The effect of maxilla impacted canine positions on root resorption of adjacent teeth using cone-beam computed tomography imaging

Objective@#To determine the effect of the impacted position of the maxillary canine on the root resorption of the adjacent incisor using Cone-beam Computed Tomography (CBCT) imaging. @*Methods@#This was an analytic quantitative study. The research sample determined CBCT images of treatment patients at the Orthodontic Specialist Policlinic in Dental Hospital of Airlangga University over a three-year period and secondary data taken from Pramita Laboratory. CBCT photos that met the inclusion criteria, including mesially impacted canine or close to central or lateral incisors with completely formed anatomy were then analyzed. Multiple linear regression was used to determine x-axis, y-axis, z-axis position of the impacted canine on the severity of root resorption of the adjacent incisor, and the effect of impacted canines on all axes simultaneously on the severity of root resorption of the adjacent incisors. @*Results@#The position of the impacted canine in the x-axis and z-axis planes had a significant influence on the root resorption of the adjacent incisor. Meanwhile, impacted canine from the y-axis plane showed non-significant influence on the root resorption. @*Conclusion@#The position of the impacted canine when viewed in all planes of the tooth axis has a significant effect on the severity of root resorption of the adjacent incisor

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

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

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

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

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

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

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

Clasificación alternativa para terceros molares / Alternate classification for third molars

Resumen Introducción En el presente artículo se describen las diferentes clasificaciones de terceros molares retenidos y se recomienda una nueva clasificación que permite predecir la dificultad para la remoción respectiva. Objetivo Lo anterior tiene la finalidad servir de guía para que los estudiantes o profesionales en Odontología utilicen como clasificador el grado de dificultad de terceras molares, el cual se constituiría en un instrumento de medición del tiempo necesario para remover la pieza dental, los pasos necesarios para dicha remoción y la morbilidad relacionada.

Abstract Introduction Different literaly classifications of impacted wisdom teeth will be shown in adddition to a new categorization wich predicts their removal difficulty. Aim The goal of the above statement is to be used as a guide for students and/or collegues to classify the degree of difficulty as a tool to measure the needed time to extract the tooth and the necessary steps to remove it and the related morbility.

Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial

Abstract The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Resumo O objetivo desta pesquisa é avaliar a eficácia do uso de LBP (laser de baixa potência) na redução da dor, edema e trismo após exodontia de terceiros molares inferiores impactados. Ensaio clínico randomizado triplo-cego do tipo boca dividida foi realizado na Universidade Federal do Ceará. Para os critérios de inclusão era necessário que o paciente apresentasse indicação clara para a remoção de ambos os terceiros molares inferiores, além da obrigatoriedade de que ambos os molares estivessem em posições semelhantes segundo Winter (1926) e Pell & Gregory (1933). Os terceiros molares (38 e 48) foram alocados aleatoriamente no grupo teste que recebeu o protocolo de aplicação dO LBP e no grupo placebo que recebeu a simulação do protocolo, perfazendo uma amostra total de 44 cirurgias. Os pacientes do grupo teste usaram em média 1/2 da quantidade de analgésicos do que os do grupo placebo, porém, apenas nos dias quatro e cinco houve diferença estatisticamente significativa. Em relação ao trismo, o grupo teste apresentou melhores indicadores tanto em 48 horas quanto em 7 dias após a cirurgia em relação ao grupo placebo, mas sem diferença estatisticamente significante. Em relação ao edema, houve medidas na amostra favoráveis ​​ao grupo teste e medidas favoráveis ao grupo placebo, mas nenhuma das medidas obteve diferença estatisticamente significativa. O uso de LBP mostrou melhores indicadores de dor e trismo após extrações complexas. Portanto, o uso de LBP é indicado como terapia complementar para reduzir morbidades causadas por exodontias complexas.

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

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

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

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

Osteotomia periférica no tratamento de cisto odontogênico glandular / Peripheral osteotomy in the treatment of glandular odontogenic cyst / Osteotomía periférica en el tratamiento del quiste odontogénico glandular

O objetivo deste artigo é relatar um caso de COG em sínfise mandibular, tratado com enucleação e osteotomia periférica. Relato de Caso: Paciente do sexo feminino, 58 anos de idade, foi encaminhada para avaliação de uma lesão mandibular, apresentando-se assintomática no momento da consulta. Foi observado um leve aumento de volume vestibular na região da sínfise mandibular, sem sensibilidade ao toque. Na tomografia foi observada imagem hipodensa, multiloculada, bem delimitada, na região de sínfise, próxima as raízes dentárias e a basilar mandibular, além de um dente incluso intralesional. Foi realizada biópsia incisional e exame histopatológico, através do qual foi estabelecido o diagnóstico de COG. Como forma de tratamento, o paciente foi submetido a enucleação com curetagem de toda lesão e a osteotomia periférica, além da remoção do dente incluso. Após um ano de acompanhamento, a paciente encontra-se livre de recorrências. Conclusão: Por fim, este caso destaca a importância de um tratamento eficaz de COG com a osteotomia periférica, considerando o tamanho da lesão, suas características e sua localização, a fim de reduzir suas chances de recidiva... (AU)

The aim of this article is to report a case of COG in mandibular symphysis, treated with enucleation and peripheral osteotomy. Case Report: A 58-yearold female patient was referred for evaluation of a mandibular lesion, instrument was asymptomatic at the time of consultation. An increase in vestibular volume was observed in the region of the mandibular symphysis, without sensitivity to touch. The tomography showed a hypodense, multiloculated, well-delimited image in the symphysis region, close to tooth roots and a mandibular basilar, in addition to an intralesional impacted tooth. An incisional biopsy and histopathological examination were performed, through which the diagnosis of COG was established. As a form of treatment, the patient underwent enucleation with curettage of the entire lesion and peripheral osteotomy, in addition to removal of the impacted tooth. After a year of follow-up, the patient is free from recurrences. Conclusion: Finally, this case highlights the importance of an effective treatment of COG with peripheral osteotomy, considering the size of the lesion, its characteristics and its location, in order to reduce its chances of recurrence... (AU)

El objetivo de este artículo es reportar un caso de COG en la sínfisis mandibular, tratado con enucleación y osteotomía periférica. Caso Clínico: Paciente femenino, de 58 años de edad, fue remitida para valoración de lesión mandibular, presentándose asintomática al momento de la consulta. Se observa ligero aumento de volumen vestibular en la región de la sínfisis mandibular, sin sensibilidad al tacto. En la tomografía se observó una imagen hipodensa, multiloculada, bien delimitada en la región de la sínfisis, próxima a las raíces dentarias y la base de la mandíbula, además de un diente intralesional. Se realizó biopsia incisional y examen histopatológico, a través del cual se estableció el diagnóstico de GOC. Como forma de tratamiento, el paciente fue sometido a enucleación con curetaje de toda la lesión y osteotomía periférica, además de extracción del diente impactado. Después de un año de seguimiento, un paciente está libre de recurrencias. Conclusión: Finalmente, este caso destaca la importancia de un tratamiento efectivo de la GOC con osteotomía periférica, considerando el tamaño de la lesión, sus características y su ubicación, para reducir sus posibilidades de recurrencia... (AU)

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

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

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

Peripheral squamous odontogenic tumor associated with an impacted mandibular third molar: A case report

Introduction: Squamous odontogenic tumor is a benign but locally infiltrative, epithelial odontogenic tumor. This case report presents a case of a peripheral variant of squamous odontogenic tumor. Case Presentation: A 29-year-old male patient presented with pain in the left posterior mandible region for one month. Radiographic examination revealed an impacted left mandibular third molar with no other abnormalities. Management and Prognosis: The impacted tooth was removed under local anaesthesia. Histopathological examination of the abnormally thick pericoronal tissue, covering the impacted tooth revealed islands of bland squamous epithelium in a background of mature fibrous connective tissue. The prognosis was good with no signs of recurrence after one year of follow- up. Conclusion: Squamous odontogenic tumor should be considered in the differential diagnosis of pericoronal pathoses, although it is rare in this location.

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

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

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

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

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

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

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

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

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

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

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

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

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

Multiple Accessory Cusps Expression at Mandibular Third Molar: A Unique Variation of Dental Crown Morphology - A Case Report

@#Accessory cusps are occasional variations in tooth morphology that can be detected clinically. Third molars have a wide range of eruption patterns and shapes but are commonly impacted. Unlike root morphology, variations in the crown morphology of the third molar have rarely been reported. Variations in crown morphology are important because they can affect clinical outcomes. Here, we present a rare case of fully erupted mandibular third molar (MTM) with multiple accessory cusps. This case report describes a case of a 31-year-old female Kenyah with a unique crown morphology of her fully erupted, vital, and functional mandibular third molar (MTM) which has multiple accessory cusps seen on the buccal surface, giving the appearance of a double tooth. Her MTM presented with an incipient caries lesion, which was managed conservatively. Documenting variations in tooth morphology is crucial for individual identification. While most people opt to have their MTMs extracted, early management of well-erupted and functional teeth should be undertaken to prevent disease progression.

Efficacy of intraosseous saline injection for pain management during surgical removal of impacted mandibular third molars: a randomized double-blinded clinical trial

Background@#Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. @*Methods@#This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. @*Results@#Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) @*Conclusion@#The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

Determining the reliability of diagnosis and treatment using artificial intelligence software with panoramic radiographs

Purpose@#The objective of this study was to evaluate the accuracy and effectiveness of an artificial intelligence (AI) program in identifying dental conditions using panoramic radiographs (PRs), as well as to assess the appropriateness of its treatment recommendations. @*Materials and Methods@#PRs from 100 patients (representing 4497 teeth) with known clinical examination findings were randomly selected from a university database. Three dentomaxillofacial radiologists and the Diagnocat AI software evaluated these PRs. The evaluations were focused on various dental conditions and treatments, includingcanal filling, caries, cast post and core, dental calculus, fillings, furcation lesions, implants, lack of interproximal tooth contact, open margins, overhangs, periapical lesions, periodontal bone loss, short fillings, voids in root fillings, overfillings, pontics, root fragments, impacted teeth, artificial crowns, missing teeth, and healthy teeth. @*Results@#The AI demonstrated almost perfect agreement (exceeding 0.81) in most of the assessments when compared to the ground truth. The sensitivity was very high (above 0.8) for the evaluation of healthy teeth, artificial crowns, dental calculus, missing teeth, fillings, lack of interproximal contact, periodontal bone loss, and implants. However, thesensitivity was low for the assessment of caries, periapical lesions, pontic voids in the root canal, and overhangs. @*Conclusion@#Despite the limitations of this study, the synthesized data suggest that AI-based decision support systems can serve as a valuable tool in detecting dental conditions, when used with PR for clinical dental applications.

Cone-beam computed tomographic reconstructions in the evaluation of maxillary impacted canines

Purpose@#Prior to cone-beam computed tomography (CBCT), orthodontic competence included radiological interpretation. Nevertheless, maxillary impacted canines (MICs), because of their position and adjacent complex anatomy, have been challenging to interpret, particularly with regard to root resorption. Although CBCT crosssectional reconstructions of MICs yielded clearer insights into its diagnosis and treatment planning, the value of simultaneously using 2 different cross-sectional or multiplanar reconstructions of the CBCT datasets - orthogonal and curved/panoramic multiplanar reconstructions - has hitherto not been considered. @*Materials and Methods@#Both orthogonal and curved/panoramic multiplanar reconstruction series of 5 screenshots were each reconstructed from the 5 cm × 5 cm CBCT datasets of 15 separate MICs. Fifteen credentialled and experienced orthodontist volunteers reviewed 2 separate PowerPoints of 15 randomized series each, 1 week apart.Their review considered 6 factors that could affect treatment: the position and level of the MIC, the presence or absence of root resorption, ankylosis, cysts, and dilaceration. @*Results@#All 15 orthodontists were statistically similar regarding overall years of experience and of CBCT use. Although either reconstruction alone allowed the orthodontists to determine whether ankylosis and, to a lesser extent, most of the other features were present or absent in the MIC, reviewing both reconstructions together was necessary to determine whether root resorption was present or absent in the adjacent tooth. @*Conclusion@#Reviewing both orthogonal and curved/panoramic multiplanar reconstructions was necessary to evaluate the presence or absence of root resorption in the teeth adjacent to MICs and that of many other features. (Imaging Sci Dent 2023; 53: 145-51)