The Clinical and Radiological Evaluation of Impacted Third Molar Position, Crown and Root Morphology.

OBJECTIVE: This study aimed to analyze the crown and root morphology of maxillary and mandibular third molars, and assess their position in relation to adjacent anatomical structures using clinical examination and radiographic images. MATERIALS AND METHODS: A total of 176 extracted impacted or partially impacted third molars were included in this study. Orthopantomogram images (OPG) were used to evaluate the number of roots, position, depth of impaction relative to the occlusal plane of the second molar, and angulation of maxillary and mandibular third molars. The extracted teeth were examined to determine the actual number of roots. The root morphology was classified using the Alavi classification system for maxillary third molars and the Machado classification for mandibular third molars. Additionally, the number of cusps, crown dimensions, and morphology were analyzed using digital and dental calipers. RESULTS: The extracted samples exhibited a significantly higher number of roots compared to the number assessed on OPG images (P<0.001). The majority of mandibular third molars had two fused roots (37.39%) and a five-cuspid crown (48.70%), while maxillary third molars had three fused roots (26.23%) and four cusps (42.62%). Both maxillary (60.66%) and mandibular third molars (61.74%) were predominantly vertically positioned. Regarding the depth of impaction, maxillary third molars were primarily classified as Class C (65.57%), while mandibular third molars were classified as Class B (47.83%). Differences in crown shape were observed, with maxillary crowns being mostly triangular (36.07%) and mandibular crowns being oval (38.26%). Maxillary third molars had shorter crowns compared to mandibular third molars (P<0.05). CONCLUSION: The root morphology of maxillary and mandibular third molars in the population of Bosnia and Herzegovina displays variability. Orthopantomogram imaging was found to be inadequate for accurate determination of the number of roots in third molars. The number of cusps on third molars cannot be relied upon as a predictor of the number of roots. The study's findings will have implications for dental practice, particularly for oral surgeons and restorative dentists.

A Large Dentigerous Cyst in a Child as a Complication of Deciduous Molar Endodontic Treatment: An Interesting Case Report with Short Literature Review.

This study presents a case report of an inflammatory dentigerous cyst of tooth #35, associated with its previously endodontically treated deciduous predecessor. Cystic lesion growth caused impaction of the second premolar, displacing it closer to the lower border of the mandible. The lesion represents a typical dentigerous cyst that possibly arises in association with periapical inflammation of a deciduous molar involving the follicle of the premolars. This report highlights the inflammatory etiology of dentigerous cysts, which mainly occur in mixed dentition. A 12-year-old patient was referred to Oral Surgery Department regarding a sizeable radiolucent lesion in the unerupted mandibular second premolar region, detected on an Orthopantomagram (OPG) X-ray. A non-vital primary predecessor had been endodontically treated at least one year before an examination, with a control OPG X-ray showing no signs of pathology at the time. The patient did not report any symptoms. Clinical examination revealed an egg-like tumefaction of the alveolar bone in the left premolar region of the mandible. Cone-beam computed tomography analysis showed a sizeable translucent lesion surrounding the crown of the impacted tooth. The lesion was enucleated in its entirety, along with the impacted premolar, under local anesthesia. Clinical findings combined with radiographic and microscopic examinations confirmed the diagnosis of an inflammatory dentigerous cyst. The seventeen month follow-up revealed good bone healing. This case presented a rare complication of endodontic treatment of deciduous teeth and informed on possible complications of endodontic therapy in deciduous teeth, emphasizing the importance of early diagnosis of cysts in preventing extraction of permanent teeth.

Epidemiological, Clinical and Radiographic Features of Supernumerary Teeth in Nonsyndromic Bosnian and Herzegovinian Population: a Monocentric Study.

Background: Supernumerary teeth (ST) represent one of the most common developmental anomalies among humans. Objective: In this study, we set a goal to investigate ST prevalence in the Bosnian and Herzegovinian population along with characteristics and complications that ST can cause. Methods: This retrospective study was based on panoramic radiographs, CBCT images, and dental records. Analyzed ST characteristics were: type, morphology, location, eruption state, location in the arch, orientation, and associated clinical complications. Statistical analysis included univariate analysis and bivariate analysis using Fisher's exact test with a confidence interval of 95% (p<0.05). Results: On a sample of 10.237 patients, ST teeth appear in 100 patients with a prevalence of 0.98%. Out of 138 analyzed ST mesiodens was the most frequent (43.47%). The most common location of the ST was maxilla (77.53%). The majority of ST were impacted (90.5%) but with no complications (71.7%). There was statistically significant relationship (p<0.001) between the type of ST and location (mesiodens and distomolars were mostly found in the maxilla). The relationship between ST type and morphology was also statistically significant (p<0.001)-mesiodens was associated with conical morphology, parapremolar with supplementary, and distomolar with tuberculate morphology. The occurrence of ST-associated retention of adjacent teeth was correlated to the type of tooth (p<0.001). Conclusion: The present study found prevalence of ST in B&H population to be low. Although associated pathology was not high early diagnosis allows optimal patient management which reduces later complications.

The Influence of Vitamin D Serum Concentration on Third Molar Extraction Outcome: a Pilot Study.

Background: In the academic world, the debate continues on the subject of how far a lack of vitamin D can affect the healing of various wounds. Objective: To determine if basal serum levels of vitamin D significantly influence clinical parameters linked to post-extraction wound healing after surgical removal of impacted/semi-impacted third molars. Methods: A total of 23 patients were included in this study. Clinical outcome parameters were: edema, trismus, pain, soft tissue healing, and dry socket signs. The research was divided into four stages. Results: Due to the high prevalence of hypovitaminosis D (91%), patients were classified into an insufficient (≥ 20 ng/ml) or a deficient group (<20 ng/ml). The results showed no statistically significant differences in pain, edema, trismus, or soft tissue healing between those two groups. A slight statistical interaction was observed in the clinical parameters related to edema and trismus assessment, but not statistically significant. We did not notice signs of "dry socket" on any of the patients. Conclusion: Within its limitations (low number of patients, high prevalence of vitamin D deficiency), this pilot study failed to find a significant influence of serum vitamin D concentrations in wound healing or post-surgery symptom (pain, edema, trismus) development after third molar extraction. Further clinical investigations are necessary to elaborate on this function of vitamin D more precisely.

Dental age assessment based on CBCT images using machine learning algorithms.

Age estimation has become inordinately significant for human beings for many reasons, such as detecting legal and criminal responsibility and other social events like a marriage license, birth certificate, etc. This paper aims to decide on the most desirable machine learning algorithm (from conventional machine learning algorithms to deep learning) for dental age estimation based on buccal bone level. The database consisted of 150 CBCT images (73 males and 77 females) from an existing base of the Faculty of Dental Medicine with Clinics, University of Sarajevo, aged 20-69. Results were obtained using the Waikato Environment for Knowledge Analysis (Weka), machine learning software in Java. Left and Right Buccal Alveolar Bone Levels are increasing with age, so they showed to be the most important attributes, especially the latter. Random Forest classifier provided the greatest result with the correlation coefficient of 0.803 and the mean absolute error of 6.022. We have also shown that considering sinus-related features can be a significant addition to the databases. Our paper is probably one of the first studies where regression algorithms based on the Support Vector Machines and Random Forest were utilized.

Sealing Ability of Mineral Trioxide Aggregate, Biodentine and Glass Ionomer as Root-End Materials: A Question of Choice.

OBJECTIVES: The goal of this study was to determine the sealing ability of MTA, Biodentine, and Fuji IX as root-end materials after ultrasonic retrograde preparation using a dye penetration method. MATERIALS AND METHODS: Seventy permanent anterior teeth were used in this study. Root canals were prepared using rotary endodontic files, and obturated using the lateral condensation technique. The resection of the root apices was performed perpendicularly to the long axis, and 3 mm deep retrocavities were made by ultrasonic tips. The samples were randomly divided into three experimental groups (N=20) and two control groups (N=5). The root-end cavities were filled with mineral-trioxide aggregate (Rootdent MTA, TehnoDent, Russia) in Group 1, Biodentine (Septodont, Saint Maur des Fossés, France) in Group 2 and Fuji IX GP (GC Corporation, Tokyo, Japan) in Group 3. The retrocavities of the positive control group were left unfilled, while retrocavities in the negative control group were sealed using a flowable composite material. The samples were made transparent, and dye penetration was assessed under a stereomicroscope (x10). The data were analyzed with the Kruskal-Wallis test and the Mann-Whitney U-test. RESULTS: The Biodentine group had a lower mean leakage value than the MTA and Fuji IX groups, and the difference was statistically significant (P<0.01). No statistical difference in apical microleakage was found between the MTA and Fuji IX groups (P>0.05). CONCLUSION: Within the limitations of this study, it was concluded that Biodentine provides better sealing ability as a root-end material than MTA and Fuji IX. There was no statistically significant difference between the sealing ability of MTA and Fuji IX as root-end materials.

Quantitative Analysis of CCL5 and ep300 in Periapical Inflammatory Lesions.

OBJECTIVES: In silico bioinformatical analysis suggested that the expression of two genes, CCL5 (C-C Motif Chemokine Receptor 5) and ep300 (Histone acetyltransferase p300), could be used as potential new biomarkers in differentiation between periapical granulomas and radicular cysts. Thus, we hypothesized that gene expression of CCL5 and ep300 in periapical lesions would classify the lesions as either granuloma or cyst. MATERIALS: Patient samples (n=122) included 46 periapical granulomas, 38 radicular cysts and 38 healthy gingival samples as controls. Real-time PCR analysis of CCL5 and ep300 transcripts was compared to SDHA (Succinate dehydrogenase complex, subunit A) as the reference. Clinical parameters (e.g., intensity of inflammation and lesion size) were measured and correlated with CCL5 and ep300 expression. ROC (Receiver operating characteristic) and logistic regression analyses were used to establish the diagnostic character of ΔCt values. RESULTS: Granulomas and radicular cysts had significantly higher expression of CCL5 and ep300 compared to controls (P<0.05). However, no differences were observed when comparing granulomas and radicular cysts. ROC analyses showed that CCL5 and ep300 have good diagnostic accuracy, but low accuracy for distinguishing between the lesions. CONCLUSIONS: This study confirmed that expression of CCL5 and ep300 is relevant for the pathogenesis of periapical inflammatory lesions but cannot be used as a distinctive marker between these lesions.

Nonsyndromic Examples of Odontogenic Keratocysts: Presentation of Interesting Cases with a Literature Review.

The odontogenic keratocyst (OKC) may occur at any age. However, it mostly occurs during the second and third decades of life. Compared to other odontogenic cysts, this type occurs with a frequency of 5-15%. It is more common in the mandible region and in the male sex. Histologically, odontogenic keratocysts are characterized by the presence of an external connective tissue capsule, with keratinizing lining of the epithelium consisting of 5-8 cell layers with marked palisadisation of polarized basal cells and a corrugated parakeratin layer. The objective of this study is to present cases of odontogenic keratocysts, with reference to the latest classification and dilemmas in therapeutic doctrine. This project was realized in the form of descriptive studies, specifically in a series of cases. A collection of four individual cases was found at the Department of Oral Surgery. Due to the proper approach towards diagnosis, adequate and detailed histopathological analysis, and suitable therapeutic procedures, all cases of odontogenic keratocysts were successfully treated without complications. Enucleation of OKC, with a regular follow-up, proved to be the effective therapeutic choice for the patients described in this paper. Only in the case of recurrence would we consider other therapeutic options, primarily enucleation in combination with Carnoy's solution.

Evaluation of periodontal ligament cell viability in different storage media based on human PDL cell culture experiments-A systematic review.

BACKGROUND/AIMS: The best treatment for an avulsed tooth is immediate replantation. If this is not possible, a proper transport medium is required for the maintenance of viability of the periodontal ligament cells (PDL). The aim was to systematically review the efficacy of different storage media used for the survival of PDL cells of avulsed teeth in the in vitro setting. METHODS: The search strategy was based on the MeSH keywords in PubMed/MEDLINE: "Transport media for avulsed teeth," "Storage media for avulsed teeth," "Knocked out teeth," "Tooth avulsion," "Biological transport of avulsed tooth," "Cell survival of avulsed tooth," "Cell viability of avulsed tooth," "Tooth replantation," and "Periodontal ligament in avulsed teeth." The "AND" and "OR" Boolean operators were applied to combine keywords. Each study was evaluated for eight criteria, including use of human PDL, in vitro cell culture models, the number of passages, types of storage media, percentages of surviving PDL cells, pH and osmolality of storage media, and the type of test used to asses PDL viability. RESULTS: In 15 selected studies, nine storage media (HBSS, tap water, DMEM, milk, saliva, 10% and 20% propolis, Gatorade, and Viaspan) were analyzed at six time points. For storage up to 2 hours, HBSS, DMEM, milk, 10% propolis, 20% propolis, and Viaspan conserved more than 80% of PDL viability. For storage at 24 hours, Viaspan showed best cell survival at 88.4%, followed by DMEM (70.9%) and 10% propolis (68.3%). Milk and HBSS showed similar PDL survival at 24 hours (57.2% and 57.3%, respectively). CONCLUSIONS: Milk remains the most convenient, cheapest, and readily available solution in most situations while also being capable of keeping PDL cells alive. Further studies are required to evaluate the efficacy of more commonly found storage media besides milk.

Analysis of palatal rugae in males and females of an average age of 35 in a population from Bosnia and Herzegovina (Sarajevo Canton).

The goal of this study is to identify and compare palatal rugae patterns in males and females of an average age of 35 in a sample population from Bosnia and Herzegovina (Sarajevo Canton), as an additional method for sex differentiation in various situations. The research did not determine any statistically significant difference in the total number of palatal rugae between the sexes, which is in line with previous research. However, in the case of the number of secondary palatal rugae where the probability of an equal average is slightly higher than the tolerance of 5%, the difference being 7.6% which may indicate that secondary palatal rugae are more common in women. However, logistic regression analysis LRA is still more successful in classifying males, 69% of them, while for women the success rate is significantly lower with only 41%. In total, 55% of subjects were correctly classified. It may be concluded that using LRA in palatal rugae could be used as an additional sex differentiation method for the population of Bosnia and Herzegovina.

Gene-expression analysis of matrix metalloproteinases 1 and 2 and their tissue inhibitors in chronic periapical inflammatory lesions.

BACKGROUND: Periapical inflammatory lesions have been investigated previously, but understanding of pathogenesis of these lesions (granulomas and radicular cysts) at the molecular level is still questionable. Matrix metalloproteinases (MMPs) are enzymes involved in the development of periapical pathology, specifically inflammation and tissue destruction. To elucidate pathogenesis of periapical granulomas and radicular cysts, we undertook a detailed analysis of gene expression of MMP-1, MMP-2 and their tissue inhibitors, TIMP-1 and TIMP-2. METHODS: A total of 149 samples were analyzed using real-time PCR (59 radicular cysts, 50 periapical granulomas and 40 healthy gingiva samples as controls) for expression of MMP-1, MMP-2, TIMP-1 and TIMP-2 genes. The determination of best reference gene for expression analysis of periapical lesions was done using a panel of 12 genes. RESULTS: We have shown that ß-actin and GAPDH are not the most stable reference controls for gene expression analysis of inflammatory periapical tissues and healthy gingiva. The most suitable reference gene was determined to be SDHA (a succinate dehydrogenase complex, subunit A, flavoprotein [Fp]). We found that granulomas (n = 50) and radicular cysts (n = 59) exhibited significantly higher expression of all four examined genes, MMP-1, MMP-2, TIMP-1, and TIMP-2, when compared to healthy gingiva (n = 40; P < 0.05). CONCLUSION: This study has confirmed that the expression of MMP-1, MMP-2, TIMP-1, and TIMP-2 genes is important for the pathogenesis of periapical inflammatory lesions. Since the abovementioned markers were not differentially expressed in periapical granulomas and radicular cysts, the challenge of finding the genetic differences between the two lesions still remains.