Assessing position changes of impacted third molars in treatment of class II malocclusion with premolars extraction.

INTRODUCTION: Third molars (M3) remaining impacted in Class II malocclusion characterised with sagittal mandibular deficiency is a high probability. The null hypothesis of this study is that mesioangular M3s changes position through the eruption way in Class II malocclusion treatment requiring moderate anchorage with four first premolars extraction. The aim of this study is to reconsider the decision to surgically extract impacted third molars in four premolars extraction treatment of Class II malocclusion. MATERIAL AND METHODS: The materials consisted of the pre-treatment and post-treatment lateral cephalograms and orthopantomographs of 30 individuals with skeletal and dental Class II malocclusion with a mean chronological age of 13.48 years, who were treated by the same clinician (H.G.) with four first premolar extractions via the straight wire technique at the Ankara University Faculty of Dentistry Department of Orthodontics, Ankara, Turkey. The sagittal position of the upper and lower incisors and molars, M3 position and M3 space were evaluated with the paired-t test; the relationship between the sagittal position of the upper and lower incisors and molars and the change in M3 position were evaluated with correlation analysis.  Results: The study found the retroclination and mesial movement of the upper incisors and molars, and an increase in the M3 space by the fixed orthodontic treatment. An insignificant steepening of both the upper right M3 position and the lower right M3 position was found. A statistically significant increase in the lower right and left side M3 spaces was found. Positive correlations between lower right M3 angulation and the sagittal position of the lower incisors and first molars were found. CONCLUSION: Improvement in the mesioangulation of the M3s and an increase in the M3 space were achieved in this study. Based on the findings, it is useful to review the decision for prophylactic surgical extraction of the M3s before orthodontic treatment in such cases, taking into account the risks of postoperative complications.

A prospective randomized study on the efficacy of real-time dynamic navigation in deep horizontal mandibular third molar extractions.

PURPOSE: This study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures. METHODS: A prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p < 0.05. RESULTS: In the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant (p = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury. CONCLUSION: The precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery.

Prevalence and predictive parameters of external root resorption caused by retained wisdom teeth.

OBJECTIVES: The aim of this study was to estimate the prevalence and severity of external root resorption (RR) caused by retained third molars (M3), to compare the sensitivity of panoramic radiography (PAN) and cone beam computed tomography (CBCT) and to determine predictive factors for root resorption. MATERIALS AND METHODS: In a retrospective cross-sectional analysis, we included patients (N = 367) who underwent PAN and CBCT imaging between December 2017 and July 2019. Previous orthodontic treatment, age, gender, superimposition of second molars (M2) and M3 on PAN, retention depth, inclination angle and vertical level of contact with the M2 were used as predictor variables. The outcome variable was RR of the M2, graded according to Ericson et al. [1]. Subgroup analyses compared patients with and without suspected resorption in the PAN. RESULTS: While less than 5% of PANs suggested RR associated with M3, CBCT showed RR in 20% of all M2 with adjacent retained M3. The angle of inclination of M3, patient age and vertical level of molar contact emerged as predictive parameters, with mesial inclination, older age and deeper retention associated with increased severity of M2. CONCLUSION: Within the limitations of our study, these data confirm the poor performance of PAN in the diagnosis of RR. CBCT may be helpful in detecting RR in mesioangulated and deeply retained M3 in elderly patients, even when PAN did not suggest pathology. CLINICAL RELEVANCE: Our study may help to decide whether CBCT should be considered prior to M3 surgery.

Radiographic identification of symptomless mandibular third molars without clinical pericoronitis.

OBJECTIVES: The aim was to identify radiographic characteristics of mandibular third molars in young adults without symptoms or clinical signs of pericoronal infection. MATERIALS AND METHODS: An existing cross-sectional material, including records from clinical oral examination and panoramic radiographs (PANs) of university students, was submitted to retrospective analysis. The outcome variable was a symptomless and clinically pericoronitis-free mandibular third molar. Predictor variables for the third molar were clinical eruption level, pathological signs in the follicle, marginal bone level, radiographic depth in bone, inclination, stage of root development, and available space for eruption. Statistics included χ2 and Mann-Whitney U tests. RESULTS: Analysis included 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; SD ± 0.6). Symptomless and clinically pericoronitis-free mandibular third molars were characterized as follows: clinically unerupted in 78% of teeth, associated with reduced marginal bone level in 70%, located deeper in the bone in 87%, mesially inclined in 73%, and stage of root development incomplete in 68% (p ≤ 0.001 for all). CONCLUSIONS: Radiographic characteristics of symptomless mandibular third molars without clinical pericoronitis in young adults can be assessed from a PAN with 68-87% certainty. CLINICAL RELEVANCE: These findings may prove useful when trying to exclude non-pathological mandibular third molars from diseased teeth.

Comparison of Faster R-CNN, YOLO, and SSD for Third Molar Angle Detection in Dental Panoramic X-rays.

The use of artificial intelligence algorithms (AI) has gained importance for dental applications in recent years. Analyzing AI information from different sensor data such as images or panoramic radiographs (panoramic X-rays) can help to improve medical decisions and achieve early diagnosis of different dental pathologies. In particular, the use of deep learning (DL) techniques based on convolutional neural networks (CNNs) has obtained promising results in dental applications based on images, in which approaches based on classification, detection, and segmentation are being studied with growing interest. However, there are still several challenges to be tackled, such as the data quality and quantity, the variability among categories, and the analysis of the possible bias and variance associated with each dataset distribution. This study aims to compare the performance of three deep learning object detection models-Faster R-CNN, YOLO V2, and SSD-using different ResNet architectures (ResNet-18, ResNet-50, and ResNet-101) as feature extractors for detecting and classifying third molar angles in panoramic X-rays according to Winter's classification criterion. Each object detection architecture was trained, calibrated, validated, and tested with three different feature extraction CNNs which are ResNet-18, ResNet-50, and ResNet-101, which were the networks that best fit our dataset distribution. Based on such detection networks, we detect four different categories of angles in third molars using panoramic X-rays by using Winter's classification criterion. This criterion characterizes the third molar's position relative to the second molar's longitudinal axis. The detected categories for the third molars are distoangular, vertical, mesioangular, and horizontal. For training, we used a total of 644 panoramic X-rays. The results obtained in the testing dataset reached up to 99% mean average accuracy performance, demonstrating the YOLOV2 obtained higher effectiveness in solving the third molar angle detection problem. These results demonstrate that the use of CNNs for object detection in panoramic radiographs represents a promising solution in dental applications.

Prevalence and pattern of third molars impaction in a large Yemeni sample: a retrospective study.

The prevalence of teeth impaction varies substantially between different populations, and the impaction of third molars is the most commonly recorded. This study aimed to explore the prevalence and pattern of the third molars impactions among Yemeni population. This was a retrospective radiographic study conducted in Yemen between 2022 and 2023. The digital panoramic radiographs were collected from two major X-ray centers in Yemen. The angular position and depth of the impacted third molars were assessed according to the classifications of Winter and of Pell and Gregory, respectively. All radiographs were evaluated twice by one investigator in a two-week interval, and Kappa test was used for intra-rater reliability. Gender-wise differences, differences between both sides, and differences between maxilla and mandible were analyzed using Chi-squared tes with odds ratio (OR) for the risk of impaction. A P-value < 0.05 was considered significant. Panoramic radiographs of 6338 individuals were included. Their mean age was 35.1 ± 13.3 years andand 63.9% were females. A total of 25,352 sites (quadrants) were screened for the presence of thirds molars. Among which, 14,003 third molars (55.3%) were present in one or more sites. There were 1440 individuals (23%) with a total of 2828 impacted third molars (20% of the existing third molars). Females were less likely to have third molar impaction (OR = 0.46, CI95% = 0.4-0.52). Impaction of the mandibular third molars was significantly more frequent than the maxillary ones (OR = 1.15, CI95% = 1.04-1.26; P = 0.005). Horizontal and mesioangular impactions were statistically more frequent in the lower molars compared to the upper ones (P < 0.001 each). Contrastingly, vertical (P = 0.015), distoangular, and other impactions (P < 0.001 each)were statistically more frequent in the maxilla. Levels A and B were more frequent in the lower third molars, while level C was predominating in the upper molars (P < 0.001 each). The prevalence of third molars impaction is more frequent in males and mandibular arch. The angulation and level of impaction seem to be more complicated in the maxillary arch.

Comparison of the mandibular retromolar space in adults with different sagittal skeletal types and eruption patterns of the mandibular third-molar: a cone-beam computed tomography study.

BACKGROUND: The mandibular retromolar space (RMS) has not been extensively studied in relation to various sagittal skeletal classes and patterns of third-molar eruption. The objective of this study was to test the null hypothesis that there is no difference in the mandibular RMS among normodivergent subjects with different skeletal classes and patterns of mandibular third-molar eruption, using cone-beam computed tomography (CBCT). METHOD: A total of 105 normodivergent patients (20-40 years) were included in this study. Participants were categorized into Class I, II and III groups based on ANB and further impacted and erupted groups based on the eruption patterns of the mandibular third molars. Measurements of the mandibular RMS were taken at four planes parallel to the occlusal plane, along the cusp line. Comparative analyses were conducted among the three sagittal groups and between the impacted and erupted groups. RESULTS: The Class II group exhibited a statistically smaller RMS (P < 0.05). RMS was found to be larger in third-molar erupted group (P < 0.05). The rates of root contact and third-molar impaction was significantly higher in Class II group. (P < 0.05) CONCLUSIONS: The null hypothesis was rejected. Patients with Skeletal Class II tend to have a smaller mandibular RMS and a higher prevalence of root contact and third-molar impaction. The presence of impacted mandibular third molars was correlated with a shorter RMS. TRIAL REGISTRATION: Retrospectively registered.

Correlations of spheno-occipital synchondrosis, cervical vertebrae, midpalatal suture, and third molar maturation stages.

OBJECTIVES: To estimate the joint correlations among cervical vertebrae maturation (CVM), spheno-occipital synchondrosis (SOS), midpalatal suture maturation (MPS), and third molar mineralization (TMM) and to assess the predictive potential of SOS on CVM and MPS. MATERIALS AND METHODS: 570 pretreatment cone-beam computed tomogram (CBCT) scans from three private practices were analyzed, and MPS, CVM, SOS, and TMM stages were categorized and recorded by two independent investigators. Intra- and inter-rater reliability tests were evaluated with weighted Cohen's kappa tests. Spearman correlation coefficients for ordinal data were used to estimate the pairwise correlations among SOS, CVM, MPS, and TMM. To evaluate if SOS could predict CVM and MPS, ordinal regression models were estimated and cross-validated. RESULTS: The analysis demonstrated a robust positive correlation between SOS and CVM (r = 0.845) and between SOS and MPS (r = 0.742). A significant correlation was also observed between CVM and MPS (r = 0.659). Further correlations were identified between TMM and SOS (r = 0.444), TMM and MPS (r = 0.392), and TMM and CVM (r = 0.358). Ordinal regression models indicated the potential of using SOS as a predictive marker for CVM and MPS stages. CONCLUSIONS: With a comprehensive analysis, SOS is strongly correlated with CVM and MPS, and SOS stage can be used to predict CVM and MPS using ordinal regression. Since MPS stages are challenging to categorize due to their anatomy, this finding suggests a diagnostic tool using SOS stages or when more information on skeletal maturity of the patient is desired.

Treatment plan for maxillary third molars based on radiological findings varies among oral surgeons: a web-based "paper" clinic study.

OBJECTIVES: To evaluate variation in treatment plans and pathological findings related to maxillary second and third molars based on panoramic (PAN) images and cone beam CT (CBCT) among Danish and Dutch oral and maxillofacial surgeons. STUDY DESIGN: This web-based "paper" clinic contained 10 cases of impacted maxillary third molars comprising clinical information, PAN, and CBCT. Treatment plan and pathological findings were established based on clinical information and PAN, thereafter, based on CBCT by 28 surgeons. Options for treatment plan for third molars were no treatment, or tooth removal. Options for treatment plan for second molars were no treatment, tooth removal, or endodontic and/or filling therapy. The surgeons assessed external root resorption, marginal bone loss, and follicular space. RESULTS: A change in treatment plan between PAN and CBCT was registered between 0% and 43% of the surgeons among the cases. The surgeons did not agree completely on the treatment plan in any of the cases. Variation was present among the surgeons evaluating pathological findings. In several cases, severity of root resorption was rated worse in CBCT than in PAN. CONCLUSIONS: Variation in treatment plan and pathological findings was observed among surgeons. No correlation between change in pathological findings and change in treatment plan was found.

Chronological age estimation based on dental mineralization for Syrian population.

Dental age assessment based on evaluating dental mineralization status is one of the most common methods used in forensic practice. The aim of this study is to enhance the accuracy of age diagnostics and provide reference data from the Syrian population for forensic application. After several selection steps, a total of 280 orthopantomograms (OPGs) from 140 males and 140 females from the Syrian population divided into 14 age groups between 12 and 25 years were analysed. Based on Demirjian's classification system, the mineralization stages of third molars (18, 28, 38 and 48) as well as lower second molars (37 and 47) were evaluated. Statistical investigations and evaluations were carried out to estimate the marginal probabilities of the subjects having attained ages 14 and 18 by generalized estimating equation models. Our results show that no significant differences can be revealed in the mineralization status with respect to jaw side and sex. In the Syrian population, third molars showing mineralization stage G provide evidence of reaching the age of 14 years with the highest standard of proof ("beyond reasonable doubt"). A completed mineralization in lower second molars (stage H) provides very high marginal probabilities (more than 90%) of the subjects having attained age 14 years. Nevertheless, this cannot exclude an age under 14 years. For the age threshold of 18 years, third molars showing incomplete root development (G dental stage or lower) are associated with a low probability (less than 40%) of the subject having reached 18 years of age. A person's probability of having attained 18 years of age is very high (82- 95%) when the roots of third molars are fully developed (stage H). Nevertheless, third molars at stage H do not conclusively exclude an age under 18 years.

Assessment of the relationship between the three-dimensional precise location of the mandibular third molar and the volume ratio of the impacted mandibular third molar to the mandibular angle, and the patterns of mandibular angle fracture: A retrospective study.

This study aimed to evaluate the relationship between the precise three-dimensional location of the third molar (M3) and mandibular angle fracture (MAF) patterns and to assess the effect of the volume ratio occupied by M3 in the mandibular angle on fracture patterns. The location of M3 was assessed in 218 patients with MAF using computed tomography reconstruction. The bone volume of the mandibular angle and the bone volume occupied by M3 were measured to calculate the volume ratio of M3 to the mandibular angle (M3/MA). MAF patterns were categorized into simple fracture (Type I), displaced fracture (Type II), and comminuted fracture (Type III) based on fracture severity. The results showed that the location of M3 significantly influenced MAF patterns (vertical position: P = .001; horizontal position: P = .002; angulation: P = .027, respectively) and the volume ratio of M3/MA was significantly higher for Type III fracture than Types I and II (P < .001). Regression analysis showed that the horizontal position and angulation of M3 and the volume ratio of M3/MA were the main predictors for comminuted MAF. A larger volume ratio (odds ratio [OR], 1.201; 95% confidence interval [CI], 1.037-1.391; P < .014), Class III position (OR, 7.978; 95% CI, 1.275-49.910; P < .026), and horizontal angulation (OR, 7.212; 95% CI, 1.028-50.581; P < .047) of the M3 were more prone to comminuted MAF than simple fracture. Our findings indicate that the location of M3 significantly affects MAF patterns, and that M3 may weaken the mandibular angle by occupying more bone space, thereby increasing the risk of a comminuted fracture.

[Validation of method for estimation age of majority by the third molar maturity index on the sample of Ufa population]. / Validatsiya metoda opredeleniya vozrasta sovershennoletiya po indeksu zrelosti tret'ego molyara na vyborke naseleniya g. Ufy.

The assessment of majority age is important for determining legal responsibility. The definition of the 3rd molar maturity index (Im3) have proven to be a simple and effective method of majority age establishment, the accuracy of which has been tested in different populations. There is a clear lack of studies in this scientific area in Russia. OBJECTIVE: To test diagnostic accuracy of majority age assessment method by 3rd molar (Cameriere index) in the Ufa sample. MATERIAL AND METHODS: The number of orthopantomograms equal 120 from males and females aged from 14 to 23 years without apparent pathological changes of the pulp of teeth 38 and 48 was examined. The measures were conducted using the standard R. Cameriere method. The method of logistic regression, determination of predictive values of sensitivity and specificity were used. RESULTS: The Im3 cut-off point, that was equal 0.08, had a sensitivity of 89% and specificity of 95% in the male sample, accuracy of age group determination was 93%. In the female sample the method sensitivity was 93%, specificity - 97%, accuracy - 97%. CONCLUSION: The study results confirmed the absence of population variability of the Cameriere index value, that makes it possible to use the majority age determination method by 3rd molar for practical application in the examination of a living person at the territory of the Russian Federation.

Is the third molar the most frequently extracted tooth? A population-based study utilizing dental panoramic radiographs in adults.

OBJECTIVES: The study aimed to examine the authenticity of the often-mentioned statement that the third molar is the most frequently extracted tooth. This finding has not been shown previously in a large population-based sample. MATERIALS AND METHODS: Data comprised a nationally representative sample of 6082 panoramic radiographs taken from adults in the cross-sectional Health 2000 Survey. From the radiographs, all missing teeth were recorded. Information on congenital agenesis of individual teeth was retrieved from two published meta-analyses. Primary outcome was the frequency of missing teeth by tooth type. Explanatory variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. RESULTS: Mean age of participants (46% men, 54% women) was 53 years (SD 14.6; range 30‒97 years). Missing teeth occurred more often in women than in men (P < 0.001). The third molar was most frequently missing and the canine least frequently. In the maxilla and mandible, the third molar was missing more often than each of the other tooth types up to the age of 80 years (P < 0.01). CONCLUSIONS: When considering the rates of congenital agenesis of individual teeth, it is concluded that the third molar remained the most common tooth extracted up till the age of 80 years. CLINICAL RELEVANCE: The third molar is the most common target for extraction, but also the most common tooth associated with malpractice claims, and therefore, calls for skills, adequate equipment, and other resources for a successful extraction.

Accuracy of second and third molar maturity indices, Olze, Haavikko, and Demirjian methods for 14- and 16-year-old age thresholds assessment in Croatian children and adolescents.

This study explores the reliability of four established legal age threshold estimation approaches in a Croatian sample. We applied Haavikko stages, Demirjian stages, Olze's third molar eruption stages, and second and third molar maturity indices measurement in 593 orthopantomograms of Croatian children and adolescents aged 11.00-20.99 years old. The left mandibular second and third molar were assessed. Logistic regression analysis was conducted to test the significance of predictive variables. Logistic Receiver operating characteristic (ROC) curves were performed to evaluate the classification ability of variables for estimating 14- and 16-year-old thresholds. The areas under the ROC curve (AUC), accuracy (Acc), sensitivity (Se), specificity (Sp), Positive Likelihood Ratio (LR +), Negative Likelihood Ratio (LR-), and Bayes post-test probability (Bayes PTP) were calculated to evaluate classification performance. Results suggest that the combination of I2M&I3M is the best classifier for the 14-year-old threshold (AUC = 0.879); for males alone, I2M is an even better classifier (AUC = 0.881). The highest Acc 80.1% (95%CI, 75.9%-83.9%), Bayes PTP 86.5% (95%CI, 82.8%-89.7%) and Sp 88.9% (95%CI, 83.0%-93.3%) were by I3M < 0.81 & I2M < 0.03 in total samples; the highest Acc 86.1% (80.6%- 90.6%), Bayes PTP 87.2% (95%CI, 81.7%- 91.4%) and Sp 87.8% (95%CI, 78.2%- 94.3%) were by I2M < 0.01 in males, Acc of Haavikko Ac and Demirjian H stage in second molar is very close with slightly lower Bayes PTP and Sp. I3M is a good classifier for 16-year-old threshold (AUC = 0.889). The cut-off value I3M < 0.34 can be used to classify the 16-year-old threshold with Acc of 80.6% (95%CI, 77.2%-83.7%), Sp of 83.4% (95%CI, 79.0%-87.3%), and 81.7% (95%CI, 78.4%-84.8%) Bayes PTP. In conclusion, to classify the 14-year-old threshold, a pair of cut-off values I3M < 0.81 & I2M < 0.03 can be used in Croatian females; I2M < 0.01, Demirjian H stage, Haavikko Ac stage in second molar, and the pair I3M < 0.81 & I2M < 0.03 can all be used in Croatian males. I3M < 0.34 can classify the 16-year-old threshold in Croatian populations.

Prevalence and Pattern of Tooth Impaction: A Radiographic Study in a Trinidadian Population.

OBJECTIVE: The aim of this retrospective study was to determine the prevalence and patterns of impacted third molars in a Trinidadian population. METHODS: A total of 1500 orthopantomograms (OPG) taken at the School of Dentistry, University of the West Indies, from 2008 to 2019 in patients between 15 and 67 years old were evaluated. From the data collected, the prevalence of third molar impaction, the parameters of gender, angulation, level of impaction, and associated pathologies were evaluated. Other types of impacted teeth were also recorded. RESULTS: Of the 1500 OPG viewed, 408 (27.2%) of the study sample presented with at least one impacted third molar. 161 (39.5%) were males and 247 (60.5%) were females, with a male-to-female ratio of 1:1.5. There was a greater incidence of mandibular third molars versus maxillary third molars, which had a frequency of 77.9% and 22.1%, respectively. The most common type of impaction (Winter's classification) was horizontal in the mandible and distoangular in the maxilla. The most common level of impaction in the mandible (Pell and Gregory classification) was level 1A. The total number of impacted teeth was 775, and of these, 75 (9.7%) showed other impacted teeth besides the third molars. Canines and second premolars were the most prevalent with 7.6% and 1.5%, respectively. Caries on the second molar (49.3%) and third molars (40%) were the most frequently associated pathologies identified. CONCLUSION: The prevalence of impacted wisdom teeth in this study was 27%. These results raise awareness and provide insight among dental professionals in Trinidad as to the prevalence of impacted third molars, their patterns, as well as commonly associated pathologies, and the need for screening within the population.

Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series.

OBJECTIVES: Digital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). METHODS: Twelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. RESULTS: Survival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. CONCLUSION: The use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. CLINICAL SIGNIFICANCE: This is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.

Soft tissue inflammation around upper third molar cause limited mouth opening: common but overlooked.

OBJECTIVES: The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. MATERIALS AND METHODS: A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. RESULTS: Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6 mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9 mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. CONCLUSIONS: Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. CLINICAL RELEVANCE: Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.

A fully automated classification of third molar development stages using deep learning.

Accurate classification of tooth development stages from orthopantomograms (OPG) is crucial for dental diagnosis, treatment planning, age assessment, and forensic applications. This study aims to develop an automated method for classifying third molar development stages using OPGs. Initially, our data consisted of 3422 OPG images, each classified and curated by expert evaluators. The dataset includes images from both Q3 (lower jaw left side) and Q4 (lower right side) regions extracted from panoramic images, resulting in a total of 6624 images for analysis. Following data collection, the methodology employs region of interest extraction, pre-filtering, and extensive data augmentation techniques to enhance classification accuracy. The deep neural network model, including architectures such as EfficientNet, EfficientNetV2, MobileNet Large, MobileNet Small, ResNet18, and ShuffleNet, is optimized for this task. Our findings indicate that EfficientNet achieved the highest classification accuracy at 83.7%. Other architectures achieved accuracies ranging from 71.57 to 82.03%. The variation in performance across architectures highlights the influence of model complexity and task-specific features on classification accuracy. This research introduces a novel machine learning model designed to accurately estimate the development stages of lower wisdom teeth in OPG images, contributing to the fields of dental diagnostics and treatment planning.

AI-Driven localization of all impacted teeth and prediction of winter angulation for third molars on panoramic radiographs: Clinical user interface design.

PURPOSE: Impacted teeth are abnormal tooth disorders under the gums or jawbone that cannot take their normal position even though it is time to erupt. This study aims to detect all impacted teeth and to classify impacted third molars according to the Winter method with an artificial intelligence model on panoramic radiographs. METHODS: In this study, 1197 panoramic radiographs from the dentistry faculty database were collected for all impacted teeth, and 1000 panoramic radiographs were collected for Winter classification. Some pre-processing methods were performed and the images were doubled with data augmentation. Both datasets were randomly divided into 80% training, 10% validation, and 10% testing. After transfer learning and fine-tuning processes, the two datasets were trained with the YOLOv8 deep learning algorithm, a high-performance artificial intelligence model, and the detection of impacted teeth was carried out. The results were evaluated with precision, recall, mAP, and F1-score performance metrics. A graphical user interface was designed for clinical use with the artificial intelligence weights obtained as a result of the training. RESULTS: For the detection of impacted third molar teeth according to Winter classification, the average precision, average recall, and average F1 score were obtained to be 0.972, 0.967, and 0.969, respectively. For the detection of all impacted teeth, the average precision, average recall, and average F1 score were obtained as 0.991, 0.995, and 0.993, respectively. CONCLUSION: According to the results, the artificial intelligence-based YOLOv8 deep learning model successfully detected all impacted teeth and the impacted third molar teeth according to the Winter classification system.