Depth and proximity of third molars to the inferior alveolar canal in panoramic radiographs of a Latin American population

Introduction: extraction of lower third molars involve the possible occurrence of complications such as injury of the content of the Inferior Alveolar Canal. Methods: a cross-sectional study was conducted with a sample of 6488 lower molar records of digital panoramic radiographs of patients from 6 Latin American countries from 2010-2015. The variables studied were the depth of lower third molar according to the Pell and Gregory classification, and the proximity of a third molar to the Inferior Alveolar Canal that was evaluated according to the proposed classification, based on a modification of the Langlais et al classification.20 Descriptive and bivariate statistical analyses were performed. Results: in terms of the proximity, the highest frequency was Intact with 27.45%(n=1781). Regarding the depth of the lower third molar, the most frequent were the Position B with 46.90%(n=3043) and Position A with 46.75%(n=3033). The proximity and depth of the lower third molar had statistical difference according to age(p<0.01) and sex (p<0.001). The overall proximity of the lower third molar to the Inferior alveolar canal, according to depth was 37.52%(n=1766) in Position A, in Position B it was 54.51%(n=2566) and Position C was 7.97%(n=375) and had association between variables(p<0.001). Conclusions: taking into consideration the modified classification of Langlais et al.20, lower third molars are close to the Inferior Alveolar Canal, and according to the Pell and Gregory classification for the depth, the most frequent positions are A and B. In addition, proximity and depth were associated with each other, and with the co-variables country, age, and sex.

Introducción: la extracción de terceros molars inferiores implica la posible aparición de complicaciones, como la lesión del contenido del Canal Alveolar Inferior. Métodos: se realizó un estudio transversal con una muestra de 6488 registros de terceros molares inferiores de radiografías panorámicas digitales en pacientes de 6 países latinoamericanos, entre 2010-2015. Las variables fueron profundidad del tercer molar inferior según la clasificación de Pell y Gregory, y proximidad del tercer molar al Canal Alveolar Inferior, evaluada según una clasificación propuesta, basada en la clasificación modificada de Langlais et al.20 Se realizaron análisis estadísticos descriptivos y bivariados. Resultados: en la proximidad, la mayor frecuencia se presentó en Intacto con 27,45%(n=1781); en cuanto a la profundidad del tercer molar inferior, las más frecuentes fueron la Posición B con 46,90%(n=3043) y la Posición A con 46,75%(n=3033). La proximidad y profundidad del tercer molar inferior presentaron diferencias estadísticas de acuerdo con la edad (p<0,01) y sexo (p<0,001). La proximidad total del tercer molar inferior al canal alveolar inferior, según la profundidad fue de 37,52%(n=1766) en Posición A, en Posición B de 54,51%(n=2566) y Posición C de 7,97%(n=375). Además, se presentó asociación entre las variables (p<0,001). Conclusiones: considerando la clasificación modificada de Langlais et al.20, la mayoría de los terceros molares inferiores están próximos al canal alveolar inferior; y según la profundidad de Pell y Gregory, las posiciones más frecuentes son A y B. Además, la proximidad y la profundidad se asociaron entre sí, y con las co-variables país, edad y sexo.

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.

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.

Asociación entre apiñamiento anteroinferior y tercer molar en pacientes de 20 años de edad

Introducción: El apiñamiento dentario anteroinferior es una maloclusión frecuente en el ser humano. Entre sus causas se cita al tercer molar inferior, sin embargo, no existe suficientes estudios que avalen una dependencia estadística entre el apiñamiento y el tercer molar. Objetivo: Determinar la asociación entre el apiñamiento anteroinferior y el tercer molar inferior. Métodos: Se realizó un estudio descriptivo transversal, en el que participaron 68 estudiantes de 20 años de la facultad de Estomatología de la provincia Camagüey, durante el período de noviembre de 2019 a febrero de 2020. Se determinó presencia del tercer molar y de apiñamiento; así como, posición del tercer molar y espacio para su ubicación en el arco. Resultados: Hubo supremacía en la existencia del tercer molar inferior en pacientes estudiados, donde se presentó en su mayoría el apiñamiento anteroinferior. La posición no adecuada predominó en ambos molares inferiores, lo que coincide con una mayor prevalencia de apiñamiento. El espacio para el molar 48 fue en su generalidad suficiente, mientras para el diente 38 fue el no existe; el apiñamiento se diagnosticó tanto donde hubo el espacio suficiente como en los que estuvo o no existió. Se encontró asociación estadística entre el apiñamiento anteroinferior y el tercer molar inferior con posición no adecuada. Conclusiones: Se constató que los terceros molares inferiores estuvieron presentes en la mayoría de los casos estudiados lo que coincide con la mayor parte de los pacientes con apiñamiento anteroinferior.

Introduction: Lower anterior dental crowding is a common malocclusion in humans. Among its causes, the lower third molar is cited; however there are not enough studies to support a statistical dependence between crowding and the third molar. Objective: To determine the association between lower anterior crowding and the lower third molar. Methods: A cross-sectional descriptive study was carried out, in which 68 20-year-old students from the Dentistry Faculty of Camagüey province participated, during the period from November 2019 to February 2020. The presence of the third molar and crowding was determined; as well as, position of the third molar and space for its location in the arch. Results: There was supremacy in the presence of the lower third molar in the patients studied where there was mostly the presence of lower anterior crowding. The inadequate position prevailed in both lower molars, which coincides with a higher prevalence of crowding. The space for molar 48 was generally sufficient, while for tooth 38 it was non-existent; crowding was present where there was sufficient space as well as where space was doubtful or non-existent. There was a statistical association between lower anterior crowding and the lower third molar with improper position. Conclusions: It was found that the lower third molars were present in most of the patients studied, coinciding with the majority of patients with lower anterior crowding.

Terceiro Molar Ectópico em Incisura Mandibular / Ectopic Third Molar in the Mandibular Notch

Dentes ectópicos são frequentemente encontrados, entretanto, terceiros molares inferiores ectópicos são inco-muns, com etiologia obscura e pouco descritos na literatura pertinente. Sua localização já foi relatada nas regiões condilar, subcondilar, incisura mandibular, ângulo e borda inferior da mandíbula. Devido à importância do plane-jamento terapêutico, manejo adequado e variedade das manifestações clínicas desta condição, este trabalho teve como objetivo relatar um caso clínico de terceiro molar inferior ectópico na região de incisura mandibular, com radiolucência aumentada ao redor da coroa, em um paciente do gênero masculino, de 28 anos e sem sintomato-logia. Acompanhamento radiográfico pode ser indicado, no entanto, em pacientes sintomáticos ou com alterações patológicas associadas, a extração deve ser considerada. Diante disso, o tratamento de escolha foi a extração do dente 38 sob anestesia geral, por via intraoral, tendo em vista a posição dentária, radiolucência e morbidade as-sociada à cirurgia. O tecido mole circundante foi enviado para análise anatomopatológica. O paciente evoluiu sem intercorrências durante avaliação pós-operatória (AU)

Ectopic teeth are frequently found, however, ectopic lower third molars are uncommon, with obscure etiology and little described in the pertinent literature. Its location has been reported in the condylar, subcondylar, mandibular notch, angle and lower edge of the mandible. Due to the importance of therapeutic planning, adequate manage-ment and variety of clinical manifestations of this condition, this study aimed to report a clinical case of an ectopic lower third molar in the region of the mandibular notch, with increased radiolucency around the crown, in a male gender pacient, 28 years old and without symptoms. Radiographic follow-up may be indicated, however, in symp-tomatic patients or patients with associated pathological changes, extraction should be considered. Therefore, the treatment of choice was the extraction of tooth 38 under general anesthesia, intraorally approach, considering the dental position, radiolucency and morbidity associated with the surgery. The surrounding soft tissue was sent for anatomopathological analysis. The patient evolved uneventfully during the postoperative evaluation (AU)

Synergistic anti-inflammatory effect of NSAIDs plus B vitamins administered pre and postoperatively in third molar surgery: randomized clinical trial / Efeito anti-inflamatório sinérgico da associação de AINEs e vitaminas do complexo B administrada no pré e pós-operatório de cirurgia de terceiros molares: ensaio clínico randomizado

Objective : The aim of the present study was to evaluate the synergistic anti-inflammatory effect of Non-steroidal anti-inflammatory drugs (NSAIDs) plus B vitamins administered pre and postoperatively in surgeries of impacted mandibular third molars. Material and Methods : Double-blind randomized clinical trial, sixty-six patients participated and were randomized into 2 groups. The control group was administered meloxicam 15 mg intramuscularly plus placebo orally and to the experimental group, meloxicam 15 mg intramuscularly plus vitamins B [B1, B6, and B12] orally; both treatments were administered preoperatively. The anti-inflammatory effect was evaluated by pain intensity, facial swelling (facial contour measurements), and mouth opening (distance between the upper and lower incisors) during the post-surgical phase. Student's t-test was performed for independent samples. Results : In all the evaluated times (1 hour, 6 hours, 12 hours, 24 hours, 2 days, and 3 days after the end of the surgery) the experimental group presented a significantly lower intensity of pain compared to the control group (p<0.05). The highest pain intensity was recorded at 6 hours (17.7 ± 9.1 mm in the experimental group and 34.5 ± 21.3 mm in the control group). Swelling and mouth opening were similar in both groups, at all times evaluated (p>0.05). Conclusion : In the present study, the administration of NSAIDs plus B vitamins (B1, B6, B12) produced lower intensity of pain compared to the administration of only NSAIDs. Nevertheless, swelling and mouth opening were similar in all evaluations for both study groups (AU)

Objetivo : O objetivo do presente estudo foi avaliar o efeito anti-inflamatório sinérgico de anti-inflamatórios não esteroidais (AINEs) com vitaminas do complexo B administrados no pré e pós-operatório de cirurgias de terceiros molares inferiores impactados. Material e Métodos: Ensaio clínico randomizado duplo-cego, 66 participantesque foram randomizados em 2 grupos. O grupo controle recebeu Meloxicam 15 mg por via intramuscular + placebo por via oral e o grupo experimental, Meloxicam 15 mg por via intramuscular + vitaminas B [B1, B6 e B12] por via oral; ambos os tratamentos foram administrados no pré-operatório. O efeito anti-inflamatório foi avaliado pela intensidade da dor, edema facial (medidas do contorno facial) e abertura da boca (distância entre os incisivos superiores e inferiores) durante a fase pós-cirúrgica. Foi aplicado o teste t de Student para amostras independentes. Resultados: Em todos os tempos avaliados (1 hora, 6 horas, 12 horas, 24 horas, 2 dias e 3 dias após o término da cirurgia) o grupo experimental apresentou uma intensidade de dor significativamente menor em relação ao grupo controle (p <0,05). A maior intensidade de dor foi registrada em 6 horas (17,7 ± 9,1 mm no grupo experimental e 34,5 ± 21,3 mm no grupo controle). Edema e abertura bucal foram semelhantes nos dois grupos, em todos os momentos avaliados (p>0,05). Conclusão: No presente estudo, a administração de AINEs com vitaminas do complexo B (B1, B6, B12) resultou em menor intensidade de dor em comparação com a administração apenas de AINEs. No entanto, o edema e a abertura da boca foram semelhantes em todas as avaliações para ambos os grupos de estudo (AU).

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

Abstract This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Utilização e percepção da tomografia computadorizada de feixe cônico por especialistas em cirurgia e traumatologia bucomaxilofacial para avaliação de terceiros molares inferiores impactados / Use and perception of cone beam computed tomography by oral & maxillofacial surgeons for impacted lower third molars evaluation

Objetivo: conhecer o perfil demográfico e as características que levam à solicitação de tomografia computa-dorizada de feixe cônico (TCFC) pelos especialistas em Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do estado do Rio Grande do Sul, para diagnóstico e planejamento cirúrgico de terceiros molares inferiores (3MI) impactados. Métodos: foram enviados questionários eletrônicos para todos os especialistas em CTBMF do RS. O questionário compreendia perguntas demográficas, clínicas e imaginológicas. O teste Qui-Quadra-do foi utilizado para verificar a associação entre as variáveis. Resultados: 115 questionários foram respondi-dos.O exame mais solicitado foi a panorâmica (95%). A TCFC foi solicitada por 50 especialistas (30 utilizam software). Localização do canal mandibular, dilaceração radicular e reabsorção do segundo molar são os aspectos mais avaliados na TCFC (P < 0,05); já o contato da raiz com o canal mandibular foi dito ser avaliado nos dois exames. Complicações permanentes foram relatadas por 21 especialistas, associadas a profissionais com maior tempo de graduação e/ou especialização (P < 0,05), mas não com o tipo de exame solicitado (P > 0,05). Na percepção dos especialistas, a TCFC tem papel importante em casos de alta complexidade. Con-clusão: a panorâmica ainda é o exame mais utilizado para avaliação de 3MI impactados pelos especialistas em CTBMF do RS, porém a TCFC tem sido solicitada para complementação do diagnóstico e planejamento e como meio de segurança jurídica do profissional.(AU)

Objective: to recognize the demographic profile and the characteristics that lead to the request of cone beam computed tomography (CBCT) by Oral & Maxillofacial (OMF) Surgeons in the state of RS for the diagnosis and surgical planning of impacted lower third molars (3LM). Methods: electronic questionnaires were sent to all OMF surgeons in RS. The questionnaire comprised demographic, clinical, and imaging questions. The chi-square test was used to verify the association between variables. Results: 115 questionnaires were answered. The most requested exam was the panoramic (95%). CBCT was requested by 50 specialists (30 use software). Localization of the mandibular canal, root dilaceration, and resorption of the second molar are the most evaluated aspects in the CBCT (P <0.05); the contact of the root with the mandibular canal was said to be evaluated in both exams. Permanent complications were reported by 21 OMF surgeons, and were related to the time of graduation and/or specialization (P < 0.05), but not to the type of exam (P > 0.05). In the OMF surgeons' perception, the CBCT has an important role in cases of high complexity. Conclusion: panoramic radiograph still is the most used exam for the assessment of impacted 3LM by OMF surgeons in RS, however, CBCT has been requested to complement the diagnosis and treatment plan, and as a means of professional legal security.(AU)

Effect of different factors on patient perception of surgical discomfort in third molar surgery

Abstract: The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Association between Pell and Gregory classification and the difficulty of the extraction of the lower third parties / Associação entre a classificação de Pell e Gregory e a dificuldade da extração dos terceiros molares inferiores

ABSTRACT Lower third molar extraction is a common procedure in Oral and Maxillofacial Surgeons routine. However, even though this procedure is frequent, sometimes its course is unexpected. In this scenario, some developed classifications help to predict the difficulty level for such extractions. Objective This study aimed to verify the association of Pell and Gregory classifications I and II and surgical difficulty through lower third molar extractions. Methods Voluntary patients from the Dentistry Course of the State University of Rio Grande do Norte, between 16 and 45 years of age, who met the inclusion criteria, had their third molars classified according to Pell and Gregory. Results A total of 42 elements were extracted. There were no statistically significant differences for the correlation of Pell and Gregory classification with the surgical difficulty considering the variables such as surgery time (p=0.419), osteotomy needs (p=0.428) and number of anesthetic tubes (0.939). As for the need for odontosection, only when comparing the teeth classified as AI and IIA, the difference in favor of AI elements was statistically significant (p=0.008). There were no accidents or complications. Conclusions Pell and Gregory classification was not a good predictor of surgical difficulty, and further studies on this subject are recommended.

RESUMO A exodontia dos terceiros molares inferiores é um procedimento comum na rotina dos Cirurgiões Bucomaxilofaciais. Entretanto, mesmo este procedimento sendo frequente, por vezes, o seu curso se mostra de forma inesperada. Neste cenário, algumas classificações desenvolvidas auxiliam na predição do nível de dificuldade para tais extrações. Objetivo Este trabalho objetivou, por meio de extrações de terceiros molares inferiores, verificar a associação das classificações I e II de Pell e Gregory e a dificuldade cirúrgica. Métodos Pacientes voluntários do Curso de Odontologia da Universidade do Estado do Rio Grande do Norte, entre a faixa etária de 16 a 45 anos, que se encaixaram nos critérios de inclusão, tiveram seus terceiros molares classificados de acordo com Pell e Gregory e extraídos. Resultados Um total de 42 elementos foram extraídos. Não existiram diferenças estatisticamente significantes para a correlação da classificação de Pell e Gregory com a dificuldade cirúrgica levando-se em conta as variáveis tempo de cirurgia (p = 0,419), necessidades de osteotomia (p= 0,428) e quantidade de anestubes (0,939), quanto a necessidade de odontossecção, apenas quando comparados os dentes classificados como IA e IIA, a diferença a favor dos elementos IA foi estatisticamente significativa (p = 0,008), inexistindo acidentes e complicações. Conclusão A classificação de Pell e Gregory não se mostrou como um bom preditor da dificuldade cirúrgica, sendo recomendado que novos estudos sejam realizados sobre essa temática.

The influence of flap design on patients' experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review

Abstract Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.

The Effect of Pain and Swelling Related to Third Molars on Oral Health-Related Quality of Life

ABSTRACT Objective: To evaluate the effect of pain and swelling related to third molars on patients' quality of life prior to third molar surgery. Material and Methods: The effects on quality of life with reference to oral health of 246 healthy patients seeking treatment of third molars were analyzed using the 14-item Oral Health Impact Profile (OHIP) questionnaire before surgery. The patients' sociodemographic characteristics, medical and dental history, reasons for third molar removal were recorded. Adverse effects of pain and swelling on oral health-related quality of life were recorded. Results: The mean age of the patients included in the study was 23.15 years, with maximum male patients and the mean OHIP-14 score of 8.01 ± 7.51. About 36.97% of patients reported that their chief complaint was pain/swelling due to third molar infection, and 27.9% of subjects reported one or more of the 14 OHIP items. The odds of reporting for age with ≥25 years was approximately 2 times greater than age with ≤25 years (OR=1.56, 95% CI: 1.01-2.57) and tooth loss due to traumatic history (OR=3.14, 95% CI: 2.12-6.54). Conclusion: Adverse influences on quality of life were seen in a significant number of patients seeking third molar removal. The probabilities increased by 3-fold for patients who had experienced pain or swelling than asymptomatic individuals.

Modified coronectomy procedure for mandibular third molar: association of platelet-rich fibrin / Técnica de coronectomia de terceiro molar inferior modificada: associação de plasma rico em fibrina

ABSTRACT The present case report describes a modified technique of coronectomy for mandibular third molar with association of Platelet-Rich Fibrin Graft (PRF). The panoramic radiograph showed proximity of the roots of the vertical positioned 48 tooth with the superior wall of the mandibular canal, since the erasure of the superior cortical of the mandibular canal was observed. Due to the risk of injury to the inferior alveolar nerve, the technique of coronectomy was chosen. After the realized the coronectomy, in order to promote the regeneration of soft and hard tissues and also to prevent pulp changes that could lead to pain, pulp necrosis and infection, the PRF graft was used to fill the surgical defect formed by removal of the crown. Good healing evolution was observed and after 12 months of clinical and radiographic follow-up there was complete bone formation in the area where the crown was removed and no complications were observed.

RESUMO O presente caso clínico descreve uma técnica modificada de coronectomia de um terceiro molar inferior com a associação de Plasma Rico em Fibrina (PRF). A radiografia panorâmica mostrou proximidade das raízes do dente 48 posicionado verticalmente com a cortical superior do canal mandibular, The panoramic radiograph showed proximity of the roots of the vertical positioned 48 with the superior wall of the mandibular canal, ma vez que, observou-se o desaparecimento da cortical superior do canal. Devido ao risco de lesão ao nervo alveolar inferior, a técnica de coronectomia foi empregada. Depois de realizada a coronectomia, com o objetivo de favorecer a regeneração dos tecidos moles e duros e também de prevenir alterações pulpares que poderiam causar dor, necrose pulpar e infecção, o enxerto de PRF foi usado para preencher o defeito formado pela remoção da coroa. Boa evolução cicatricial foi observada 12 meses pós-operatórios, o acompanhamento clínico e radiográfico mostrou completa formação óssea na área onde a coroa foi removida e não foram observadas complicações.

Radiographic Assessment of Third Molars Agenesis Patterns in Young Adults

ABSTRACT Objective: To determine the prevalence of third molar agenesis and associated characteristics. Material and Methods: A total of 2374 panoramic radiographs were retrieved from the radiological archives and evaluated in a computer monitor under optimum viewing conditions. The basic demographic data (age and sex) and the primary findings regarding the presence or absence of third molars in the maxillary and mandibular arches were recorded systematically in a specially designed proforma. Categorical variables were compared using the Chi-square test. Results: A total of 2000 panoramic radiographs were included in the study, of which 1004 were females (50.2%), and 996 were of males (49.8%). The incidence of third molar agenesis was 486 patients (24.3%). Maxillary third molar showed a higher prevalence of agenesis (28.8%) than mandibular third molars (16.4%). A total of 1514 patients (75.7%) had third molars in all four quadrants, and the remaining 486 patients (24.3%) had agenesis of third molar tooth in at least one of the quadrants. Single tooth agenesis was observed in 219 (11%) patients, two teeth agenesis in 172 (8.6%) patients, three teeth agenesis in 39 (2%) patients, and four teeth agenesis in 56 (2.8%) patients. Conclusion: The present study exhibited a maximum number of single tooth agenesis. It was also observed that maxillary third molar agenesis is more than the mandibular third molar and the right side is more than the left side. Agenesis of the third molar is more prevalent in males as compared to females.

Relação da exodontia de terceiros molares e a ocorrência de parestesia do nervo alveolar inferior: uma revisão narrativa / Relationship of third molar extraction and occurrence of lower alveolar nerve paresthesia: a narrative review

Terceiros molares inferiores podem apresentar uma estreita relação com o nervo alveolar inferior, aumentando as chances de lesão durante o ato cirúrgico. Objetivo: descrever a relação entre a exodontia de terceiros molares e a ocorrência da parestesia do nervo alveolar inferior. Revisão de literatura: cirurgia para exodontia de dentes terceiros molares é o procedimento mais frequentemente realizado entre as cirurgias bucais e, como todo tipo de cirurgia, possui riscos e acidentes e/ou complicações que podem acometer os pacientes tal como a parestesia. Esta é uma condição que altera a sensibilidade de determinada área e pode ocorrer em consequência de traumas diretos ao nervo ou pela compressão deste, devido a hematoma e edema, levando a desconforto e incômodo. Considerações finais: é importante o profissional cirurgião-dentista atentar para o planejamento correto, criterioso e fazer uso de exames complementares, a fim de precaver possíveis complicações durante o ato cirúrgico. Caso a parestesia aconteça, podem ser utilizados tratamentos medicamentosos, a laser ou cirúrgicos, com resultados em longo prazo positivos e reversão do caso.(AU)

Lower third molars may present a close relation with the inferior alveolar nerve increasing the chances of injury during the surgical act. In view of this, this literature review aims to describe the relationship between the extraction of molars third and the occurrence of inferior alveolar nerve paresthesia. Paresthesia is a condition that alters the sensitivity of a certain area and can occur as a result of direct trauma to the nerve or compression of the nerve due to hematoma and edema. It leads to discomfort and discomfort, and it is important for the professional to attend to the correct, judicious planning and to make use of complementary exams. If paraesthesia occurs, medical, laser or surgical treatments are used, with positive long- -term results and reversal of the case. (AU)

Pre-emptive low-dose ketamine with local anesthesia reduces postoperative morbidity after third molar surgery: a systematic review and meta-analysis / Ketamina en dosis bajas con anestesia local reduce la morbilidad postoperatoria de la cirugía del tercer molar: revisión sistemática y metanálisis

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.

Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.

Análisis ortopantomográfico en la determinación de la posición recurrente de terceros molares / Orthopantomographic analysis in determining the recurrent position of third molars

Objetivo: caracterizar las posiciones recurrentes en terceros molares a través del análisis ortopantomográfico en pacientes del Centro Especializado en Odontología "Dr. Mario Cerda e Hijos" en la ciudad de Riobamba durante el periodo 2015-2018. Material y Métodos: se realizó un estudio de tipo observacional, descriptivo y de corte transversal, en el que se analizaron ortopantomografías de pacientes del entorno de investigación. Se trabajó con la totalidad de la población, constituida por de 172 radiografías, analizando la posición de 688 terceros molares, en pacientes con edades comprendidas entre 15 a 50 años. Los datos fueron recolectados a partir de la técnica de la medición, utilizando el negatoscopio y la regla milimetrada, los que fueron agrupados según las clasificaciones de Winter y de Pell y Gregory. Resultados: de 688 terceros molares analizados, el 48,1% se observó en posición vertical, seguido de la posición mesioangular con el 31,2%; clase II con 43,3%, clase I en 31,8% y clase III con 18,8%; nivel B con 35,6%, nivel C en 34,9% y nivel A con 23,4%. Conclusión: la posición vertical, la clase I y el nivel C, resultaron más frecuente en los terceros molares del maxilar; mientras que en la mandíbula fueron la posición mesioangular, la clase II y el nivel B.

Objective: to characterize the recurrent positions in third molars through the orthopantomographic analysis in patients of the Specialized Center in Dentistry "Dr. Mario Cerda e Hijos" in the city of Riobamba-Ecuador during the period 2015-2018. Material and Methods: an observational, descriptive, and cross-sectional study was carried out, in which orthopantomographies of patients were analyzed in this research. The studied population was made up of 172 radiographs, the position of 688 third molars was analyzed in patients aged between 15 to 50 years. Considering the technique, the data collected was the measurement using the negatoscope and the millimeter ruler, which were grouped according to the Winter and Pell and Gregory classifications. Results: 688 third molars were analyzed, the 48.1% was observed in vertical position, followed by the mesioangular position with 31.2%; class II with 43.3%, class I in 31.8% and class III with 18.8%; level B with 35.6%, level C with 34.9% and level A with 23.4%. Conclusion: The vertical position, class I and level C were more frequent in the maxillary third molars; while in the mandible they were the mesioangular position, class II, and level B.

Effects of Oral Diazepam or Inhalatory Nitrous OxideOxygen for Conscious Sedation During Third Molar Surgery: A Randomized Controled Trial, Split Mouth Design / Efectos del Diazepam Oral o la Inhalación de Óxido Nitroso-Oxígeno para la Sedación Consciente Durante la Cirugía del Tercer Molar: Un Ensayo Controlado Aleatorio, Diseño de Boca Dividida

ABSTRACT: Anxiety in dental surgery may lead to behavioral and physiological changes for the patient and constitute a frequent challenge for the oral surgeon. The objective of this study was to compare the effect of inhalatory nitrous oxide and oxygen (N2O/O2) with oral diazepam conscious sedation in vital signs of patients undergone third molar extraction. Outpatients who needed removal of partially impacted, bilateral lower third molars, during the period of one year, were included. Each patient underwent conscious sedation with either oral diazepam or inhalatory N2O/O2 on a randomized controlled trial, split-mouth design. Systolic and diastolic blood pressure, heart rate and oxygen blood saturation were the changes measured before, at the beginning and the end of the procedure. Also, surgical procedure duration was recorded. Data from vital signs were submitted to analysis of variance and the duration of the surgery to paired Student's t-test. Twenty-five healthy outpatients (13 women and 12 men) with a mean age of 21.6 years were studied. There was an increase in systolic and diastolic pressure and in heart rate in the beginning; these values decreased and stabilized at the end of the surgical procedure in both treatments (p < 0.001) being lower in N2O/O2 but without difference between treatments. The surgical procedure duration was lower and occurred an expected increase of oximetry under N2O/O2 sedation (p < 0.001). Both treatments were effective for the conscious sedation but N2O/O2 showed better outcomes, mainly in duration of the surgery.

RESUMEN: La ansiedad en la cirugía dentoalveolar puede conducir a alteraciones fisiológicas y de comportamiento en el paciente, constituyendo así un desafío frecuente para el cirujano maxilofacial. El objetivo de este estudio fue comparar el efecto del óxido nitroso inhalatorio con oxígeno (N2O/O2) y la sedación consciente oral con diazepam por médio de los signos vitales de pacientes sometidos a la extracción del tercer molar. Fueron incluídos pacientes ambulatoriales com necesidad de exodoncia de terceros molares inferiores bilaterales, parcialmente impactados, durante el período de un año. Cada paciente fue sometido a sedación consciente con diazepam oral o N2O/O2 por inhalación en un ensayo controlado aleatorio, diseño de boca dividida. La presión arterial sistólica y diastólica, la frecuencia cardíaca y la saturación de oxígeno en la sangre fueron medidos antes, al inicio y al final del procedimiento. Además, se registró la duración del procedimiento quirúrgico. Los datos de los signos vitales fueron enviados para análisis de varianza y la duración de la cirugía para la prueba t de Student pareada. Se estudiaron 25 pacientes ambulatorios sanos (13 mujeres y 12 hombres) con una edad media de 21,6 años. Al início hubo un aumento en la presión sistólica y diastólica y en la frecuencia cardíaca; estos valores disminuyeron y se estabilizaron al final del procedimiento quirúrgico en ambos tratamientos (p <0,001), siendo más bajos en N2O/ O2 pero sin diferencia entre los tratamientos. La duración del procedimiento quirúrgico fue menor y se produjo un aumento esperado de la oximetría bajo sedación con N2O/O2 (p <0,001). Ambos tratamientos fueron efectivos para la sedación consciente, pero el N2O/O2 mostró mejores resultados, principalmente en la duración de la cirugía.

Patterns of Mandibular Third Molar Impaction in an Iranian Subpopulation

Abstract Objective: To assess the patterns of mandibular third molar impaction in an Iranian subpopulation. Material and Methods: This retrospective descriptive study evaluated 1000 panoramic radiographs retrieved from the archives of a private radiology clinic in Kermanshah city, Iran. Depth of impaction, position of impacted mandibular third molar relative to the mandibular ramus according to Pell and Gregory's classification and angle of impacted tooth according to Winter's classification were determined. Data were analyzed using the Chi-square and Wilcoxon tests. Results: Of 1000 radiographs, 230 (23%) showed an impaction of at least one mandibular third molar. Mandibular third molar impaction was more common in females (60%). Mesioangular (35.9%) and vertical (34.8%) impactions were the most common angles of impaction in the right and left sides, respectively. Level C (40.3%) and Class I (63.7%) were the most common types of impaction in terms of depth of impaction and position relative to ramus, respectively. No significant difference was observed between the right and left sides of the mandible in terms of patterns of mandibular third molar impaction (p>0.05). Conclusion: Mandibular third molar impaction was relatively common in the studied population. The mesioangular, level C and Class I impaction patterns were the most frequent.

The effects of bioadhesive hyaluronic acid gel versus diclofenac after surgical removal of impacted wisdom teeth

Surgical extraction of impacted lower wisdom teeth is a frequent minor intraoral surgical process. It is regularly linked with aching and postoperative consequences as pain and swelling. The aim of this study is to evaluate the efficacy of two methods in reducing swelling and pain subsequent to the removal of impacted wisdom teeth. This randomized study incorporated 20 patients with impacted wisdom teeth of different surgical complexity. Topical hyaluronic acid gel 2g/2ml with aloe vera (Kin®Care) was given to the patients to be applied to the surgical area three times a day, or diclofenac sodium tablet 50mg (Voltaren®) to be taken every eight hours, for one week. Swelling was estimated using a strip gauge technique, and pain with a visual analogue scale. Evaluations were made on day one of surgical treatment and on 72hrs and one week later. Statistically no significant differences were identified regarding the swelling and pain values between the two treatment groups on the third and seventh day after surgery. Hyaluronic acid gel was as efficient as diclofenac tablets in reducing the two parameters. The use of hyaluronic acid may be advantageous in medically compromised patient such as those with hypertension, chronic asthma, gastric ulcers or in those with any contraindications to using non-steroidal anti-inflammatory drugs, or in pregnant patients to reduce pain and swelling subsequent to impacted wisdom teeth surgery.