Does virtual reality reduce anxiety and pain in patients undergoing third molar surgery? A systematic review and meta-analysis.

This study aimed to systematically review the literature to evaluate the effectiveness of virtual reality in reducing anxiety and pain in patients undergoing third molar surgeries. Clinical trials evaluating patients who used virtual reality (VR) compared with no VR in the management of pain or anxiety after third molar extractions were included. A literature search was conducted in five electronic databases to identify relevant articles: Medline (PubMed interface), Web of Science, Virtual Health Library, Embase, and Scopus. There were no restrictions on the time or language of publication. The risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB 2.0). A total of six studies were included in the qualitative analysis and three in the quantitative analysis. The results of the meta-analyses on anxiety revealed that patients in the intervention group before VR already showed less anxiety compared to those in the control group (-0.28 [-0.44 to -0.13, 95%CI] I²=24.51%. In the post-intervention evaluation, the group that received VR remained with a lower level of anxiety and a slight reduction compared to the pre-intervention. (-0.34 [-0.49 to -0.19, 95%CI] I²=36.61%. Virtual reality can be a clinical resource in dental care because it seems to cause a small reduction in anxiety, and with still uncertain results in the reduction of postoperative pain in extractions of third molars.

Equine cheek tooth repulsion using small diameter repulsion pins: 20 cases.

BACKGROUND: Reported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years. OBJECTIVES: Describe the outcome for 20 cases after dental repulsion using small diameter repulsion pins. STUDY DESIGN: Retrospective case series. METHODS: Records of horses that underwent cheek tooth repulsion were reviewed (2014-2023). Inclusion criteria included: mandibular or maxillary cheek tooth extraction where oral extraction failed and repulsion was used to complete extraction, and where clinical follow up information was available. Repulsions were carried out under sedation with a regional nerve block or under a short general anaesthetic, using a small diameter repulsion pin (3-5 mm). Intra-operative radiographs facilitated instrument placement. The alveolus was packed with polymethyl methacrylate post-extraction. Horses were re-examined at 4-6 weeks post-operatively. RESULTS: Twenty cases were included. Patients had a mean age of 10.3 years old (range 5-16 years). The majority (75%) of teeth had pre-existing dental fractures. Maxillary (n = 15) and mandibular cheek teeth (n = 5) were all successfully repulsed, with 16 cases performed with the horse standing and 4 with the horse under general anaesthesia. Intra-operative complications included damage to the mandibular bone (n = 1). Short-term complications (n = 2) included superficial surgical site infection, and dehiscence of one sinus flap. Long-term complications included the recurrence of sinusitis (n = 1) and small intra-alveolar fragments causing persistent bitting problems in another patient. MAIN LIMITATIONS: Retrospective study design, small number of cases. CONCLUSIONS: When oral extraction fails, cheek tooth repulsion using small diameter repulsion pins is an effective extraction technique. The total intra- and post-operative complication rate was 25%, which is comparable to previously published complication rates for repulsion using Steinmann pins and also those encountered after trans-buccal screw extraction.

Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial.

INTRODUCTION: Exodontia is commonly considered as a risk factor for the development of medication-related osteonecrosis of the jaw (MRONJ) in individuals exposed to bone modifying agents. This study was aimed at assessing the efficiency and safety of a gaseous oxygen-ozone mixture as an adjuvant to a standard exodontia to reduce the risk of MRONJ development. METHODS: A randomized, open-label, phase II, single-center clinical trial involving 117 patients at risk of MRONJ was conducted. The study protocol tested injections of an oxygen-ozone mixture in the post-extraction site. Participants were randomly assigned to two groups: oxygen-ozone therapy, and standard tooth extraction protocol. Post-extraction wound healing was assessed using the Inflammatory Proliferative Remodeling (IPR) Wound Healing Scale. RESULTS: The oxygen-ozone therapy group exhibited a significant improvement in wound healing post-extraction during the inflammatory and proliferative phases, as indicated by the IPR scale scores at 3-5 days (p = 0.006) and 14 days (p < 0.001) respectively. CONCLUSION: Oxygen-ozone therapy shows promise in improving post-extraction healing in patients at risk of MRONJ. Future studies with larger sample sizes and multicenter collaborations are recommended to confirm the validity of these findings and explore the long-term efficacy of ozone therapy.

EXtraction or PREServation? EXPRESS survey of patients' preference for toothache in public health facilities of Eastern India.

OBJECTIVE: To investigate patients' preference for extraction or preservation for toothache and hypothetical anterior tooth pain along with the specific reason for their choice. BASIC RESEARCH DESIGN: Cross-sectional analytical semi-structured interview study. PARTICIPANTS: A sample of 703 adult dental outpatients visiting secondary and tertiary government health centres with toothache due to dental caries in Eastern India. MAIN OUTCOME MEASURES: Patients preferring restorative or extraction services for toothache, specific reason, and socio-demographic background factors for anterior and posterior teeth. RESULTS: Half (50.1%) choose preservation for present toothache and 79.9% for hypothetical front tooth pain. Immediate relief from toothache for extraction and the motive to preserve natural teeth for preservation were the main reasons expressed. In logistic regression, participants preferring extraction were more likely to be aged 25-34 years (OR = 1.94), 55+ years (OR=33.32), have primary and below education level (OR=1.99), have had a previous extraction (OR=1.99) and be unaware of preservation options (OR=2.34). For assumed anterior tooth pain, those between 25-34 years (OR=0.39) were more likely to choose preservation. Participants with primary and below education levels (OR=1.99) and unaware of preservation options (OR=1.95) chose extraction of the front tooth irrespective of their choice of treatment for the present toothache. CONCLUSION: Notable differences between the choices to preserve or extract a posterior tooth were not found. There was greater preference towards preserving anterior teeth. Future research should identify additional barriers to the preference and utilization of restorative services.

A novel method for simulating ex vivo tooth extractions under varying applied loads.

BACKGROUND: Tooth extraction is a common surgical procedure where the invasiveness of the surgery can affect the nature of the dentoalveolar remodelling which follows. However, there is very little biomechanical data relating the loading applied during tooth extraction to the outcomes of the procedure. The purpose of this pilot study is to present a novel ex vivo experimental method for measuring tooth extraction mechanics and to explore preliminary metrics for predicting extraction success. METHODS: A custom experimental apparatus was developed in-house to extract central incisors from ex vivo swine mandible samples. Twenty-five (n = 25) incisors were extracted at different rates in displacement- and force-control, along with an intermittent ramp-hold scheme for a total of five schemes. Peak forces and extraction success were recorded for each test. Video analysis assisted in determining the instantaneous stiffnesses of the dental complex during continuous extractions, which were compared using the K-means clustering algorithm. FINDINGS: Tooth extraction forces ranged from 102 N to 309 N, with higher-rate tests tending towards higher peak forces (141 N - 308 N) than the lower-rate tests (102 N-204 N) for displacement- and force-controlled schemes. The K-means algorithm clearly identified load rates among tests, indicating that higher-rate loading increased system stiffness relative to the lower-rate tests. INTERPRETATION: The developed experimental method demonstrated a desirable degree of control. The preliminary results suggest the influence of load rate on the mechanical response of the dental complex and extraction outcome. Future work will further investigate the biomechanics of tooth extraction and relate them to tissue damage to improve future tooth extraction procedures.

Interproximal Reduction Facilitating Orthodontic Teeth Extraction.

Extractions are routinely performed in orthodontics to gain space for teeth alignment. Crowded, malaligned, and overlapped teeth make it difficult for the dental surgeon to engage the beaks of the extraction forceps on the concerned tooth for extraction. An improper grip often leads to complications of instrument slippage, crown fracture, and more commonly, luxation of adjacent teeth. This article aims to help with atraumatic orthodontic extractions and reduce such complications. This case report examines an interproximal reduction technique using standard grit, taper, flat-end diamond bur (Mani TF-20, ISO 171/014, Mani, Inc., Tochigi, Japan) for the tooth to be extracted to create enough space for proper placement of the forceps and to prevent injury to adjacent structures. It can be useful for orthodontic extractions or other cases of tooth extractions with inadequate access.

Evaluation and Comparison of Physics Forceps and Conventional Forceps in Bilateral Dental Extraction: A Randomized, Split-Mouth, Clinical Study.

Background Interest in atraumatic tooth extraction has increased because it aims to preserve the dental alveolus. Several tools have been designed for atraumatic extraction, including the recently invented physics forceps. This study aims to assess the physics forceps and compare the clinical outcomes to the conventional forceps. Methodology A prospective, randomized, split-mouth, single-blind study was conducted among 20 healthy patients needing bilateral extraction. Participants were randomly assigned to perform physics forceps extraction on one quadrant and conventional forceps extraction on the opposite quadrant. Clinical outcomes were recorded and compared, including time taken for extraction, root fracture, buccal cortical plate fracture, postoperative pain, patient satisfaction, and post-extraction socket healing. Results The mean extraction time of physics forceps was shorter than conventional forceps but without statistical significance. Root and buccal cortical plate fractures were lower in the physics forceps group. Statistical difference in postoperative pain was found on the third postoperative day as pain scored higher in the physics group (p = 0.038). Higher patient satisfaction was found in the physics forceps group (85%). Post-extraction socket healing was equal in 75% of the cases. Conclusions Physics forceps is a novel and efficient atraumatic dental extractor. It reduces intraoperative time, is associated with higher patient satisfaction, and has comparable clinical outcomes to conventional forceps.

Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review.

BACKGROUND: Temporomandibular disorders (TMDs) have multiple aetiological factors. Although some evidence suggests invasive and lengthy dental procedures may contribute towards TMD development, there is a relative paucity in the literature regarding an association between elements of paediatric dental general anaesthesia (pDGA) and TMDs. This review aims to consider the impact of dental rehabilitation (and its constituent elements) performed under general anaesthesia on the development of TMDs in childhood and adolescence and identify theories and/or gaps in knowledge which may benefit from future research. METHODS: Due to the need to preliminarily examine the nature and extent of the current evidence base, a scoping review approach was chosen. The review was conducted based on the framework provided by the methodological working group of the Joanna Briggs Institute (JBI) for conducting systematic scoping reviews. Electronic databases MEDLINE, Embase, Scopus, Web of Science and Cochrane Library were searched as well as the grey literature using OpenGrey, Nexis, Ethos, Google Scholar and ProQuest, with eligible studies uploaded onto Zotero (Mac Version 5.0.96.2). RESULTS: A total of 810 records were identified. After removing duplicates and those not available in English, 260 were identified for title and abstract screening. Seventy-six records underwent full-text review of which only one met the broad inclusion criteria. The most common reasons for exclusion were no specific relation to general anaesthesia, not specifically relating to dental treatment and only being concerned with TMD management. The included study found that while development of TMDs following dental rehabilitation under GA did occur in children, whether the problems caused by treatment were exacerbated by other elements of the pDGA process remains unknown. CONCLUSION: This review has confirmed a distinct paucity of research in this field. While there is no current tangible scientific evidence that common and routine dental procedures lead to TMD, the literature shows that alterations to any one or a combination of critical factors can contribute to TMD development, which may be collectively exacerbated by iatrogenic macrotrauma during the pDGA process. We have highlighted elements of pre-, peri- and post-operative pDGA, alongside biopsychosocial factors, which may contribute to TMD development in childhood and adolescence and may benefit from future research.

Effectiveness of Leg Raise and Leg Fold Maneuver to Prevent Syncope During Extraction of Teeth: A Pilot Study.

Objectives The primary objective of this study is to evaluate the effectiveness of leg raise and leg fold maneuvers to prevent syncope during extraction procedures. Methods This study included 30 patients with a previous history of syncope and dental anxiety. Patients were randomly divided into two groups consisting of 15 patients each. Group I (test group) patients were educated about a few physical maneuvers, and instructions were given preoperatively about when to perform them. Group II (control group) underwent extraction conventionally. The blood pressure, saturation, pulse rate, and clinical signs and symptoms of the patients were assessed preoperatively, intraoperatively, and postoperatively. Informed consent was obtained from all the patients. Results There is a significant difference between the control and study groups in terms of the occurrence of syncope and patient comfort. This indicates that the leg raise and leg fold maneuvers reduce the occurrence of syncope during extraction. No participant in the test group experienced syncope post-treatment, while five subjects (33.3%) experienced syncope in the control group. Conclusion Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope. Leg raise and leg fold maneuvers improved the hemodynamics of the patients.

Comparative Clinical Study of the Effect of Nigella Sativa Oil on Soft Tissue Healing and Inflammation Reduction Compared to Eugenol in the Context of Dry Socket.

Research background Dry socket is one of the most common complications occurring after the extraction of a permanent tooth, but despite its high incidence, there is no established treatment for this condition. Nigella sativa oil has anti-inflammatory properties and enhances wound healing. Thus, we have decided to conduct a study to evaluate the efficacy of Nigella sativa oil in the context of dry sockets.  Aim of the study This study aims to evaluate the effect of a Nigella Sativa oil dressing compared with an Eugenol dressing for the treatment of dry sockets in terms of accelerating soft tissue healing and reducing the intensity of inflammation.  Materials and methods A total of 36 patients (19 males, 17 females), ranging between 20 and 50 years, 40 sockets with Alveolar osteitis randomized into 20 sockets for each group. In the first group, Eugenol with a Gelfoam carrier was used, in the second group, Nigella Sativa oil with a Gelfoam carrier was used and after copious irrigation with normal saline in both groups. Soft tissue healing and the degree of inflammation were monitored on the third (T1) and seventh (T2) days.  Results The results of our study showed clinical and statistical superiority in favor of the Nigella Sativa oil group compared to the Eugenol group at time T2, where the P-value was less than 0.05.  Conclusions Within the limits of our study, we found that Nigella Sativa oil led to better healing of soft tissues and reduced the intensity of inflammation in the context of dry socket, and was superior in effectiveness to Eugenol, and we recommend its use for the treatment of dry socket.

Topical-Ozonized Olive Oil - A Boon for Post-Extraction Cases: A Randomized Controlled Trial.

Background Post-surgical therapy in exodontia patients has historically been largely centered on pain and infection prevention. Healing of the extraction wound has rarely received any importance during regular dental extractions, despite being an inherent element of the process of tooth extraction itself. This study aimed to analyze the analgesic and antibacterial efficacy of topical-ozonized olive oil compared to regular drugs administered post-operatively to patients who have undergone tooth extraction as well as evaluate the healing effects of the former on the extraction site. Methodology A total of 200 patients in need of exodontia were randomly divided into two groups, with group A (case group) receiving ozonized olive oil as a topical application for three days and group B (control group) receiving standard post-operative treatment (antibiotics and analgesics). On day five, patients in both groups were assessed for wound healing using the Landry, Turnbull, and Howley Index and for pain using the visual analog scale (VAS). Results On days two and three, the P-value for differences in pain (VAS score) between the two groups was 0.409, but on day five, it was 0.180. According to the Landry, Turnbull, and Howley index, the P-value for differences in wound healing between the groups on day five was 0.025. When comparing the two groups, there was no discernible difference in the amount of discomfort perceived after surgery. While both groups saw improvement in wound healing and pain, the case group coped better than the control group in terms of wound healing. Conclusions This study demonstrated that ozonized olive oil may be used as a safe and effective alternative to conventional painkillers and antibiotics and can speed up wound healing after exodontia.

Evaluation of Record Keeping in Exodontia Department of Punjab Dental Hospital, Lahore: A Clinical Audit.

INTRODUCTION: An audit was conducted in the exodontia department of Punjab Dental Hospital, Lahore, to assess the quality of records being kept by the undergraduate students in their third and final year, who form a major chunk of the workforce in the hospital, working in the mentioned department. The main objective behind this exercise was to improve the standards of record keeping and bring them in line with the standards practiced around the world, ultimately resulting in better patient care. METHODOLOGY: This audit was undertaken while keeping in view all the necessary steps of a successful clinical audit. Initially, 150 records were randomly obtained from undergraduates of both third and fourth years and evaluated against a modified CRABEL score, which grades the records on a scale of 100. The results of this part of the audit were shared with the batches that were doing their clinical rotation in exodontia at the time of this audit, and a teaching session was conducted on better record-keeping standards. Following this, a repetition of the previous audit was undertaken to complete the audit cycle.  Results: The most commonly omitted component in the records in the initial audit was the patient complaint closely, followed by proper medical history and supervisor signatures. In the following, 'reaudit' compliance was seen to be improved, and all the components of record-keeping less commonly being omitted except medical history and date. CONCLUSION: A more comprehensive patient record keeping is possible with proper intervention and inculcation of record-keeping awareness in the undergraduate course, especially in the clinical years.

Manejo das fraturas mandibulares associadas à exodontia de 3º molar inferior / Management of mandibular fractures associated with lower third molar extraction

A remoção cirúrgica dos terceiros molares é um procedimento comumente realizado por cirurgiões bucomaxilos, e acidentes e complicações podem estar relacionados a esse procedimento. A fratura mandibular é um acidente incomum, mas que apresenta grande potencial de gerar morbidade aos pacientes. Diante disso, evidencia-se a importância de uma abordagem precoce após o trauma, bem como o acompanhamento posterior e a determinação correta do tratamento. Nesse sentido, este estudo objetiva investigar na literatura os protocolos existentes de tratamentos de fraturas mandibulares transoperatórias associadas à exodontia de terceiros molares inferiores. Para isso, foi realizada uma revisão de literatura sistemática, de caráter exploratório e descritivo, na base de dados Pubmed através dos descritores mandibular fracture, extraction e treatment. As buscas foram realizadas com restrição de tempo de 2016 a 2021. Dos 18 artigos compatíveis à proposta, 6 artigos passaram pelos critérios de inclusão e exclusão. Desses, a análise da maioria dos autores é clara em se referir às exodontias de terceiros molares como fator para fraturas mandibulares e mencionar qual protocolo de atendimento seguir, caso aconteça a fratura. Conclui-se que a redução fechada ou aberta são possibilidades de abordagem, entretanto existe uma preferência, pela redução aberta por acesso extraoral ou intrabucal com fixação interna rígida, visto que, ela elimina o período de bloqueio maxilomandibular, facilitando o retorno à função.

Surgical removal of third molars is a common procedure performed by bucomaxilos surgeons, and accidents and complications can be related to this procedure. Mandibular fracture is an uncommon accident, but it has great potential to generate morbidity in patients. Because of this, the importance of an early approach after trauma is evident, as well as the subsequent follow-up and correct determination of treatment. In this sense, this objective is to investigate in the literature the existing protocols for the treatment of transverse mandibular fractures associated with the extraction of lower third molars. To this end, a systematic exploratory and descriptive literature review were conducted in the Pubmed database using the descriptors mandibular fracture, extraction and treatment. The searches were performed with a time restriction from 2016 to 2021. Of the 18 articles compatible with the proposal, 6 articles passed the inclusion and exclusion criteria. Of these, the analysis of most authors is clear in referring to third molar extractions as a factor for mandibular fractures and mentioning which treatment protocol to follow if a fracture occurs. It is concluded that closed or open reduction are possible approaches, however there is a preference for open reduction by extraoral or intraoral access with rigid internal fixation, since it eliminates the period of maxillomandibular block, facilitating the return to function.

Complications post simple exodontia: A systematic review.

Exodontia procedures are not without complications, which are the dentist's responsibility to avoid by taking into account clinical, imaging, systemic, and operative factors, among others. The purpose of this systematic review is to determine and analyze the prevalence of complications post simple exodontia (CPES). The method used in this systematic review was adapted from the Cochrane Handbook and PRISMA statement. A systematic search was conducted in PubMed, Scopus and ScienceDirect using the search terms "Exodontia" AND "Complications". The search was conducted from the starting coverage date to January 31, 2020. The inclusion criteria were studies on simple exodontia, studies on CPES prevalence and human studies. Studies on complications after third molar exodontia, generalities in exodontia, narratives and systematics literature reviews, book chapters, and animal studies were excluded. A total of 1,446 articles were found in the first search using the search strategy (725 in PubMed, 96 in Scopus and 631 in ScienceDirect). After duplicates were removed, 948 articles were obtained. After reading the title and abstract, 9 articles were read in full. Finally, 3 articles were included in the review, with the most common complications being trismus, alveolitis, pain, dehiscence, infections, and retained roots. Trismus of the chewing muscles, alveolitis and retained roots were the most prevalent CPES, which were most likely related to the surgeon's experience, surgery duration and tissue trauma during surgery.

Responsabilidade profissional por lesão do nervo lingual durante exodontia de terceiro molar inferior: análise de nove processos judiciais / Professional responsibility for lingual nerve injury during lower third molar extraction: analysis of nine court proceedings

Introdução: A remoção cirúrgica dos terceiros molares inferiores apresenta o risco potencial de lesões a estruturas nobres como o nervo lingual devido sua localização anatômica. O grau de comprometimento do nervo indicará se a lesão é transitória ou permanente. A injúria nervosa pode motivar o paciente a acionar judicialmente o cirurgião-dentista, e sendo evidenciada a culpa profissional, caberá a reparação pecuniária dos danos causados ao paciente, sejam de natureza material ou moral. Objetivo: Analisar nove decisões judiciais de 1ª e 2ª instância, disponíveis no site do Tribunal de Justiça de São Paulo (TJSP), motivadas pela lesão do nervo lingual durante a exodontia de terceiro molar inferior. Metodologia: Após a leitura e análise foram extraídas informações como: perfil das partes, tempo de duração dos processos, procedência ou não da ação, valor da indenização, responsabilidade profissional e presença de TCLE. Resultados: Na primeira instância, seis dos nove casos foram julgados improcedentes; em segunda instância, quatro destas sentenças foram reformadas para procedência. No total, após decisão de segunda instância, houve procedência da ação em sete dos nove casos. Nas ações procedentes, as indenizações para dano moral variaram de R$ 5 mil a R$ 50 mil, sendo a imperícia e negligência as modalidades de culpa mais atribuídas aos profissionais. Conclusão: Sabendo-se que a lesão do nervo lingual durante a extração de terceiro molar inferior, mesmo previsível, nem sempre é evitável, verifica-se a importância do TCLE (ou documento similar) na prática clínica como instrumento de defesa jurídica do profissional, diante da alegação de falha de informação. Este documento foi mencionado em apenas três dos nove casos processuais, sendo em que em dois destes não houve constatação de falha técnica ou de informação (ação improcedente nas duas instâncias)

Introduction: Surgical removal of lower third molars presents the potential risk of injury to noble structures such as the lingual nerve due to its anatomical location. The level of nerve involvement will indicate whether the injury is transient or permanent. Nervous injury can motivate the patient to sue the dentist, and if professional guilt is evidenced, it will be up to pecuniary compensation for the damage caused to the patient, whether of a material or moral nature. Objective: To analyze nine court decisions of 1st and 2nd instances, available on the Court of Justice of State of São Paulo (Brazil) website, motivated by lingual nerve injury during lower third molar extraction. Methodology: After reading and analysis, information was extracted such as: profile of the litigating parties, duration of the processes, judge decision for the action, indemnity value, professional responsibility and presence of TCLE. Results: In the first instance, six of the nine cases were dismissed, the sentence was reformed in four cases, confirming the merits of the action in seven of the nine cases. In the cases of valid actions, compensation for moral damages ranged from R$ 5 thousand to R$ 50 thousand, with malpractice and negligence being the types of fault most attributed to professionals. Conclusion: Knowing that lingual nerve injury during mandibular third molar extraction, even if predictable, is not always avoidable, the importance of the informed consent (or similar document) in clinical practice as an instrument for the professional's legal defense is mandatory, to avoid the allegation of miss information. This document was mentioned in only three of the nine cases, and in two of these there was no finding of technical or information failure (unfounded action in both instances)

Clinical, Diagnostic and Histological Findings Involving Cheek Teeth Hypercementosis in Nine Horses.

Hypercementosis is infrequently reported to affect the cheek teeth of horses and presents as mineral deposits either attached (peripheral) or solitary ovoid (nodular) structures in the tooth bearing region. There is overlap between radiological and histological appearance of hypercementosis, cementoma, and equine odontoclastic tooth resorption and hypercementosis (EOTRH). The clinical presentation, imaging features, surgical management, and histological findings of nine horses that presented for dental lesions and associated hypercementosis of cheek teeth are reported. Horses were 4-15 years old and presented for either nasal discharge or facial swelling. Peripheral and nodular mineral structures were identified using radiographs or computed tomography in six and three horses, respectively. Eight of nine cases involved maxillary cheek teeth. Of six cases with peripheral hypercementosis, three had enlargement of the apical cross-sectional area that was greater than the coronal cross-sectional area thus preventing extraction along the normal eruption pathway and necessitating sectioning (two cases) and repulsion. Nodular hypercementosis lesions were extracted in three of the four cases. Post-extraction complications occurred in five cases; four cases required additional procedures. All horses returned to their intended use, ie riding or pasture. Histology of extracted dental and proliferative mineral material revealed hypercementosis characterized by large sheets of eosinophilic matrix with lacunae (usually empty; presumed artifact) and frequent, irregular, basophilic cement lines. All cases had evidence of chronic inflammation, such as caries, chronic fractures and/or pulpitis. The findings of this case series share many features with previous published descriptions of cementoma and with histological findings of hypercementosis lesions of EOTRH. Further investigation into differentiation of these entities is warranted.

Collagenase Administration into Periodontal Ligament Reduces the Forces Required for Tooth Extraction in an Ex situ Porcine Jaw Model.

Minimally invasive exodontia is among the long-sought-for development aims of safe dental medicine. In this paper, we aim, for the first time, to examine whether the enzymatic disruption of the periodontal ligament fibers reduces the force required for tooth extraction. To this end, recombinantly expressed clostridial collagenase G variant purified from Escherichia coli was injected into the periodontal ligament of mesial and distal roots of the first and second split porcine mandibular premolars. The vehicle solution was injected into the corresponding roots on the contralateral side. Following sixteen hours, the treated mandibles were mounted on a loading machine to measure the extraction force. In addition, the effect of the enzyme on the viability of different cell types was evaluated. An average reduction of 20% in the applied force (albeit with a large variability of 50 to 370 newton) was observed for the enzymatically treated roots, reaching up to 50% reduction in some cases. Importantly, the enzyme showed only a minor and transient effect on cellular viability, without any signs of toxicity. Using an innovative model enabling the analytical measurement of extraction forces, we show, for the first time, that the enzymatic disruption of periodontal ligament fibers substantially reduces the force required for tooth extraction. This novel technique brings us closer to atraumatic exodontia, potentially reducing intra- and post-operative complications and facilitating subsequent implant placement. The development of novel enzymes with enhanced activity may further simplify the tooth extraction process and present additional clinical relevance for the broad range of implications in the oral cavity.

Knowledge and Attitude Among the Saudi Dentists Towards Coronectomy of Impacted Mandibular Third Molars.

Purpose: Compared to the complete extraction of impacted third molars that are in close proximity to the mandibular canal, the coronectomy procedure is used as an alternative, owing to its minimal risk of damaging the Inferior alveolar nerve. Despite clear coronectomy concepts mentioned in the literature, the procedure is debatable. This study aimed to assess the knowledge and attitude towards the coronectomy procedure among dentists in Saudi Arabia. Patients and Methods: The 16 close-ended questionnaire was distributed electronically to 377 dentists over the country. It included the demographic data and the options given to their patients with complicated impacted third molars, and the number of coronectomy they have performed. The retrieved data were exported and transferred to the SPSS software program for analysis. The Chi-squared and Fisher's exact tests were used as appropriate for comparisons. A P-value <0.05 was considered significant. Results: Only 54 (15%) participants performed coronectomy procedure, and only 28.3% of the participants advised their patients to do coronectomy. Nearly two-thirds of the participants (71.9%) were aware of coronectomy procedures, with no significant differences (P> 0.05) between the groups. About 68.9% of the participants agreed that coronectomy aims to protect inferior alveolar nerve damage. More than 60% of participants believed that coronectomy is a reliable technique, while 40.6% of participants claimed that they were capable of deciding whether to do coronectomy or extraction. No significant differences were found between the groups concerning most of the study variables (P> 0.05). Conclusion: Knowledge of Saudi dentists towards coronectomy is good, while their attitude is still low. More learning strategies about coronectomy should be implemented.

Exodoncia de tercera y cuarta molar fusionadas. Reporte de caso / Fused third and fourth molar exodontia. Case report

RESUMEN Las anomalías dentarias son producidas por alteraciones en la odontogénesis que se refleja en la variación de tamaño, número y forma de los dientes. Dentro de estas alteraciones se encuentra la fusión dentaria que se considera como la unión de dos gérmenes dentarios que forman una estructura dentaria grande y única. La fusión de las molares es poco habitual tiene una prevalencia muy baja. En el presente caso el diagnóstico fue tercera molar fusionada a cuarta molar retenida en posición vertical. El tratamiento quirúrgico fue la exodoncia a colgajo; para el éxito de la misma se tuvo en cuenta: 1) visualización completa de la corona y 2) eliminación de trabas que impidan la luxación y la avulsión de las piezas fusionadas. Finalmente, la exodoncia se llevó a cabo de manera exitosa.

ABSTRACT Dental anomalies are produced by alterations in odontogenesis which is reflected in the variation in size, number and shape of the teeth. Among these alterations is dental fusion, which is considered as the union of two dental germs that form a large and unique dental structure. The fusion of the molars is rare and has a very low prevalence. In the present case, the diagnosis was that the third molar fused to the fourth retained molar in an upright position. The surgical treatment was flap extraction. For a successful extraction, the following was considered: 1) full visibility of the crown and 2) elimination of obstacles that prevent dislocation and avulsion of the fused pieces. At last, the extraction was carried out successfully.

Passo-a-passo para utilização de fibrina rica em plaquetas como agente hemostático após exodontia: descrição da técnica / Step-by-step for use of platelet-rich fibrin as a hemostatic agent after exodontic: description of the technique

A extração dentária é um dos procedimentos mais frequentes em cirurgia oral e maxilofacial e está relacionada a mudanças fisiológicas no processo alveolar. Neste sentido, entre as principais complicações transoperatórias está a hemorragia, que ocorre geralmente devido a lesões de vasos sanguíneos presentes no alvéolo dentário onde se realizou a exodontia. Uma alternativa para se obter a hemostasia é a utilização da Fibrina Rica em Plaquetas (PRF), um concentrado leucoplaquetário, obtido através do sangue do paciente. A membrana obtida é rica em leucócitos, plaquetas e fatores de crescimento que promovem a modulação de células envolvidas no processo de cicatrização, favorecendo um melhor e mais rápido reparo das lesões cirúrgicas. Esta matriz de fibrina apresenta diversas utilidades para a odontologia, demonstrando bons resultados, além do baixo custo e fácil obtenção. O objetivo deste artigo é descrever a técnica de obtenção da PRF usada como agente hemostático após exodontia, orientando assim, sua reprodutibilidade e utilização.

Tooth extraction is one of the most frequent procedures in oral and maxillofacial surgery and is related to physiological changes in the alveolar process. In this sense, among the main transoperative complications is hemorrhage, which usually occurs through the dental alveolus, due to damage to the blood vessels where the extraction was performed. An alternative to obtain hemostasis is the use of Fibrin Rich in Platelets (PRF), which is a white platelet concentrate obtained from the patient's blood that undergoes a centrifugation step. The membrane obtained after this process is rich in leukocytes, platelets and growth factors that promote modulation of cells involved in the healing process, favoring a better and faster repair of surgical lesions. This fibrin matrix has several uses for dentistry, showing good results, in addition to being low cost and easy to obtain. The aim of this article is to describe the technique for obtaining Platelet-Rich Fibrin (PRF) used as a hemostatic after tooth socket extraction, thus allowing its reproducibility and use.