Safer alternative for extraction of impacted supernumerary teeth of a patient in the mixed dentition stage with the aid of an image-guided operating system

Precise extraction of impacted supernumerary tooth in the maxillary anterior region with a digital guide plate: A case report

RATIONALE

Removal of impacted supernumerary teeth requires precision and accuracy to prevent iatrogenic injury to important anatomical structures during dental surgery and to improve postoperative healing.

PATIENT CONCERNS

A 12-year-old girl visited our department for the assessment and management of her deviated front teeth.

DIAGNOSIS

Impacted supernumerary tooth extraction in the maxillary anterior region.

INTERVENTIONS

The digital guide plate was fabricated after the integration of cone beam computed tomography data with that obtained from scanning the patient's dental model. Impacted supernumerary tooth extraction was performed.

OUTCOMES

The use of the digital guide plate and planting instruments made the removal of the impacted supernumerary tooth less invasive, faster, and more accurate, whereas the wound was smaller, and the patient experience more comfortable.

LESSONS

Combining the digital guide plate with planting instruments offers a useful aid for the removal of impacted supernumerary teeth among the maxillary anterior region and is, thus, worth promoting.

Application of a surgical guide in the extraction of impacted mesiodentes: a randomized controlled trial

OBJECTIVE

To explore and evaluate the application of a surgical guide in the extraction of impacted mesiodentes.

MATERIALS AND METHODS

Patients with impacted mesiodentes approachable from the labial side of the maxilla were randomly divided into three groups. The surgical guide for group I was made using cone beam computed tomography (CBCT) and dental cast, whereas the surgical guide for group II was only made using CBCT data. Group I and group II were first evaluated to determine whether guide use could accurately locate the cementoenamel junction (CEJ) of the mesiodentes, and the impacted mesiodentes were extracted with the help of the surgical guide. Group III underwent an operation without a guide. For all patients, the preoperative design time, tooth searching time, operation time, complications, and costs were measured.

RESULTS

The guides for group I and group II could locate the CEJ of the mesiodentes accurately, with good application effect during the operation. Group I and group II required additional preoperative design time compared with group III. However, the tooth searching time and operation time in groups I and II were significantly reduced compared with those in group III. Group I and group II showed no intraoperative complications, and two cases in group III showed imprecision during localization. The overall cost for group III was higher than that of group I or group II. But group I and group II required extra visits and costs.

CONCLUSIONS

Despite some limitations, the surgical guide assisted with mesiodentes extraction and can improve the quality of the operation quality as well as reducing its economic burden, difficulty, and duration. Through proper design, we can create a high-quality surgical guide using only CBCT data.

CLINICAL RELEVANCE

The surgical guide can be used as an important assistive tool in alveolar surgery.

[Application of digital positioning guide plate in extraction of impacted supernumerary teeth]

OBJECTIVE

To explore the application of digital positioning guide plate in extraction of impacted supernumerary teeth and evaluate its clinical efficacy.

METHODS

From March to August, 2019, 30 patients with labial impacted supernumerary teeth treated in the Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University were enrolled in this study. Fifteen of the patients were treated with digital positioning guide plate to remove the impacted supernumerary teeth (test group). According to the CBCT data and the dentition model of the patients, the positioning guide plate was positioned by avoiding the important anatomical structure with the tooth-bone surface as the support to design the soft tissue incision line and bone tissue exposure range. The other 15 patients who were treated without the use of the guide plate for operation served as the control group. The design time, tooth searching time, operation time and complications were compared between the two groups.

RESULTS

The positioning guide plate was well attached during the operation and allowed quick location of the supernumerary teeth while helping to expose the supernumerary teeth and avoid the damage of the adjacent important anatomical structures. The pre-operative design time was 50 ± 5 min in the test group and 0 min in the control group. The average time of tooth finding in the test group was 5±2 min, as compared with 10±3 min in the control group (t=15.40, P < 0.01); the average time of operation was significantly shorter in the test group than in the control group (25±4 min vs 45±6 min; t=35.50, P < 0.01). No intraoperative complications occurred in the test group, and slight deviation occurred in one case in the control group.

CONCLUSIONS

The application of digital positioning guide plate in extraction of embedded supernumerary teeth can significantly shorten the time of tooth finding, reduce the difficulty of operation, and improve the quality of operation.

Feasibility of a 3D Surgical Guide Technique for Impacted Supernumerary Tooth Extraction: A Pilot Study with 3D Printed Simulation Models

This study aimed to evaluate the feasibility of a 3-dimensional (3D) planned surgical guide technique designed for impacted supernumerary teeth (STs) extraction using 3D printed simulation models. In total, 17 participants from two university hospitals were recruited. Each participant performed surgery with both the conventional and surgical guide techniques. The following parameters were evaluated: (1) The time required for ST extraction, (2) the area of the window opening, and (3) the volume of the material removed. Time required for ST extraction was 213.65 ± 167.45 sec and 114.76 ± 42.87 sec in the conventional and surgical guide techniques, respectively, with significant differences (p = 0.028). The required area of the window opening was 48.10 ± 9.44 mm2 and 45.90 ± 8.17 mm2, respectively, in the conventional and surgical guide techniques, with no significant differences (p > 0.05). The required volume of the material removed was 121.65 ± 43.69 mm3 and 99.12 ± 17.88 mm3 in the conventional and surgical guide techniques, respectively, with significant differences (p = 0.031). The 3D planned surgical guide technique was effective for impacted ST extraction. Within the limits of this study, the surgical guide technique allows us to accomplish minimally invasive surgery within a shorter duration.