Effects of Passiflora incarnata and Valeriana officinalis in the control of anxiety due to tooth extraction: a randomized controlled clinical trial

OBJECTIVE

This study evaluated the efficacy of Valeriana officinalis L. and Passiflora incarnata L. to control anxiety, surgical discomfort, and changes in vital signs of patients undergoing extraction of two unilateral third molars.

MATERIALS AND METHODS

This study is a randomized, triple-blinded clinical trial. Fifty-four patients were allocated into three groups (Valeriana officinalis L., Passiflora incarnata L., and placebo). Anxiety levels were assessed using the State-Trace Anxiety Inventory (STAI) index, surgical discomfort using the QCirDental, and through the measurement of vital signs. The surgical times evaluated were before (T0), during (T1), and after surgery (T2).

RESULTS

There was evidence that both Valeriana officinalis L. and Passiflora incarnata L., reduced STAY-S scores between T0 and T2 (p < .05), unlike placebo (p = .129). There was no change in surgical discomfort in all groups over time, and vital signs presented variable results.

CONCLUSION

Phytotherapy drugs showed a reduction in anxiety state compared to the placebo group during third molar extraction procedure.  CLINICAL TRIAL REGISTRATION: klRBR-6kcxvrc, March 10, 2022.

method in an orthopantomographic sample of subadults from South India

In forensic practice, medicolegal physicians are often tasked with estimating age using dental evidence. This calls for an uncomplicated, reliable, and reproducible method for dental age estimation, enabling physicians to proceed without specific odontological expertise. Among various dental methods, third molar eruption analyses are less complicated and easier to perform. In our study, we explored the effectiveness of Gambier et al.'s scoring system, which examines the eruption of all third molars. We retrospectively analysed 1032 orthopantomograms (528 males and 504 females) of individuals aged between 15 and 24 years. The mean chronological age increased with the progression of stages (1 to 3) and phases (A to D) of the third molar eruption for both sexes. In terms of stages, none showed significant discrimination between minors (<18 years) and adults (>18 years), especially for males. However, Gambier's phase D displayed a relatively high likelihood of being 18 years or older, with an overall 85.9 % of males and 95.7 % of females having all third molars in stage 3 being 18 years or older. While the tested method could be helpful in indicating the completion of the 18th year of life, caution is advised (due to a high percentage of false positives), and it should be used alongside other age assessment methods by experts.

Decision tree analysis for age estimation in living individuals: integrating cervical and dental radiographic evaluations within a South African population

Age estimation in living individuals around the age of 18 years is medico-legally important in undocumented migrant cases and in countries like South Africa where many individuals are devoid of identification documents. Establishing whether an individual is younger than 18 years largely influences the legal procedure that should be followed in dealing with an undocumented individual. The aim of this study was to combine dental third molar and anterior inferior apophysis ossification data for purposes of age estimation, by applying a decision tree analysis. A sample comprising of 871 black South African individuals (n = 446 males, 425 = females) with ages ranging between 15 and 24 years was analyzed using panoramic and cephalometric radiographs. Variables related to the left upper and lower third molars and cervical vertebral ring apophysis ossification of C2, C3, and C4 vertebrae analyzed in previous studies were combined in a multifactorial approach. The data were analyzed using a pruned decision tree function for classification. Male and female groups were handled separately as a statistically significant difference was found between the sexes in the original studies. A test sample of 30 individuals was used to determine if this approach could be used with confidence in estimating age of living individuals. The outcomes obtained from the test sample indicated a close correlation between the actual ages (in years and months) and the predicted ages (in years only), demonstrating an average age difference of 0.47 years between the corresponding values. This method showed that the application of decision tree analysis using the combination of third molar and cervical vertebral development is usable and potentially valuable in this application.

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis

OBJECTIVE

Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery.

MATERIALS AND METHODS

Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023.

RESULTS

Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively.

CONCLUSIONS

The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports.

CLINICAL RELEVANCE

The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

Prevalence of Impacted Teeth: A Radiographical Retrospective Rio de Janeiro Population-Based Study

Background

The early detection of impacted teeth is essential for the prevention of future malocclusions and possible lesions. The aim of this study is to assess the prevalence of impacted teeth and associated pathological lesions.

Methods

One thousand six hundred and two panoramic radiographs were analyzed for this retrospective study. The prevalence of impacted teeth, the presence of supernumerary teeth and cystic or tumoral lesions associated, and the type of angulation of third molars using Winter's classification were accessed. The descriptive statistics and the Chi-squared test were performed (P < 0.05).

Results

One thousand three hundred and ninety-seven panoramic radiographs fulfilled impacted criteria. A prevalence of 541 (38.7%) impacted teeth was observed, with the female gender significantly higher (P < 000.1). Of the total impacted teeth (n = 541), the overall mean impacted of lower third molars was 55.6%. Twenty-nine (5.3%) supernumerary teeth and four lesions were verified. The angulations most observed in the upper (76.6%) and lower (39.2%) third molars were vertical (P < 000.1) and mesioangulated (P < 000.1), respectively.

Conclusion

The impacted tooth prevalence was 38.7%, more common in females than in males. The lower third molars presented the highest prevalence of impacted, and the most common angulations were vertical and mesioangulated. Only four associated lesions were observed.

DENTAL AGE ESTIMATION USING THE RADIOGRAPHIC VISIBILITY OF PERIODONTAL LIGAMENT AROUND LOWER THIRD MOLARS AMONG SELECTED NIGERIANS

Background

Age estimation for sporting activities, legal age determination and migration purpose is oftentimes essential, which makes the need for a scientifically proven method of age estimation an important aspect of medical practice. Forensic odontology is an essential aspect of forensic practice and may be a veritable tool in age estimation.

Aim and Objective

The objective of this study was to evaluate the usefulness of orthopantomograms (OPG) in age estimation among selected Nigerians.

Methodology

A retrospective assessment of 202 OPGs was done to review the visibility of the periodontal ligament of third molars with completed root formation according to the methods described by Olze et al (2010). Individual ages were then calculated by deducting date of exposure from the date of birth recorded in years. Mean age with standard deviation were calculated for each group.

Results

Assessing the minimum and maximum age at which each of the stages of the radiographic visibility of the periodontal ligament as seen on the OPGs revealed that there was a gradual increase in the age at which the stage increment occurred, with a few exceptions. Comparison of the radiographic visibility of the periodontal ligament revealed that males tend to achieve early periodontal visibility stages compared to females, but the reverse was observed in later stages. Age 17 is more than likely attained in any person found within stages 1 to 3 as the minimum age found in these stages were above 17 years.

Conclusion

With a few exceptions, the assessment of periodontal ligament visibility on OPGs can adequately predict the age of individuals. Thus, the use of this method may need to be combined with other methods in accurate determination of dental age in instances of forensic age estimation.

Radiological evaluation of inferior alveolar nerve displacement after removal of impacted mandibular third molars prior to sagittal split osteotomy

INTRODUCTION

We hypothesize that the removal of mandibular third molars (M3) 6 months prior to a bilateral sagittal split osteotomy (BSSO) could allow the displacement of the inferior alveolar nerve (IAN) in a favorable lingual position. This study aimed to radiographically compare the position of IAN before and after M3 removal in patients with Class II malocclusion.

MATERIALS AND METHOD

The CBCT images of 30 randomly selected patients (mean age 15.5 years, 19 females and 11 males) were segmented regarding the mandibular bone and the IAN canal. Mandibles were then superimposed and compared using 3D slicer (www.slicer.org). An orthonormal system was constructed, and the coordinates of IAN were assessed in the x- (horizontal axis), y- (depth axis), and z- (vertical axis) directions.

RESULTS

The mean changes in x- and z-values were 0.37 %, -0.09 % for the right IAN, 0.07 %, and -0.10 % for the left IAN, respectively. Y-axis was the dimension the most impacted by the M3 removal with a mean variation of -11.96 % for the right IAN, and 0.45 % for the left nerve (p1=0.74 and p2=0.04, respectively). Three patients presented a change in the IAN position superior to 1 mm on at least one coordinate axis. We observed a more important change in x-values of the right IAN in male than in female (p = 0.04), and no significant modifications regarding the other dimensions. Finally, there was no correlation between the age of the patients and the changes in IAN position.

CONCLUSION

This study confirms the absence of influence of mandibular third molar removal on the inferior alveolar nerve route prior to BSSO.

Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography

OBJECTIVES

To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference.

METHODS

CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05).

RESULTS

The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN.

CONCLUSIONS

The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal.

CLINICAL RELEVANCE

Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks.

An observational analysis of risk factors associated with symptomatic third molar teeth

BACKGROUND

Third molar teeth (wisdom teeth) are a common cause of pain and infection in young adults. The study aimed to describe the prevalence of symptomatic third molar teeth and identify factors which predispose to third molar symptoms in a birth cohort.

METHODS

An observational study was undertaken nested in the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth cohort based in south west England. The main outcomes were self-reported third molar pain, swelling and treatment for third molar problems, taken from questionnaires completed at age 23 years. The exposures including sex, dental history, socioeconomic status, diet, and genetic factors were obtained from earlier ALSPAC data.

RESULTS

In total 4,222 ALSPAC participants responded to one or more questions about third molar teeth. The final sample included more female participants than male participants. The majority of participants (56.6%) reported at least one episode of pain associated with their third molars. Females had greater odds than males of reporting swelling (adjusted odds ratio (OR) 1.97; 95%confidence interval (CI) 1.56, 2.51), pain (adjusted OR=1.96; 95%CI 1.56, 2.51) and receiving both non-surgical and surgical treatment (adjusted OR=2.30; 95%CI 1.62, 3.35, adjusted OR=1.54; 95%CI 1.17, 2.06 respectively). Participants with previously filled teeth had greater odds of third molar extraction. There were no strong associations between index of multiple deprivation (IMD) score or sugar intake and the third molar outcomes. There was weak evidence for a genetic contribution to third molar pain.

CONCLUSIONS

Symptomatic third molars are common in this age group, with over half of the participants reporting pain or other symptoms. Female participants had greater odds for third molar pain, swelling and treatment.

Early pathological changes of peri-coronal tissue in the distal area of erupted or partially impacted lower third molars

AIM

This study was performed to histologically evaluate peri-coronal tissues of partially impacted and erupted third molars that did not exhibit pathologic peri-coronal radiolucency.

MATERIALS AND METHODS

Healthy patients with erupted or partially erupted (with part or all of the dental crown present in the oral cavity) mandibular third molars (classified as IA and IIA according to the Pell and Gregory classification) and vertically positioned (according to the Winter classification or erupted third molars) associated with peri coronal radiolucency of equal to or less than 2.5 mm. Associated with third molar surgery, tissue sampling from the distal area was performed, which was subjected to an anatomopathological examination to determine the histological nature.

RESULTS

One hundred teeth (100 patients) were selected, and 100 specimens were analyzed. 53% of the sample were included in the non-pathological group and 47% showed pathological changes (fibrotic tissue (n 15), periodontal cyst-like (n 9), squamous epithelial metaplasia (4 cases), islands of odontogenic epithelial residues organized micro-cyst with keratocystic/ameloblastic appearance (4 cases), granulation tissue (n 8), giant cell tumour (n 4) and lobular capillary hemangioma (n 4)). Pathological changes did not have differences in incidence between the gender (p value = 0.85) and did not show any correlation with age, (p value = 0,96).

CONCLUSIONS

These findings suggest that radiographic appearance may not be a reliable indicator of the absence of disease within a dental follicle. Therefore, clinicians should pay attention to or follow up on even peri-coronal radiolucency of less than 2.5 mm.

Early root migration after a mandibular third molar coronectomy

PURPOSE

This prospective cohort study aimed to assess early root migration after a coronectomy of the mandibular third molar at 2 and 6 months after surgery.

METHODS

We included all patients treated with a coronectomy of an impacted mandibular third molar. The primary outcome measure was the extent of postoperative root migration after 2 and 6 months. Migration was measured as the distance between the root complex and a fixed point on the inferior alveolar canal. The secondary aim was to identify factors (age, impaction pattern, and patient sex) that affected the extent of root migration.

RESULTS

One hundred and sixty-five coronectomies were performed in 141 patients (96 females and 45 males; mean age 33.1 years, SD 16.0). The 2-month checkup was completed by 121 patients that received 141 coronectomies. The 6-month check-up was completed by 73 patients that received 80 coronectomies. The mean root migrations were 3.30 mm (SD 2.53 mm) at 2 months and 5.27 mm (SD 3.14 mm) at 6 months. In the 2-6-month interval, the mean root migration was 2.58 mm (SD 2.07 mm). The extents of migration were similar during the 0-2-month interval and the 2-6-month interval (p = 0.529). Younger age was associated with greater root migration, and females experienced significantly greater migrations than males (p = 0.002).

CONCLUSION

Roots migrated more rapidly in the first two postoperative months, compared to the 2-6-month interval. Age was negatively correlated with the extent of root migration, and females showed significantly greater migrations than males.

Third molar position after completion of orthodontic treatment: a prospective follow-up

OBJECTIVES

To prospectively follow up a previously reported sample, analyzing (1) changes in third molar (M3) position after completion of 2 different types of orthodontic treatment: (2) non-extraction treatment with (HG) vs without cervical headgear (non-HG) and (3) first or second premolar extractions (PM1-2) compared to a non-extraction group (NE).

METHODS

A total of 474 patients were prospectively followed up. Panoramic radiographs were taken pre- (T1), post-treatment (T2) and at follow-up (T3). T3 records (a mean of three years after treatment) were available for 135 (HG vs non-HG) and 134 patients (PM1-2 vs NE), respectively. Angulation, vertical position, relation with the mandibular canal and mineralization status of M3 at T2 and T3 were statistically compared.

RESULTS

The HG group presented more M3 with ideal vertical orientation at T3. In NE-cases, further improvement in angulation and orientation can be expected after debonding, as well as a deterioration in the relationship with the mandibular canal. Extractions accelerated upper M3 vertical eruption and PM2 extractions led to long-term larger lower retromolar spaces.

CONCLUSIONS

The use of cervical headgear increased upper M3 uprighting three years after debonding, while little changes in M3 position were found after orthodontic treatment with extractions. However, PM2 extractions led to larger retromolar spaces and better M3 angulation in the long term.

Effect of orthodontic extraction of mandibular premolars on third molar angulation after treatment with fixed appliances : A cross-sectional study

PURPOSE

Orthodontic treatment involving premolar extractions might improve the angulation of lower third molars, which are the teeth most often impacted. This study analyzes the impact of first/second lower premolar extraction during orthodontic therapy on the angulation of mandibular third molars.

METHODS

A total of 120 patients treated non-extraction (n = 40), with extraction of first (n = 40), or second lower premolars (n = 40) were included. The mesiodistal angulation of lower third molars relative to the adjacent tooth and their developmental stage were evaluated from posttreatment orthopantomograms. Between-group differences were statistically evaluated at a significance level of 0.05.

RESULTS

The orthopantomograms of 120 patients (51% female) with a median age of 15.2 years at the time of debonding were evaluated after a mean treatment duration time of 2.9 years. No difference (P > 0.05) was seen between the average angulation of the lower third molars of the right (mean = 24.4°, standard deviation [SD] 13.6°) and the left side (mean = 23.6°, SD 14.1°). No differences in the angulation of the lower third molar were found between the non-extraction and extraction groups for the right (P = 0.44) or the left side (P = 0.22). Likewise, no differences were found when comparing the first and second premolars for the right (P = 0.26) or the left side (P = 0.10). Premolar extraction was associated with an advanced root development stage of the right third molar (odds ratio 7.1; 95% confidence interval 1.1-48.1; P = 0.04), with no differences between extraction of the first or second premolar (P = 0.10).

CONCLUSION

Orthodontic treatment involving premolars extractions might be associated with a small acceleration in root development, but not with the angulation, of lower third molars.

Influence of inflammation on bleeding and wound healing following surgical extraction of impacted lower third molars

OBJECTIVE

This study aimed to investigate the effect of inflammatory states following impacted lower third molar (ILTM) surgery regarding postoperative bleeding and wound healing.

METHODS

The study included patients who underwent extraction of ILTMs associated with or without inflammatory conditions. Post-extraction bleeding and wound healing were assessed. In addition, mean grey values (MGVs) of alveolar bone and bone height using an orthopantomography radiograph were analyzed.

RESULTS

A total of 376 patients were enrolled; 171 pericoronitis, 51 pulpitis, 44 chronic periapical periodontitis, 36 chronic periodontitis, and 74 control. The bleeding score in the control group was significantly lower than in the periapical periodontitis and periodontitis groups. Excellent wound healing for control, pericoronitis, pulpitis, periapical periodontitis, and periodontitis groups was (78.38%, 35.67%, 70.59%, 70.45%, and 33.33%, respectively). Patients with pericoronitis and periodontitis had significantly poorer wound healing (P < 0.01). The MGV in periapical periodontitis and periodontitis was considerably lower than in the control group.

CONCLUSIONS

The inflammatory conditions associated with ILTMs increase the risk of bleeding. So suturing with the placement of local hemostatic agents over a pressure pack alone is recommended. The poorest wound healing was in localized gingival inflammation. Furthermore, MGV was affected by age and was lower with periapical periodontitis.

Efficacy of submucosal injection of hyaluronidase after mandibular third molar surgery: a randomized controlled trial

Objectives

This study aimed to investigate the efficacy of postoperative submucosal injection of hyaluronidase (HUD) for reducing sequelae and quality of life (QOL) after mandibular third molar (M3M) surgery.

Materials and Methods

Participants with bilateral impacted M3M underwent surgical extraction with a split-mouth randomized controlled study design. M3M were removed by the same surgeon in 2 sessions, one a control and the other experimental. Submucosal injection of HUD was performed in the experimental session and submucosal injection of saline in the control session. Mouth opening, facial swelling, and pain intensity were measured before surgery, and then 2 and 7 days after surgery. The QOL of participants following surgery was evaluated by means of a patient-centered outcome questionnaire (PCOQ).

Results

A total of 36 patients was included in the final data analysis. There was a significant reduction in the maximal mouth opening and postoperative pain in the experimental side at the 2 and 7 days after surgery (P<0.05), and a remarkable difference in facial swelling was reported on the experimental side 7 days after surgery (P<0.05). The PCOQ demonstrated that participants reported less pain and swelling on the experimental side.

Conclusion

The present study provides clinical evidence that submucosal administration of HUD immediately after M3M surgery reduced postoperative discomfort and improved patients' QOL.

The radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars

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.

[Surgical placement of third molars to replace other teeth: “spare wheels”]

Introduction

The prognostic improvement for dental auto-transplants is the result of a better understanding in the physiopathology of the periodontium and also of the refining of the technical operative procedure. This fact allows the use of third molars as donor site for the replacement of absent, or first or second badly decayed molars.

Discussion

This possible therapy is a supplement argument for the conservation of third molars and their extraction must be indicated only when the anatomic situation presents a pathological risk.

Results

If, in adults, it is possible to compare the advantages and disadvantages with the classical implant or prosthetic techniques, it should however be considered as first choice therapy for adolescents and young adults. Indeed, in these cases, the lower risk of root ankylosis avoids passive intrusion and the osteogenic effect of the desmodontium allows normal alveolar bone formation.

Angular and positional changes of the maxillary third molars after orthodontic treatment with different premolar extraction patterns

OBJECTIVES

To evaluate the angular and positional changes of the maxillary second (M2) and third molars (M3) after orthodontic premolar extraction treatment according to patient skeletal classification and growth pattern.

MATERIALS AND METHODS

Panoramic radiographs of patients treated with extraction of the first or second premolars (n = 116) and patients treated without extraction (n = 92), taken before orthodontic treatment (T0) and after completion of multibracket appliance therapy (T1) were analyzed. Angle classification, growth pattern, crowding, and incisor inclination were recorded. The palatal (PP) and interorbital planes (IOP) were used as reference lines. Changes in the M3 angulation relative to PP and IOP (T0-T1) within the same group were evaluated with paired t-tests. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used for comparisons between the groups. Accordingly, pairwise comparisons were performed with Mann-Whitney U-tests or independent t-tests (P < .05).

RESULTS

The M3 angulation related to the PP and the IOP did not differ significantly between the extraction and nonextraction groups. The M2 angulation improved in the premolar extraction group between T0 and T1 (M2/PP, P < .001). According to Archer's classification, the change in the vertical position of M3 differed significantly between the extraction and nonextraction groups (P < .001).

CONCLUSIONS

The angulation of M3 improved over time regardless of the extraction decision. The vertical eruption pattern of M3 was positively influenced only in the extraction group. M2 became significantly more upright in the orthodontic extraction treatment groups.

A test to study the influence of impaction on mandibular third molar development and forensic age estimation in a sample of south Indian children and young adults

It has been argued that the impaction of the third molars could result in delayed maturation, which, in turn, could affect age estimations in criminal proceedings. In view of this, the present study was undertaken to determine whether the impaction status could delay the chronological process of third molar mineralization in a sample of south Indian children and young adults. The orthopantomograms (OPGs) of 915 children and young adults of south Indian origin aged between 15 and 22 years were evaluated. Mineralisation stage and impaction status were determined for all lower third molars. Descriptive statistics were performed at stages D to H of Demirjian staging system. The results of independent t-test show that the impaction resulted in statistically significant slower mineralization in impacted lower third molars at stages D to F in both sexes. It was ascertained that the mean ages with the impacted lower third molars at stage G were 0.98-1.38 years higher in males and 0.50-0.80 years higher in females than those with non-impacted lower third molars. For stage H, the mean ages were 0.14-0.21 years higher in males and 0.25-0.44 years higher in females. The probabilities of being 18 years and above is higher for non-impacted lower third molars at stages G and H than those with impacted ones. It is concluded that the impaction could result in delayed maturation in the lower third molars of the studied sample. Further studies are warranted in a more diverse sample.

Do upper third molars provide more accurate age estimation in the adult based on the pulp-to-tooth ratio than lower third molars? A cone-beam CT study

Introduction

Age-at-death estimation is an essential part of the identification process of individuals in many forensic dentistry cases where identity of the individual cannot be resolved by visual recognition or other means. Dental age estimation in adults is more of a challenge as most teeth complete their development by the age of 18 years.

Aim

This study aims at using the mesio-distal (MD) pulp-to-tooth ratio taken at the cervix of upper third molars (UM3) to estimate age at the time of radiographic imaging.

Materials and Methods

A set of 135 Cone-beam computed tomography (CBCT) radiographs of UM3s for a random sample of 135 Jordanian adults (65 females, 70 males; age range = 18–63 years, mean age = 34.4 years, SD = 11.2 years) were used. Both pulp and tooth MD diameters were measured at the cervix. MD pulp-to-tooth ratios for UM3s were correlated with age.

Results

Statistically significant negative moderate correlation was found between the age of the individual and the cervix MD pulp/tooth ratio (r = −0.516). This indicates that only 26.6% of the variation in age can be explained by the cervix MD pulp-to-tooth ratio.

Conclusions

This study concludes that cervix MD pulp-to-tooth ratio of UM3s, although apparently stronger than that of lower M3s (r = −0.361), is not a sufficiently reliable estimator of age in adults, and this is perhaps attributed to the greater variability in the time line of third molars development.

The wisdom behind the third molars removal: A prospective study of 106 cases

Purpose

This paper aims to evaluate the decision-making of wisdom teeth extractions (M3s extraction) and the epidemiological profile in the targeted population.

Materials and method

This was a prospective analysis study of 106 patients at our hospital august 20, 1953 specialist hospital, which is a referral center between January 1, 2020 and January 1, 2021. The patients are divided into 2 groups according decision-making of wisdom teeth removal based on scientific evidence if it's right or wrong.

Results

There was no statistically significant difference between the groups regarding sex (P = 0.478), educational level (P = 0.718), or working status (P = 0.606). Furthermore, there was no statistically significant difference between the groups regarding general co-morbidity (P = 1.00) or oral history (P = 0.28). The mean age of the sample was 32.12 years (SD = 11.337 years, range = 17–70 years, median = 30 -years). We reported that only 28% of the third molars were surgically extracted. We included in Group (I), 81 patients who were treated for third molars removal which the decision-making was justified. In Group (II), 25 patients were treated for third molars removal which the decision-making was unjustified. Group (I) comprised 30 men and 51 women with a mean age of 30 years. Group (II) comprised 7 men and 18 women with a mean age of 27 years. The assessment of surgical outcomes (operating time, blood loss, hospital stay) showed no difference between groups.

Discussion

Monitoring asymptomatic wisdom teeth appears to be an appropriate strategy. Regarding retention versus prophylactic extraction of asymptomatic wisdom teeth, decision-making should be based on the best evidence combined with clinical experience.76.4% had a reason for extraction that was justified. The reasons why extraction of the wisdom tooth was not justified in our study population was either: extraction for prophylaxis or in the case of asymptomatic non-pathological third molars; without scientific evidence.

Conclusion

This subject, which is perpetually debated, requires updating dental health authorities by evaluating new conservative procedures.

•

Third molars are a major focus of interest in dentistry.

•

Preliminary indication and wrong decision-making for teeth extraction have resulted in many healthy teeth being sacrificed.

•

Debate continues about the best strategies for the management of wisdom teeth.

Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis

OBJECTIVES

The aim of this study is to verify whether the diagnostic accuracy of cone beam computed tomography (CBCT) is superior to panoramic radiography (PR) in predicting inferior alveolar nerve (IAN) exposure during the lower third molar extraction.

MATERIALS AND METHODS

Eight electronic databases were searched up to September 2020. Studies that evaluated the accuracy (sensitivity, specificity, positive-predictive value, and negative predictive value) of both imaging methods were included. The gold standard was the visualization of the IAN exposure during the extraction of lower third molars. The gray literature was also used to include any other paper that might meet the eligibility criteria. The meta-analysis was performed with OpenMeta-Analyst and ReviewManager v.5.3 software. The methodology of the studies was evaluated using QUADAS-2.

RESULTS

Among the search, three studies met all the eligibility criteria and were included in the qualitative and quantitative synthesis. The meta-analysis was conducted with all included studies. Accuracy values for CBCT were 95.1% for sensitivity (p=0.666) and 64.4% for specificity (p<0.001). For PR sensitivity and specificity, we observed 73.9% (p=0.101) and 24.8% (p<0.001), respectively.

CONCLUSIONS

Both exams were reliable for detecting positive cases of exposure of the IAN. However, CBCT had a better performance compared to PT in predicting IAN exposure during surgery.

CLINICAL RELEVANCE

To better understand the CBCT accuracy in predicting the IAN exposure during surgery, since this event can increase the likelihood of IAN injury and, consequently, cause neurosensory disturbances.

Surgical experience and patient morbidity after third molar removal

OBJECTIVES

The present study aimed to assess differences in patients' postoperative morbidity after third molar removal in relation to the surgeon's level of experience and other intraoperative factors.

MATERIAL AND METHODS

Patients admitted for prophylactic removal of asymptomatic third molars were prospectively followed up on day 3 and 10 after surgery in the context of the M3BE-study. Uni- and multivariable logistic regression was performed to assess the associations between surgeon's (in)experience and postoperative discomfort. Other contributing factors were gender, age, extraction method (osteotomy or not), and number of extractions and involved jaws.

RESULTS

In total, 7 senior surgeons and 28 surgical residents operated 2560 patients (8672 third molars). Differences in postoperative morbidity on day 3 and 10 after surgery were small. The results showed no significant associations between surgeon's inexperience and postoperative discomfort (pain, trismus, swelling), except for persistent pain (day 10; OR 1.468; p = 0.0016). No effect was observed on the occurrence of postoperative nerve complications. It was shown that postoperative morbidity was more dependent on factors like age, gender, number of extractions and intraoperative osteotomy.

CONCLUSION

We may conclude that patient recovery following third molar removal is affected by other factors than surgical experience. However, surgical residents seemed to cause significantly more persisting pain problems 10 days after surgery.

Third molar agenesis in modern humans with and without agenesis of other teeth

Background

The number of teeth in the human dentition is of interest both from developmental and evolutionary aspects. The present case-control study focused on the formation of third molars in modern humans aiming to shed more light on the most variable tooth class in the dentition.

Materials and Methods

For this reason, we investigated third molar formation in a sample of 303 individuals with agenesis of teeth other than third molars (agenesis group) and compared it to a sex and age matched control group of 303 individuals without agenesis of teeth other than third molars.

Results

The prevalence of third molar agenesis in the agenesis group was 50.8%, which is significantly higher than the 20.5% in the control group (p < 0.001). The chance of a missing third molar in the agenesis group was increased by 38.3% (p < 0.001), after controlling for the agenesis in other teeth factor. When considering the amount of missing third molars per individual, a clear tendency towards more missing third molars was evident in the agenesis group compared to the control group. The frequency of bilaterally missing third molars in the agenesis group was 29% in the maxilla, as well as in the mandible, which is about three times higher than the frequency of unilaterally missing third molars (p < 0.001). In the control group, bilaterally missing third molars occurred in 8.6% in the maxilla and 8.9% in the mandible.

Conclusion

The present results indicate that genetic factors involved in tooth agenesis affect also the dentition as a whole. Furthermore, the third molars are more vulnerable to factors involved in agenesis of other teeth and they are more often affected as a whole. These findings seem to be associated with the evolutionary trend in humans towards reduced molar number.

Alveolar iodine tampon packing after impacted third molar surgery improves oral health-related quality of life and postoperative sequela: a randomized study

Objective

The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar.

Material and methods

Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort.

Results

This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort.

Conclusions

Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.

A new model of classification of third molars development and its correlation with chronological age in a Brazilian subpopulation

The present study correlated the mineralization of third molars to chronological age using a modified classification based on Demirjian's stages in a Brazilian subpopulation and compared with the original classification. A total of 1082 patients with age ranging from 6 to 26 years were included in the sample, with at least one third molar on panoramic radiographs. The third molars were classified according to the original Demirjian classification (8 stages) and a new model based on the Demirjian method, where the original stages were grouped into four stages: AB-enamel mineralization; CD-crown dentin mineralization; EFG-root formation; and H-complete development. Statistical analyses were performed by Kruskal-Wallis/Dunn tests (α = 0.05) and the multinomial logistic regression model. Data were analyzed according to percentiles for the probability of an individual being over 18 years old. The mean ages of the stages in both classifications did not present a significant difference between superior and inferior arches (p < 0.05). The differences in mean ages between all the stages of mineralization were statistically significant (p < 0.001) only for the 4-stage classification. Males attained root formation and complete formation earlier than females (p < 0.05) in the 4-stage classification. The modified classification system showed dependence between chronological age and mineralization stages of third molars, simplifying the age estimation process. At stage H, females present a 95.7% chance of being over 18, while for males, this probability is 89.6%. This modified classification system simplifies the dental age estimation process based on third molars and can be used as a reference for future studies.

Accidental displacement of mandibular Third molars into the submandibular space - Two case reports, a suggested surgical approach and management algorithm

Displacement of a mandibular third molar into a fascial space is a relatively rare event with potentially serious complications. The surgical procedure to remove a displaced tooth, or part thereof from these spaces may be difficult due to poor access and an abundance of vital structures within these spaces. Here, we present two cases of submandibular displacement, suggest an intra-oral approach and algorithm to help guide practitioners with management of displaced third molars in the submandibular space.

Correlation Between Height and Impacted Third Molars and Genetics Role in Third Molar Impaction

Aim

This study sought to evaluate the relationship between height of an individual and the presence of impaction of maxillary and mandibular third molars, and to determine the role of genetics in third molar impaction.

Materials and Methods

This was a case-control study, with cases consisted of 200 subjects with third molar impactions; and 200 controls without third molar impactions. Height of subjects was measured, and saliva samples were collected from all the subjects. DNA was extracted from saliva samples. To investigate the role of selected genes in the etiology of third molar impactions, Taqman Genotyping using SNPs identified for jaw growth, height and tooth agenesis was employed. Five candidate genes were investigated using 11 markers (SNPs).

Results

The mean height of cases was significantly lower than that of the control subjects (p = 0.04). No difference was found in allele frequency between cases and controls for 10 of the 11 SNPs. However, for rs6504591 the p value was near significance (p = 0.07) with odd ratio of 2.131. Subjects with lower third molar impactions were significantly shorter than those who have fully erupted third molars.

Conclusions

Subjects with lower third molar impactions were significantly shorter than those who have fully erupted third molars. We observed that individuals with third molar impaction tend to have T allele at the locus, suggesting that the T allele at the locus may increase the risk for having an impacted third molar. The rs6504591 G/T variation on human chromosome 17 (WNT9B gene) appears to increase risk by twofolds for impaction albeit with inability to detect significance due to small sample size.

Examination of regressive features of third molars for the purpose of age assessment in the living by means of rescaled regression analyses

The main criterion of dental age assessment in living adolescents and young adults is the evaluation of third molars' mineralization. Concerning forensic age assessment after the completion of third molars' mineralization, apposition of secondary dentine and narrowing of the periodontal membrane as seen as decreasing radiolucent areas in the radiographs for mandibular third molars have already been described as regressive features. The present study examines the combination of both these features for the purpose of age assessment in regression analyses after rescaling the data to make it on the interval scale. To this end, a total of 1245 orthopantomograms was evaluated, taken from 606 females and 639 males in the age group of 15-40 years. The apposition of secondary dentine and narrowing of the periodontal membrane as seen as decreasing radiolucent areas in the radiographs were determined for the lower third molars. The correlation of the features with the chronological age was assessed by means of rescaled regression analyses. Furthermore, regression formulas for age assessment were established. The values of the standard error of estimate ranged between 3.55 and 4.52 years. In general, the rescaled regression of the examined features appears to be suited for forensic age assessment. A limitation of the present study is the comparatively low number of evaluable teeth in the examined age group. Due to an incomplete development or a lack of the mandibular third molars, only a mere half of the respective teeth could be included in the statistical analysis.

Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis

PURPOSE

The aim of this study was to evaluate the influence of cyclobenzaprine and dexamethasone on ​the electrical activity of the masticatory muscles in patients who had undergone lower third molar surgery.

METHODS

Thirty bilateral impacted lower third molars with indication of extraction were randomised into three groups: the control group, the dexamethasone, and the cyclobenzaprine group. To obtain muscular electrical activity and mouth opening, an electromyographic device was used at mandibular rest and maximum voluntary contraction and compared pre- and post-operatively.

RESULTS

During muscle contraction, no significant difference was observed in the electromyographic records on the non-operated side. On the operated side, there was a reduction in electrical activity for both drugs pre-operatively and immediately post-operatively compared to the control group. All pharmacological agents promoted a higher mouth opening compared to control group.

CONCLUSION

The results suggest that dexamethasone and cyclobenzaprine may be useful as an adjuvant in the prevention of motor dysfunctions in third molar surgery.

Preoperative Anatomic Evaluation of the Relationship Between Inferior Alveolar Nerve Canal and Impacted Mandibular Third Molar in a Population of Bhubaneswar, Odisha, Using CBCT: A Hospital-Based Study

Purpose

To evaluate the correlation between the position of inferior alveolar nerve canal and the angulation of impacted mandibular third molars using cone beam computed tomography (CBCT) in a hospital-based study in the state of Odisha, India.

Materials and Methodology

Three hundred cases of impacted third molars in 200 patients (154 males; 46 females) were included in the study, for whom an initial periapical or panoramic radiograph had revealed that the mandibular canal and the lower third molars were in close proximity. A CBCT scan of each patient was carried out to assess how the canal position influenced the class and position of impaction, angulation of impaction and bone contact.

Results

Class II position B impactions were found in 78.37% cases where the position of ID canal was approximate to the lingual plate and inferior to third molar (73.75%). The results were statistically significant (p = 0.00). 80% of the ID canals showed bone contact. Of these 73.75% ID canals showed lingual bone contact. Mesioangular impactions were most common in mandible and significantly associated with lingual and inferior positioning of the canal.

Conclusions

The study mostly exhibited patients having mesioangular class II position B third molar impactions of the mandible. The position of the canal has a significant influence on the type of impaction and the bone contact.

Third molar tooth agenesis and pattern of impaction in patients with palatally displaced canines

OBJECTIVES

To investigate the association between third molar agenesis and pattern of impaction, missing teeth, and peg-shaped lateral incisor with palatal canine displacement (PDC).

MATERIALS AND METHODS

The pretreatment orthodontic orthopantomograms of 438 patients (122 males and 316 females) diagnosed with PDC were included. A total of 338 patients with normally erupted canines who had a preexisting radiograph as part of their orthodontic treatment (125 males and 313 females) served as controls. Orthopantomograms were evaluated for missing third molars, third molar eruption status, and type of impaction, third molar spaces, third molar width, and angulation.

RESULTS

In the PDC group, at least one third molar was missing in 48% and 19% in the upper and lower arches, respectively. Also, 38% and 67% of PDC patients had at least one third molar impaction in the upper and lower arches, respectively. The difference between the PDC and control groups was significant for both missing and impacted third molars ( P < .001 for each). The most common type of third molar impaction in the upper arch was vertical and distoangular in the PDC and control groups, respectively. Upper and lower third molar width and spaces were reduced in PDC patients when compared with the control group ( P < .001). In PDC patients, missing teeth and peg-shaped lateral incisors were recorded in 5.6% and 9.1%, respectively.

CONCLUSIONS

PDC patients showed a high prevalence of third molar agenesis and impaction. Upper and lower third molar width and space were reduced in the PDC patients. There were no significant associations between tooth agenesis (other than third molars) and the PDC anomaly.

The Use of Premolar Extractions With Orthodontic Treatment Does not Guarantee an Improved Eruption Potential of Third Molars

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Influence of orthodontic premolar extraction therapy on the eruption of the third molars: A systematic review of the literature. Brezulier D, Fau V, Sorel O. J Am Dent Assoc 2017;148(12):903-12.

SOURCE OF FUNDING

Information not available.

Comparison of the effect of premolar extraction and non-extraction on the position and developmental changes of the lower third molars

The aim of the present study was to comprehensively assess the posttreatment effect of premolar extraction versus non-extraction on the position and development of the lower third molars. The sample consisted of 227 patient's pre- and posttreatment panoramic radiographs (53 with four premolar extractions, 174 without extractions). The position and developmental stage of the lower third molars were evaluated by using Pell-Gregory's, Winter's, modified Miloro-DaBell's and Demirjian's classifications, respectively. Premolar extraction had a considerably positive influence on the position and development of the lower third molars and therefore could provide better prognosis for their eruption.

[Consequences of impacted wisdom teeth extraction on the periodontal environment of second molars. A pilot study]

INTRODUCTION

Wisdom teeth extraction is a common procedure, generally considered as safe by patients. However, complications are possible, especially periodontal ones. The aim of this study was to evaluate the frequency and the consequences of periodontal complications at the level the 2nd molars after extraction of the wisdom teeth.

MATERIAL AND METHODS

A single-center retrospective observational multi-operator study was conducted at the university hospital of Besançon - France. The files of all the adult patients who underwent extraction of four impacted wisdom teeth by mean of a standardized surgical technique between November 2012 and November 2014 and who could be followed 1 year postoperatively at least and that precisely mentioned the periodontal status of the surgical sites were included. Postoperative complications, gingival and plaque indexes according to Loë and Silness, periodontal attachment level and periodontal second molar probing were recorded. The main judgment criterion was the occurrence of a periodontal complication in the second molar areas.

RESULTS

The files of 20 patients (15 women - 5 men), operated on by five different surgeons, met the inclusion criteria. Two patients suffered from dry socket at one of the avulsion sites. No patient had a gingival or plaque index greater than 2. No gingival recession or periodontal pocket over 4mm was found.

DISCUSSION

Extraction of impacted third molars in young healthy adults didn't have any impact on the second molars periodontal environment in our study. Literature suggests that surgical technique greatly influences the occurrence and the extent of periodontal sequelae.

The effect of first and second premolar extractions on third molars: A retrospective longitudinal study

OBJECTIVES

To analyse the effect of first and second premolar extractions on eruption space for upper and lower third molars and on third molar position and angulation during orthodontic treatment.

METHODS

The sample consisted of 296 patients of which 218 patients were orthodontically treated without extraction and 78 patients with extraction of first or second premolars. The eruption space for third molars was measured on pre- and posttreatment lateral cephalograms, whereas the angulation, vertical position, the relation with the mandibular canal and the mineralization status of third molars were evaluated using pre- and posttreatment panoramic radiographs. All data were statistically analyzed.

RESULTS

The increase in eruption space and the change in vertical position of upper and lower third molars significantly differed between patients treated with and without premolar extractions, whereas the change in angulation, relationship with the mandibular canal and mineralization status of the third molars did not significantly differ between patients treated with and without premolar extractions.

CONCLUSIONS

The retromolar space and the position of third molars significantly change during orthodontic treatment in growing patients. Premolar extractions have a positive influence on the eruption space and vertical position of third molars, whereas they do not influence the angular changes of third molars. Due to the retrospective character of the study, these conclusions should be carefully considered. Further prospective research is necessary for better insights into this complex topic.

CLINICAL SIGNIFICANCE

This study stresses the importance of considering the possible effects of orthodontic treatment on third molars during treatment planning.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.

Comparative study of analgesia with bupivacaine 0.25% versus 0.5% for third molar removal under general anesthesia

BACKGROUND

The aim of this study was to compare the effectiveness and duration of action of two concentrations of bupivacaine with adrenaline for postoperative pain in patients undergoing surgical removal of four third molars under general anesthesia.

METHODS

Sixty patients undergoing surgical removal of four wisdom teeth received bupivacaine 0.5% (n = 30) or 0.25% (n = 30). The severity of pain in the immediate recovery period and at 2 and 24 h after surgery was recorded using the visual analogue scale. Differences were assessed by box and whisper plot and the Student's t-test.

RESULTS

The analgesic effects of the 0.25% and 0.5% doses were significantly different (P = 0.022) at 30 min after surgery but not after 2 and 24 h. The difference of mean of 0.25% and 0.5% was much higher after 0.5 h but less after 2 and 24 h.

CONCLUSIONS

Bupivacaine 0.5% was statistically better for pain control during the immediate postoperative period, but there was no significant difference in pain control between the two dose strengths at 2 and 24 h after surgery.

[National survey: Avulsion of included wisdom teeth in mandibular orthognathic surgery]

INTRODUCTION

There is no recommendation concerning wisdom teeth (WT) extraction in mandibular orthognathic surgery. We carried out an investigation among the members of the French Society of Stomatology and Oro-maxillofacial Surgery (SFSCMFCO), in order to evaluate the practices and habits of maxillofacial surgeons in this field.

MATERIALS AND METHODS

We emailed the 424 members of the SFSCMFCO with a questionnaire.

RESULTS

We obtained 143 feedbacks that could be exploited. In total, 72.5% of practitioners prefer WT to be extracted before performing a bilateral sagittal spilt osteotomy (BSSO). In this case, a period of 6 months between the two surgeries was considered as desirable by more than 70% of the surgeons. In total, 74.6% of the surgeons thought that the presence of WT could make a BSSO more complicated. However, 73.9% of the surgeons would not postpone the BBSO in a patient ready for surgery but with remaining impacted WT.

DISCUSSION

A majority of surgeons think that the presence of impacted WT may complicate a BSSO and increases the risk of bad split. Most of the authors recommend extracting the impacted WT 6 months before BSSO at least. However, these potential complications are easy to overcome and don't compromise the final result. Therefore, we think that impacted WT should not delay a BSSO if the orthodontic preparation makes the patient ready for surgery.

Time of mineralization of permanent teeth in children and adolescents in Gaborone, Botswana

The mineralization sequence of permanent dentition can be used to assess the stage of development and age of individuals. The most commonly used methods are based on the assessment of developmental stages of target groups of teeth on one side of the lower jaw. When compared with the rest of the world, fewer studies have been done on dental age in Sub-Saharan Africa, particularly in the region of Southern Africa. The aim of this study was to determine the chronology of mineralization of permanent teeth by the evaluation of developmental stages according to the Demirjian's method from 1973 and to evaluate dental age by using sex-specific self-weighted scores for dental stages and 50th percentile conversion tables of total maturity scores of seven mandibular teeth. We used a sample of panoramic radiographs (OPTs) of black African children and adolescents from the city of Gaborone, Botswana, with the aim of forming an appropriate sample to evaluate the development of the teeth in this socio-geographic environment. The final sample consisted of 1760 OPTs (807 males and 953 females) of individuals aged 6-23 years. The developmental stages of the all permanent teeth in the left side of the maxilla and the mandible were evaluated. Comparing the maxilla and the mandible, we found similar development within different stages for most of the teeth. In comparison to the average age at each stage of development, including the third molars between males and females, it is evident that females are slightly faster in developing permanent teeth, but without statistical significance for most of the developmental stages. Applying 50th percentile conversion tables for calculating the dental age for the first seven mandibular teeth, 616 OPTs of the children (299 males and 317 females), aged 6.08-16.80 years, were evaluated and their dental age was calculated. Mean dental age was overestimated in comparison to chronological age by 1.25±1.11 years and 0.72±1.02 years for males and females, respectively (p<0.001). These findings indicate that Demirjian's method from 1973 is not suitable for routine use and that there is a need for establishing specific standards for Botswana children of black African origin for dental age estimation.

Dental age estimation in living individuals using 3.0 T MRI of lower third molars

In order to increase the validity of age estimation in adolescents and young adults when there is no legitimation for X-ray examinations, it seems desirable to be able to assess the mineralization of third molars using X-ray-free imaging procedures. In the present study, the mineralization stages of lower third molars were determined prospectively in 269 male and 248 female individuals aged 12 to 24 years using 3.0 T MRI. The classification system of Demirjian et al. was used to determine the stages. This study presents the minima and maxima, means and standard deviations, median values, and lower and upper quartiles separately for both sexes, for the mineralization stages B-H. Statistically significant sex differences were observed for the mineralization stages C, E, F, and G, and a faster developmental rate was observed for males. It was concluded that magnetic resonance imaging is an X-ray-free alternative to orthopantomography when assessing mineralization of third molars.

Coronectomy: Partial Odontectomy or Intentional Root Retention

Coronectomy is considered in patients older than 25, where there is an intimate relationship between the roots of a retained lower third molar (occasionally second or first molars) and the inferior alveolar nerve, in noncontraindicated circumstances. It may be used on younger patients with a medium to high risk of inferior alveolar nerve damage. The decision to use this technique is made with the aid of cone-beam computed tomography scans. Short- to medium-term success rate is excellent, but long-term studies are not yet available. The technique is gaining wider acceptance, although there are differences in the indications and actual technique used within and between countries.

Analysis and evaluation of relative positions of mandibular third molar and mandibular canal impacts

Objectives

This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage.

Materials and Methods

Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimensional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated.

Results

When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the mandibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images.

Conclusion

The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage.

Common Matrix Metalloproteinases (MMP-8, -9, -25, and -26) Cannot Explain Dentigerous Cyst Expansion

OBJECTIVE

Mechanisms of the dentigerous cyst formation from the normal eruption follicle is unknown but disturbances in the proteolytic activity have been suspected, since the growth of these cysts is accompanied by local bone destruction. The aim of the present study was to evaluate the expression of matrix metalloproteinases (MMP) in human dental dentigerous cysts and healthy dental follicles.

MATERIALS AND METHODS

We studied 10 patients with dentigerous cysts and 10 healthy dental follicles from the lower jaw in respect to their immunoexpression of MMPs -8, -9, -25, and -26 and tissue inhibitor of metalloproteinases -1 (TIMP-1).

RESULTS

MMP-8 was expressed slightly more in cyst epithelium than in odontogenic epithelium of healthy controls dental follicle but the difference lacked statistical difference. Other MMPs and TIMP-1 did not differ regarding the studied specimens.

CONCLUSION

Differences in MMP expression cannot solely explain the cyst expansion suggesting the potential involvement of other osteolytic mechanisms.

Prevalence of cysts and tumors around the retained and unerupted third molars in the Indian population

AIM

Tooth impaction is a frequent phenomena and surgical removal of these teeth are the commonest of the dental surgical procedures. The debate over the removal of asymptomatic impacted third molars still continues. The aim of this retrospective study was to determine the incidence of development of cysts and tumors around the retained and unerupted third molars in the Indian population.

MATERIAL AND METHODS

5486 impacted third molars of 4133 patients were studied through the panoramic radiographs for the presence of associated cysts and tumors. The ages of the patients ranged from 17 to 67 years, with a mean of 33.7 years. The results were evaluated using the Pearson chi-square test. P-values less than 0.05 were considered to be statistically significant.

RESULTS

There were 134 cysts (2.24%) and 63 tumors (1.16%) found that were associated with impacted third molars, of which 3 were malignant (0.05%). 143 patients had symptoms such as swelling or pain due to cystic or neoplastic lesions. The remainder 54 patients had no symptoms suggestive of pathology. The most common cyst was dentigerous cyst and the most common tumor was ameloblastoma.

CONCLUSION

The results indicate that cysts and tumors do develop in a relatively small but still considerable minority of patients. The fact that a considerable number of patients had no signs or symptoms indicating pathology is certainly worth considering. Consultation should be sought from dental specialists if there are symptoms in the third molar region.