Spontaneous bone regeneration after enucleation of large mandibular cysts: a radiographic computed analysis of 27 consecutive cases.

PURPOSE: This study evaluated the spontaneous bone healing after enucleation of large mandibular cysts subjectively and with a computed analysis of postoperative panoramic radiographs. PATIENTS AND METHODS: Twenty-nine patients had large mandibular cysts treated by surgical enucleation. Postoperative clinical and radiographic examinations were performed at 6, 12, and 24 months in 27 patients. Bone regeneration and reduction of the residual cavities and bone density were evaluated with a computed analysis of preoperative and postoperative panoramic radiographs. A subjective and clinical radiographic evaluation of the healing process also was performed. RESULTS: Uneventful healing and spontaneous filling of the residual cavities was obtained in all cases. The computed analysis of the postoperative radiographs showed mean values of reduction in size of the residual cavity of 12.34% after 6 months, 43.46% after 12 months, and 81.30% after 24 months. The increase in bone density was 37% after 6 months, 48.27% after 12 months, and 91.01% after 24 months. CONCLUSION: Spontaneous bone regeneration can occur in large mandibular cysts without the aid of any filling materials. This simplifies the surgical procedure, decreases the economic and biologic costs, and reduces the risk of postoperative complications.

[Surgery of lower third molars and lesions of the lingual nerve]. / Chirurgia dei terzi molari inferiori e lesioni del nervo linguale.

OBJECTIVE: The authors describe a technical expedient applied during the removal of totally or partially impacted lower third molars, in order to prevent lingual nerve damage. EXPERIMENTAL ASSAY: Retrospective study. MATERIALS AND METHODS: The sample includes 1835 extractions of totally or partially impacted lower third molars, performed on 1030 patients, 493 males and 537 females, aging between 12 and 72 years. All the operations were carried out under local anaesthesia with standardization of the surgical protocol. A mucoperiosteal paramarginal flap was used in case of germectomy, whereas a mucoperiosteal marginal flap with mesial releasing incision was used in case of fully mature teeth. Ostectomy and tooth sectioning were performed using a round and fissure bur respectively, assembled on a straight low-speed handpiece and under irrigation with sterile saline. RESULTS: The authors reported only one case of transient lingual nerve paresthesia (0.05%) which occurred in a 19-years old female presenting a totally impacted third molar mesial-lingual inclination. Symptoms disappeared spontaneously one week postoperatively. Therefore the overall incidence of permanent nerve damage was equal to 0%. CONCLUSIONS: The data reported in literature show a lingual nerve lesion incidence ranging between 0% and 22%. With this simple surgical expedient the incidence of permanent lingual damage was 0%. Thus, it is the authors' opinion that this simple expedient should be applied in all cases of impacted third molar removal.

Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications.

PURPOSE: To analyze and compare complications and side effects after removal of 1,500 mandibular impacted third molar teeth in three age groups. MATERIALS AND METHODS: The sample comprised 868 patients, 462 women and girls and 406 men and boys aged 9 to 67 years. The patients were divided according to age into the following three groups: group A, aged 9 to 16 years; group B, aged 17 to 24 years; group C, older than 24 years of age. RESULTS: The incidence of complications and side effects was 2.6% in group A, 2.8% in group B, and 7.4% in group C. All complications were temporary except in one instance of mandibular nerve paresthesia that occurred in a group C patient, in whom symptoms were still present 25 months after surgery. CONCLUSION: This study showed no significant difference in the complication rate between groups A and B, but complications significantly increased in group C.

[The extraction of the lower third molars: germectomy or late avulsion?]. / Estrazione dei terzi molari inferiori: germectomia o avulsione tardiva?

INTRODUCTION: Lower third molars show the highest incidence of impaction and have been held responsible for pathologies such as pericoronitis, periodontitis, second molars tooth-crown resorption, pain, cysts or odontogenic tumors, primary or secondary crowding of the dentition. Early removal of these teeth to prevent the overmentioned problems is widely acknowledged, as many studies demonstrated a direct correlation between age and incidence of complications. These studies mostly refer to adult patients, while studies about germectomies are few. Because recent contributions showed that the risk of development of these pathologies in presence of impacted third molars is quite low while a certain morbidity associated to this procedure may be expected, a very careful risk to benefit ratio must be considered. The purpose of this study was therefore to compare the incidence of complications and side effects in three age groups, in order to obtain some informations about the choice of the best moment for operation. MATERIALS AND METHODS: The patients, 462 females and 406 males, were divided, according to age, in the following three groups: group A included patients from 9 to 16 years; group B included patients from 17 to 24 years; group C included patients over 24 years. All patients were treated under local anesthesia; surgical procedure and instruments were standardized. RESULTS: In group A, formed by 500 germectomies, the incidence of complications was 2.6% (10 instances of secondary infections, 2 instances of trismus, 1 instance of excessive postoperative bleeding). Group B included 570 procedures and the incidence of complications was 2.8% (3 instances of alveolar osteitis, 7 instances of secondary infections, 2 instances of excessive postoperative bleeding, 2 instances od second molar lesions, 1 instance of inferior alveolar nerve paresthesia, 1 instance of trismus). Group C included 430 procedures and the incidence of complications was 7.4% (2 instances of second molar lesions, 9 instances of alveolar osteitis, 8 instances of secondary infections, 4 instances of excessive postoperative bleeding, 6 instances of inferior alveolar nerve paresthesia, 3 instances of trismus). All complications were transient; in one instance only of mandibular nerve paresthesia in group C symptoms were still present 25 months after the operation. DISCUSSION AND CONCLUSIONS: This study has shown no significant differences between group A and B, while complications significantly increase in group C. Recent researches have shown that: a) there is a low risk of development of pathologies correlated to third molar impaction; b) nowadays there are not valid criteria to evaluate the future eruption of the impacted tooth; c) a direct correlation between third molar impaction and anterior dental crowding hasn't been demonstrated yet; d) morbidity of the procedure is relevant. Therefore germectomy should be performed: a) if morphostructural alterations or ectopic impactions are present; b) in case eruption is not allowed for dysplastic alterations of the germs or pathological processes of the mandible; c) to gain space in the posterior segments of the lower jaw when distalization of first and second molars is necessary; d) in case of excessive anterior-posterior mandibular growth.