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Yan ZY, Xu JY, Zhang JY, Li QX, Chen LW, Wu BZ, Cui NH. Optimal tooth sectioning using a surgical handpiece and elevator: a finite element study of horizontally deeply impacted mandibular third molars. Clin Oral Investig 2024; 28:439. [PMID: 39037593 DOI: 10.1007/s00784-024-05834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators. METHODS CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1-5 mm), tooth section fissure width (1-3 mm), elevator depth in fissure (2-6 mm), elevator position (buccal, lingual, central), elevator width (2-5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue. RESULTS Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width (~ 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M. CONCLUSIONS Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process. CLINICAL SIGNIFICANCE These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.
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Affiliation(s)
- Zi-Yu Yan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Street Zhong Guan Cun, Haidian District, Beijing, 100081, PR China
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Jin-Yang Xu
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Jing-Yu Zhang
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Qing-Xiang Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Street Zhong Guan Cun, Haidian District, Beijing, 100081, PR China
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Liang-Wei Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Street Zhong Guan Cun, Haidian District, Beijing, 100081, PR China
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Bin-Zhang Wu
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 37A Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Nian-Hui Cui
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Street Zhong Guan Cun, Haidian District, Beijing, 100081, PR China.
- Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China.
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He X, Gao Y, Shen J, Pan Q, Chen J, He Y. Removal of Horizontally Impacted Mandibular Third Molars Using the Three-Piece or T-Shaped Tooth Sectioning Method. J Oral Maxillofac Surg 2024:S0278-2391(24)00218-0. [PMID: 38648861 DOI: 10.1016/j.joms.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The extraction of horizontally impacted mandibular third molars (HM3) can be a complicated surgery. Appropriate tooth sectioning methods can reduce the operation time and postoperative complications. PURPOSE The current study compares operative time and postoperative pain between HM3 removed using the three-piece or T-shaped tooth sectioning techniques. STUDY DESIGN, SETTING, SAMPLE A randomized single-blind prospective clinical trial on HM3 extraction was carried out between June and December 2022 in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University. Patients with local or systemic infection, poor oral hygiene, and systemic disease were excluded. PREDICTOR VARIABLE The predictor variable was the tooth sectioning method. The subjects were randomized to a three-piece or T-shaped group. MAIN OUTCOME VARIABLE(S) The primary outcome variables were the operative time and postoperative pain measured using a visual analog scale (VAS). The secondary outcome variables were the rates of primary bleeding, mouth opening reduction, swelling, patient satisfaction measured using a VAS, and quality of life measured using a postoperative symptom severity scale. COVARIATES The covariates included age, sex, side and classification of HM3, and the relationship of HM3 to the inferior alveolar nerve canal. ANALYSES The data were analyzed using the independent samples t-test, paired t-test, χ2, and rank sum test. A significance level set at P < .05. RESULTS The sample included 60 patients in the three-piece group and 66 patients in the T-shaped group. The operative time of the three-piece group (14.73 ± 3.21 minutes) was shorter than that of the T-shaped group (19.25 ± 4.29 minutes) (P < .05). On days 3 and 7, VAS of pain were 2.24 ± 1.89 and 0.15 ± 0.40 in the three-piece group and 3.95 ± 2.44 and 0.48 ± 0.68 in the T-shaped group (P < .05). The VAS of patient satisfaction in the three-piece group (6.05 ± 1.29) was better than the T-shaped group (4.90 ± 1.05) on day 7 (P < .05). CONCLUSION AND RELEVANCE The three-piece tooth sectioning for HM3 removal was associated with shorter duration, slighter postoperative symptoms, and higher patient satisfaction and may be considered as a recommended practice for dentists.
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Affiliation(s)
- Xianyi He
- Resident, Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China; Resident, Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
| | - Yichen Gao
- Resident, Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China; Resident, Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
| | - Jie Shen
- Resident, Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China; Resident, Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
| | - Qing Pan
- Lecturer, Medical Device Regulatory Research and Evaluation Center West China Hospital, Sichuan University, Chengdu, China
| | - Junliang Chen
- Associated Professor, Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China; Associated Professor, Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
| | - Yun He
- Professor, Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China; Professor, Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China.
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Lau XE, Ma S, Choi JJE. New aerosol-decreasing dental handpiece functions sufficiently decrease pulp temperature: An in vitro study. J Prosthodont 2024; 33:259-265. [PMID: 36918297 DOI: 10.1111/jopr.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE To assess the changes in intrapulpal temperature between electric high-speed handpieces of different coolant functions ('Water Jet' and 'Water Spray'), coolant port designs (1- and 4-port), suction use, and bur and tooth types using an experimental in vitro setup. MATERIALS AND METHODS Forty-four extracted anterior and posterior teeth were collected. A total of 18 groove cuts (n = 18/coolant port spray design, bur and tooth type group) and 12 groove cuts (n = 12/tooth type and suction use) were completed, with a total of 264 groove cuts. Real-time temperature and duration were recorded at 1-s intervals throughout the preparation process using a thermocouple and digital data logger setup (GFX Data Logger Series and EL USB-TC; Lascar Electronics Inc., USA), and the data retrieved using EasyLog Software (EasyLog USB; Lascar Electronics Inc., USA). Statistical analysis was performed (SPSS V.27) for the change in temperature using the analysis of variance and post hoc analysis. RESULTS The majority of the specimen cuts, regardless of tooth (anterior or posterior) and bur (diamond or carbide) types, handpiece coolant port design, and suction use showed an overall decreasing trend in intrapulpal temperature. No cuts caused a mean temperature change that reached the critical temperature of 42.5°C or resulted in an overall increase in intrapulpal temperature when the 60-s duration was completed. CONCLUSIONS The tested electric handpieces efficiently reduced intrapulpal temperature, with the majority displaying a decreasing trend. A greater decrease in intrapulpal temperature was observed in canines compared to premolars; carbide burs compared to diamond; and with no suction preparations compared to when suction was used.
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Affiliation(s)
- Xin Er Lau
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sunyoung Ma
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Joanne Jung Eun Choi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Pacheco A, Soós B, Lempel E, Simon I, Maróti P, Möhlhenrich SC, Szalma J. The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment. Clin Oral Investig 2023; 27:6769-6780. [PMID: 37783802 PMCID: PMC10630220 DOI: 10.1007/s00784-023-05289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES The aim of this in vitro study was to evaluate the effect of a 3D-printed drill sleeve (DS) on the precision and duration of coronectomy sections. MATERIALS AND METHODS Thirty-six trainees and oral surgeons performed 72 coronectomy cuts in a 3D-printed, entirely symmetric mandible model. Coronectomy was performed freehand (FH) on one side and with a DS on the other side. The occurrence of "too superficial" (≥ 4 mm unprepared lingual tooth tissue) and "too deep" (drilling ≥ 1 mm deeper as tooth contour) cuts and sectioning times were registered. RESULTS In 7 cases, the sections were "too deep" with FH, while none with DS (OR: 18.56; 95%CI: 1.02-338.5; p = 0.048). The deviation between virtually planned and real cut depths was significantly greater in the FH group (1.91 ± 1.62 mm) than in DS group (1.21 ± 0.72 mm) (p < 0.001). A total of 18 "too superficial" buccolingual sections occurred with FH, while 8 cases with DS (OR: 3.50; 95%CI: 1.26-9.72; p = 0.016). Suboptimal sections did not correlate with experience (p = 0.983; p = 0.697). Shortest, suboptimal drillings were most frequently seen distolingually (OR: 6.76; 95% CI: 1.57-29.07; p = 0.01). In the inexperienced group, sectioning time was significantly longer with FH (158.95 ± 125.61 s vs. 106.92 ± 100.79 s; p = 0.038). CONCLUSIONS The DS effectively reduced tooth sectioning times by less experienced colleagues. Independently from the level of experience, the use of DS obviated the need for any preparation outside the lingual tooth contour and significantly decreased the occurrence of "too superficial" cuts, leaving thinner unprepared residual tooth tissue lingually. CLINICAL RELEVANCE Coronectomy sections may result in lingual hard and soft tissue injury with the possibility of damaging the lingual nerve. The precision of the buccolingual depth-control can be improved, while surgical time can be reduced when applying a drilling sleeve.
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Affiliation(s)
- Ana Pacheco
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Balázs Soós
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Edina Lempel
- Department of Conservative Dentistry and Periodontology, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Imre Simon
- 3D Printing and Visualization Centre, University of Pécs, 2. Boszorkany St, 7624, Pécs, Hungary
| | - Péter Maróti
- 3D Printing and Visualization Centre, University of Pécs, 2. Boszorkany St, 7624, Pécs, Hungary
- Medical Skills Education and Innovation Centre, Medical School, University of Pecs, 12. Szigeti St, 7624, Pécs, Hungary
| | | | - József Szalma
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary.
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Lau XE, Liu X, Chua H, Wang WJ, Dias M, Choi JJE. Heat generated during dental treatments affecting intrapulpal temperature: a review. Clin Oral Investig 2023; 27:2277-2297. [PMID: 37022531 PMCID: PMC10159962 DOI: 10.1007/s00784-023-04951-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Heat is generated and transferred to the dentine-pulp complex during various dental procedures, such as from friction during cavity preparations, exothermic reactions during the polymerisation of restorative materials and when polishing restorations. For in vitro studies, detrimental effects are possible when intra-pulpal temperature increases by more than 5.5°C (that is, the intra-pulpal temperature exceeds 42.4°C). This excessive heat transfer results in inflammation and necrosis of the pulp. Despite numerous studies stating the importance of heat transfer and control during dental procedures, there are limited studies that have quantified the significance. Past studies incorporated an experimental setup where a thermocouple is placed inside the pulp of an extracted human tooth and connected to an electronic digital thermometer. METHODS This review identified the opportunity for future research and develop both the understanding of various influencing factors on heat generation and the different sensor systems to measure the intrapulpal temperature. CONCLUSION Various steps of dental restorative procedures have the potential to generate considerable amounts of heat which can permanently damage the pulp, leading to pulp necrosis, discoloration of the tooth and eventually tooth loss. Thus, measures should be undertaken to limit pulp irritation and injury during procedures. This review highlighted the gap for future research and a need for an experimental setup which can simulate pulp blood flow, temperature, intraoral temperature and intraoral humidity to accurately simulate the intraoral conditions and record temperature changes during various dental procedures.
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Affiliation(s)
- Xin Er Lau
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Xiaoyun Liu
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Helene Chua
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Wendy Jingwen Wang
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Maykon Dias
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Joanne Jung Eun Choi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand.
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Li K, Xie B, Chen J, He Y. Breakage and displacement of the high-speed hand-piece bur during impacted mandibular third molar extraction: three cases. BMC Oral Health 2022; 22:222. [PMID: 35668519 PMCID: PMC9169269 DOI: 10.1186/s12903-022-02253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background The high-speed hand-piece bur is one of the methods to perform tooth sectioning during the minimally traumatic extraction of impacted mandibular third molars. During tooth sectioning, the breakage of the bur might take place when it is improperly used. Three cases of the breakage and displacement of a high-speed hand-piece bur during extraction are reported, aiming to remind dental surgeons of this complication. Case presentation The bur fragment in case 1 was embedded in the mandibular bone under the previously removed crown of tooth 48 and distal to tooth 47. The bur fragment in case 2 was embedded in the lingual edge of the socket and partly beneath the mucosa on the lingual side. The position of the bur fragment in case 3 was similar to that of case 1 but was completely embedded in the spongious bone. The three cases were performed by first-year residents, and all of the bur fragments were successfully removed by attending doctors after accurately locating them by radiological examination. Conclusions In order to avoid breakage of the high-speed hand-piece bur, the number of uses of the bur should be monitored and the integrity and state of the bur should be carefully checked. Moreover, light pressure with little lateral force should be used during tooth sectioning. If bur breakage and displacement occur, the retrieval protocol should be determined based on the imaging findings and conducted as soon as possible to avoid serious consequences.
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Lempel E, Szalma J. Effect of spray air settings of speed-increasing contra-angle handpieces on intrapulpal temperatures, drilling times, and coolant spray pattern. Clin Oral Investig 2021; 26:523-533. [PMID: 34145477 PMCID: PMC8212794 DOI: 10.1007/s00784-021-04030-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Objectives Decreasing aerosol leaks are of great interest, especially in the recent era of COVID-19. The aim was to investigate intrapulpal heat development, coolant spray patterns, and the preparation efficiency of speed-increasing contra-angle handpieces with the spray air on (mist) or off (water jet) settings during restorative cavity preparations. Methods Standard-sized cavities were prepared in 80 extracted intact human molar teeth using diamond cylindrical drills with a 1:5 speed-increasing contra-angle handpiece. A custom-made device maintained the standardized lateral drilling force (3 N) and predetermined depth. Temperatures were measured using intrapulpal thermocouple probes. The four experimental groups were as follows: mist cooling mode at 15 mL/min (AIR15), water jet cooling mode at 15 mL/min (JET15), mist cooling mode at 30 mL/min (AIR30), and water jet cooling mode at 30 mL/min (JET30). The coolant spray pattern was captured using macro-photo imaging. Results The JET15 group had the highest increase in temperature (ΔT = 6.02 °C), while JET30 (ΔT = 2.24 °C; p < 0.001), AIR15 (ΔT = 3.34 °C; p = 0.042), and AIR30 (ΔT = 2.95 °C; p = 0.003) had significantly lower increases in temperature. Fine mist aerosol was formed in the AIR15 and AIR30 preparations but not in the JET15 and JET30 preparations (p < 0.001). The irrigation mode had no influence on the preparation time (p = 0.672). Conclusions Water jet irrigation using coolant at 30 mL/min appeared to be the optimal mode. Considering the safe intrapulpal temperatures and the absence of fine mist aerosols, this mode can be recommended for restorative cavity preparations. Clinical significance To increase infection control in dental practices, the water jet irrigation mode of speed-increasing handpieces with coolant flow rates of 30 mL/min should be considered for restorative cavity preparations. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04030-3.
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Affiliation(s)
- Edina Lempel
- Department of Conservative Dentistry and Periodontology, Medical School, University of Pécs, 5. Dischka St, 7621, Pécs, Hungary
| | - József Szalma
- Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, 5. Dischka Gy St, Pécs, 7621, Hungary.
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Is it possible to filter third molar cases with panoramic radiography in which roots surround the inferior alveolar canal? A comparison using cone-beam computed tomography. J Craniomaxillofac Surg 2021; 49:971-979. [PMID: 34090736 DOI: 10.1016/j.jcms.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Inferior alveolar nerve (IAN) entrapment in third molar (M3) roots bears a significant risk for nerve injury. The aim of this study was to identify specific panoramic radiographic (PR) signs that can reliably identify IAN entrapment (IANE) root conformations. In a retrospective case-control study, 10 IANE and 218 non-IANE third molar risk cases were examined by PR and CBCT. The collected data included "classic" specific high-risk panoramic signs, number of M3 roots, extent of inferior alveolar canal (IAC)-root tip overlap, rotated position of M3 and impaction pattern. After bivariate analysis, sensitivity, specificity, positive and negative predictive values, positive likelihood ratios (LR+) and accuracy (area under the curve [AUC]) were calculated for the most significant predictive variables. Interruption of both cortical lines (LR+: 43.6; AUC: 96.0%) and upward diversion of the IAC (LR+: 36.3; AUC: 96.5%) were the most accurate single signs indicating IANE. Upward diversion combined with root darkening and interruption of the IAC (AUC: 97.4%) and the combination of darkening with interruption and with a rotated M3 (LR+:130.8; AUC: 97.8%) were the most accurate combinations predicting IANE. IANE may be correctly filtered with PR when focusing on the signs of upward diversion, darkening, interruption and rotated M3 position, especially in cases involving their multiple (≥3) presence. CBCT evaluation is highly recommended in these cases before partial and total tooth removals.
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Recommended Drilling Parameters of Tungsten Carbide Round Drills for the Most Optimal Bone Removals in Oral Surgery. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3108581. [PMID: 30581849 PMCID: PMC6276513 DOI: 10.1155/2018/3108581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/06/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022]
Abstract
Background High temperatures during drilling can cause thermal osteonecrosis and abnormal wound healing. According to our best knowledge, a widely accepted recommendation for optimal drilling parameters in routine oral surgery bone removals does not exist. Purpose Our aim was to investigate the correlations of different drilling parameters, including axial load and revolution speed on drilling temperatures and preparation times. Materials and Methods Standard, 5 mm deep cavities were drilled in 20 PCF (lb/ft3) dens polyurethane blocks with 3 mm (50PCF) cortical layer using new and worn, 3.1mm in diameter tungsten carbide round drills. Worn drills were used in 50 impacted third molar operations before. Axial loads of 3N, 10N, and 25N and speeds of 4.000-8.000-16.000-40.000 revolutions per minute (rpm) were tested. Temperature differences of drilling parameters were calculated by 1-way ANOVA, followed by Tukey's HSD post hoc tests. Time differences and differences among “optimal” and “suboptimal” groups (with the cut-off value of 3°C and 3s) were estimated by Kruskal-Wallis test with pairwise comparisons. P<0.05 was considered significant. Results The highest mean temperatures with new and worn drills were 4.64±0.53°C and 6.89±1.16°C, while drilling times varied between 0.16±0.02s and 22.77±5.45s. A 3°C and 3s cut-off value classified drillings significantly to (1) optimal [3N and 8000-16000-40000 rpm or 10N and 4000-8000-16000-40000 rpm] or suboptimal due to (2) high temperatures or (3) long preparation times. Using worn drills, the following parameters should be avoided: 3N with 4.000-8.000 rpm, 10N with 40000 rpm, and 25N at any revolutions. Discussion The study extensively mapped the drilling temperatures and preparation times of tungsten carbide round drills. Temperatures did not exceed 10°C during drillings with maximal amount of cooling, as well as the drilling parameters, which kept temperatures and preparation times in the most optimal range which were clearly established.
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