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Guldiken IN, Gulsever S, Malkoc Y, Yilmaz ZC, Ozcan M. Prophylactic third molar removal: are oral surgeons and orthodontists aligned in preventive approaches? BMC Oral Health 2024; 24:1072. [PMID: 39261783 PMCID: PMC11391810 DOI: 10.1186/s12903-024-04819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND There is a general consensus among dental professionals regarding the extraction of impacted third molars in the presence of clinical symptoms. However, there is less agreement on the management of asymptomatic third molars. The objective of this study is to compare the perspectives of oral surgeons and orthodontists regarding the indications for the extraction of asymptomatic third molars. It is possible that healthcare professionals from different specialties may approach the extraction of these teeth in different ways. METHODS In this cross-sectional study, a web-based questionnaire has been employed to collect data by inquiring about the reasons why participants prefer the extraction of asymptomatic third molars. Descriptive statistics were employed to evaluate the data obtained. The level of significance was set at P < 0.05. RESULTS Prophylactic extraction of partially impacted molars was more favored among the participants (P < 0.05). The orthodontists preferred prophylactic extraction due to the risk of late anterior dental crowding (LADC); however, the oral surgeons preferred pre-pregnancy extractions (P < 0.05). The extraction decision for partial impaction was higher in females when the risk of distal caries was considered. For fully impacted ones, it was higher in males when the risk of caries and pericoronitis were considered (P < 0.05). CONCLUSIONS Orthodontists preferred extraction because of the risk of LADC and caries, while oral surgeons focused on preventing pericoronitis, pathology, focal infection, and symptoms during pregnancy. This divergence between the participants may inform the guidelines for prophylactic management of third molars. These findings may be pertinent in gender medicine. CLINICAL RELEVANCE This study has been enlightening for departments to consult each other before the extraction of a patient's asymptomatic third molar.
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Affiliation(s)
- Ipek Necla Guldiken
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istinye University, Vadi Campus, Ayazaga Mah. Azerbaycan Cad. (Vadistanbul 4A Blok), Sariyer, Istanbul, 34396, Turkey.
| | - Serap Gulsever
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - Yagmur Malkoc
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - Zeynep Cukurova Yilmaz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - Mutlu Ozcan
- Department of Operative Dentistry, School of Dentistry, University of Zurich, Zurich, Switzerland
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Kanizaj Ugrin S, Špalj S. Comparison of efficacy of thermoplastic retainer with round and rectangular bonded lingual wire retainer in the mandible two years after orthodontic treatment: a randomised controlled trial. Clin Oral Investig 2024; 28:183. [PMID: 38424224 DOI: 10.1007/s00784-024-05572-y] [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: 05/06/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To analyse three protocols in maintaining the stability of orthodontic therapy results and their effect on gingival health. MATERIALS AND METHODS Sixty-six subjects (pre-therapeutic age 11-18 years; 68% female) randomly allocated into three retention groups of equal size were analysed. The first group had a 0.673 × 0.268 mm (0.027 × 0.011 inches) rectangular braided steel retention wire bonded to the lingual surfaces of all mandibular teeth from canine to canine, and the second group had a 0.406 mm (0.016 inches) round twisted steel wire. The third group was the control, without wires, and only with vacuum-formed retainers. All three groups had vacuum-formed removable retainers in the maxilla. The frequency of wire detachment/breakage/loss of retainer, the occurrence of crowding of mandibular incisors, and changes in intercanine width and gingival health were monitored. RESULTS Incidence and severity of relapse differed between groups (p = 0.001 and 0.049) being most common in the removable retainer group (incidence 68.2%; severity 0.7 ± 1.0 mm), followed by the round wire group (36.4%; 0.5 ± 1.2 mm) and rectangular wire group (13.6%; 0.1 ± 0.1 mm). The intercanine width decreased more without a bonded retainer (incidence 68.2%; severity 0.5 ± 0.7 mm) and with the round wire more (45.5%; 0.5 ± 0.7 mm) than with the rectangular (27.3%; 0.1 ± 0.3 mm). The difference was significant for incidence (p = 0.025), but not severity. Detaching of the wires/breakage/loss of retainer was similar. There were no significant differences in the accumulation of biofilm, calculus and gingivitis between appliances. CONCLUSION A rectangular wire is the most effective in retention, and the impact of retention appliances on gingival health is similar. TRIAL REGISTRATION ClinicalTrials.gov, NCT05121220. Registered 02 October 2021 - Retrospectively registered. CLINICAL RELEVANCE Studying guidelines for reducing relapse, proper use of materials and appliances, the behavior of retention wires according to their profile in the retention phase, and possibilities of maintaining oral health will contribute to improving the stability of orthodontic therapy results.
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Affiliation(s)
- Silvija Kanizaj Ugrin
- Orthodontic Clinic Orthonova, Zagreb, Croatia.
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
| | - Stjepan Špalj
- Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
- Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
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Palikaraki G, Mitsea A, Sifakakis I. Effect of mandibular third molars on crowding of mandibular teeth in patients with or without previous orthodontic treatment: a systematic review and meta-analysis. Angle Orthod 2024; 94:122-132. [PMID: 37848193 DOI: 10.2319/032323-205.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/01/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To assess the scientific evidence related to the role of the mandibular third molars on the late crowding of the lower anterior teeth in patients with or without previous orthodontic treatment. The secondary outcomes included changes in mandibular arch width and arch length. MATERIALS AND METHODS The databases PubMed, Scopus, ProQuest, and Google Scholar were searched from inception until April 2022. The included papers were studies evaluating the role of mandibular third molars on crowding of mandibular anterior teeth in patients of any age and gender, with mandibular third molars impacted or semi-impacted or erupted. Predetermined and prepiloted data collection forms were used to record the necessary information. RESULTS Thirteen observational studies were included in the present systematic review. Most of them were assigned an overall risk of bias of moderate risk while the rest of them were at high risk. Four studies found an association between the presence of mandibular third molar and mandibular incisor crowding. Finally, seven studies were included in the quantitative analysis. Three different meta-analyses were conducted: for patients (a) with or (b) without previous orthodontic treatment and (c) in combination for patients with and without previous orthodontic treatment. According to the pooled results of all three meta-analyses, random effects model yielded a significant benefit for those without third molars compared to those with third molars regarding crowding, mean Little's irregularity index and mean arch length. CONCLUSIONS Lower third molars may contribute to mandibular crowding and lower arch constriction. Further prospective research of high quality is needed to clarify the impact of third molars on anterior mandibular crowding.
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Dentoalveolar Surgery. J Oral Maxillofac Surg 2023; 81:E51-E74. [PMID: 37833029 DOI: 10.1016/j.joms.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Lyros I, Vasoglou G, Lykogeorgos T, Tsolakis IA, Maroulakos MP, Fora E, Tsolakis AI. The Effect of Third Molars on the Mandibular Anterior Crowding Relapse-A Systematic Review. Dent J (Basel) 2023; 11:dj11050131. [PMID: 37232782 DOI: 10.3390/dj11050131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
The present systematic review updates the evidence on wisdom teeth contributing to lower incisor crowding following orthodontic treatment. Relevant literature was searched on online databases, namely Pubmed, Scopus, and Web of Science, up to December 2022. Eligibility criteria were formulated using the PICOS approach and PRISMA guidelines. Eligible research included original clinical studies involving patients previously being treated orthodontically with permanent dentition at the end of treatment, regardless of sex or age. The initial search yielded 605 citations. After considering eligibility criteria and removing duplicates, only 10 articles met the criteria for inclusion. The risk of bias of eligible studies was evaluated using the Cochrane Handbook for Systematic Reviews and Interventions tool. The majority were highly biased, mainly regarding allocation concealment, group similarity, and assessment blinding. The vast majority did not report statistically significant associations between the presence of third molars and crowding relapse. However, a minor effect has been suggested. Seemingly, there is no clear connection between mandibular third molars and incisor crowding after orthodontic treatment. The present review did not find adequate evidence to advocate preventative removal of the third molars for reasons of occlusal stability.
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Affiliation(s)
- Ioannis Lyros
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | - Ioannis A Tsolakis
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54623 Thessaloniki, Greece
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Michael P Maroulakos
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Fora
- Department of Oral Medicine and Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Apostolos I Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH 44106, USA
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Clinical Indications to Germectomy in Pediatric Dentistry: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020740. [PMID: 35055565 PMCID: PMC8775662 DOI: 10.3390/ijerph19020740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/10/2022]
Abstract
Germectomy is a procedure often required in patients at developmental age. It is defined as the surgical removal of the third molar at a very specific stage of development. The aim of this study was to systematically analyze the literature in terms of clinical indications for germectomy in patients at developmental age. Literature searches were performed using PubMed, Google Scholar, Cochrane Library and Scopus from 1952 to 30 June 2021. The study protocol was registered after the screening stage (PROSPERO CRD42021262949). The search strategy identified 3829 articles: 167 from PubMed, 2860 from Google Scholar, 799 from Cochrane Library and 3 from Scopus. Finally, eight full-text papers were included into the qualitative analysis. Based on the included studies, clinical indications for germectomy were mainly related to orthodontic causes, infectious and cariogenic causes and prophylaxis. Based on these results, it is not possible to present evidence-based clinical indications for germectomy in patients at developmental age. Clinical trials on this subject focused specifically on patients at developmental age are awaited.
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Mardiati E, Komara I, Halim H, Kurnia D, Maskoen AM. Sensitivity and Specificity of Mandibular Third Molar Calcification at Chronological Age and Hand Wrist Maturation Stage to Discriminate Between Female and Male at Pubertal Growth Period. Open Dent J 2021. [DOI: 10.2174/1874210602115010551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The mandibular third molar is the last tooth that is not completely developed by the time pubertal growth has been finished. Maturation of the mandibular third molar is one of the physiological maturation indicators that can be used to determine the stage of pubertal growth.
Objective:
The aim of the study was to determine the sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period.
Methods:
It is a retrospective study with a cross-sectional approach using panoramic and hand-wrist digital radiographs of 279 females and 144 males, age 8-17 years, with a total of 423 panoramic radiographs and 423 hand-wrist radiographs. Statistical analysis was performed using Excel Mega Stat. ANOVA to analyze the differences between mandibular third molar calcification at chronological age and hand-wrist maturation stage, and t-test was used to analyze the differences between females and males. Spearman rank correlation was used for the analysis of the correlation between mandibular third molar calcification with chronological age and hand-wrist maturation stage; sensitivity and specificity were used to discriminate the pubertal growth period between mandibular third molar calcification and hand-wrist maturation stage.
Results:
There were significant differences found in mandibular third molar crown maturation stage B and C, but no significant difference was observed between mandibular third molar stage A, D, E, F, G and H, between females and males. The highest percentage of mandibular third molar crown formation in females was observed at stage D (6.68%) at MP3u, and in males, it was observed at stage D (8.83%) at SMI-4. The highest percentage of root formation in females was stage E (8.24%) at the SMI-10 stage, and males stage F (4.86%) at MP3u. The correlation was observed between mandibular third molar calcification with hand-wrist, females 0.22 and males 0.43, and chronological age 0.60 for females and 0.69 for males. The highest sensitivity of mandibular third molar calcification of 97.0% was observed in female at SMI-4 of hand-wrist maturation with specificity of 100%, while in male, a sensitivity of 94.5% was observed at SMI-2 stage with a specificity of 99.99%.
Conclusion:
There were significant differences found in mandibular third molar calcification between females and males except for stage B and stage C; weak correlation was observed between mandibular third molar calcification and hand-wrist, and moderate correlation was observed with chronological age. The sensitivity and specificity in females and males indicate that mandibular third molar calcification is only useful for diagnosing the pre-pubertal growth phase.
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Zigante M, Pavlic A, Morelato L, Vandevska-Radunovic V, Spalj S. Presence and Maturation Dynamics of Mandibular Third Molars and Their Influence on Late Mandibular Incisor Crowding: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910070. [PMID: 34639372 PMCID: PMC8508372 DOI: 10.3390/ijerph181910070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the relationship between the absence, presence and dynamics of mandibular third molar development and the occurrence and amount of late mandibular incisor crowding. Dental plaster casts and panoramic radiographs of 72 orthodontically untreated subjects from the Nittedal growth study, Norway were analyzed. The subjects were recalled for a checkup at 12, 15, 18 and 21 years of age. Mandibular incisor crowding was assessed using Little's irregularity index and dental maturation of the third molars by the Cameriere's index. The majority of the subjects (64%) had ≥1 mm increase in irregularity; 22% experienced an increase of 0.1-0.9 mm and 14% had unchanged or decreased irregularity. Incisor irregularity increased with age, regardless of absence or presence of third molars. The amount of change in incisor irregularity from 12 to 21 years did not differ significantly between subjects with hypodontia of third molars, extraction and those with third molars present. No differences were observed between erupted, unerupted or impacted third molars. No correlation was found between the amount of change in irregularity and maturation of the third molars. In conclusion, occurrence and amount of mandibular late incisor crowding is not significantly influenced by the presence of mandibular third molars or their development dynamics.
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Affiliation(s)
- Martina Zigante
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia; (A.P.); (S.S.)
- Correspondence:
| | - Andrej Pavlic
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia; (A.P.); (S.S.)
- Department of Pediatric Dentistry, Faculty of Dental Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia
| | - Luka Morelato
- Department of Oral Surgery, Faculty of Dental Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia;
| | - Vaska Vandevska-Radunovic
- Department of Orthodontics, Institute of Clinical Dentistry, University of Oslo, Geitmyrsveien 71, 0317 Oslo, Norway;
| | - Stjepan Spalj
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia; (A.P.); (S.S.)
- Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
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The rationale for orthodontic retention: piecing together the jigsaw. Br Dent J 2021; 230:739-749. [PMID: 34117429 DOI: 10.1038/s41415-021-3012-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Retaining teeth in their corrected positions following orthodontic treatment is one of the most challenging aspects of orthodontic practice. Despite much research, the rationale for retention is not entirely clear. Teeth tend to revert to their pre-treatment positions due to periodontal and gingival, soft tissue, occlusal and growth factors. Changes may also follow normal dentofacial ageing and are unpredictable with great variability. In this overview, each of these factors are discussed with their implications for retention, along with adjunctive procedures to minimise relapse. The state of current knowledge, methods used to assess relapse, factors regarded as predictive of or associated with stability as well as overcorrection are outlined. Potential areas requiring further investigation are suggested. The way in which the clinician may manage current retention practice, with a need for individualised retention plans and selective retainer wear, is also considered.
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Milos D, Pavlic A, Vandevska Radunovic V, Zigante M, Matthewson A, Spalj S. Craniofacial Growth in Adolescence and its Influence on the Mandibular Incisor Crowding. Acta Stomatol Croat 2021; 55:37-44. [PMID: 33867536 PMCID: PMC8033627 DOI: 10.15644/asc55/1/5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background To analyze craniofacial growth during adolescence from the ages of 12 to 21 years and its relation to late mandibular incisor crowding. Material and Methods The study included 61 orthodontically untreated subjects (49% males). Lateral cephalograms were used to assess the jaw growth and inclination of the incisors. Little's Irregularity Index and the anterior mandibular dental arch depth of mandibular dentition were measured. Results A reduction of the skeletal class angle (ANB) was observed in both genders, although it was significant only in males (η2=0.188; p=0.015). The growth of the mandible was more prominent compared to that of the maxilla, and it was more prominent in males than in females. The skeletal vertical dimension, however, demonstrated a significant reduction in both genders (η2=0.527-0.593, p<0.001). The mandibular incisors tended to retrocline in both genders, while the maxillary ones tended to procline in males, and slightly retrocline in females. A decrease in the mandibular dental arch depth occurred in both genders (η2=0.259; p<0.05). An increase in the irregularity of incisors for 1.8±1.7 mm on average (95% CI 1.3-2.2; η2=0.520; p<0.001) was observed in both genders. A logistic regression revealed that less sagittal growth of maxilla (increase of SNA angle ≤2°) and reduction of convexity in skeletal sagittal interjaw relationship (reduction of ANB ≥1°) were significant predictors of the occurrence of crowding (Δ Little Irregularity Index ≥1mm) yielding odds ratios of 4.9 and 4.8. Conclusions The differential growth of the maxilla and mandible is related to the occurrence of late crowding, mostly in smaller amounts in maxillary sagittal growth compared to the mandible.
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Affiliation(s)
| | - Andrej Pavlic
- - Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Croatia
| | | | - Martina Zigante
- - Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Croatia
| | - Alana Matthewson
- - Department of Orthodontics Maxillofacial Unit Morriston Hospital, Swansea, United Kingdom
| | - Stjepan Spalj
- - Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Croatia.,- Department of Dental Medicine 1, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia
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Vandeplas C, Vranckx M, Hekner D, Politis C, Jacobs R. Does Retaining Third Molars Result in the Development of Pathology Over Time? A Systematic Review. J Oral Maxillofac Surg 2020; 78:1892-1908. [PMID: 32681826 DOI: 10.1016/j.joms.2020.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The present systematic review was conducted to assess the available literature on pathologies associated with third molar retention. MATERIALS AND METHODS A systematic literature search was conducted in MEDLINE (PubMed), Embase, and Cochrane Library and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Relevant reports were selected using predefined inclusion and exclusion criteria. Pathology related to third molar retention included caries, periodontal pathology, second molar external root resorption, and pathologic widening of the third molar pericoronal space. The methodologic quality of each study was reviewed using a pathology-specific tool to assess the risk of bias. RESULTS A total of 37 studies were included for qualitative analysis. The available data showed that asymptomatic retained third molars frequently become diseased with increasing age of the patient and increased retention time. Caries and periodontal pathology were most frequently observed, especially in partially erupted third molars and mesially inclined mandibular third molars. Overall, the available data were regarded as medium to fair quality evidence. CONCLUSIONS The available data have revealed that retained asymptomatic third molars rarely remain disease-free over time. Increasing age and, thus, increasing retention time seemed associated with greater disease prevalence. Well-designed, prospective follow-up studies are needed to substantiate the clinical management of asymptomatic disease-free third molars.
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Affiliation(s)
- Cedric Vandeplas
- Researcher, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Myrthel Vranckx
- Researcher, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Dominique Hekner
- Surgical Resident, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Constantinus Politis
- Department Head, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Coordinator Research Group, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; and Professor, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ghaeminia H, Nienhuijs ME, Toedtling V, Perry J, Tummers M, Hoppenreijs TJ, Van der Sanden WJ, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev 2020; 5:CD003879. [PMID: 32368796 PMCID: PMC7199383 DOI: 10.1002/14651858.cd003879.pub5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. OBJECTIVES To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . SELECTION CRITERIA We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. MAIN RESULTS This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure any of our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS Insufficient evidence is available to determine whether asymptomatic disease-free impacted wisdom teeth should be removed or retained. Although retention of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is very low certainty. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the current lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision-making with people who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain these teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.
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Affiliation(s)
- Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Arnhem, Netherlands
| | - Marloes El Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Verena Toedtling
- Department of Oral and Maxillofacial Surgery, Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - John Perry
- Hospital Dental Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theo Jm Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, Netherlands
| | - Wil Jm Van der Sanden
- Department of Quality and Safety of Oral Health Care, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theodorus G Mettes
- School of Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Cotrin P, Freitas KMS, Freitas MR, Valarelli FP, Cançado RH, Janson G. Evaluation of the influence of mandibular third molars on mandibular anterior crowding relapse. Acta Odontol Scand 2020; 78:297-302. [PMID: 31833442 DOI: 10.1080/00016357.2019.1703142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate the influence of mandibular third molars on relapse of mandibular anterior crowding in orthodontically treated patients.Material and Methods: Sample included orthodontic records of 108 patients: Group 1: 72 patients (39 female; 33 male) with third molars present in the postretention evaluation stage. Group 2: 36 patients (18 female; 18 male) who did not present the third molars in the postretention evaluation stage. Panoramic radiographs and dental models were evaluated at three different stages: pre-treatment; posttreatment and postretention. Panoramic radiographs showed the presence or absence of third molars in the 3 evaluated stages and on the dental models, overbite and mandibular anterior crowding was measured by the Little Irregularity Index. For intergroup comparisons, t-tests and a multifactorial regression analysis were used.Results: There was no statistically significant difference in the relapse of mandibular anterior crowding among the groups with and without mandibular third molars at the postretention stage.Conclusion: The presence or absence of mandibular third molars did not influence the relapse of mandibular anterior crowding in orthodontically treated patients.
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Affiliation(s)
- Paula Cotrin
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | - Marcos Roberto Freitas
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | | | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
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Aliaga-Del Castillo A, Janson G, Arriola-Guillén LE, Laranjeira V, Garib D. Effect of posterior space discrepancy and third molar angulation on anterior overbite. Am J Orthod Dentofacial Orthop 2018; 154:477-486. [DOI: 10.1016/j.ajodo.2017.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/28/2022]
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Genest-Beucher S, Graillon N, Bruneau S, Benzaquen M, Guyot L. Does mandibular third molar have an impact on dental mandibular anterior crowding? A literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:204-207. [DOI: 10.1016/j.jormas.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
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Cheng HC, Peng BY, Hsieh HY, Tam KW. Impact of third molars on mandibular relapse in post-orthodontic patients: A meta-analysis. J Dent Sci 2018; 13:1-7. [PMID: 30895087 PMCID: PMC6388845 DOI: 10.1016/j.jds.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Whether third molars contribute to or aggravate relapse, particularly in the mandibular dental arch, after orthodontic treatment remains controversial. Orthodontic clinicians vary widely in their practice regarding prophylactic third molar removal after orthodontic treatment. The present study systematically reviewed and meta-analyzed the available literature, and assessed the impact of third molar removal on the relapse of mandibular dental arch alignment after orthodontic treatment. MATERIALS AND METHODS Relevant literature was searched on online databases, namely Pubmed, Embase, and Cochrane. Outcomes of post-orthodontic mandibular relapse were evaluated in terms of the Little's irregularity index, intermolar width, and arch length. Statistical analysis was conducted using the Review Manager software (Version 5.3, The Cochrane Collaboration, Oxford, England). RESULTS Our initial search strategy yielded 360 citations, of which three retrospective studies were selected. The Little's irregularity index (weighted mean difference = 0.80, 95% confidence interval = 0.13-1.47, P = 0.02) differed significantly between the erupted third molar extraction group and agenesis third molar group; whereas the arch length and intermolar width did not. No outcome differed significantly between the impacted third molar extraction group and agenesis third molar group. CONCLUSION Removal of the mandibular third molars is recommended for alleviating or preventing long-term incisor irregularity.
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Affiliation(s)
- Hsin-Chung Cheng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Bou-Yue Peng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsueh-Yin Hsieh
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ka-Wai Tam
- Department of Surgery, Taipei Medical University – Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
- Center for Evidence-based Medicine, Taipei Medical University, Taipei, Taiwan
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Mahmoudzadeh M, Farhadian M, Alijani S, Azizi F. Comparaison de deux arcs initiaux (A-NiTi et NiTi thermiques) pour évaluer la quantité d’alignement dentaire et la perception de la douleur : étude clinique randomisée. Int Orthod 2018; 16:60-72. [PMID: 29478924 DOI: 10.1016/j.ortho.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Majid Mahmoudzadeh
- Département d'orthodontie, faculté dentaire, université de sciences médicales, Hamadan, Iran
| | - Maryam Farhadian
- Unité de recherche de modélisation, biostatistique et santé publique des maladies non transmissibles, université d'Hamadan de sciences médicales, Hamadan, Iran
| | - Sara Alijani
- Département d'orthodontie, faculté dentaire, université de sciences médicales, Hamadan, Iran
| | - Fatemeh Azizi
- Département d'orthodontie, faculté dentaire, université de sciences médicales, Kermanshah, Iran.
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Clinical comparison of two initial arch wires (A-NiTi and Heat Activated NiTi) for amount of tooth alignment and perception of pain: A randomized clinical trial. Int Orthod 2018; 16:60-72. [PMID: 29478933 DOI: 10.1016/j.ortho.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to compare two initial arch wires, 0.014″ A-NiTi and 0.016″ Heat Activated NiTi (HANT), for amount of tooth alignment and perception of pain. MATERIALS AND METHODS In total, 59 orthodontic patients (21 males and 38 females) from three orthodontic clinics participated in this 2-arm, parallel-group clinical trial and were randomized to 0.014″ A-NiTi (n=30) or 0.016″ HANT groups (n=29). Patient recruitment commenced in April 2016 and ended in December 2016. Age of the patients was between 12 to 25 years with an average of 17.92±3.74 years. Eligibility criteria included permanent dentition, non-extraction treatment plan in lower arch, Irregularity Index>2 in lower arch, no systemic disease influencing pain, no chronic Non Steroid Anti Inflammatory Drug (NSAID) therapy, and no history of dental pain, mucosal ulcers or temporomandibular disorders (TMD). Blinding was applicable to the patients and outcome assessment. The primary outcome was to compare the reduction of the Irregularity Index mean from bonding sessions to 4 weeks later in these groups and the secondary outcome was evaluation of the pain according to the modified McGill Pain Questionnaire (MPQ) with Visual Analogue Scale questionnaire (VAS). RESULTS The mean differences of irregularity indices between the two groups are not statistically significant (95% CI: 0.39-1.03; P=0.36) and according to the questionnaire, there was no significant difference between the two groups in trigger, site, description, duration, beginning, medication, and pain reduction over time. However, the VAS scale of HANT group was significantly higher than that of A-NiTi (P=0.04). CONCLUSION Results from this investigation suggested that there was no clinical difference in amount of tooth alignment and perception of pain between 0.014″ A-NiTi and 0.016″ HANT wires.
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Sugiki Y, Kobayashi Y, Uozu M, Endo T. Association between skeletal morphology and agenesis of all four third molars in Japanese orthodontic patients. Odontology 2018; 106:282-288. [PMID: 29330705 PMCID: PMC5995980 DOI: 10.1007/s10266-017-0336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to clarify differences in skeletal morphologies between male and female orthodontic patients with and without agenesis of all four third molars. A total of 64 patients (32 males and 32 females) with agenesis of all four third molars without agenesis of other teeth were selected as the third molars agenesis group (group 1). In addition, 64 patients (32 males and 32 females) with all these teeth were selected as controls (group 2). Lateral cephalograms taken between the ages of 14 and 30 years were used to compare skeletal morphology between groups 1 and 2 and between sexes. Maxillary length (P < 0.001), lower facial height (P < 0.05), gonial angle (P < 0.001) and mandibular plane angle (P < 0.001) were significantly smaller in group 1 than in group 2. Irrespective of the presence or absence of all four third molars, males had significantly smaller lower facial height (P < 0.01) and mandibular plane angle (P < 0.001) and significantly greater total mandibular length (P < 0.001), mandibular body length (P < 0.001) and mandibular ramus height (P < 0.001) than females. Japanese orthodontic patients with agenesis of all four third molars had significantly small maxillary length, lower facial height, gonial angle and mandibular plane angle.
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Affiliation(s)
- Yoshiko Sugiki
- Orthodontic Dentistry, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan.
| | - Yoshiki Kobayashi
- Orthodontic Dentistry, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
| | - Miwa Uozu
- Orthodontics and Dentofacial Orthopedics, Field of Oral and Maxillofacial Growth and Development, Course of Clinical Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
| | - Toshiya Endo
- Orthodontics and Dentofacial Orthopedics, Field of Oral and Maxillofacial Growth and Development, Course of Clinical Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
- Department of Orthodontics, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
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Abstract
Maintaining teeth in their corrected positions following orthodontic treatment can be extremely challenging. Teeth have a tendency to move back towards the original malocclusion as a result of periodontal, gingival, occlusal and growth related factors. However, tooth movement can also occur as a result of normal age changes. Because orthodontics is unable to predict which patients are at risk of relapse, those which will remain stable and the extent of relapse that will occur in the long-term, clinicians need to treat all patients as if they have a high potential to relapse. To reduce this risk, long term retention is advocated. This can be a significant commitment for patients, and so retention and the potential for relapse must form a key part of the informed consent process prior to orthodontic treatment. It is vital that patients are made fully aware of their responsibilities in committing to wear retainers as prescribed in order to reduce the chance of relapse. If patients are unable or unwilling to comply as prescribed, they must be prepared to accept that there will be tooth positional changes following treatment. There is currently insufficient high quality evidence regarding the best type of retention or retention regimen, and so each clinician's approach will be affected by their personal, clinical experience and expertise, and guided by their patients' expectations and circumstances.
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Affiliation(s)
- S J Littlewood
- St Luke's Hospital, Little Horton Lane, Bradford, BD5 0NA, United Kingdom.,Leeds Dental Institute, University of Leeds, United Kingdom
| | - S Kandasamy
- School of Dentistry, The University of Western Australia.,Centre for Advanced Dental Education, Saint Louis University, MO, USA.,West Australian Orthodontics, Midland, WA, Australia
| | - G Huang
- University of Washington, Department of Orthodontics, Seattle, Washington, USA
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Pithon MM, Baião FCS, Dantas de Andrade Sant'Anna LI, da Silva Coqueiro R, Maia LC. Influence of the presence, congenital absence, or prior removal of third molars on recurrence of mandibular incisor crowding after orthodontic treatment: Systematic review and meta-analysis. J World Fed Orthod 2017. [DOI: 10.1016/j.ejwf.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goyal S, Verma P, Raj SS. Radiographic Evaluation of the Status of Third Molars in Sriganganagar Population - A Digital Panoramic Study. Malays J Med Sci 2016; 23:103-112. [PMID: 28090184 DOI: 10.21315/mjms2016.23.6.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Third molar (M3) agenesis and impaction are associated with evolution, changed dietary habits, and human jaw growth. The aim of the study was to radiographically evaluate the prevalence of M3s agenesis, impacted M3s with different impaction patterns, and the approximation of Inferior Dental Canal (IDC) with impacted mandibular M3s roots among the Sriganganagar population. METHODS The study included 700 randomly selected subjects from OPD with an age range of 25-45 years. Digital OPGs were taken for all subjects using Kodak 8000C digital OPG machine. The M3 impaction patterns were evaluated using Winter's classification. RESULTS The prevalence of subjects with at least one M3 agenesis was found to be 34.1% and with 95% confidence interval was 30.6% to 37.6%. The overall M3s agenesis was 16.8% with more prevalence in the males. The patients with agenesis of one M3, two M3s, three M3s, and four M3s were 14.4%, 11.3%, 3.7% and 4.7%, respectively. M3 agenesis was more in the upper jaw and on the left side. The total impacted M3s were 21.11% with more prevalence in mixed diet subjects. Mesioangular was most common impaction pattern, and notching was most prevalent IDC relationship with impacted mandibular M3s roots. CONCLUSION This study highlighted the evolutionary increasing M3 agenesis and the importance of diagnostic OPG for seeing the status of M3s in jaws.
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Affiliation(s)
- Sharry Goyal
- Department of Oral Medicine & Radiology, Surendera Dental College & Research Institute, Sriganganagar, 335001 Rajasthan, India
| | - Pradhuman Verma
- Department of Oral Medicine & Radiology, Surendera Dental College & Research Institute, Sriganganagar, 335001 Rajasthan, India
| | - Seetharamaiha Sunder Raj
- Department of Oral Medicine & Radiology, Surendera Dental College & Research Institute, Sriganganagar, 335001 Rajasthan, India
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Ghaeminia H, Perry J, Nienhuijs MEL, Toedtling V, Tummers M, Hoppenreijs TJM, Van der Sanden WJM, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev 2016:CD003879. [PMID: 27578151 DOI: 10.1002/14651858.cd003879.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. OBJECTIVES To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. SELECTION CRITERIA Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. MAIN RESULTS This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures.One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth.One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch.The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.
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Affiliation(s)
- Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 14, Nijmegen, Netherlands, 6525 GA
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Abstract
Background Third molar influence on anterior crowding is controversial, but they are assumed to play a major role in compromising dental arch space. Aim To evaluate the relationship among impaction, agenesis and crowding in black South African males. Subjects and method Mandibles and maxillae of 535 black South African males in the Raymond A. Dart Collection of Human Skeletons, University of the Witwatersrand were examined for anterior crowding and third molar agenesis and impaction. Dental crowding was determined using Little's irregularity index. Results Individuals with impaction showed more moderate-to-extreme crowding than those with agenesis. Bilateral third molar presence was more frequently associated with ideal-to-minimal crowding. Weak positive but significant correlations between crowding and impaction were found (mandible, ρ = 0.154, p = 0.000; maxilla ρ = 0.130, p = 0.000). The direction was the opposite for bilateral presence of molars (mandible, ρ = -0.135, p = 0.02; maxilla, ρ = -0.111, p = 0.010). Odds of mandibular crowding were greatest in individuals with impaction (OR = 3.22, CI = 1.716-6.05, p < 0.001). Maxillary results were similar. Conclusion Third molar impaction plays a role in anterior crowding. Third molar presence was not associated with anterior crowding, while agenesis did not explain absence of crowding.
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Affiliation(s)
- Temitope Esan
- a Department of Restorative Dentistry, Faculty of Dentistry, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Osun , Nigeria
| | - Lynne A Schepartz
- b School of Anatomical Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , ZA , South Africa.,c University of Pennsylvania Museum of Archaeology and Anthropology , Philadelphia , PA , USA
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Dalstra M, Sakima MT, Lemor C, Melsen B. Drifting of teeth in the mandible studied in adult human autopsy material. Orthod Craniofac Res 2015; 19:10-7. [DOI: 10.1111/ocr.12103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M. Dalstra
- Section of Orthodontics; School of Dentistry; Aarhus University; Aarhus Denmark
| | - M. T. Sakima
- Araraquara School of Dentistry; State University of São Paulo (UNESP); Araraquara Brazil
| | - C. Lemor
- Section of Orthodontics; School of Dentistry; Aarhus University; Aarhus Denmark
| | - B. Melsen
- Section of Orthodontics; School of Dentistry; Aarhus University; Aarhus Denmark
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Di Marco A, Sicilia M, Crivelli L, Ghedini T, Motta Jones J. Inquadramento clinico e trattamento chirurgico dei terzi molari inferiori inclusi. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Altan AB, Sinanoğlu EA, Üçdemir E, Sandalci S, Karaman AI. Dentofacial Morphology in Third Molar Agenesis. Turk J Orthod 2015. [DOI: 10.13076/tjo-d-15-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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You TM, Ban BH, Jeong JS, Huh J, Doh RM, Park W. Effect of premolar extraction and presence of the lower third molar on lower second molar angulation in orthodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:278-83. [DOI: 10.1016/j.oooo.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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The role of mandibular third molars on lower anterior teeth crowding and relapse after orthodontic treatment: a systematic review. ScientificWorldJournal 2014; 2014:615429. [PMID: 24883415 PMCID: PMC4032723 DOI: 10.1155/2014/615429] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/04/2014] [Accepted: 04/11/2014] [Indexed: 11/18/2022] Open
Abstract
AIMS To evaluate the role of third molars in the development of crowding or relapse after orthodontic treatment in the anterior segment of the dental arch. METHODS PubMed search of the literature was performed selecting all the articles relevant to the topic and limiting the studies to controlled trials on humans and written in English language. Systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. RESULTS A total of 12 clinical studies were included in the review. A high risk of bias was found in most of the articles, either because the relative items assessed were inadequate or because they were unclearly described. The third molars were not correlated with more severe anterior tooth crowding in most of the studies. However, four of them described a different outcome. CONCLUSION Definitive conclusions on the role of the third molars in the development of anterior tooth crowding cannot be drawn. A high risk of bias was found in most of the trials, and the outcomes were not consistent. However, most of the studies do not support a cause-and-effect relationship; therefore, third molar extraction to prevent anterior tooth crowding or postorthodontic relapse is not justified.
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International benchmarking of hospitalisations for impacted teeth: a 10-year retrospective study from the United Kingdom, France and Australia. Br Dent J 2014; 216:E16. [DOI: 10.1038/sj.bdj.2014.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/09/2022]
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36
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38
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Okşayan R, Topçuoğlu T. Effects of Mandibular Third Molar Angulation and Position on Crowding. Turk J Orthod 2013. [DOI: 10.13076/tjo-d-13-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bibona K, Shroff B, Best AM, Lindauer SJ. Factors affecting orthodontists' management of the retention phase. Angle Orthod 2013; 84:225-30. [DOI: 10.2319/051313-372.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Objective:
To test the null hypothesis that orthodontist characteristics and factors related to retainer choice do not influence the management of the retention phase with regard to frequency and duration of follow-up care provided.
Materials and Methods:
Orthodontists (n = 1000) were randomly selected to participate in an online survey divided into three categories: background, retainer choice, and time management.
Results:
Of the 1000 selected participants, 894 responded. When deciding the type of retainer to use, the following were considered most frequently: pretreatment malocclusion (91%), patient compliance (87%), patient oral hygiene (84%), and patients' desires (81%). Orthodontists who considered the presence of third molars (P = .03) or “special needs” patients (P = .02) had significantly more follow-up visits than those who did not. When vacuum-formed retainers (VFRs) were prescribed, there were significantly fewer visits (P = .02) compared to when other types of retainers were used. As practitioner experience increased, so did the number of visits (P < .0001). Orthodontists who considered the primary responsibility of retention to fall on the patient had significantly fewer follow-up visits (P < .0001) than those who considered it either a joint or orthodontist-only responsibility.
Conclusions:
The null hypothesis was rejected because the number of follow-up visits during the retention phase was affected by practitioner experience, whether VFRs were used, whether the orthodontist considered the presence of third molars or special-needs patients when choosing the type of retainer, and to whom the orthodontist attributed responsibility during the retention phase.
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Affiliation(s)
- Kevin Bibona
- Resident, Department of Orthodontics, Virginia Commonwealth University, Richmond, Va
| | - Bhavna Shroff
- Professor and Graduate Program Director, Department of Orthodontics, Virginia Commonwealth University, Richmond, Va
| | - Al M. Best
- Professor, Department of Biostatistics, School of Dentistry, Virginia Commonwealth University, Richmond, Va
| | - Steven J. Lindauer
- Professor and Chair, Department of Orthodontics, Virginia Commonwealth University, Richmond, Va
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Karasawa LH, Rossi AC, Groppo FC, Prado FB, Caria PHF. Cross-sectional study of correlation between mandibular incisor crowding and third molars in young Brazilians. Med Oral Patol Oral Cir Bucal 2013; 18:e505-9. [PMID: 23385508 PMCID: PMC3668880 DOI: 10.4317/medoral.18644] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/11/2012] [Indexed: 11/24/2022] Open
Abstract
Objectives: The aim of this study was to evaluate transversally the clinical correlation between lower incisor crowding and mandible third molar.
Study Design: Three hundred healthy volunteers (134 male and 166 female), aged 20.4 (±2.4) years-old were submitted to a complete clinical examination and filled up a questionnaire about gender, age, total teeth number and presence or absence of superior and inferior third molar. After a recent panoramic radiography were evaluated. The multiple logistic regression showed that none of the studied factors influenced the mandibular incisor crowding.
Results: The proportion of both molars present or both absent was higher than the other conditions (Chi-square, p<.0001). The multiple logistic regression showed that any of the studied factors, influenced (p>.05) the mandibular incisor crowding. Despite the statistical significance, wear orthodontics appliances showed a little correlation (odds ratios < 1.0) in the mandibular incisor crowding.
Conclusion: Presence of maxillary and/or mandibular third molars has no relation with the lower incisor crowding.
Key words:Malocclusion, third molars, lower incisor crowding, mandible.
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Affiliation(s)
- Lilian-Harumi Karasawa
- Department of Morphology, Anatomy area, Piracicaba Dental School, State University of Campinas - UNICAMP, Brazil
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Asymptomatic third molar extractions: Evidence-based informed consent. J World Fed Orthod 2012. [DOI: 10.1016/j.ejwf.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ogawa T, Osato S. Growth changes of the mandibular body with eruption of mandibular third molars: analysis of anatomical morphometry and quantitative bone mineral content by using radiography. Ann Anat 2012; 195:143-50. [PMID: 23031389 DOI: 10.1016/j.aanat.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/11/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
This study aimed to analyze growth changes in mandibular body morphology and quantitative bone mineral content (QBMC) with eruption of mandibular third molars (M3s) and the relationship between those variables and posterior mandibular body length. Linear and angular measurements were conducted using standard lateral radiographs of 37 dried mandibles in Hellman's dental developmental stages IVA (14 specimens) to VA (23 specimens). Cortical and trabecular basal bone mineral contents (CBMC and TBMC) in the mandible were expressed in millimeter titanium equivalent values using a titanium step wedge. The largest significant change in the mandibular body morphology was an increase in the horizontal dimension (M2DP'-Go': 7.59mm), followed by vertical dimension - total height of the mandibular body (THOMB: 4.96mm) and mandibular cortical width (MCW: 1.22mm). The gonial angle (GA) decreased significantly by 6.72° between stages IVA and VA. The mandibular cortical index (MCI) was classified only as C1 or C2 in each stage. Among 4 types of line profile, types 1 and 2 were most commonly observed in both stages. Mean values for CBMC and TBMC increased significantly between stages IVA and VA. Posterior mandibular body length (MeF'-Go') correlated positively with M2DP'-Go', THOM, MCW, and CBMC (r=0.816, 0.698, 0.595, and 0.507), respectively and negatively with GA (r=-0.582). These results demonstrated that the morphological changes in the posterior mandibular body and the QBMC increased significantly with M3 eruption, while the GA became significantly smaller. The posterior mandibular body length had a linear correlation with these variables.
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Affiliation(s)
- Takahiro Ogawa
- Department of Histology, The Nippon Dental University, School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
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Pierse JE, Dym H, Clarkson E. Diagnosis and management of common postextraction complications. Dent Clin North Am 2012; 56:75-viii. [PMID: 22117943 DOI: 10.1016/j.cden.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Extraction of impacted teeth is one of the most common surgical procedures performed by oral and maxillofacial surgeons. Every surgical procedure results in some degree of postoperative bleeding and inflammation, typically manifesting as pain and edema. Although the complex physiology of the human body is beyond the scope of this article, the educated clinician should have an understanding of the time line associated with these processes so as to determine whether a patient's complaint of postoperative bleeding, pain, or swelling represents a normal response to surgical trauma or an aberrant reaction.
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Affiliation(s)
- Joseph E Pierse
- Department of Dentistry/Oral & Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue, Box 187, Brooklyn, NY 11201, USA
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[Histological analysis of dental follicles after unerupted mandibular third molar extraction]. ACTA ACUST UNITED AC 2011; 112:343-7. [PMID: 21962558 DOI: 10.1016/j.stomax.2011.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 01/28/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The extraction of third mandibular tooth germ (M3) is often prophylactic to avoid orthodontic treatment relapse and to prevent infectious or tumoral diseases developing from the dental sac. The purpose of this study was to screen for early histopathological modification of dental follicles (inflammatory, infiltration, or epithelial metaplasia) after extraction of third mandibular tooth germ (M3) on asymptomatic patients. The secondary objective was to study the proliferative activity of the epithelium by dosing the anti Ki-67 antibody. PATIENTS AND METHOD Twenty dental follicles extracted from 12 boys and eight girls between 14 and 18 years of age were examined under phototonic microscopy. The proliferative activity of the epithelium was assessed by immuno-histochemistry. RESULTS Three dental follicles presented with focal epidermoid metaplasia of the epithelium, without odontogenic tumoral proliferation. In all other cases, the cylindrical epithelial cell structure was normal. A mild chronic inflammatory infiltrate was present in 30% of the cases. Immuno-histochemical analysis revealed labeling of very rare epithelial lining cells, slightly more in cases presenting with metaplasia. DISCUSSION The prevalence of early morphological changes of dental sac is low. This histo-morphological study does not support the systematic extraction of asymptomatic mandibular tooth germs (M3).
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Quaglio CL, de Freitas KMS, de Freitas MR, Janson G, Henriques JFC. Stability and relapse of maxillary anterior crowding treatment in class I and class II Division 1 malocclusions. Am J Orthod Dentofacial Orthop 2011; 139:768-74. [PMID: 21640883 DOI: 10.1016/j.ajodo.2009.10.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The maxillary anterior teeth are the most important to facial esthetics because they are the first to show on a smile. Therefore, stability of the maxillary anterior teeth alignment is an important issue. The objective of this study was to compare the stability of maxillary anterior tooth alignment in Class I and Class II Division 1 malocclusions. METHODS The sample comprised dental casts of 70 patients with Class I and Class II Division 1 malocclusions and a minimum of 3 mm of maxillary anterior crowding measured by an irregularity index. The patients were treated with extractions and evaluated at pretreatment and posttreatment and at least 5 years after treatment. The sample was divided into 3 groups: group 1, Class I malocclusion treated with 4 first premolar extractions comprising 30 subjects, with an initial age of 13.16 years and 8.59 mm of initial maxillary irregularity; group 2, Class II malocclusion treated with 4 first premolar extractions comprising 20 subjects, with an initial age of 12.95 years and 11.10 mm of maxillary irregularity; and group 3, Class II malocclusion treated with 2 first maxillary premolar extractions comprising 20 subjects, with an initial age of 13.09 years and 9.68 mm of maxillary irregularity. RESULTS The decrease in the maxillary irregularity index was significantly greater in group 2 than in group 1 during treatment. The stability of maxillary anterior alignment was 88.12% over the long term; 77% of the linear displacement of the anatomic contact points tended to return to their original positions. CONCLUSIONS Stability of maxillary anterior alignment between the 3 groups was similar. The stability of maxillary anterior alignment was high over the long term, but a high percentage of teeth tended to return to their original positions.
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Affiliation(s)
- Camila Leite Quaglio
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
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Olayemi AB. Assessment and determination of human mandibular and dental arch profiles in subjects with lower third molar impaction in Port Harcourt, Nigeria. Ann Maxillofac Surg 2011; 1:126-30. [PMID: 23482900 PMCID: PMC3591016 DOI: 10.4103/2231-0746.92775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM The aim of this study was to determine the normal size of the mandible and the difference in dental arch length and total teeth size space that is necessary to prevent lower third molar impaction. BACKGROUND The mandible is an important component of facial skeleton and its morphology is relevant to the determination of acceptable aesthetics. In addition, function of the dentition is dependent on the available space for positioning of all the teeth including the third molar, and for enough space to be created, the sizes of the mandible and dental arch must be within normal ranges. MATERIALS AND METHODS Impaction of the lower third molar was assessed by clinical evaluation and radiography. The total length of the mandible is determined by adding the distance between the midpoint of the tragus and soft tissue around the angle of the mandible to the distance between the angle and the soft tissue in the region of the chin. Mandibular width is the distance between the two angles of the mandible. The teeth sizes of the three anterior teeth, the two premolars, and the two molars were measured with a divider/ruler and recorded. The anterior-posterior distance of the arch from the midline to the retromolar pad was also measured. RESULTS There were 44 (53%) females and 39 (47%) males. Eighty-one (97.6%) of the participants were between 16 and 23 years old, while 2 (2.4%) were in the fourth decade. There were 38 (45.8%) cases of impaction and 45 (54.2%) cases of unimpacted mandibular third molar. The means/standard deviation values for mandibular length for males in each group are 18.20 ± 0.98 and 18.20 ± 1.13 cm, respectively. The values for mandibular length for females in each group are 17.20 ± 0.76 and 17.60 ± 1.07. There are significant differences between the genders for mandibular length (P < 0.05, 95% CI). The means/standard deviation values for mandibular width for both genders in each group are also shown. There are also significant differences between the genders for mandibular width (P < 0.05, 95% CI). Normal sized mandible should have a length within or above 17.22-19.33 cm in males and 16.44-18.67 cm in females, while normal dental arch-total teeth size difference range should be within or above 0.71-1.20 cm in males and 0.76-1.10 cm in females in order to accommodate a properly erupting third molar. CONCLUSIONS Based on these figures, clinicians may be justified to perform a preventive or therapeutic surgical removal of the impacted lower third molars of the postpubertal patients whose parameters fall below these set values. This study is also useful for evaluation of patients who would need orthognathic and reconstructive surgeries.
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Kandasamy S. Evaluation and management of asymptomatic third molars: Watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 2011; 140:11-7. [DOI: 10.1016/j.ajodo.2011.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lyotard N, Hans M, Nelson S, Valiathan M. Short-term postorthodontic changes in the absence of retention. Angle Orthod 2010; 80:1045-50. [PMID: 20677953 DOI: 10.2319/010210-7.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate short-term postorthodontic tooth movement without retention. MATERIALS AND METHODS Thirty consenting patients participated in the study. At the end of active treatment (T(1)), final archwires were removed while leaving the fixed appliances on, and alginate impressions were taken. Four weeks later (T(2)) a second set of impressions was taken. A clinical examination performed at T(2) determined if the fixed appliances could be removed or if additional treatment was required. Based on the examination, patients were divided into two groups. Patients in group I (n = 13) had their fixed appliances removed, while those in group II (n = 17) required additional treatment. The American Board of Orthodontics' Objective Grading System scores and the following six variables were measured on plaster casts at T(1) and T(2): maxillary and mandibular crowding or spacing, overbite, overjet, and mandibular intercanine and intermolar widths. Data were analyzed to detect potential changes from T(1) to T(2) and to evaluate differences between the groups. RESULTS Mandibular crowding, overjet, and interproximal contacts worsened for the entire sample, while marginal ridges, occlusal contacts, and total American Board of Orthodontics scores improved. No statistically significant changes were found within group I from T(1) to T(2). Mandibular crowding, overbite, overjet, alignment/rotations, and interproximal contacts worsened within group II from T(1) to T(2), while marginal ridges and occlusal contacts improved. Significant differences were noted between the groups in terms of alignment/rotations, interproximal contacts, and mandibular intercanine width. CONCLUSION Short-term postorthodontic tooth movement without retainers demonstrated improvement in specific characteristics of the occlusion but negatively affected alignment and interproximal contacts in the sample.
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Okazaki K. Relationship between initial crowding and interproximal force during retention phase. J Oral Sci 2010; 52:197-201. [PMID: 20587942 DOI: 10.2334/josnusd.52.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study investigated the change in interproximal force (IPF) in mandibular anterior teeth during retention and the relationship between the irregularity index before orthodontic treatment and the IPF. The effect that an erupting third molar had on IPF was also examined. Forty treated patients (40 with extraction of four bicuspids) were followed for 18 months during the retention phase. The irregularity index was determined from initial plaster casts. The total IPF was determined by measuring the interdental frictional forces at the mandibular anterior teeth by withdrawing a metal strip. The total IPF increased during the retention phase until 18 months, and there was a positive correlation between the irregularity index and total IPF 6 to 18 months after active treatment. An erupting third molar did not affect the total IPF. An increase in the total IPF may be an indication of relapse in mandibular anterior crowding. In conclusion, orthodontists should pay special attention to potential relapse in the lower anterior teeth 6 months after active treatment in cases with severe anterior crowding before treatment.
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Affiliation(s)
- Kumiko Okazaki
- Division of Applied Oral Sciences, Nihon University Graduate School of Dentistry, Tokyo, Japan.
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