1
|
Zou QL, Tang ZQ, Huang LS, Wang XH, Bao ZX. Association between age, gender, and oral traumatic ulcerative lesions: a retrospective study. BMC Oral Health 2024; 24:536. [PMID: 38715009 PMCID: PMC11075228 DOI: 10.1186/s12903-024-04312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Oral traumatic ulcerative lesions (OTUL) are commonly encountered in clinical practice, yet there is limited research on their clinical characteristics and traumatic etiological factors. This retrospective study aimed to analyze the age, gender, clinical characteristics, and traumatic etiological factors in a large cohort of patients with OTUL and provide valuable insights for dental clinicians to optimize patient care and prevention strategies. METHODS A total of 1543 patients with OTUL were enrolled in this study. Age, gender, medical history, clinical characteristics and traumatic etiological factors were collected and analyzed. Logistic regression analysis was performed to determine the significance of age and gender as factors related to OTUL. RESULTS The study revealed significant variations in clinical characteristics and traumatic etiological factors among different age groups and between genders. Logistic regression analysis demonstrated that both age and gender were significant factors related to OTUL. CONCLUSION The clinical characteristics of OTUL and traumatic etiological factors appear to be significantly different according to age and gender. More targeted prevention strategies should be implemented for all age and gender groups.
Collapse
Affiliation(s)
- Qi-Lu Zou
- Department of Oral Medicine, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Dongfeng West Road 195, Guangzhou, 510182, China
| | - Zhi-Qun Tang
- Department of Oral Medicine, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Dongfeng West Road 195, Guangzhou, 510182, China
- Department of General Dentistry II, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, China
| | - Li-Shan Huang
- Department of Endodontology, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, China
| | - Xin-Hong Wang
- Department of Oral Medicine, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Dongfeng West Road 195, Guangzhou, 510182, China
| | - Zhe-Xuan Bao
- Department of Oral Medicine, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Dongfeng West Road 195, Guangzhou, 510182, China.
- Department of General Dentistry II, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Cardoso GB, Savegnago GDO, Hirsch WDB, Vizzotto MB, Liedke GS. Pathologic conditions associated with impacted third molars: A retrospective study of panoramic radiographs in a Southern Brazilian population. Imaging Sci Dent 2023; 53:303-312. [PMID: 38174038 PMCID: PMC10761288 DOI: 10.5624/isd.20230036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose This study investigated the prevalence of developmental and acquired pathologic conditions associated with impacted third molars (3Ms) in a Southern Brazilian population and evaluated whether demographic and tooth characteristics were correlated with the presence of bone or tooth lesions. Materials and Methods Panoramic radiographs were assessed for developmental (bone-related) or acquired (tooth-related) pathoses associated with impacted upper or lower 3Ms. Data on tooth positioning, tooth development, and patient demographics were collected. A trained, calibrated postgraduate student evaluated all images. Binary and multivariate logistic regression models were used to assess associations between outcomes and the demographic and radiographic variables. The threshold for statistical significance was set at 5% (P<0.05). Results The sample comprised panoramic radiographs from 2054 patients, predominantly female (59.2%), with a mean age of 27.2 ± 11.5 years. Overall, 4066 impacted 3Ms were evaluated, revealing 471 (11.6%) developmental and 710 (17.5%) acquired pathoses. Among the developmental pathoses, 460 (95.2%) were indicative of dentigerous cysts. Male sex, lower 3M location, vertical or distoangular positioning, and incomplete root formation were associated with an elevated likelihood of developmental pathology. Lower tooth position, complete root formation, and partial eruption were linked to an increased probability of an acquired pathology in the third or second molar. Conclusion The prevalence of pathologic conditions associated with impacted 3Ms was low. Male sex, lower 3M placement, horizontal or distoangular positioning, and incomplete root formation were associated with developmental pathoses, while lower tooth position, complete root formation, and partial eruption were related to acquired pathoses.
Collapse
Affiliation(s)
- Gabriela Brum Cardoso
- Dental Sciences Post-Graduation Program, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Mariana Boessio Vizzotto
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | |
Collapse
|
3
|
Blasi A, Cuozzo A, Marcacci R, Isola G, Iorio-Siciliano V, Ramaglia L. Post-Operative Complications and Risk Predictors Related to the Avulsion of Lower Impacted Third Molars. Medicina (B Aires) 2023; 59:medicina59030534. [PMID: 36984537 PMCID: PMC10051195 DOI: 10.3390/medicina59030534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.
Collapse
Affiliation(s)
- Andrea Blasi
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Alessandro Cuozzo
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Renata Marcacci
- Department of Oral Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy;
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
- Correspondence: ; Tel.: +39-095-378-2638
| | - Vincenzo Iorio-Siciliano
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| | - Luca Ramaglia
- Department of Periodontology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (A.B.); (A.C.); (V.I.-S.); (L.R.)
| |
Collapse
|
4
|
Ahmedi J, Agani Z, Ademi Abdyli R, Prekazi Loxha M, Hamiti‐Krasniqi V, Rexhepi A, Stubljar D. Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal. Clin Exp Dent Res 2023; 9:75-81. [PMID: 36245293 PMCID: PMC9932237 DOI: 10.1002/cre2.675] [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: 05/18/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars. MATERIAL AND METHODS Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7. RESULTS Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction. CONCLUSIONS Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.
Collapse
Affiliation(s)
- Jehona Ahmedi
- Department of Oral SurgeryUniversity of PrishtinaPrishtinaKosovo
| | - Zana Agani
- Department of Oral SurgeryUniversity of PrishtinaPrishtinaKosovo
| | | | | | | | | | - David Stubljar
- In‐medico, Department of Research and DevelopmentMetlikaSlovenia
| |
Collapse
|
5
|
Li K, Xu W, Zhou T, Chen J, He Y. The radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars. BMC Oral Health 2022; 22:642. [PMID: 36567318 PMCID: PMC9791750 DOI: 10.1186/s12903-022-02681-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The indication for removal of asymptomatic fully impacted third molars is still controversial. In this study, radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars was performed, aiming to provide a reference for clinical prophylactic extraction of these teeth. METHODS Patients with impacted mandibular third molars were included and the maximum width of the dental follicle around the crown was measured in horizontal, sagittal and coronal sections by cone beam computed tomography. The dental follicles were stained with haematoxylin-eosin, analysed by a pathologist and classified as normal, inflammatory or cystic. A Chi-squared test was used to analyse the association of the incidence of inflammation and cysts with the clinical variables of the impacted mandibular third molars. RESULTS Thirty-seven samples were normal dental follicles; 52 samples showed inflammatory infiltration with an incidence of 57.14%; 2 samples with a maximum dental follicle width of 2-3 mm were diagnosed as odontogenic cysts, and the incidence was 2.20%. There was no significant difference in the incidence of inflammatory and cystic dental follicles between males and females, or between different age groups (P > 0.05). With an increase of the maximum width of the dental follicle, there was a rise in the incidence and degree of infiltration of chronic nonspecific inflammation. CONCLUSION Asymptomatic impacted mandibular third molars tend to be extracted, especially for teeth with a 2-3 mm maximum width of the dental follicle on radiological examination.
Collapse
Affiliation(s)
- Kuncai Li
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Wei Xu
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Tiejun Zhou
- grid.488387.8Department of Pathology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junliang Chen
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Yun He
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| |
Collapse
|
6
|
De Sousa AS, Neto JV, Normando D. The prediction of impacted versus spontaneously erupted mandibular third molars. Prog Orthod 2021; 22:29. [PMID: 34568986 PMCID: PMC8473507 DOI: 10.1186/s40510-021-00376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate the predictive capacity of orthodontists and oral maxillofacial surgeons (OMFSs) in anticipating the process of impaction or eruption of lower third molars (L3Ms) through the examination of serial panoramic radiographs. Methods Sixty-eight lower third molars (L3Ms) were analyzed in 34 orthodontically treated patients without extraction. Twenty-seven OMFSs and 27 orthodontists were randomized in order to analyze the radiographs. Initially, the evaluators issued the prognosis for the L3Ms in XR1, a posterior for the XR1 + XR2. Concordance of the diagnosis was examined using Kappa statistics, and the differences between the groups of evaluators were examined using the chi-square test at p<0.05. Results When examining XR1 in cases where the teeth erupted spontaneously, the prognostic accuracy rate for OMFSs and orthodontists was similar, 63 and 65.7%, respectively (p=0.19). When evaluating XR1 + XR2, the accuracy among orthodontists (60%) was similar to that reported for XR1 (p=0.19), while OMFSs presented a reduction in the accuracy (55.3%, p<0.0001). When the L3Ms remained impacted, accuracy in XR1 was lower than in spontaneously erupting L3Ms, although similar between OMFSs (50.1%) and orthodontists (49.1%). Furthermore, for impacted L3Ms, when examining XR1 + XR2, the OMFSs presented a significant higher accuracy (71.8%, p <0.0001). Conclusions Orthodontists and OMFSs seem unable to predict spontaneous eruption or impaction of the lower third molars from single or longitudinal x-rays. When adding a second longitudinal x-ray, orthodontists and more significantly OMFSs tend to indicate more extractions.
Collapse
Affiliation(s)
- Amanda Silva De Sousa
- Department of Orthodontics, Faculty of Dentistry, Federal University of Pará, Belém, Brazil
| | | | - David Normando
- Department of Orthodontics, Federal University of Pará, Avenida Pedro Àlvares Cabral, 880, Apto 2500, Bairro Umarizal, Belém, Pará, CEP 66050400, Brazil.
| |
Collapse
|
7
|
Proteomic analysis of human dental pulp in different clinical diagnosis. Clin Oral Investig 2020; 25:3285-3295. [PMID: 33159586 DOI: 10.1007/s00784-020-03660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/27/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The present study aimed to identify proteins obtained from pulp tissue and correlate with each clinical diagnosis (healthy pulp, inflamed pulp, and necrotic pulp). MATERIALS AND METHODS A total of forty-five molars were used. Three biological replicas were evaluated. Lysis and sonication were used for protein extraction. Protein quantification was assessed by using the Bradford technique, and shotgun proteome analysis was performed by nanoUPLC-MSE using a Synapt G2 mass spectrometer. Mass spectra data were processed using the Waters PLGS software, and protein identification was done using the human Uniprot database appended to the PLGS search engine. RESULTS A total of 123 different proteins were identified in all evaluated pulp conditions. Among these, 66 proteins were observed for healthy pulp, 66 for inflamed pulp, and 91 for necrotic pulp. Most protein identification was related to immune response, multi-organism process, platelet activation, and stress in inflamed pulp samples compared to healthy pulp. Proteins related to cellular component organization or biogenesis, developmental process, growth, immune response, multi-organism process, response to stimulus, signaling, stress, and transport were identified in cases of apical periodontitis compared to inflamed pulp. CONCLUSIONS The progression of the disease to inflamed pulp promoted a high abundance of proteins related to the immune system and stress. Comparing the necrotic pulp with inflamed pulp conditions, a high abundance of proteins was noticed related to metabolism, transport, and response between organisms. CLINICAL RELEVANCE This finding may assist in future studies of new markers, understanding of tissue engineering, and development of future products.
Collapse
|
8
|
Prognosis for the impacted lower third molars: Panoramic reconstruction versus tomographic images. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:625-631. [PMID: 32981872 DOI: 10.1016/j.oooo.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this cross-sectional accuracy study was to compare panoramic reconstruction (PR) and multiplanar reconstruction (MPR) images, which are used to establish the prognosis for impacted mandibular third molars in relation to professional decision making. STUDY DESIGN Images of 10 patients who had undergone cone beam computed tomography (CBCT) examination were selected, resulting in 2 distinct groups of images, with 10 in each group: PR and MPR. To check prognostic accuracy, 2 images from each group were randomly selected and reinserted into the sample, totaling 24 images. A questionnaire was completed by 54 professionals: 27 orthodontists and 27 oral and maxillofacial surgeons (OMFSs). Data were evaluated by using the χ2 and McNemar's tests and Kappa statistics at P < .05. RESULTS There were no statistically significant differences when isolated PR images were compared with MPR images by orthodontists (P = .72) or OMFSs (P = .45). However, there were significant differences in the professional decision regarding the prognosis for impacted teeth, where OMFSs indicated the need for more extractions compared with orthodontists (P < .0001). CONCLUSIONS There are no differences between PR and multiplanar CBCT images with regard to the determination of the prognosis for impacted mandibular third molars. However, there was a difference in the decision making between the different specialties.
Collapse
|
9
|
Libdy MR, Rabello NM, Marques LS, Normando D. The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs. Dental Press J Orthod 2020; 25:68-74. [PMID: 32965389 PMCID: PMC7510487 DOI: 10.1590/2177-6709.25.4.068-074.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/25/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. METHODS 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). RESULTS The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). CONCLUSIONS Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.
Collapse
Affiliation(s)
| | | | - Leandro Silva Marques
- Universidade Federal dos Vales do Jequitinhonha e Mucuri,
Departamento de Ortodontia (Diamantina/MG, Brazil)
| | - David Normando
- Universidade Federal do Pará, Departamento de Ortodontia (Belém/PA,
Brazil)
| |
Collapse
|
10
|
Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, Renton T, Dickson R. Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-116. [PMID: 32589125 PMCID: PMC7336222 DOI: 10.3310/hta24300] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed. OBJECTIVE The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars. METHODS Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care. RESULTS The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group's lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out. LIMITATIONS Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking. CONCLUSIONS The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy. FUTURE WORK Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037776. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Juliet Hounsome
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Gerlinde Pilkington
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - James Mahon
- Coldingham Analytical Services, Berwickshire, UK
| | - Angela Boland
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Eleanor Kotas
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Tara Renton
- Oral Surgery, Dental Hospital, King's College London, London, UK
| | - Rumona Dickson
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| |
Collapse
|
11
|
SANTANA LG, PEREIRA TS, FERNANDES IB, SOUZA MMGD, PAIVA SM, RAMOS-JORGE ML, MARQUES LS. Impaction of mandibular third molars after orthodontic treatment by the edgewise method: a retrospective study. Braz Oral Res 2020; 34:e065. [DOI: 10.1590/1807-3107bor-2020.vol34.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/07/2020] [Indexed: 11/22/2022] Open
|
12
|
Hatami A, Dreyer C. The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex. Aust Dent J 2019; 64:302-311. [PMID: 31465537 DOI: 10.1111/adj.12716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/30/2022]
Abstract
The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.
Collapse
Affiliation(s)
- A Hatami
- Department of Orthodontics, School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia
| | - C Dreyer
- Department of Orthodontics, School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
13
|
Keyhan SO, Fallahi HR, Cheshmi B, Mokhtari S, Zandian D, Yousefi P. Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery? Maxillofac Plast Reconstr Surg 2019; 41:29. [PMID: 31448247 PMCID: PMC6682838 DOI: 10.1186/s40902-019-0212-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Background Reduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments. Methods To address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient's satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar's tests. Results The pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient's satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant. Conclusion Due to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.
Collapse
Affiliation(s)
- Seied Omid Keyhan
- 1Stem cell & Regenerative Medicine Network, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Fallahi
- 2School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,3Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Cheshmi
- Faculty of Dentistry, Boroujerd Islamic Azad University, Boroujerd, Iran
| | - Sajad Mokhtari
- 1Stem cell & Regenerative Medicine Network, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dana Zandian
- 2School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,3Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Yousefi
- 5Department of Prosthodontics, College of Dentistry, Isfahan University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Pilloud MA, Heim K. A Test of Age Estimation Methods on Impacted Third Molars in Males. J Forensic Sci 2018; 64:196-200. [DOI: 10.1111/1556-4029.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Marin A. Pilloud
- Department of Anthropology University of Nevada 1664 North Virginia Street Reno NV
| | - Kelly Heim
- Department of Anthropology University of Nevada 1664 North Virginia Street Reno NV
| |
Collapse
|
15
|
Study of Pathological Changes in the Dental Follicle of Disease-Free Impacted Third Molars. J Maxillofac Oral Surg 2018; 17:611-615. [PMID: 30344407 DOI: 10.1007/s12663-018-1131-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022] Open
Abstract
Background The prophylactic extraction of third molars is a common practice in dental offices, but divergent opinions are found in the literature regarding the indication of this procedure. The aim of the present study was to determine the prevalence of pathological changes associated with the pericoronal tissue of asymptomatic impacted third molars that could justify prophylactic extraction. Materials and Methods A cross-sectional observational study was conducted in which 109 pericoronal tissues with no radiographic evidence of pathology were histopathologically analyzed. The specimens were fixed in 10% formalin, embedded in paraffin, stained with hematoxylin and eosin and analyzed individually by two pathologists. Result The frequency of inflammatory infiltrate in the dental follicle of patients older than 20 years of age was significantly higher than that of younger patients (p = 0.004), demonstrating an association between inflammation in the dental follicle and patient age. The occurrence of squamous metaplasia was also greater in patients older than 20 years (p = 0.042), demonstrating that the prevalence of squamous metaplasia increases with age. A significant association was also found between inflammation and squamous metaplasia (p < 0.001). Conclusion Pathological changes may be present in the dental follicle of impacted third molars even in the absence of clinical or radiographic signs of disease.
Collapse
|
16
|
Abstract
OBJECTIVES The aim of this study was to evaluate available knowledge and identify knowledge gaps within the field of oral and maxillofacial surgery, by systematically collecting and evaluating systematic reviews. Twelve specific domains were selected: surgical removal of teeth, antibiotic and corticosteroid prophylaxis, orofacial infections, dental and facial trauma, orthognathic surgery, reconstructive surgery, benign tumors, cysts, premalignant lesions, oral complications of treatment of malignant tumors, hyperbaric oxygen therapy, temporomandibular joint surgery, cost effectiveness of different surgical treatments, and ethics. METHODS The literature search, covering four databases, was conducted during September 2014: PubMed, The Cochrane library, Centre for Reviews and Dissemination and EBSCO dentistry and oral science source. Retrieved systematic reviews were quality assessed by AMSTAR. RESULTS In all, 1,778 abstracts were identified, of which 200 met the inclusion criteria. Forty-five systematic reviews were assessed as of high to moderate quality. The results disclosed some existing evidence in a few domains, such as surgical removal of teeth and implant survival after sinus lifts. However, in all domains, the search revealed a large number of knowledge gaps. Also of concern was the lack of data regarding health economics and ethics. CONCLUSIONS In conclusion, there is a need for well-conducted clinical research in the fields of oral and maxillofacial surgery.
Collapse
|
17
|
Ryalat S, AlRyalat SA, Kassob Z, Hassona Y, Al-Shayyab MH, Sawair F. Impaction of lower third molars and their association with age: radiological perspectives. BMC Oral Health 2018; 18:58. [PMID: 29618350 PMCID: PMC5885350 DOI: 10.1186/s12903-018-0519-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 03/20/2018] [Indexed: 11/20/2022] Open
Abstract
Background Third molars are the most commonly impacted teeth, and their extraction is the most commonly performed procedure in oral and maxillofacial surgery. The aim of the present study is to describe the pattern of mandibular third molar impaction and to define the most appropriate age for prophylactic extraction of mandibular third molar teeth. Methods A total of 1198 orthopantomographs (OPGs) with 1810 impacted lower third molars were reviewed by two authors. The pattern of eruption in relation to patient’s age was examined using standard radiographic points and angles. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, IL, USA). Results In patients older than 20 years, vertical pattern of impaction was the most common (21.4%); while in young patients; horizontal impaction was more common (21.3%). Furthermore, there was a constant pattern of increase in Pell-Gregory ramus class 1 with increasing age, as the prevalence of class 1 was 0% at age 18 years compared to 54.9% at the age of 26 years. Conclusion Frequency of vertical impaction of lower third molars was seen more at an older age (> 20 years) in this study, with an increase in the retromolar space. Late extraction of mandibular third molar teeth (i.e. after the age of 20) is therefore recommended when prophylactic extraction is considered.
Collapse
Affiliation(s)
- Soukaina Ryalat
- Department of oral surgery, oral medicine, oral pathology, periodontics and oral radiology, faculty of dentistry, The University of Jordan, Amman, Jordan.
| | | | - Zaid Kassob
- Department of oral surgery, oral medicine, oral pathology, periodontics and oral radiology, faculty of dentistry, The University of Jordan, Amman, Jordan
| | - Yazan Hassona
- Department of oral surgery, oral medicine, oral pathology, periodontics and oral radiology, faculty of dentistry, The University of Jordan, Amman, Jordan
| | - Mohammad H Al-Shayyab
- Department of oral surgery, oral medicine, oral pathology, periodontics and oral radiology, faculty of dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- Department of oral surgery, oral medicine, oral pathology, periodontics and oral radiology, faculty of dentistry, The University of Jordan, Amman, Jordan
| |
Collapse
|
18
|
Al Fotawi RAM, Philip MR, Premnath SN. Assessment of the referral system for surgical removal of third molars at the Dental Faculty, King Saud University. Int Dent J 2017; 67:360-370. [PMID: 28771709 DOI: 10.1111/idj.12321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There is compelling evidence that prophylactic extraction of third molars is a health problem that needs to be addressed. In particular, the vast amount of evidence demonstrating complications after removal of third molars, rather than supporting the necessity of removal or the negative effects of retention, raise this concern. OBJECTIVE The aim of this study was to investigate the referral system for third molar extraction at our institution by assessing patient opinions and the experience of the oral surgeons and the referring dentists. The main outcome measures of concern were the reasons for third molar extraction, patient awareness about the surgery and the comorbidities that may accompany the surgery. METHODS Pilot cross-sectional survey questionnaires were distributed at the Dental Faculty Clinic at King Saud University, from 15 March 2015 to 30 June 2016 by the staff in charge of the patient waiting area, oral surgery clinic, primary care clinic and specialist clinic. RESULTS Of 400 potential respondents, 226 completed the survey (response rate: 54%). Of these patients, 91% knew why they had been referred to the oral surgery department, but 73.5% did not understand the surgical extraction procedure or its complications. In total, 45.2% of the patients referred had no signs or symptoms, and 36% were referred for prophylactic reasons. In conclusion, our system needs reassessment. To combat the subjective health practice of routinely referring patients for prophylactic extraction, the role of primary care should be emphasised by implementing a system for regular patient check-ups, and public awareness should be increased.
Collapse
Affiliation(s)
| | - Manju Roby Philip
- Oral and Maxillofacial Department, Dental Faculty, King Saud University, Riyadh, Saudi Arabia
| | | |
Collapse
|
19
|
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]
|
20
|
|