odontoma composto associado à não erupção de dente decíduo, uma vez que odontomas costumam ser detectados preferencialmente na segunda década de vida do paciente, sendo associados à impacção de dentes permanentes. Além disso, apresenta um protocolo de abordagem clínica para esses casos quando diagnosticados em idade precoce no paciente infantil.(AU)

Objective: to report a rare case of impaction of a primary mandibular incisor due to the presence of a compound odontoma and describe its clinical management. Case report: a 4-year-old boy presented with a "missing" primary left mandibular lateral incisor. Radiographs showed impaction of the unerupted incisor by adjacent radiopaque structures consistent with a compound odontoma. The patient was recalled periodically for 2 years, at which time surgical excision was performed. The diagnosis of compound odontoma was confirmed histologically, and the permanent mandibular central incisors erupted uneventfully; the patient was referred for orthodontic treatment. Final considerations: this case report describes an unusual case of compound odontoma associated with an unerupted deciduous tooth; odontomas are rare in this age range, occurring predominantly in the second decade of life and in association with impaction of permanent teeth. We also propose a protocol for clinical management of such early-onset cases.(AU)

Odontectomia parcial intecional: relato de caso clínico / Intentional partial odontectomy: a case report

Introdução: A Odontectomia Parcial Intencional ou Coronectomia é uma abordagem cirúrgica que consiste na remoção da porção coronária de molares mandibulares impactados e a manutenção das suas raízes no alvéolo dentário. Esta técnica é indicada quando há íntima relação entre o dente e o canal mandibular e tem por principal objetivo evitar lesões ao nervo alveolar inferior. Relato de Caso: Paciente do sexo masculino, 24 anos, ASA I, compareceu a Clínica Escola de Cirurgia de uma universidade pública para exodontia de terceiro molar inferior impactado (48). Ao exame clínico o dente apresentava-se semi-incluso e ao exame radiográfico (panorâmica e tomografia computadorizada), observou-se íntima relação da raiz do dente com o canal mandibular. Diante disto, foi realizada Odontectomia Parcial Intencional, com o intuito de preservação de feixe vásculo-nervoso adjacente. Paciente evoluiu satisfatoriamente sem sinais de infecção ou alteração sensorial de nervo alveolar inferior. Considerações finais: A Odontectomia Parcial Intencional é uma técnica segura, eficaz e de previsibilidade significativa, sendo uma alternativa que pode ser empregada em exodontias de molares mandibulares inclusos próximos ao canal mandibular, minimizando os riscos de lesões nervosas para os pacientes... (AU)

Introduction: Intentional partial odontectomy or coronectomy is a surgical approach that consists of removing the coronary portion of impacted mandibular molars and maintaining their roots in the dental alveolus. This technique is indicated when there is an intimate relationship between the tooth and the mandibular canal and its main objective is prevent injuries to the lower alveolar nerve. Case Report: Male patient, 24 years old, ASA I, compared the Clinical School of Surgery of a public university for extraction of the impacted lower third molar (48). On clinical or dental examination, we present semi impacted wisdom tooth and on radiographic examination (panoramic + computed tomography), an intimate relationship between the root of the tooth and the mandibular canal was observed. Therefore, intentional partial odontectomy was performed in order to preserve the adjacent vascular-nervous bundle. The patient progressed satisfactorily without signs of infection or sensory alteration of lower alveolar nerve. Final considerations: Intentional partial odontectomy is a safe, effective and predictable technique, being an alternative that can be used in extractions of mandibular molars, including those close to the mandibular canal, minimizing the risk of nerve injuries to patients... (AU)

Impactación dentaria por odontoma compuesto: reporte de caso y revisión de literatura / Dental impactation caused by odontoma: case report and literature review

Resumen Actualmente los odontomas son los tumores odontogénicos más frecuentes. Son considerados hamartomas, compuestos por células epiteliales odontogénicas y mesenquimatosas diferenciadas, y muestra tejidos dentales en su estructura. Se presenta una revisión de la literatura seguido por un reporte de caso de un odontoma compuesto en el maxilar inferior de un paciente de 13 años asociado a la inclusión del segundo molar inferior derecho (4.7). Se realizó la exéresis del tumor y la correspondiente biopsia para confirmar el diagnóstico.

Abstract At present time odontomas are the most common odontogenic tumors. They are hamartomas, composed of epithelial odontogenic and mesenchymal cells, presenting dental tissue in their structure. A literature review followed by a case report are presented. The case report presents a compound odontoma in the inferior maxillary of a 13-year-old patient, associated with the inclusion of the second right inferior molar (4.7). The exeresis followed by the biopsy of the tumor were performed to confirm the clinical diagnosis.

Tumor odontogénico adenomatoide en dos adolescentes / Adenomatoid odontogenic tumor in two adolescents

Se describen 2 casos clínicos de adolescentes de ambos sexos, quienes presentaron edemas en el lado izquierdo de la mandíbula con reabsorción dental y en la porción anterior del maxilar, respectivamente. La histopatología reveló una variante folicular intraósea del tumor odontogénico adenomatoide. El tratamiento quirúrgico empleado fue una enucleación con resultados satisfactorios.

Two cases reports of adolescents from both sexes are described, they presented edemas in the left side of the maxillary with dental reabsorption and in the anterior portion of the maxillary, respectively. The histopathology revealed an intraosseous folicular variety of the adenomatoid odontogenic tumor. The surgical treatment used was an enucleation with satisfactory results.

Causes of impacted maxillary incisors and progresses in orthodontic treatment / 上海交通大学学报（医学版）

An impacted tooth is a tooth that cannot erupt normally when its eruption is blocked or it is erupted in the wrong direction and posi-tion. The most commonly impacted teeth is the third molar, while in the anterior region, the most common is the maxillary canine, followed by the maxillary central incisor and the maxillary lateral incisor. In recent years, the treatment of impacted maxillary incisors often uses open and closed eruption techniques with traction. Although most of the prognosis is good, traction difficulties, root resorption and alveolar bone loss are often encountered in the case of root dilacerations. This article reviews the progresses in the treatment of impacted maxillary incisors.

Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial

BACKGROUND: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery.METHODS: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer.RESULTS: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013).CONCLUSION: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Diagnóstico de quiste dentígero en sacos foliculares de terceros molares incluídos / Diagnosis of dentigerous cysts in follicular sacs of retained third molars

Objetivo: establecer el tipo de patología más frecuente asociada a terceros molares incluidos extraídos en las clínicas de cirugía oral de la Facultad de Odontología de la Universidad Nacional de Colombia y la frecuencia de aparición de quistes dentígeros, rango de edad, sexo y la región anatómica en que predominan. Métodos: se revisaron 17 sacos foliculares de 11 pacientes atendidos en las clínicas de cirugía oral, entre agos-to del 2018 y febrero de 2019. Resultados: se recolectaron 7 biopsias de 5 pacientes masculinos y 10 de 7 pacientes femeninos, con edades comprendidas entre los 17 a 24 años (media: 20.40), se realizó estudio histopatológico con hematoxilina-eosina, cuyos datos obtenidos se analizaron para determinar frecuencia, edad, sexo y patología aso-ciada. Se encontraron 15 casos que mostraron cambios quísticos diagnosticados como quistes dentígeros y 2 casos diagnosticados como saco folicular. Conclusiones: aunque la muestra es pequeña, este estudio da indicios que los sacos foliculares asociados a terceros molares incluídos están altamente implicados en la formación de quistes dentígeros.

Objective: To establish the most frequent type of pathology associated to retained third molars extracted in the oral surgery clinics of the Dentistry School at Universidad Nacional de Colombia and the frequency of appearance of dentigerous cysts, age, sex and the anatomical region in which they predominate. Methods: A series of 17 follicular sacs were evaluated out of a total of 11 patients attended in the oral surgery clinics between August 2018 and February 2019. Results: Seven biopsies were collected from 5 male patients and ten from seven female patients aged between 17 and 24 years (mean: 20.40), histopathological study was performed with hematoxylin-eosin, the data obtained was analyzed to determine frequency, age, sex and associated pathology. It where found 15 cases that showed cystic changes diagnosed as dentigerous cysts and two cases diagnosed as follicular sac. Conclusions: Although the sample is small, this study gives indications that follicular sacs associated with retained third molars may be highly involved in the formation of dentigerous cysts.

Effectiveness of kinesio taping on postoperative morbidity after impacted mandibular third molar surgery: a prospective, randomized, placebo-controlled clinical study

Abstract Objective Our study seeks to investigate the effectiveness of kinesio taping (KT) on postoperative morbidity compared to placebo and control groups after impacted third molar surgery. Methodology Sixty patients with impacted mandibular third molar were included in this prospective, randomized, placebo-controlled clinical study. After surgical extraction of the impacted tooth, patients were allocated into three groups (20 patients each): group 1 received KT (kinesio), group 2 received placebo taping (placebo), and group 3 received no taping (control). The groups were compared regarding facial swelling, pain and trismus. Swelling was evaluated using a tape measuring method. Pain was assessed by a visual analog scale and the number of analgesic tablets taken. Trismus was determined by measuring maximum mouth opening. Results In the KT group, all parameters reduced significantly on 2nd and 4th postoperative days compared to other groups; however, placebo and control groups revealed comparable outcomes. On 7th day, all groups showed comparable results. Conclusions The KT application is an effective method for reducing morbidity after impacted mandibular third molar surgery. However, placebo taping is not as effective as proper taping. Placebo taping shows similar results compared to no taping regarding facial swelling percentage, pain and trismus.

Avaliação da eficácia de diferentes protocolos de analgesia preemptiva em cirurgias odontológicas / Evaluation of the effectiveness of different preemptive analgesia protocols in dental surgery

A analgesia preemptiva tem como princípio a administração de fármacos antes do início dos estímulos dolorosos, a fim de reduzir ou prevenir a dor pós-operatória. Apesar da sua importância, os efeitos da analgesia preemptiva em cirurgias odontológicas reportados na literatura ainda são conflitantes. Assim, o objetivo deste estudo foi avaliar a eficácia clínica de diferentes classes de medicamentos para analgesia preemptiva, em 2 propostas de investigação 1) cirurgias para exodontia de terceiros molares impactados; 2) cirurgias periodontais a retalho. Para tal, foram realizados ensaios clínicos randomizados placebo-controlados onde os participantes recebiam, 1 hora antes da cirurgia, o medicamento teste e o placebo em cirurgias distintas, em um desenho boca-dividida. Na primeira proposta de investigação, de um total de 376 pacientes com necessidade de exodontia de terceiros molares inferiores classe IIB, foram selecionados 100 pacientes, com idade entre 18 - 30 anos (22,4±2,9), alocados em 5 grupos (n = 20 por grupo), sendo: 1) paracetamol; 2) cetoprofeno; 3) ibuprofeno; 4) nimesulida; 5) dexametasona). Através de escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h e edema foi avaliado nos tempos baseline, 24h, 48h, 72h e 7 dias pós-operatórias. As diferenças entre o medicamento de teste e o placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O ibuprofeno e a nimesulida apresentaram efeitos preemptivos gerais mais altos no controle de dor ao longo do tempo, sem diferenças entre eles (p = 0,557). O paracetamol mostrou efeitos gerais mais baixos no controle do edema ao longo do tempo, quando comparado aos outros medicamentos em teste, que mostraram efeitos semelhantes (p<0,05). Também foram observados melhores resultados na quantidade de medicamentos de resgate para o ibuprofeno e a nimesulida, sem diferenças entre eles (p = 0,999). Ibuprofeno e a nimesulida mostraram melhores efeitos preemptivos gerais nas cirurgias de terceiros molares inferiores impactados e assim devem ser considerados caso a caso como medicamentos de escolha em analgesia preemptiva. Na segunda proposta de investigação, de um total de 360 indivíduos com necessidade de cirurgias a retalho, foram selecionados 40 pacientes, com idade entre 18 a 60 anos (43,40 ± 11,91), alocados em 2 grupos (n = 20 por grupo), sendo 1) ibuprofeno; 2) nimesulida. Através da escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h. As diferenças entre medicamento teste e placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada separado foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O uso de medicação de resgate foi menor e o tempo pós-operatório foi maior nos grupos teste ibuprofeno e nimesulida em comparação ao placebo (p<0,001). E o grupo nimesulida apresentou escores de EVA mais baixos nos tempos T12, T24, T72 horas (p<0,001; p<0,001; p<0,007), mostrando-se um coadjuvante benéfico para o controle da dor pós-operatória em cirurgias periodontais a retalho.

Preemptive analgesia has as its principle the administration of drugs before the start of painful stimuli, in order to reduce or prevent postoperative pain. Despite its importance, the effects of preemptive analgesia in dental surgeries reported in the literature are still conflicting. Thus, the objective of this study was to evaluate the clinical efficacy of different classes of drugs for preemptive analgesia, in 2 different research proposals: 1) surgeries for extraction of impacted third molars; 2) periodontal flap surgeries. To this end, randomized placebo-controlled clinical trials were carried out where the participants received, 1 hour before surgery, the test drug and the placebo in different surgeries, in a mouth-divided design. In the first research proposal, from a total of 376 patients in need of extraction of lower third molars, class IIB, 100 patients were selected, aged between 18 - 30 years (22.4 ± 2.9), allocated in 5 groups ( n = 20 per group), being: 1) acetaminophen; 2) ketoprofen; 3) ibuprofen; 4) nimesulide; 5) dexamethasone). Through a visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h and edema was assessed at baseline, 24h, 48h, 72h and 7 postoperative days. Differences between test drug and placebo were determined as response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. Ibuprofen and nimesulide higher overall preemptive sinks in pain controls over time, with no differences between them (p = 0.557). Paracetamol general effects resulting from lower control of edema over time, when compared to other drugs under test, which affect other similar effects (p <0.05). Better results were also observed in the quantity of rescue drugs for ibuprofen and nimesulide, with no differences between them (p = 0.999). It was concluded that ibuprofen and nimesulide are the main general preemptive effects in impacted lower third molar surgeries. Thus, in the decision-making process for preemptive analgesia, ibuprofen and nimesulide should be considered case by case as the drugs of choice. In the second research proposal, from a total of 360 individuals in need of retail surgery, 40 patients were selected, aged between 18 and 60 years (43.40 ± 11.91) years, allocated in 2 groups (n = 20 per group), being 1) ibuprofen; 2) nimesulide. Through the visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h. The differences between the test drug and the placebo were determined as the response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. The nimesulide group had lower complementary EVA scores at times T12, T24, T72 hours (p <0.001; p <0.001; p <0.007). The use of rescue medication was less secondary and the postoperative time was longer in the ibuprofen and nimesulide test groups compared to placebo (p <0.001). Thus, nimesulide can be considered a beneficial adjunct to the control of postoperative pain in periodontal flap surgeries.

Protocolo de laser de baixa potência na prevenção de dor, edema e trismo decorrente de extrações de terceiros molares inferiores retidos: estudo clínico, comparativo, randomizado e duplo cego / The effect of lowlevel laser protocol on the prevention of pain, edema and trismus due to retained lower third molar extractions: a clinical, comparative, randomized, double blind study

O objetivo desse ensaio clínico randomizado (split mouth) foi avaliar um protocolo de laser de baixa potência, no controle de dor, edema e trismo após extração de terceiros molares retidos. Foram selecionados 13 pacientes com terceiros molares inclusos bilateralmente e com posição semelhante foram utilizados para um estudo de boca dividida. Os pacientes foram distribuídos de forma randomizada, conforme o tratamento administrado, Lado Laser: dose única de laser de baixa potência no comprimento de onda 810 nm, 6 J (100 mW, 60s/ponto); e lado sham: simulação de aplicação do laser. Após a cirurgia realizada, os pacientes foram acompanhados três dias consecutivos para avaliação da 1) Dor, através da média de consumo de analgésico de resgate (NAR), Escala Visual Analógica (EVA) nos períodos de 0h, 1h, 2h, 3h, 12h, 24h, 48h, 72h e média do tempo de consumo do primeiro analgésico; 2) Edema, através da EVA, e média obtidas das medidas faciais lineares obtidas entre o ângulo mandibular até canto do olho, do tragus até comissura labial e do tragus até mento (porção central) nos períodos de 0h, 24h, 48h, 72h; 3) Trismo, através da média de abertura bucal nos períodos de 0h, 24h, 48h, 72h. Os resultados da EVA mostram que o laser controlou melhor a dor nos períodos de 3 (p = 0,010), 24 (p = 0,002), e 48 horas (p = 0,013). Não houve diferença entre Laser e Sham para NAR (p = 0,329) e para o tempo necessário para o primeiro consumo de analgésico (p = 0,462). Os resultados da EVA para edema mostram que o laser controlou melhor nos períodos de 24 (p = 0,041) e 48 horas (p = 0,013). A redução da abertura bucal foi menor no grupo Sham em todos os períodos avaliados (p < 0,05). Conclui-se que o protocolo de laser utilizado nessa pesquisa permitiu redução de dor e edema, conduto sem efeito para o trismo(AU)

The aim of this randomized clinical trial (split mouth) was to evaluate a low intensity laser protocol to control pain, edema and trismus after extraction of retained third molars. . For this, 13 patients with similarly positioned bilateral third molars were used and each patient served twice as a sample unit. Patients were randomized according to the treatment they would receive, laser side: single low power laser at 810 nm wavelength, 6 J (100 mW, 60s / dot); and sham side: laser application simulation. After surgery, patients were followed for three consecutive days to assess 1) Pain, by means of rescue analgesic consumption (NAR), Visual Analog Scale (VAS) in the periods of 0h, 1h, 2h, 3h, 12h , 24h, 48h, 72 h and mean time of first analgesic use; 2) Edema, through VAS, and mean obtained from the linear facial measurements obtained between the mandibular angle to the corner of the eye, the tragus to the labial commissure and the tragus to the chin (central por tion) in the periods of 0h, 24h, 48h, 72h; 3) Trismus, through the mouth opening average in the periods of 0h, 24h, 48h, 72h. The VAS results show that the laser better controlled pain at periods of 3 (p = 0.010), 24 (p = 0.002), and 48 hours (p = 0.013). There was no difference between Laser and Sham for NAR (p = 0.329) and for the time required for the first analgesic use (p = 0.462). VAS results for edema show that the laser controlled better at 24 (p = 0.041) and 48 hours (p = 0.013). Mouth opening redu ction was smaller in the Sham group in all periods evaluated (p <0.05). It is concluded that the laser protocol used in this research allowed pain and edema reduction, conduit without effect for trismus(AU)

Prevalence of impacted teeth among a sample of yemeni population and their association with sex and age / Prevalencia de dientes impactados entre una muestra de población yemení y su asociación con el sexo y la edad

Aim: the aim of the study was to assess the prevalence of impacted teeth and its association with sex and age among a sample of the Yemeni population. Materials and Methods: A cross sectional study design was employed. The study included 999 radiographical records of patients who had panoramic X- rays previously done. All radiographs were assessed for the number and type of impacted teeth, pathology-associated impaction, sex, age and location (mandible and/or maxilla). The collected data was analyzed using SPSS®version21 software. Results: The study sample comprised digital panoramic radiographs of Yemeni patients aged 17 to 54 years (mean 26.6 years). The present study found 542 patients (54.3%) presented with at least one impacted tooth. The 17 to 25 years age group of the study sample had the highest prevalence of tooth impaction (28.6%). Only 10 (1.0%) case presented pathologies associated with the impacted teeth. There was a significant difference in the number of male 203 (20.3%) and female 339 (33.9%) patients with impacted teeth (p=0.031). Impacted teeth occurred slightly more often in the mandible (42.8%) compared to the maxilla (42.4%). Conclusion: The prevalence of impacted teeth among a sample of Yemeni population was high. Third molars and canines were the most common impacted teeth. The prevalence of impacted teeth in females was higher than in males and it was higher in the mandible than in the maxilla, with the younger patients with a higher prevalence of impaction.

Objetivo: el objetivo del estudio fue evaluar la prevalencia de dientes impactados y su asociación con el sexo y la edad en una muestra de la población yemení. Material y Métodos: se empleó un diseño de estudio transversal. El estudio incluyó 999 registros radiográficos de pacientes con radiografías panorámicas realizadas previamente. Todas las radiografías fueron evaluadas en relación al número y tipo de dientes impactados, patología asociada a la impactación, sexo, edad y ubicación (mandíbula y/o maxilar). Los datos recopilados se analizaron utilizando el software SPSS® version 21. Resultados: La muestra del estudio comprendió radiografías panorámicas digitales de pacientes yemeníes entre 17 a 54 años (media 26,6 años). El presente estudio encontró que 542 pacientes (54,3%) presentaron al menos un diente impactado. El grupo de edad de 17 a 25 años de la muestra de estudio tuvo la mayor prevalencia de impactación dental (28,6%). Solo 10 casos (1,0%) presentaron patologías asociadas a los dientes impactados. Hubo una diferencia significativa en el número de pacientes masculinos 203 (20.3%) y femeninos 339 (33.9%) con dientes impactados (p=0.031). Los dientes impactados ocurrieron con un poco más de frecuencia en la mandíbula (42.8%) en comparación con el maxilar (42.4%). Conclusión: La prevalencia de dientes impactados entre una muestra de población yemení fue alta. Los terceros molares y caninos fueron los dientes más comúnmente impactados. La prevalencia de dientes impactados en las mujeres fue mayor que en los hombres y fue mayor en la mandíbula que en el maxilar, y los pacientes más jóvenes mostraron una mayor prevalencia de impactación.