Evaluation and Management of Impacted Teeth in the Adolescent Patient

The Management of a Geriatric Patient Using Dabigatran Therapy on Dentigerous Cyst with Oral Bleeding

Jaw cysts represent a great matter of interest in oral and maxillofacial surgery. Jaw cyst surgery is a common intervention in oral surgery but, in the case of a multidisciplinary patient, the oral surgeon needs to meet with other specialists. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, and commonly few or no symptoms are reported. However, the most common diagnosis for dentigerous cyst is represented by eruption of the affected tooth or accidental diagnosis. Commonly, dentigerous cysts may be related to impacted third molars; in the case of impacted third molars and a dentigerous cyst, the tooth should be removed along with the cyst in the same intervention. Mandibular dentigerous cysts are common in children and adults, while dentigerous cysts are a rare neoformation in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with the mandibular nerve, and/or the patient has a medical history that may represent a relative or absolute contraindication. We present the case of a rare symptomatic manifestation of dentigerous cyst in an elderly patient in treatment with dabigatran therapy; for the treatment of dentigerous cysts in the elderly, we suggest a multidisciplinary approach with the use of the histological examination and a careful follow-up.

Relationship between the Status of Third Molars and the Occurrence of Dental and Periodontal Lesions in Adjacent Second Molars in the Polish Population: A Radiological Retrospective Observational Study

The aim of this study was to evaluate the effect of third molars on caries, external root resorption, and alveolar bone loss on the distal surface of adjacent second molars. A total of 2488 panoramic radiographs of adult Poles were evaluated. Third molars were classified, according to eruption status, into non-impacted, partially, or completely impacted, and according to angulation into horizontal, mesioangular, vertical, and distoangular. Completely impacted third molars were assigned as reference group. The odds ratios (ORs) and 95% confidence intervals for the occurrence of the above-mentioned pathologies were 1.39 (1.09-2.21), 6.51 (3.72-10.11), and 2.42 (1.22-4.09), respectively, for second molars with adjacent erupted third molars and 1.54 (1.11-2.82), 10.65 (7.81-20.19), and 5.21 (3.38-10.81), respectively, when partially impacted third molars were next to second molars. The ORs of lesions were significantly higher for horizontally and mesioangularly impacted third molars. Within the limitation of a radiological study, it might be concluded that the presence of erupted third molars is a risk factor for caries, while the presence of impacted third molars increases the risk of root resorption and bone loss on the distal surface of second molars.

Comparison of Efficacy of Coumarin and Chymotrypsin/Trypsin in Patients Undergoing Surgical Removal of Lower Third Molars: A Prospective Study

Background Third-molar surgeries are very commonly done by oral and maxillofacial surgeons. Pain and swelling that is associated with this procedure is a frequent reason for the patient's discomfort and apprehension. There is a need to look for a drug that can substantially reduce postoperative swelling amongst the patients. Pain, swelling, and trismus are common complications that are encountered after third molar surgery. These complications have a major impact on the quality of life of patients undergoing minor surgical procedures. Aim The aim of this study was to compare the effectiveness of coumarin and trypsin/chymotrypsin in the reduction of postoperative sequelae for mandibular third molar surgeries. Materials and methods The research was carried out at Saveetha Dental College and Hospital in the Department of Oral and Maxillofacial Surgery. The study consisted of 50 individuals, 25 individuals received tablets of coumarin, and 25 individuals received tablets containing a combination of trypsin/chymotrypsin postoperatively. Patients were evaluated postoperatively for pain and swelling. Postoperative pain was measured on days one, three, and seven after surgery using a visual analog scale. The postoperative swelling was measured on postoperative days three and day seven via a four-point technique. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). P-values less than 0.05 were considered statistically significant. The independent samples t-test was used to compare the outcomes between the two groups. Results It was found that study participants in the trypsin/chymotrypsin group reported statistically significantly less pain postoperatively than participants receiving coumarin (p=0.001). There was more reduction in swelling postoperatively in patients who were given trypsin/chymotrypsin as compared to the participants who were given coumarin, and the results were statistically significant. Conclusion Based on the data obtained, it can be inferred that the trypsin/chymotrypsin combination was more effective in reducing postoperative sequelae like pain and swelling than coumarin in the mandibular third molar surgeries.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps

BACKGROUND

As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery.

METHODS

Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2).

RESULTS

No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2.

CONCLUSIONS

Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Application of Cone Beam Computed Tomography in Risk Assessment of Lower Third Molar Surgery

Risks of lower third molar surgery like the inferior alveolar nerve injury may result in permanent consequences. Risk assessment is important prior to the surgery and forms part of the informed consent process. Traditionally, plain radiographs like orthopantomogram have been used routinely for this purpose. Cone beam computed tomography (CBCT) has offered more information from the 3D images in the lower third molar surgery assessment. The proximity of the tooth root to the inferior alveolar canal, which harbours the inferior alveolar nerve, can be clearly identified on CBCT. It also allows the assessment of potential root resorption of the adjacent second molar as well as the bone loss at its distal aspect as a consequence of the third molar. This review summarized the application of CBCT in the risk assessment of lower third molar surgery and discussed how it could aid in the decision-making of high-risk cases to improve safety and treatment outcomes.

[Dental implant placement in the area of ectopic and impacted teeth]

The paper presents two clinical cases demonstrating the effectiveness of using surgical templates for the installation of dental implants in the areas of ectopic and impacted teeth in case of patient's disagreement on their removal or other methods of treatment.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

A Scoping Review of the Efficacy of Diode Lasers Used for Minimally Invasive Exposure of Impacted Teeth or Teeth with Delayed Eruption

Background: The use of diode lasers for oral surgery soft tissue procedures is associated with less pain and bleeding, quick recovery, and better surgical site visibility. Objectives: This scoping review identifies and analyses the evidence evaluating the efficacy of the diode laser surgical exposure of impacted teeth or teeth with delayed eruption (both with no overlaying bone) vs. conventional scalpel surgical exposure. Materials and Methods: The PubMed/Medline, SCOPUS, and Google Scholar databases were searched up to January 2022 for randomized clinical trials and case-control studies comparing diode laser impacted-tooth surgical exposure vs. conventional surgical methods. Furthermore, the surgical exposure of an impacted mandibular canine or premolars with a 940 nm (InGaAsP) diode laser was presented. Results: The literature search revealed no high-quality evidence. However, four prospective studies were identified. Diode laser application was associated with less pain or analgesic need, minimal/no bleeding, and no need for suturing after surgery. The laser wavelengths used were 808, 810, 935, and 980 nm. A comparison of the study outcomes was not possible; all the studies had methodological issues and their funding sources were not mentioned. Conclusions: Adequately powered clinical trials are needed for comparing outcomes from diode laser surgical exposure vs. conventional methods, identifying the ideal laser characteristics, and assessing the long-term periodontal health of laser-exposed teeth and any potential risks.