Wisdom Tooth Autotransplantation for the Missing Maxillary Central Incisors Using a 3D-Printed Replica: A Case Report.

In this case report, we describe a 19-year-old man who underwent an autotransplantation of a lower third molar into the extracted region of his upper central incisors. Due to trauma, the patient's upper right and left central incisors had been extracted. He visited our clinic and requested to perform autotransplantation of his own teeth into the upper central incisor part because he wanted to use his natural teeth. So, we decided to extract his lower right third molar and autotransplant it into the extraction part of the upper central incisors. Immediately after extraction of the lower right third molar, the tooth was autotransplanted into the upper anterior region using a 3D-printed resin replica of the donor tooth and artificial sockets of the recipient site. Then, the root canal treatment was performed, and a temporary crown was set. Next, orthodontic treatment was done to flatten the curve of Spee. After completing the orthodontic treatment, a final prosthodontic restoration was set on the autotransplanted tooth. Four years later, the autotransplanted tooth remained stable with a healthy periodontium. This case demonstrates that if a patient has a request to use their natural teeth, autotransplantation of a wisdom tooth into the anterior region can be a useful method to replace the missing teeth.

Age-related patterns in mandibular third molar eruption: presenting new forensic age assessment reference data from a Chinese population.

Valid reference data are essential for reliable forensic age assessment procedures in the living, a fact that extends to the trait of mandibular third molar eruption in dental panoramic radiographs (PAN). The objective of this study was to acquire valid reference data for a northern Chinese population. The study was guided by the criteria for reference studies in age assessment.To this end, a study population from China comprising 917 panoramic radiographs obtained from 430 females and 487 males aged between 15.00 and 25.99 years was analysed. Of the 917 PANs, a total of 1230 mandibular third molars were evaluated.The PANs, retrospectively evaluated, were performed for medical indication during the period from 2016 to 2021. The assessment of mandibular third molars was conducted using the staging scale presented by Olze et al. in 2012. Two independent examiners, trained in assessing PANs for forensic age estimation, evaluated the images. In instances where the two examiners diverged in their assessments these were subsequently deliberated, and a consensus stage was assigned.The mean age increased with higher stages for both teeth and both sexes. The minimum age recorded for stage D, indicating complete tooth eruption, was 15.6 years in females and 16.1 years in males. Consequently, the completion of mandibular third molar eruption was observed in both sexes well before reaching the age of 18. In light of our results, it is evident that relying solely on the assessment of mandibular third molar eruption may not be sufficient for accurately determining the age of majority. Contrary to previous literature, this finding of a completed eruption of the mandibular third molars in northern Chinese individuals is only suitable for detecting the completion of the 16th year of life in males according to our results. However, as the results are inconsistent compared to other studies in the literature, the trait should not be used as the only decisive marker to prove this age threshold in males from northern China.

Third molar eruption in dental panoramic radiographs as a feature for forensic age assessment - new reference data from a German population.

Forensic age assessment in the living can provide legal certainty when an individual's chronological age is unknown or when age-related information is questionable. An established method involves assessing the eruption of mandibular third molars through dental panoramic radiographs (PAN). In age assessment procedures, the respective findings are compared to reference data. The objective of this study was to generate new reference data in line with the required standards for mandibular third molar eruption within a German population. For this purpose, 605 PANs from 302 females and 303 males aged 15.04 to 25.99 years were examined. The PANs were acquired between 2013 and 2020, and the development of the mandibular third molars was rated independently by two experienced examiners using the Olze et al. staging scale from 2012. In case of disagreement in the assigned ratings, a consensus was reached through arbitration. While the mean, median and minimum ages were observed to increase with each stage of mandibular third molar eruption according to the Olze method, there was considerable overlap in the distribution of age between the stages. The minimum age for stage D, which corresponds to complete tooth eruption, was 16.1 years for females and 17.1 years for males. Thus, the completion of mandibular third molar eruption was found in both sexes before reaching the age of 18. In all individuals who had at least one tooth with completed eruption and who were younger than 17.4 years of age (n = 10), mineralization of the teeth in question was not complete. Based on our findings, the feature of assessing mandibular third molar eruption in PAN cannot be relied upon for determining age of majority.

Studying eruption patterns of mandibular third molars for forensic age assessment: Introducing current reference data from a population of black South Africans.

INTRODUCTION: Evaluation of the eruption of mandibular third molars in orthopantomograms (OPGs) is a method of forensic age assessment. The objective of our study was to provide valid reference data for this trait within a population of black South Africans. The study was guided by the criteria for reference studies in age assessment. MATERIALS AND METHODS: A study population from Pretoria, South Africa comprising 670 OPGs obtained from 338 black females and 332 black males aged between 15.00 and 25.97 years was analysed. All OPGs were performed for medical indication during the period from 2011 to 2022 and were retrospectively evaluated. From the 670 OPGs, a total of 1021 mandibular third molars were evaluated. The assessment of mandibular third molars was conducted using the staging scale presented by Olze et al. in 2012. Two experienced dentists evaluated the OPGs independently of each other. If the two examiners diverged in their assessments, a consensus stage was assigned. RESULTS: As expected, the mean, median and minimal age increased with higher stages for both teeth and both sexes. The minimum age recorded for stage D, indicating complete tooth eruption, was 15.79 years in females and 16.62 years in males. CONCLUSION: As it is the case for previous reference studies in other countries, placing exclusive reliance on the evaluation of mandibular third molar eruption is inadequate for ascertaining the age of majority among Black South Africans. Future studies need to examine if our results are transferable to other countries in Sub-Saharan Africa.

The success rates and outcomes of mandibular third molar coronectomy: 167 cases.

PURPOSE: The purpose of this study was to assess success rates and to report complications of coronectomy of mandibular third molars (M3M), including intra-operative failure, pain, infection, dry socket, inferior dental alveolar (IAN) and lingual nerve (LN) injuries and re-operation rates. METHODS: Retrospective analysis of 167 coronectomies completed between January 2017 to December 2022 was undertaken. RESULTS: The success of coronectomy was 93%. Intra-operative failure was reported to be 3.6% (n = 8). Complications accounted for pain (15%, n = 24), infection (9%, n = 15) and dry socket (3.6%, n = 6). Three patients required removal of M3M root at 3 months (n = 2) and 24 months (n = 1), accounting for 1.8% re-operation rate. A total of number of patients who suffered a nerve injury was 12; three of these were permanent (LN - 1.2%, n = 2; IAN - 0.6%, n = 1), nine were temporary (IAN - 1.2%; n = 2, LN - 2.4%; n = 4; site not specified - 1.8%, n = 3). No patients with intra-operative failure and re-operation suffered IAN or LN injury post-operatively. CONCLUSION: Coronectomy offers a successful strategy for management of high risk M3M. The treatment outcomes can be improved with careful case selection and adjusting surgical technique, including assessment of root morphology, incomplete crown sectioning technique and avoidance of lingual retraction. Reporting of coronectomy success as a factor of surgical outcome, presence or absence of permanent IAN injury, persistent symptoms or any other long-standing complications (such as LN injury), and the need for re-operation accounting for root migration status may be a useful tool to measure coronectomy outcomes.

The necessity of removal of third molars involved in mandibular fractures: A retrospective study.

This retrospective analysis aimed to investigate the necessity of removing the wisdom tooth in cases of angle fractures of the mandible. The study retrieved 595 mandible fractures from January 2006 to December 2021 through the Hospital Inpatient Enquiry System, of which 303 involved a fracture through the angle of the mandible, including the wisdom tooth socket. Of these, 203 (66.9%) underwent open reduction and internal fixation with retention of the third molar. The authors found that only four (2%) patients returned for the removal of plates and the retained third molar during the follow-up period. Therefore, the authors concluded that wisdom teeth removal should remain an exception during open reduction and internal fixation of mandibular angle fractures unless they hinder fracture reduction, pose a potential infection risk, or interfere with occlusal stability.

A clinical presentation of markerless augmented reality assisted surgery for resection of a dentigerous cyst in the maxillary sinus.

Dentigerous cysts (DC) in the maxillary sinus are rare and pose challenges for effective treatment. Despite various available surgical techniques, a definitive approach remains debated. This study introduces a markerless Augmented Reality Assisted Surgery (ARAS) system that utilizes tooth image recognition and surgical simulation to enhance the precision of maxillary sinus DC extractions. Using advanced technology, such as 3-dimensional (3D) intraoral scanning and CT imaging for accurate data capture, the system aligns virtual models with patient anatomy without external markers, demonstrating a minimally invasive surgical solution. The ARAS system enabled precise surgical planning and realization of a DC extraction in the maxillary sinus by creating a bone window in direct contact with the cyst, assisting in complete removal with minimal risk to adjacent structures. The ARAS system may aid surgeons in visualizing patient anatomy during surgery, with overlays of relevant medical images, aiding in precise localization and minimizing tissue damage.

Food texture and vitamin D influence mouse mandible form and molar roots.

Industrialization influenced several facets of lifestyle, including softer nutrient-poor diets that contributed to vitamin D deficiency in post-industrzialized populations, with concomitantly increased dental problems. Here we simulated a post-industrialized diet in a mouse model to test the effects of diet texture and vitamin D level on mandible and third molar (M3) forms. Mice were raised on a soft diet with vitamin D (VitD) or without it (NoD), or on a hard diet with vitamin D. We hypothesized that a VitD/hard diet is optimal for normal mandible and tooth root form, as well as for timely M3 initiation. Subsets of adult NoD/soft and VitD/soft groups were bred to produce embryos that were micro-computed tomography (µCT) scanned to stage M3 development. M3 stage did not differ between embryos from mothers fed VitD and NoD diets, indicating that vitamin D does not affect timing of M3 onset. Sacrificed adult mice were µCT-scanned, their mandibles 3D-landmarked and M3 roots were measured. Principal component (PC) analysis described the largest proportion of mandible shape variance (PC1, 30.1%) related to diet texture, and nominal shape variance (PC2, 13.8%) related to vitamin D. Mice fed a soft diet had shorter, relatively narrower, and somewhat differently shaped mandibles that recapitulated findings in human populations. ANOVA and other multivariate tests found significantly wider M3 roots and larger root canals in mice fed a soft diet, with vitamin D having little effect. Altogether our experiments using a mouse model contribute new insights about how a post-industrial diet may influence human craniodental variation.

Surgical difficulty and postoperative course of the third molar extraction under general anesthesia: An intervention trial.

BACKGROUND: Third molar extractions are one of the most common surgical procedures in the area of ​​stomatology. However, we know that even if they are minor surgeries, they can cause a postoperative period with local and systemic repercussions. Thus, the aim of this intervention trial is to determine the relationship between clinical parameters (pain, inflammation and trismus) and serum parameters (C-reactive protein (CRP), IL-6 and fibrinogen) that are modified in the first postoperative week, and the appearance of complications after extraction with general anesthesia, using the Pederson scale. METHODS: The research question was: Can postoperative discomfort after third molar extraction under general anesthesia be predicted using Pederson scale? An interventional trial was carried out of third molar extractions under general anesthesia in Dr. Peset University Hospital. Patient selection was performed randomized using MS Excel. Then were divided into two groups (n = 126): group A (2 complex extractions) and group B (4 extractions: 2 simple and 2 complex). All parameters were collected at the surgery and 7 days after surgery. RESULTS: The clinical postoperative parameters showed significant differences in relation to surgical difficulty. In summary, the degree of surgical difficulty can be predicted with the Pederson scale before extracting mandibular third molars. CRP and fibrinogen levels increase significantly with the degree of surgical difficulty. CONCLUSION: Significant differences (p < 0.001) were observed in all the intraoperative parameters according to surgical difficulty as assessed by the Pederson scale. Therefore, this scale was a good indicator to estimate the patient's postoperative period.

Neurosensory Deficits of the Mandibular Nerve Following Extraction of Impacted Lower Third Molars-A Retrospective Study.

BACKGROUND: Neurosensory deficits are one of the major complications after impacted lower third molar extraction leading to an impaired patient's quality of life. This study aimed to evaluate the incidence of neurosensory deficits after lower third molar extraction and compare it radiologically to the corresponding position of the inferior alveolar nerve. METHODS: In a retrospective study, all patients who underwent impacted lower third molar extraction between January and December 2019 were compiled. Therefore, clinical data as well as preoperative radiological imaging were assessed. RESULTS: In total, 418 patients who underwent lower third molar extractions (n = 555) were included in this study. Of these, 33 (5.9%) had short-term (i.e., within the initial 7 postoperative days) and 12 (1.3%) long-term (i.e., persisting after 12 months) neurosensory deficits documented. The inferior alveolar nerve position in relation to the tooth roots showed apical position in 27%, buccal position in 30.8%, lingual position in 35.4%, and interradicular position in 6.9%. CONCLUSIONS: A statistically significant increased incidence of neurosensory deficits occurs when the inferior alveolar nerve is directly positioned lingually to the tooth roots (p = 0.01).

Third Molar Eruption in Dental Panoramic Radiographs as a Feature for Forensic Age Assessment-Presentation of a New Non-Staging Method Based on Measurements.

The evaluation of third molar eruption in dental panoramic radiographs (DPRs) constitutes an evidence-based approach for forensic age assessment in living individuals. Existing methodologies involve staging morphological radiographic findings and comparing them to reference populations. Conversely, the existing literature presents an alternative method where the distance between third molars and the occlusal plane is measured on dental plaster models. The aim of this study was to adapt this measurement principle for DPRs and to determine correlation between eruption and chronological age. A total of 423 DPRs, encompassing 220 females and 203 males aged 15 to 25 years, were examined, including teeth 38 [FDI] and 48. Two independent examiners conducted the measurements, with one examiner providing dual assessments. Ultimately, a quotient was derived by comparing orthogonal distances from the mesial cementoenamel junctions of the second and third molars to a simplified radiological occlusal plane. This quotient was subsequently correlated with the individual's age. We estimated correlations between age and quotients, as well as inter- and intra-rater reliability. Correlation coefficients (Spearman's rho) between measurements and individuals' ages ranged from 0.555 to 0.597, conditional on sex and tooth. Intra-rater agreement (Krippendorf's alpha) ranged from 0.932 to 0.991, varying according to the tooth and sex. Inter-rater agreement ranged from 0.984 to 0.992, with distinctions drawn for different teeth and sex. Notably, all observer agreement values fell within the "very good" range. In summary, assessing the distance of third molars from a simplified occlusal plane in DPRs emerges as a new and promising method for evaluating eruption status in forensic age assessment. Subsequent reference studies should validate these findings.

Acupuncture and Traditional Chinese Medicine in the Treatment of Peripheral Facial Palsy Caused by Wisdom Tooth Extraction: A Case Report.

BACKGROUND: Peripheral facial palsy is characterized by acute peripheral facial nerve paralysis. While most cases have no identifiable cause, some are linked to infectious or noninfectious factors. The potential connection between herpes simplex virus-1 and peripheral facial palsy has been studied since the 1970s, with a small number of cases reported following tooth extraction. Patients who have treatment delayed for over a year and still exhibit no signs of recovery have a bleak prognosis. In this case, factors contributing to facial paralysis in this patient are facial nerve injury as a result of wisdom teeth extraction, improper nursing, and delayed treatment. CASE PRESENTATION: A 23-year-old female presented with numbness and stiffness on the right side of the outer skin around the lips. These symptoms persisted for about 4 years after the extraction of the right lower wisdom tooth. Physical examination revealed House-Brackmann grade II peripheral facial paralysis. Acupuncture and traditional Chinese medicine treatments were initiated with an aim to facilitate nerve repair and neurofacilitation in the affected area. Following a 4-week course of treatment, the patient experienced a decrease in numbness and stiffness in the area, and treatment was discontinued. CONCLUSION: The combination of acupuncture and traditional Chinese medicine is a safe and promising supplementary therapy for peripheral facial palsy caused by wisdom tooth extraction. Nevertheless, it is imperative to conduct larger scale and randomized controlled studies to determine whether these complementary interventions have a significant additive or synergistic effect toward achieving complete recovery in the patients.Die periphere Fazialisparese ist durch eine akute periphere Gesichtsnervenlähmung gekennzeichnet. Meist ist keine erkennbare Ursache feststellbar, doch besteht bei einigen Fällen ein Zusammenhang mit infektiösen oder nicht-infektiösen Faktoren. Ein möglicher Zusammenhang zwischen dem Herpes-simplex-Virus-1 (HSV-1) und der peripheren Fazialisparese wird seit den 1970er Jahren untersucht, und es wurde über eine kleine Zahl von Fällen nach einer Zahnextraktion berichtet. Patienten, bei denen die Behandlung erst nach einjähriger Verzögerung oder noch später beginnt und die keine Anzeichen für eine Besserung zeigen, haben eine ungünstige Prognose. In diesem Fall sind die Faktoren, die zur Gesichtslähmung des Patienten beitragen, eine Verletzung des Nervus facialis infolge der Weisheitszahnextraktion, unsachgemäße Pflege und ein verzögerter Behandlungsbeginn.Eine 23-jährige Frau stellte sich mit Taubheitsgefühl und Steifigkeit auf der rechten Seite im Bereich der äußeren Haut um die Lippen herum vor. Die Symptome bestanden seit der Extraktion des rechten unteren Weisheitszahns etwa 4 Jahre zuvor. Die körperliche Untersuchung ergab eine periphere Fazialisparese Grad II nach House-Brackmann. Es wurde eine Behandlung mit Akupunktur und traditioneller chinesischer Medizin begonnen, um die Nervenreparatur und die Neurofazilitation im betroffenen Bereich zu fördern. Nach vierwöchiger Behandlung kam es bei der Patientin zu einer Abnahme des Taubheitsgefühls und der Steifigkeit im betroffenen Bereich und die Behandlung wurde beendet.Die Kombination von Akupunktur und traditioneller chinesischer Medizin ist eine sichere und erfolgversprechende ergänzende Therapie für die periphere Fazialisparese nach Weisheitszahnextraktion. Allerdings müssen unbedingt größere und randomisierte kontrollierte Studien durchgeführt werden, um festzustellen, ob diese komplementärmedizinischen Methoden in Hinblick auf das Ziel einer vollständiger Genesung der Patienten einen signifikanten additiven oder synergistischen Effekt haben.

The Management of Infected Oroantral Fistula After Maxillary Third Molar Removal: A Case Report.

Oroantral communication is an unnatural communication of the maxillary sinus with the oral cavity, often resulting from dental extractions, infection, trauma, or excision of cysts or tumors. Pathological epithelialization of oroantral communication leads to oroantral fistula. Various techniques have been proposed for surgical closure. Uneventful healing of the defect can be achieved in the absence of antral infection. Hence, medical management of maxillary sinusitis should precede surgical closure of the defect. Here, we report a case of an oroantral fistula of the left maxillary third molar, caused by a secondary infection of the extraction site, managed primarily by antibiotics, topical steroids, and irrigating agents followed by surgical closure. It is essential to carefully inspect the post-extraction socket of maxillary teeth due to its high risk of development of oroantral communication. Also, the management of oroantral communications needs early detection to prevent infection and to prevent transforming into an oroantral fistula. In case of an infected oroantral communication or fistula, priority rests on treating the infection first and followed by surgical repair.

Surgical removal of third molars in a young adult: review of indications and surgical techniques.

Germectomy is a surgical method most typically performed in young adults. The indications for treatment are controversial. The purpose of this review was to determine the correct indications for germectomy and to discuss the advantages and disadvantages of the procedure. We reviewed the surgical techniques (anesthetic methods, patient preparation, and flap designs) and complications. Germectomy for orthodontic purposes is a common indication for surgical removal of tooth germ among young patients. Several studies have supported removal at an earlier age to produce fewer surgical complications. Several surgical techniques have been described in the literature.

The Association Between Skeletal Facial Types and Third Molars Impaction in a Saudi Arabian Subpopulation: A CBCT Study.

Purpose: To assess the state of mandibular and maxillary third molars in relation to different facial types in a Saudi population using cone-beam computed tomography (CBCT) records. Patients and Methods: A retrospective study was performed on CBCTs. Statistical analysis determined the relationship between impacted maxillary and mandibular third molars and different skeletal facial types. The degree of third molar impaction was evaluated. Results: A total of 198 CBCTs from subjects were evaluated, with a mean age of 34.2 years. Archer II classification was found to be significantly associated with all skeletal profiles. The incidence of mesioangular impactions in lower third molar showed a notable increase in the brachyfacial group, which was statistically significant. Conclusion: In conclusion, this study demonstrates that different facial types are associated with the angulation of third molar impactions.

Comparative Investigation of Anti-Inflammatory Effect of Platelet-Rich Fibrin after Mandibular Wisdom Tooth Surgery: A Randomized Controlled Study.

This study evaluated the anti-inflammatory effect of platelet-rich fibrin (PRF) applied to the extraction socket after impacted mandibular third molar surgery with subjective and objective parameters. Forty-eight patients with impacted wisdom teeth in bilateral and similar positions were included in the study. The control group was formed with the standard surgery and the PRF group was formed with local PRF application in addition to standard procedure (n = 96). The anti-inflammatory activity of PRF on postoperative 2nd and 7th days was evaluated subjectively by clinical parameters and objectively by biochemical parameters. Postoperative 2nd- and 7th-day follow-up data of pain, edema, and trismus in the PRF group were found to be statistically significantly lower. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found to be statistically significantly lower in the PRF group than the control in the postoperative 2nd-day follow-up period (p < 0.001). There was no statistically significant difference in interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) parameters when the PRF group and the control group were compared in both follow-up periods (p > 0.05). The study has demonstrated the effectiveness of locally applied PRF after ITM surgery via clinical parameters and objective data. The quantitative analysis of CRP and ERS can be an effective parameter in determining the amount of inflammation after ITM surgery.

Prevention of Dry Socket with Ozone Oil-Based Gel after Inferior Third Molar Extraction: A Double-Blind Split-Mouth Randomized Placebo-Controlled Clinical Trial.

Tooth extraction is followed by a sequence of elaborate local changes affecting hard and soft tissues. Dry socket (DS) can occur as intense pain around and in the extraction site, with an incidence from 1-4% after generic tooth extraction to 45% for mandibular third molars. Ozone therapy has gained attention in the medical field because of its success in the treatment of various diseases, its biocompatible properties and its fewer side effects or discomfort than drugs. To investigate the preventive effect of the sunflower oil-based ozone gel Ozosan® (Sanipan srl, Clivio (VA), Italy) on DS, a double-blind split-mouth randomized placebo-controlled clinical trial was conducted according to the CONSORT guidelines. Ozosan® or the placebo gel were put in the socket, and the gels were washed off 2 min later. In total, 200 patients were included in our study. The patient population comprised 87 Caucasian males and 113 Caucasian females. The mean age of the included patients was 33.1 ± 12.4 years. Ozosan reduced the incidence of DS after inferior third molar extraction from 21.5% of the control to 2% (p < 0.001). Concerning the dry socket epidemiology, the incidence was not significantly correlated with gender, smoking or mesioangular, vertical or distoangular Winter's classification. Post hoc power calculation showed a power of 99.8% for this data, with alpha = 0.001.

Risk Factors for Delayed-Onset Infection after Mandibular Wisdom Tooth Extractions.

Wisdom tooth extraction is one of the most commonly performed procedures by oral maxillofacial surgeons. Delayed-onset infection (DOI) is a rare complication of wisdom tooth extraction, and it occurs ~1-4 weeks after the extraction. In the present study, risk factors for DOI were investigated by retrospectively analyzing the cases of 1400 mandibular wisdom tooth extractions performed at Kagawa University Hospital from April 2015 to June 2022. Inclusion criteria were patients aged >15 years with a wisdom tooth extraction per our procedure. The exclusion criteria were patients with insufficient medical records, a >30-mm lesion around the wisdom tooth shown via X-ray, colonectomy, radiotherapy treatment of the mandible, the lack of panoramic images, and lesions other than a follicular cyst. The DOI incidence was 1.1% (16 cases), and univariate analyses revealed that the development of DOI was significantly associated with the Winter classification (p = 0.003), position (p = 0.003), hypertension (p = 0.011), and hemostatic agent use (p = 0.004). A multivariate logistic regression analysis demonstrated that position (OR = B for A, 7.75; p = 0.0163), hypertension (OR = 7.60, p = 0.013), and hemostatic agent use (OR = 6.87, p = 0.0022) were significantly associated with DOI development. Hypertension, hemostatic use, and position were found to be key factors for DOI; long-term observation may thus be necessary for patients with these risk factors.

Neural Differentiation of Wisdom Tooth Follicle Stem Cells on a Nano-Hydrogel Scaffold Containing Salvia Chloroleucat to Treat Nerve injury in the Cancer of Nervous System.

The human third molar's follicle is one of the sources of stem cells with high differentiation capacities which can be used in nervous system cancer treatment particularly in nerve damge. The purpose of this research was to identify the effects of the aqueous extract of Salvia chloroleuca on the differentiation of the human dental follicle-derived mesenchymal stem cells to neural cells for treti. In this experimental study, the method of culture of digested tissue fragments was used to isolate stem cells from three samples of the extracted wisdom teeth follicles. The nano-hyaluronic acid scaffold has been synthesized by the sol-gel method as a porous composite and the S. chloroleuca extract has been loaded into it. The scaffold was analyzed in terms of mechanical properties, drug release and toxicity. Afterwards, the cells were seeded onto the scaffold using the immersion method. After 21 days, cell differentiation was investigated by morphological confirmation methods and confirming the expression of ß-tubulin and MAP2 genes at mRNA and protein levels. Morphological assessment revealed neural differentiation in the cells of the groups of nano-hyaluronic acid scaffold with S. chloroleuca extract and nano-hyaluronic acid scaffold with S. chloroleuca extract + 10% retinoic acid. Furthermore, the expression of MAP2 and ß-tubulin in these groups was confirmed by RT-PCR, real time PCR and western blot assays. The results of this research showed that the follicle of the third molar contains stem cells with a high capacity for differentiation. Moreover, the extract of S. chloroleuca, could lead to induction of neural differentiation in stem cells.