Age estimation through the development of third molars in a case of multiple dismemberment / Estimación de la edad mediante el desarrollo de terceros molares en un caso de desmembramiento múltiple

El crimen organizado se ha convertido en un flagelo a nivel internacional conformado por grupos al margen de la ley que realizan todo tipo de actividades que involucran desde tráfico de personas, secuestros, extorsiones, narcotráfico y muchos otros delitos. Producto de este fenómeno, la desaparición y ejecución de personas es cada día más frecuente, en muchos casos los cuerpos son quemados o desmembrados para impedir o hacer más difícil la identificación. La odontología forense se ha convertido en una disciplina transcendental en la identificación de cadáveres y restos óseos, además de contar con múltiples métodos para estimar la edad aproximada de una persona. Se presenta el caso de un descuartizamiento múltiple de tres individuos masculinos donde era indispensable identificar si alguno correspondía a una persona menor de 18 años.

Organized crime has become an international scourge made up of outlaw groups that carry out all kinds of activities ranging from human trafficking, kidnapping, extortion, drug trafficking and many more. As a result of this phenomenon, the disappearance and execution of people is becoming more frequent every day, in many cases the bodies are burned or dismembered to prevent or make identification more difficult. Forensic odontology has become a transcendental discipline in the identification of corpses and skeletal remains, in addition to having multiple methods to estimate the approximate age of a person. The case of a multiple dismemberment of three male individuals is presented, where it was essential to identify a person under 18 years of age.

Clasificación alternativa para terceros molares / Alternate classification for third molars

Resumen Introducción En el presente artículo se describen las diferentes clasificaciones de terceros molares retenidos y se recomienda una nueva clasificación que permite predecir la dificultad para la remoción respectiva. Objetivo Lo anterior tiene la finalidad servir de guía para que los estudiantes o profesionales en Odontología utilicen como clasificador el grado de dificultad de terceras molares, el cual se constituiría en un instrumento de medición del tiempo necesario para remover la pieza dental, los pasos necesarios para dicha remoción y la morbilidad relacionada.

Abstract Introduction Different literaly classifications of impacted wisdom teeth will be shown in adddition to a new categorization wich predicts their removal difficulty. Aim The goal of the above statement is to be used as a guide for students and/or collegues to classify the degree of difficulty as a tool to measure the needed time to extract the tooth and the necessary steps to remove it and the related morbility.

Germenectomía de los terceros molares con cefalometría predictiva de brote

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 por ciento) y la edad de 14 años (40,6 por ciento). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 por ciento y 75 posoperatorias para un 96,2 por ciento. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico(AU)

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5 percent) and the age of 14 years (40.6 percent) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4 percent and 75 postoperative for 96.2 percent. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure(AU)

Prevalencia de Complicaciones de Post Exodoncia de Terceros Molares / Prevalence of Post-Extraction Complications of Third Molars

El Centro de Salud Familiar (CESFAM) de San Pedro de Atacama, es el único establecimiento de Atención de salud en la comuna y alrededores, se hace imperativo para los Cirujanos Dentistas ser resolutivos y entregar una solución efectiva a la demanda local. El objetivo de este trabajo consistió en determinar prevalencia de complicaciones postexodoncia de terceros molares de pacientes atendidos en CESFAM San Pedro de Atacama entre enero y octubre de 2020. Estudio descriptivo de corte transversal entre enero y octubre 2020, se realizó revisión retrospectiva de fichas clínicas manuales y base de datos electrónica de atenciones odontológicas realizadas en CESFAM. Se incluyeron en el estudio pacientes mayores 18 años, sistémicamente sanos o ASA II compensados, que se hayan realizado exodoncia de tercer molar superior o inferior y que hayan asistido a control clínico a los 7 días. Se excluyeron fichas clínicas ilegibles o sin evolución, pacientes que tuvieran antecedentes de pericoronaritis hasta 7 días previos y pacientes inmunocomprometidos. La frecuencia de complicaciones postoperatorias se relacionó según dificultad de la intervención (leve/moderada/alta) y si el diente era maxilar o mandibular. Se realizó un análisis descriptivo y estadístico de los datos obtenidos mediante prueba exacta de Fisher para evaluar asociación entre las variables utilizando programa estadístico STATA v. 15. Entre enero y octubre de 2020 se realizaron 146 exodoncias de terceros molares; 61 fueron de dificultad leve (41,7 %), 58 dificultad moderada (39,8 %) y 21 dificultad alta (18,5 %). El total de complicaciones postexodoncia alcanza 5,4 % (n=8) donde la complicación más frecuente es alveolitis. Las complicaciones postexodoncia se relacionan significativamente con el nivel de dificultad leve (p0,05).

The Communnity Health Center (CESFAM) of San Pedro de Atacama, is the only establishment of health assistance in the community and surroundings, it is imperative for Dental Surgeons to be decisive and deliver an effective solution to local demand. Determinate the prevalence of post-extraction complications of third molars in patients treated at CESFAM San Pedro de Atacama between January and October 2020. Descriptive cross- sectional study between January and October 2020. It has been done a retrospective review of manual clinical records and electronic database of dental care performed at CESFAM. Patients over 18 years old, systemically healthy or compensated ASA II, who had extracted an upper or lower third molar and who had attended a 7-day clinical check-up were included in the study. Were excluded Illegible or no follow up clinical records, patients with a history of pericoronitis up to 7 days previously, and immunocompromised patients. The frequency of postoperative complications was related to the difficulty of the intervention (mild / moderate / high) and whether the tooth was maxillary or mandibular. A descriptive and statistical analysis of the data obtained by Fisher's exact test was carried out to evaluate the association between the variables using the statistical program STATA v. 15. Between January and October 2020, 146 third molar extractions were performed; 61 were of mild difficulty (41.7 %), 58 of moderate difficulty (39.8 %) and 21 of high difficulty (18.5 %). The result of post-extraction complications reached 5.4 % (n = 8), where the most frequent complication was alveolitis. Post-extraction complications are significantly related to the level of mild difficulty (p 0,05).

Desplazamiento de Tercer Molar Inferior a Espacio Submandibular: Reporte de Caso y Revisión de Literatura / Lower Third Molar Displacement to Submandibular Space: Case Report and Literature Review

El desplazamiento de un tercer molar a un espacio anatómico adyacente, ya sea en su totalidad o un fragmento de este, se encuentra descrito como una complicación rara pero posible de las exodoncias de terceros molares. En este reporte se aborda específicamente el desplazamiento accidental de un tercer molar inferior hacia el espacio submandibular izquierdo, el cual fue resuelto quirúrgicamente mediante un abordaje intraoral bajo anestesia general por el equipo de cirugía maxilofacial del Hospital de Urgencia Asistencia Pública, Santiago, Chile. Se realizó una revisión de literatura en la plataforma PubMed con las palabras claves "third molar - submandibular - displacement" obteniendo un total de 17 artículos en los cuales se reportan 15 casos. El propósito del presente escrito fue presentar recomendaciones sobre el manejo actual de esta complicación en base a la literatura disponible.

The displacement of a third molar into an adjacent anatomical space, either in its entirety or a fragment of it, has been described as a rare but posible complication of third molar extractions. This report will specifically address the accidental displacement of a lower third molar into the left submandibular space, which was surgically removed through an intraoral approach under general anesthesia, by the maxillofacial surgeon team of "Hospital de Urgencia Asistencia Pública", Santiago, Chile. An literature review was carried out on PubMed platform with the keywords ""third molar - submandibular - displacement"", obtaining a total of 17 articles where are reported 15 cases. The purpose of this paper is to present recommendations on the current management of this complication based on the available literature.

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Complicaciones en la extracción de terceros molares mandibulares incluídos, retenidos e impactados. Revisión de la literatura / Complications in the extraction of impacted, and retained third molars. Literature Review

La literatura científica sostiene que los terceros molares muy a menudo son lo que contemplan varías complicaciones al momento del procedimiento quirúrgico, debido no solo a su erupción sino también a sus diferentes características que suceden como anatomía, forma, posición de su erupción, etc. Para ello el estudio complementario Integral antes de pasar al acto quirúrgico es la primera opción que se hace. Para que un correcto tratamiento post-quirúrgico sea efectivo tanto antibiótico farmacológico, biomateriales integrales, etc. Objetivo: Establecer por medio de una revisión de la literatura cuáles son las acciones o procedimientos quirúrgicos ejecutándose que pueden evitar las complicaciones más prevalentes en la extracción de terceros molares mandibulares incluídos, retenidos e impactados. Materiales y métodos: Se plantea un estudio de tipo descriptivo y de análisis respectivamente con 2 tipos de bases electrónicas: PubMed y SciELO tomando como sustentación artículos que contemplen meta-análisis, revisiones sistemáticas, revisiones literarias, etc. Resultados: Se confirmó que el mejor procedimiento ante quizás una posible: hemorragia, fracturas, laceraciones, etc. es el buen manejo quirúrgico farmacológico durante la cirugía y posterior a esta. Conclusión: Con esta revisión de la literatura se llega a la idea de que un correcto diagnóstico, manejo estricto farmacológico y el conocimiento de las complicaciones que pueden suscitarse durante y posterior en las extracciones dentales son acciones correctas que se utilizan muy comúnmente durante el procedimiento quirúrgico, lo que evita sus respectivas dificultades.

After the various articles compiled by different authors, is becomes clear that the third molars are very often what contemplate various complications at the time of the surgical procedure, due not only to their eruption but also to their different characteristics that occur such as anatomy, shape, position of its eruption, etc. For this reason, the comprehensive complementary study before proceeding to the surgical act is the first option that is made. For a correct post-surgical treatment to be effective both antibiotic-pharmacological, integral biomaterials, etc. Purpose: To establish through a review of the literatura which are the actions or surgical procedures being performed that can avoid the most prevalent complications in the extraction of included, retained and impacted mandibular third molars. Materials and methods: A descriptive and analytical study is proposed, respectively, with 2 types of electronic databases: PubMed and SciELO, taking as support articles that include meta-analyses, systematic reviews, literary reviews, etc. Results: It was confirmed that the best procedure for perhaps a possible one: hemorrhage, fractures, lacerations, etc. It is good pharmacological surgical management during and after surgery. Conclusion: With this review of the literature, the idea is reached that a correct diagnosis, strict pharmacological management and knowledge of the complications that can arise during and after dental extractions are correct actions that are very commonly used during the surgical procedure. , which avoids their respective difficulties.

Cambios Hemodinámicos Asociados a Exodoncias de Terceros Molares Inferiores con el Uso de Articaína 4 % y/o Lidocaína 2 %: Una revisión sistemática / Hemodynamic Changes Associated with Lower Third Molar Extractions with the Use of Articaine 4 % and/or Lidocaine 2 %: A systematic Review

La exodoncia de los terceros molares inferiores es uno de los procedimientos clínicos más comunes en el cual el control del dolor mediante el bloqueo anestésico del nervio alveolar inferior, bucal y lingual resulta ser fundament al y la manera más común de hacerlo es mediante la infiltración de soluciones de anestesia local. Entre ellos la lidocaína y articaína son algunos de los más comunes y pueden estar asociado a vasoconstrictores como la epinefrina que puede provocar aumento de la presión arterial y frecuencia cardíaca razón por la cual se hace necesario la monitorización de cambios hemodinámicos durante la cirugía. Describir los cambios hemodinámicos asociados al uso de lidocaína al 2 % y/ o articaína al 4 % en la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en relación a distintos tiempos operatorios. Se realizó una revisión sistemática en las bases de datos de PubMed, SCOPUS, Web of Science y Sciencedirect. Se analizaron 7 ensayos clínicos controlados en los que utilizaron articaína al 4 % y/o lidocaína al 2 % con epinefrina al 1:100,000 y/o 1:200,000 en volúmenes de 1,8 a 5,4 mL, en los cuales evaluaron la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en distintos tiempos de la cirugía. Si bien hubo cambios en PAS, PAD, FC y SPO2, todas se mantuvieron dentro de rangos normales bajo el uso de articaína al 4 % y lidocaína al 2 % con epinefrina 1:100,000 y/o 1:200,000 a volúmenes de 1,8 a 5,4mL medidas a distintos tiempos operatorios.

The extraction of lower third molars is one of the most common clinical procedures in which pain control through anesthetic blockade of the lower alveolar, buccal and lingual nerves turns out to be essential and the most common way to do it is through the infiltration of solutions of local anesthesia. Among them, lidocaine and articaine are some of the most common and may be associated with vasoconstrictors such as epinephrine, which can cause an increase in blood pressure and heart rate, which is why it is necessary to monitor hemodynamic changes during surgery. To describe the hemodynamic changes associated with the use of 2 % lidocaine and/or 4 % articaine in systolic and diastolic pressure, heart rate and partial oxygen saturation in relation to different operative times. A systematic review was carried out in the PubMed, SCOPUS, Web of Science and Sciencedirect databases. Seven controlled clinical trials were analyzed in which 4 % articaine and/or 2 % lidocaine were used with epinephrine at 1:100,000 and/or 1:200,000 in volumes of 1,8 to 5,4 mL, in which systolic pressure was evaluated. and diastolic, heart rate and partial oxygen saturation at different times of surgery. Although there were changes in SBP, DBP, HR and SPO2, all remained within normal ranges under the use of 4 % articaine and 2 % lidocaine with epinephrine 1:100,000 and/or 1:200,000 at volumes of 1,8 to 5 .4mL measured at different operative times.

Efectividad del uso transoperatorio de solución electrolizada de superoxidación para la prevención de infecciones postoperatorias en cirugía de terceros molares / Effectiveness of the trans-operative use of electrolyzed superoxidation solution for the prevention of post-operative infections in third molar surgery

La cirugía de terceros molares es uno de los procedimientos más realizados dentro de la práctica odontológica, generalmente conlleva la prescripción de fármacos, incluidos antibióticos indicados para prevenir la aparición de procesos infecciosos. La resistencia antimicrobiana es considerada como un problema de salud pública a nivel mundial, por lo que el uso de antibióticos debe ser cauteloso. La solución electrolizada de súperoxidación ha demostrado tener efectos bactericidas, virucidas y ha sido utilizada para la prevención y el tratamiento de procesos infecciosos. El objetivo del presente estudio fue demostrar la efectividad de dicha solución en la prevención de infecciones posteriores a la cirugía de terceros molares. Se realizó un estudio aleatorizado, ciego, prospectivo en 20 pacientes utilizando un diseño split mouth, en donde cada paciente fue sujeto control y experimental, en el grupo control se irrigó durante el procedimiento con solución de súperoxidación y no se prescribió antibiótico posterior, mientras que en el grupo control se irrigó con solución fisiológica y se prescribió antibiótico posterior. Se realizaron 40 cirugías en 20 pacientes utilizando en cada paciente ambas terapéuticas. Se analizó el dolor postoperatorio, inflamación y presencia de infección. El dolor y la inflamación fueron ligeramente superiores en el grupo experimental al tercer día; sin embargo, al séptimo día los resultados fueron similares. No se presentó ningún caso de infección postoperatoria. El uso de solución de súperoxidación transoperatoria puede ser una herramienta muy útil en la prevención de infecciones postoperatorias posterior a cirugía de terceros molares en pacientes sanos en cirugías con dificultad leve a moderada (AU)

Third molar surgery is one of the most performed procedures in dental practice, generally involving the prescription of drugs including antibiotics indicated to prevent the onset of infectious processes. Antimicrobial resistance is considered a public health problem worldwide, so the use of antibiotics should be cautious. The electrolyzed super oxidation solution has been shown to have bactericidal and virucidal effects and has been used for the prevention and treatment of infectious processes. The objective of the present study was to demonstrate the effectiveness of said solution in the prevention of infections after third molar surgery. A randomized, blind, prospective study was conducted in 20 patients using a split mouth design where each patient was a control and experimental subject, in the control group they were irrigated during the procedure with super oxidation solution and no subsequent antibiotic was prescribed. while the control group was irrigated with physiological solution and a subsequent antibiotic was prescribed. Forty surgeries were performed on 20 patients using both therapies in each patient. Postoperative pain, inflammation and presence of infection were analyzed. Pain and inflammation were slightly higher in the experimental group on third day, however on seventh day the results were similar. There were no cases of postoperative infection. The use of trans operative super oxidation solution can be a very useful tool in the prevention of postoperative infections after third molar surgery in healthy patients undergoing surgeries with mild to moderate difficulty.(AU)

Efecto del tratamiento de la morfología oclusal con materiales para restauraciones preventivas / Effect of treating occlusal morphology with materials for preventive restorations

Introducción: las fosas y fisuras son áreas formadas por delgadas irregularidades de la capa del esmalte de la superficie oclusal. La compleja morfología en dientes posteriores es un determinante biológico asociado al desarrollo de caries. Objetivo: evaluar el efecto de diversas formas de tratar la morfología oclusal en la adaptación y penetración de materiales utilizados en restauraciones preventivas. Material y métodos: diseño experimental e in vitro. Sesenta terceros molares fueron distribuidos aleatoriamente en dos grupos: surco sin ameloplastia y con ameloplastia; además, contaban con acondicionamiento del esmalte que se subdividió en tres subgrupos: 1) sellador de fosas y fisuras, 2) adhesivo/sellador de fosas y fisuras y 3) adhesivo/ resina Flow. Resultados: los subgrupos adhesivo/sellador y adhesivo/ Flow alcanzaron mayores valores de adaptación íntima a las paredes del surco. Las diferencias fueron significativas entre los materiales (p = 0.0009). Las mayores zonas de desadaptación resultaron para el sellador sin y con ameloplastia. La penetración de los materiales fue mayor en los surcos con ameloplastia. En los surcos tratados con ameloplastia, el adhesivo/Flow reveló el mayor porcentaje de penetración y la mejor adaptación a las paredes del surco. Conclusiones: la penetración del material está positivamente correlacionada con la profundidad del surco. El sellador con y sin ameloplastia mostró pobre adaptación a las paredes del surco (AU)

Introduction: pits and fissures are areas formed by fine irregularities in the enamel layer of the occlusal surface. The complex morphology in posterior teeth are biological determinants associated with the development of caries. Objective: to evaluate the effect of various ways of treating occlusal morphology on the adaptation and penetration of materials used in preventive restorations. Material and methods: experimental design, in vitro. Sixty third molars were randomly distributed into two groups: groove without ameloplasty and with ameloplasty, with enamel conditioning with three subgroups: 1) pit and fissure sealer, 2) adhesive/pit and fissure sealer, 3) adhesive/resin flow. Results: the adhesive/sealant and adhesive/flow subgroups reached higher values of intimate adaptation to the furrow walls. The differences were significant between the materials (p = 0.0009). The largest areas of maladjustment were found for the sealant without and with ameloplasty. The penetration of the materials was greater in the grooves with ameloplasty. In the grooves treated with ameloplasty, the adhesive/flow revealed the highest percentage of penetration and the best adaptation to the walls of the groove. Conclusions: the penetration of the material is positively correlated with the depth of the furrow. The sealant with and without ameloplasty showed poor adaptation to the sulcus walls (AU)

Caracterización epidemiológica, clínica y cefalométrica del brote anormal de los terceros molares / Epidemiological, clinical and cephalometric characterization of the abnormal eruption of third molars

Introducción: El brote de los terceros molares es un proceso que no está del todo explicado, pero durante su erupción puede provocar diferentes accidentes o complicaciones. Objetivo: Caracterizar el brote anormal de los terceros molares según variables epidemiológicas, clínicas y cefalométricas. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente «Mártires del Moncada», de Santiago de Cuba, desde noviembre de 2019 a febrero de 2020. La población estuvo conformada por jóvenes de 18 a 25 años de edad; la muestra fue seleccionada por muestreo aleatorio simple. Se tuvieron en cuenta las siguientes variables: sexo, color de la piel, brote anormal y otras variables cefalométricas. Resultados: De los 84 dientes incluidos en el estudio, se detectaron 66 terceros molares con brote anormal (78,6 %). El promedio asociado al brote de estos molares de espacio óseo superior insuficiente fue igual para los superiores con medias de 25,9 mm; el de angulación inadecuada resultó obtuso en el superior izquierdo con 128,3º y agudo en los inferiores derechos con 58,8º; asimismo el mayor diámetro mesiodistal inadecuado fue el de los inferiores derechos con 15,7 mm. Conclusiones: El brote anormal de los terceros molares se caracteriza por afectar, de forma importante, a féminas y a individuos mestizos. Su observación se singulariza, fundamentalmente, en molares inferiores con espacios óseos posteriores reducidos, mesioangulaciones y diámetros mesiodistales considerables.

Introduction: eruption of the third molars is a process that is not fully explained in the literature; however it is known that their eruption can cause different complications. Objective: to characterize the abnormal eruption of third molars according to epidemiological, clinical and cephalometric variables. Methods: an observational, descriptive and cross-sectional study was carried out at "Mártires del Moncada" Provincial Teaching Dental Clinic, in Santiago de Cuba, from November 2019 to February 2020. The population consisted of young people aged 18-25 years; the sample was selected by simple random sampling. Gender, skin color, abnormal eruption and other cephalometric variables were taken into account. Results: sixty-six third molars with abnormal eruption were detected from the 84 teeth included in the study (78.6%). The average associated with the eruption of these molars with insufficient upper bone space was the same for the upper ones with means of 25.9 mm; the average with inadequate angulation was obtuse in the upper left third molar with 128.3º and the acute one in the lower right third molars with 58.8º; the lower right third molars likewise had the largest inadequate mesiodistal diameter with 15.7 mm. Conclusions: the abnormal eruption of third molars is characterized by significantly affecting females and mixed-race individuals. Its observation is singled out, fundamentally, in lower molars with reduced posterior bone spaces, mesioangulations and considerable mesiodistal diameters.

Has the literature thoroughly categorized the lower third molars? A new classification of the various lower third molar root forms for a better understanding of their morphology / ¿La literatura ha categorizado minuciosamente los terceros molares inferiores? Una nueva clasificación de las diversas formas radiculares del tercer molar inferior para una mejor comprensión de su morfología

SUMMARY: Impacted lower third molars (IL3M) have different root shapes and numbers. This study aimed to create a classification for IL3M root forms, that should aid in understanding roots morphology. A retrospective cross-sectional study on patients had IL3M at the university clinics between 2017 and 2019. Panoramic radiographs were retrieved to classify the roots into fused roots (FR): one or two roots connected from furcation to apices, and separated roots (SR): two or more roots not connected from furcation to apical third, and each type has different forms. Statistical analysis was done by Chi-Square test. Five-hundred patients, males (54.6 %) and females (45.4 %) were included. SR were in 591 teeth (75.5 %), and FR in 192 teeth (24.5 %). Statistically significant associations emerged between SR and males (60 %) and between FR and females (66 %) (p = .000). SR forms were straight (45.8 %), joined roots (28.2 %), one straight and one curved (13.3 %), roots curved distal (9.1 %), roots curved mesial (2.5 %), and more than two roots (0.3 %). FR forms were straight (87.5 %), curved distal (9.4 %), S-shaped (2.1 %), and curved mesial (1 %). The common angulations of IL3M with SR were vertical (39 %) followed by mesioangular (25.7 %), while FR were mostly vertical (39.1 %) or horizontal (23.9 %). The classification is applicable on panoramic radiographs, and complements Winter and Pell & Gregory to provide a better description of IL3M status by adding root morphology to the angulation, occlusal, and ramus relationship.

Los terceros molares inferiores impactados (3MII) tienen diferentes formas y números de raíces. Este estudio tuvo como objetivo crear una clasificación para las formas de raíz 3MII, que debería ayudar a comprender la morfología de las raíces. Realizamos un estudio transversal retrospectivo de pacientes con 3MII en las clínicas universitarias entre 2017 y 2019. Se recuperaron radiografías panorámicas para clasificar las raíces en raíces fusionadas (RF): una o dos raíces conectadas desde la zona de furca a los ápices y raíces separadas (RS): dos o más raíces no conectadas desde la bifurcación al tercio apical, y cada tipo con formas diferentes. El análisis estadístico se realizó mediante la prueba Chi-Cuadrado. Se incluyeron 500 pacientes, hombres (54,6 %) y mujeres (45,4 %). RS se observó en 591 dientes (75,5 %) y RF en 192 dientes (24,5 %). Surgieron asociaciones estadísticamente significativas entre RS y hombres (60 %) y entre RF y mujeres (66 %) (p = .000). Las formas de RS eran rectas (45,8 %), raíces unidas (28,2 %), una recta y una curva (13,3 %), raíces curvas distales (9,1 %), raíces curvas mesiales (2,5 %) y más de dos raíces (0,3 %).). Las formas RF eran rectas (87,5 %), curvas distales (9,4 %), en forma de S (2,1 %) y curvas mesiales (1 %). Las angulaciones comunes de 3MII con RS fueron verticales (39 %), seguidas de mesioangular (25,7 %), mientras que RF fueron mayoritariamente verticales (39,1 %) u horizontales (23,9 %). La clasificación es aplicable en radiografías panorámicas y complementa a Winter y Pell & Gregory para proporcionar una mejor descripción del estado de 3MII al agregar la morfología de la raíz a la relación de angulación, oclusal y rama.

Manejo das fraturas mandibulares associadas à exodontia de 3º molar inferior / Management of mandibular fractures associated with lower third molar extraction

A remoção cirúrgica dos terceiros molares é um procedimento comumente realizado por cirurgiões bucomaxilos, e acidentes e complicações podem estar relacionados a esse procedimento. A fratura mandibular é um acidente incomum, mas que apresenta grande potencial de gerar morbidade aos pacientes. Diante disso, evidencia-se a importância de uma abordagem precoce após o trauma, bem como o acompanhamento posterior e a determinação correta do tratamento. Nesse sentido, este estudo objetiva investigar na literatura os protocolos existentes de tratamentos de fraturas mandibulares transoperatórias associadas à exodontia de terceiros molares inferiores. Para isso, foi realizada uma revisão de literatura sistemática, de caráter exploratório e descritivo, na base de dados Pubmed através dos descritores mandibular fracture, extraction e treatment. As buscas foram realizadas com restrição de tempo de 2016 a 2021. Dos 18 artigos compatíveis à proposta, 6 artigos passaram pelos critérios de inclusão e exclusão. Desses, a análise da maioria dos autores é clara em se referir às exodontias de terceiros molares como fator para fraturas mandibulares e mencionar qual protocolo de atendimento seguir, caso aconteça a fratura. Conclui-se que a redução fechada ou aberta são possibilidades de abordagem, entretanto existe uma preferência, pela redução aberta por acesso extraoral ou intrabucal com fixação interna rígida, visto que, ela elimina o período de bloqueio maxilomandibular, facilitando o retorno à função.

Surgical removal of third molars is a common procedure performed by bucomaxilos surgeons, and accidents and complications can be related to this procedure. Mandibular fracture is an uncommon accident, but it has great potential to generate morbidity in patients. Because of this, the importance of an early approach after trauma is evident, as well as the subsequent follow-up and correct determination of treatment. In this sense, this objective is to investigate in the literature the existing protocols for the treatment of transverse mandibular fractures associated with the extraction of lower third molars. To this end, a systematic exploratory and descriptive literature review were conducted in the Pubmed database using the descriptors mandibular fracture, extraction and treatment. The searches were performed with a time restriction from 2016 to 2021. Of the 18 articles compatible with the proposal, 6 articles passed the inclusion and exclusion criteria. Of these, the analysis of most authors is clear in referring to third molar extractions as a factor for mandibular fractures and mentioning which treatment protocol to follow if a fracture occurs. It is concluded that closed or open reduction are possible approaches, however there is a preference for open reduction by extraoral or intraoral access with rigid internal fixation, since it eliminates the period of maxillomandibular block, facilitating the return to function.

Efficacy of antibiotic prophylaxis on third molar extraction / Eficácia da profilaxia antibiótica na extração de terceiros molares

Introduction: Third molar extraction surgery is a common dental procedure, often challenging with increased post-operative complications. The need for antibiotic prophylaxis in these cases remains debated. Objective: The aim of this study was to evaluate the effect of antibiotic prophylaxis on the postoperative clinical course of third molar extraction surgeries. Material and method: Sixty-three patients were randomly allocated into two groups after extraction of the four third molars. ATB group (N = 33) the patients received 1g of amoxicillin one hour before the surgical procedure, CTR group (N = 30) the patients did not receive antibiotic prophylaxis. Clinical analyses were performed at 3, 7, 14, and 30 days after the surgical procedure. These analyses consisted of assessing oedema, variation in mouth opening, and soft tissue healing. Furthermore, patient-centered analyses were also carried out through the application of the visual analogue scale (VAS) to assess pain, inflammation, bleeding, difficulty opening the mouth, and chewing. Result: No influence of antibiotic prophylaxis was observed on the evolution of clinical parameters of healing, oedema, and mouth opening. Patients did not notice differences regarding their comfort during the postoperative period. Conclusion: The incidence of complications observed in the present study was low and was not related to infectious processes. The use of prophylactic antibiotic therapy has no beneficial effects on the postoperative clinical course in third molar extraction.

Introdução: Exodontia de terceiro molar é um procedimento odontológico comum, frequentemente desafiador, com complicações pós-operatórias aumentadas. A necessidade de profilaxia com antibióticos nesses casos ainda é motivo de debate. Objetivo: O objetivo deste estudo foi avaliar o efeito da profilaxia com antibióticos no curso clínico pós-operatório das cirurgias de extração do terceiro molar. Material e método: Sessenta e três pacientes foram randomicamente alocados em dois grupos posteriormente a cirurgia de exodontia dos quatro terceiros molares. Grupo ATB (N = 33) utilizou 1g de amoxicilina uma hora antes do procedimento cirúrgico e grupo CTR (N = 30) sem profilaxia antibiótica. Os dentes foram classificados de acordo com Pell & Gregory e Winter. Análises clínicas foram realizadas nos períodos de 3, 7, 14 e 30 dias após o procedimento cirúrgico. As análises consistiram na avaliação do edema, variação de abertura de boca e a cicatrização dos tecidos moles. Também foram executadas análises centradas nos pacientes por meio da aplicação da escala visual analógica (VAS) para avaliação de dor, inflamação, sangramento, dificuldade de abertura bucal e de mastigação. Resultado: Não houve diferenças entre os grupos em relação ao posicionamento dos dentes. Não foi observada influência da profilaxia antibiótica nos parâmetros clínicos de cicatrização, edema e abertura de boca. Os pacientes não notaram diferenças em relação ao seu conforto no pós-operatório. Conclusão: A incidência de complicações foi baixa e não foi relacionada a processos infecciosos. O uso de antibioticoterapia profilática não apresentou efeitos benéficos para o curso clínico pós-operatório em exodontia de terceiros molares.

Análisis de datos intra y postquirúrgicos en exodoncias unitarias realizadas por alumnos de grado de la FOUBA / Analysis of intra and post-surgical data in single extractions performed by FOUBA undergraduate studens

La exodoncia es el procedimiento odontológico más antiguo del que se tiene registro, pero pocas publi-caciones abarcan con detalle esta temática. Conocer los pormenores de esta práctica puede servir para generar políticas educativas, sanitarias, como así también sistematizarla y bajar así sus riesgos y complicaciones. El objetivo del presente estudio fue describir y analizar variables quirúrgicas asocia-das a las extracciones unitarias de piezas dentarias. Los datos se analizaron mediante las pruebas Chi-cuadrado de Pearson, exacta de Fisher y Kruskal-Wallis, según lo que correspondía (p<0,05, signifi-cativo). Concurrieron más mujeres que hombres, con una mediana de edad de 37 años (intervalo, 18 a 86), siendo los terceros molares las piezas más ex-traídas. La pieza que requirió más odontosecciones fue el primer molar superior, mientras que la pieza que requirió más alveolectomías fue el tercer mo-lar inferior, siendo esta última la pieza con mayores complicaciones intra y post quirúrgicas, incluso una alteración nerviosa. La caries penetrante fue amplia-mente el motivo más frecuente de exodoncias (79%) superando los reportes en estudios similares, La du-ración promedio (DE) de las extracciones unitarias fue de 39 minutos (21), pero difirió significativamente entre piezas dentarias (p<0,05). Las complicaciones post quirúrgicas se asociaron significativamente a cirugías más prolongadas (p<0,05). La cantidad de anestubos utilizados también difirió significativa-mente entre piezas dentarias (p<0,05), siendo el sec-tor posterior inferior el que más cantidad necesitó. Los datos aportados en el estudio pueden ser utiliza-dos para mejorar recursos en los servicios de salud odontológicos (AU)

Dental extractions are the first procedures reported in dentistry, but few articles focus on its individual details. With proper information, educational and health policies could be systematically improved, and thus reduce risks and complications. The aim of the study was to describe and analyze surgical variables associated with single tooth extractions performed by students. The practice of 500 single extractions on 500 patients who attended the Oral and Maxillofacial service of the School of Dentistry of the University of Buenos Aires, between September 2021 and September 2022, performed by fourth-year students supervised by teachers, are described. Data were analyzed using Pearson's Chi-square, Fisher's exact or Kruskal-Wallis tests, as appropriate (p<0.05, significant). More women attended than men, with a median age of 37 years (range 18 to 86), with third molars being the most extracted pieces. Decay teeth was by far the most frequent reason for extractions (79%), exceeding reports in similar studies, that may be explained by a younger sample and the multiple extractions exclusion. The tooth that required the most sections was the upper first molar, while the tooth that required the most alveolectomies was the lower third molar, the latter being the tooth with the greatest intra- and post-surgical complications, including a reported nerve damage. The average duration (SD) of single extractions was 39 minutes (21), but it differed significantly between teeth (p<0.05), for example, upper central incisors presented an average of 21 (9), and upper first premolars 47 (25), characteristics not reported to date. As other studies reported, post-surgical complications were significantly associated with longer surgeries (p<0.05). The amount of anesthesia cartridges used also differed significantly between teeth (p<0.05), being the posterior mandible the one that needed the most amount. The data provided in the study can be systematically used to improve temporal and economic resources in dental health services (AU)

Láser de baja intensidad como opción terapéutica en alteración sensitiva del nervio dentario inferior: reporte de un caso / Low level laser as a therapeutic option in sensitive alteration of the inferior dental nerve: report of a case

Se presenta el caso clínico de una paciente con alte-ración de la sensibilidad, consecuente a la extracción de un tercer molar inferior retenido bajo el contexto de urgencia, resultando en la injuria del nervio denta-rio inferior. La cirugía fue realizada en el Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), en respuesta a la sintomatolo-gía dolorosa que venía presentando la paciente desde hacía tiempo, motivo por el cual concurre a la consul-ta. En este trabajo se exponen los parámetros utiliza-dos, las etapas evolutivas y los resultados obtenidos luego de un tratamiento con láser de diodo de baja intensidad, efectuado con equipamiento Woodpecker LX 16 Plus, realizado en el área de Unidad Láser de la Cátedra de Endodoncia de la FOUBA. El tratamiento fue aceptado por la paciente quien firmó el consen-timiento informado correspondiente. Se observó una pronta y favorable recuperación ante las aplicacio-nes de fotobiomodulación láser. En la sexta sesión, se pudo determinar que la recuperación sensitiva había sido completa. Asimismo, en este trabajo se hace mención a ciertos factores preventivos prequirúr-gicos a tener en cuenta para minimizar los riesgos de lesión nerviosa ante situaciones similares, tales como forma y posición de la pieza dentaria en la man-díbula, la importancia de los estudios imagenológicos como la tomografía computarizada de haz cónico (CBCT) y la técnica quirúrgica (AU)

A clinic case of a patient with alteration of sensitivity is presented, following an emergency extraction of a retained lower third molar, which resulted in the injury of the lower dental nerve. The surgery was performed at the Dental Emergency and Patient Orientation Service of the Faculty of Dentistry, University of Buenos Aires (FOUBA), in response to the painful symptomatology that the patient had been presenting for some time, reason for which the patient arrived to the clinic. This report presents the parameters used, the evolutionary stages and the results obtained after a treatment with low intensity diode laser, performed with Woodpecker LX 16 Plus equipment, carried out in the Laser Unit area of the Chair of Endodontics, FOUBA. The treatment was performed with the permission of the patient, who signed the corresponding informed consent. A prompt and favorable recovery was observed after photobiomodulatory applications. Completion of sensory recovery was determined during the six sessions. Furthermore, this work describes certain pre-surgical preventive factors to take into account to minimize the risks of nerve injury in similar situations, such as the shape and position of the tooth in the jaw, the importance of imaging studies such as cone beam computed tomography (CBCT) and the surgical technique (AU)

Comparison Between Radiographs, White and Fluorescent Images in the Diagnosis and Treatment Decisions for Occlusal Caries: An Ex Vivo Study

ABSTRACT Objective: To compare the agreement of images in white light (WL), fluorescence (FL), and digital radiographs (DR), on the diagnosis and treatment decisions for occlusal caries lesions against a micro-CT gold standard. Material and Methods: Ten extracted third molars, with enamel and/or dentin caries (ICDAS 2-4), were included. Occlusal surface images were acquired with an intraoral camera (SoproLife®) in WL and FL modes. DR was obtained using an intraoral X-ray and a semi-direct digital system. A total of 780 images were needed, organized in a template, to be later examined by twenty-six dentists invited to compose the study. The Generalized Estimation Equations model was used to compare the proportions of the correct answers between the three methods and the gold standard. When significant, Bonferroni post-hoc test was used to identify differences (α=5%). Results: Most of the examiners were specialists (76.9%) with 14.5 years of experience. All diagnostic methods were similar and showed low agreement (DR 12.7%, WL 16.5%, and FL 16.5%) compared with gold standard caries diagnostic scores. Regarding treatment decisions, mean agreement for all diagnostic methods was higher (43.2%; p<0.001), and among all methods, WL (48.1%) and FL (51.2%) modes performed better than DR (30.4%, p<0.001). Conclusion: SoproLife® images could help clinicians to propose rational, minimally invasive treatments for occlusal caries lesions.

Prevalência de radiolucência justa-apical e sua relação com terceiros molares inferiores em radiografias panorâmicas / Prevalence of juxta-apical radiolucency and association/relations with the lower third molar in panoramic radiography

Objetivo: Avaliar a prevalência da radiolucência justa-apical (RJA) e sua relação com os terceiros molares inferiores, em 1054 radiografias panorâmicas. Métodos: A amostra foi constituída por radiografias panorâmicas digitais de indivíduos maiores de 18 anos, com pelo menos um terceiro molar inferior. As imagens foram analisadas para a presença de RJA em relação à corticalização, localização, relação com o canal mandibular, angulação e profundidade de impactação do terceiro molar. Os dados foram analisados através de estatística descritiva e pelo teste Qui-quadrado, sendo que valores de p < 0,05 foram considerados como significativos. Resultados:Foi encontrada uma prevalência de 2,75% de RJA, sendo predominante no sexo feminino (p = 0,01). A RJA foi visualizada em maior número corticalizada (58,63%), lateroapical (48,27%), em dentes parcialmente intraósseo (68,97%) e mesioangulados (55,17%). Em relação ao canal mandibular, houve maior prevalência na posição sobreposta ao canal mandibular (65,52%). Conclusão: A prevalência de RJA foi de 2,75% do total de 1054 radiografias panorâmicas avaliadas. Em relação ao canal mandibular, apresentou maior prevalência sobreposto. Além disso, a maior parte das RJA se apresentaram corticalizadas, em posição lateroapical, associada a dentes em posição mesioangular. Descritores: Radiografia panorâmica. Dente serotino. Nervo mandibular.Prevalência de radiolucência justa-apical e sua relação com terceiros molares inferiores em radiografias panorâmicas

Aim: To evaluate the prevalence of juxta-apical radiolucency (JAR) and its relationship with the lower third molars and adjacent structures, in 1,054 panoramic radiographs. Methods: The sample consisted of digital panoramic radiographs of individuals over 18 years of age, with at least one lower third molar. The images were analyzed for the presence of JAR in relation to corticalization, location, impaction depth, relationship with the mandibular canal, angulation, and impaction of the third molar. Data were analyzed using descriptive statistics and the chi-square test, and values of p < 0.05 were considered significant.Results: A prevalence of 2.75% of JAR was found, with a statistical difference between JAR and gender (p = 0.01), which proved to be predominant in females. The JAR was seen in greater numbers as corticalized (58.63%), lateroapical (48.27%), and mesioangulated (55.17%), as well as in erupted teeth (31.03%). In relation to the mandibular canal, it presented a higher prevalence when superimposed upon the mandibular canal (65.52%). Conclusions:The prevalence of RJA was 2.75% of the 1,054 evaluated panoramic radiographs. In relation to the mandibular canal, it presented a higher prevalence of superimposition. In addition, most of the RJA were corticalized, in a lateroapical position, associated with teeth in a mesioangular position. Uniterms: Panoramic radiography. Third molar. Mandibular nerve.

Relación entre el diagnóstico histopatológico de sacos foliculares de terceros molares y la medida radiográfca estandarizada en radiografía panorámica digital / Relationship between histopathologic diagnosis of third molar follicular sacs and standardized radiographic measurement on digital panoramic radiography

Objetivo: establecer la relación entre el diagnóstico histopatológico de sacos foliculares de terceros molares y la medida radiográfca estandarizada en radiografía panorámica digital. Métodos: se llevó a cabo un estudio descriptivo en el que se incluyeron 28 sacos foliculares de terceros molares. Dos observadores midieron la radiolucidez pericoronal en radiografías panorámicas digitales usando un método estandarizado y se calculó el índice de correlación intraclase. Se estableció un diagnóstico radiográfco según la medida del saco, con <2.5 mm como el límite para sacos foliculares normales. Dicho diagnóstico fue comparado con el respectivo diagnóstico histopatológico. Se calculó sensibilidad y especifcidad; se aplicó la prueba de chi-cuadrado, exacta de Fisher y, fnalmente, el índice Kappa. Resultados: se obtuvo un alto grado de acuerdo entre los observadores. La prueba radiográfca tuvo una baja sensibilidad (0.27) y especifcidad (0.6) y no se encontró diferencia estadísticamente signifcativa entre estos. Conclusiones: la ausencia de hallazgos radiográfcos no implica ausencia de enfermedad. Además, no se puede establecer relación entre la presencia de quistes dentígeros y radiolucidez ≥ 2.5 mm en radiografía panorámica digital.

Objective: To establish the relationship between the histopathological diagnosis of follicular sacs of third molars and the standardized radiographic measurement in digital panoramic radiography. Methods: This was a descriptive study in which 28 follicular sacs of third molars were included. In digital panoramic radiographs two observers measured the pericoronal radiolucency using a standardized method and the intraclass correlation index was calculated. A radiographic diagnosis was established according to the size of the sac, with <2.5mm being the limit for normal follicular sacs. This diagnosis was compared with the respective histopathological diagnosis. Sensitivity and specifcity were calculated; the chi-square test, Fisher's exact test and fnally the Kappa index were applied. Results: A high degree of agreement was obtained among the observers. The radiographic test had a low sensitivity (0.27) and specifcity (0.6) and no statistically signifcant diference was found between these. Conclusions: The absence of radiographic fndings does not imply absence of disease, furthermore, no relationship can be established between the presence of dentigerous cysts and radiolucency ≥ 2.5 mm in digital panoramic radiography.

Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.