Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans

Digital robot-assisted minimally invasive impacted tooth extraction: A case report

Objective

This study investigated the clinical effects and applicability of minimally invasive impacted teeth extraction using digital robots.

Methods

A marker was bonded to the non-surgical area before surgery. A Cone-Beam Computed Tomography (CBCT) scan was obtained and uploaded to the robot software to determine the drilling position of the ring drill. During the surgery, the robot arm automatically navigated to a predetermined position, and the ring drill removed part of the bone tissue and exposed and extracted the impacted teeth. Finally, the surgeon tightly sutured the wounds to the surgical area.

Results

Three minimally invasive extractions of impacted teeth with robotic assistance were performed without complications. The surgical area showed good healing during the one-month follow-up examination.

Conclusions

Digital robot-assisted minimally invasive extraction of impacted teeth is a highly feasible clinical procedure as it minimises trauma to the surgical area and protects the surrounding blood vessels and nerve bundles, making it a safe and valuable technique with significant potential for clinical application.

The relationship of the position of mandibular third molar impaction with the development of dental and periodontal lesions in adjacent second molars

OBJECTIVE

The aim of this study was to evaluate the effect of different positions of Mandibular third molar impaction teeth on dental and periodontal lesions of mandibular second molars and correlate the lesion severity with patient age.

MATERIALS AND METHODS

This retrospective study assessed 212 CBCT images of patients who visited the department of Oral and Maxillofacial radiology of XX university between 2017 and 2021. Periodontal and dental lesion effects of impacted third molars on mandibular second molars were evaluated. While dental lesions were classified as mild, moderate, and severe, periodontal lesions were classified as mild in cases not exceeding 2/3 of the root, and severe in cases exceeding 2/3 of the root. Pearson's chi-square tests, Mann-Whitney U or Kruskal-Wallis test were used for data analsis. A multivariate logistic regression model was constructed for further analysis.

RESULTS

Periodontal lesions were frequently observed in the second molar adjacent to the third molar (157 teeth, 74.1%), dental lesions were observed in 10%. Among the third molar positions, the mesioangular position was associated with a high (88%) prevalence of periodontal lesions (p<0.001), followed by the horizontal position (71%). The periodontal lesion was more severe in cases 30-39 years old and over 40 years old than in cases under 20 years old and 21-24 years old. Distoangular, horizontal and vertical/inverse positions are less likely to increase the severity of the periodontal lesion than the mesioangular position. (OR = 0.02; p <0.001, OR = 0.28; p =0.008, OR = 0.14; p <0.001,respectively).

CONCLUSIONS

The third molars are often impacted in the mesioangular position, and this position most increases the risk of periodontal infection in the second molars. Accurate diagnosis and evaluation can minimize complications, and CBCT is a reliable imaging technique in which the position of the third molars and their relationship with the 2nd molars can be evaluated.

Is it safe and effective to extract impacted maxillary tooth adjacent to maxillary sinus via submaxillary sinus membrane space approach?-a randomized controlled trial

OBJECTIVE

To evaluate the clinical outcomes following extraction of impacted maxillary tooth adjacent to maxillary via submaxillary sinus membrane space approach.

MATERIALS AND METHODS

Seventy-two patients were enrolled in our study. The positions of the maxillary impacted tooth were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the "submaxillary sinus membrane space approach" was applied in the new method (NM) group, and the conventional "avoid maxillary sinus membrane exposure" strategy was executed in the traditional method (TM) group. The clinical and follow-up data were recorded.

RESULTS

The duration of the procedure in the TM group was significantly longer than those in the NM group (P < 0.05). Four teeth were accidentally displaced into the maxillary sinus with MSM perforation. The MSM perforation rate was slightly higher in the TM group than in the NM group, however, without significant difference between the two groups (8/36 vs. 3/36, P = 0.19). The maxillary sinus membrane perforation was associated with the displacement of tooth into the maxillary sinus (OR = 16.2, P = 0.026). The root tip exposure of the adjacent tooth was significantly higher in the TM group than in the NM group (10/36 vs. 1/36, P = 0.006). The incidence of reduced pulp vitality of the adjacent tooth was significantly higher in the TM group (10/36 vs. 1/36, P = 0.006), and it was associated with the exposure of the root tip intraoperatively (OR = 456.5, P < 0.001). The incidence of external root resorption was significantly lower in the NM group, and there was no significant association with the root exposure intraoperatively (OR = 3.7, P = 0.47).

CONCLUSIONS

Submaxillary sinus membrane space approach is a safe and efficient approach in extraction of impacted maxillary tooth. It is an alternative way for cases which are in close proximity to the maxillary sinus.

CLINICAL RELEVANCE

A novel method to extract impacted maxillary tooth adjacent to maxillary sinus.

Cone-beam computed tomography-based radiographic considerations in impacted lower third molars: Think outside the box

Purpose

This study aimed to evaluate the anatomic circle around the impacted lower third molar to show, document, and correlate essential findings that should be included in the routine radiographic assessment protocol as clinically meaningful factors in overall case evaluation and treatment planning.

Materials and Methods

Cone-beam computed tomographic images of impacted lower third molars were selected according to specific inclusion criteria. Impacted teeth were classified according to their position before assessment. The adjacent second molars were assessed for distal caries, distal bone loss, and root resorption. The fourth finding was the presence of a retromolar canal distal to the impaction. Communication with the dentist responsible for each case was done to determine whether these findings were detected or undetected by them before communication.

Results

Statistically significant correlations were found between impaction position, distal bone loss, and detected distal caries associated with the adjacent second molar. The greatest percentage of undetected findings was found in the evaluation of distal bone status, followed by missed detection of the retromolar canal.

Conclusion

The radiographic assessment protocol for impacted third molars should consider a step-by-step evaluation for second molars, and clinicians should be aware of the high prevalence of second molar affection in horizontal and mesioangular impactions. They also should search for the retromolar canal due to its associated clinical considerations.

Risk factors for root resorption of second molars with impacted third molars: a meta-analysis of CBCT studies

OBJECTIVE

The aim of this systematic review and meta-analysis is to identify the risk factors of external root resorption (ERR) on second molar (M2) due to presence of impacted third (M3) molar based on cone- beam computerised tomography (CBCT) findings.

MATERIAL AND METHODS

Search of PubMed via MEDLINE, SCOPUS, and Experta Medical dataBASE (EMBASE) was performed to identify studies assessing the risk factors of ERR in M2 due to the presence of impacted M3.

RESULTS

M2 in close proximity to mesio-angular impacted M3 had 50% higher risk of root resorption than with vertical impacted M3 (RR 0.50 95% CI [0.35, 0.73], p = .0003). Presence of the impacted M3 in the lower arch with ERR in M2 was higher (38.3%) than in the upper arch (33.8%). With respect to the inclination of impacted M3, the incidence of ERR was higher with transverse, horizontal and mesio-angular impacted M3 with 54.5%, 47.5% and 44.5% of occurrence, respectively.

CONCLUSION

ERR in M2 was significantly affected by the contact with impacted M3 and most importantly, the inclination of M3. The presence of mesio-angular, horizontal or transverse impacted M3 in close proximity to apical or middle portion of M2 could possibly be a strong risk factor for ERR in M2.