Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualification in oral surgery and maxillofacial surgeons in a Spanish subpopulation.

BACKGROUND: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. MATERIAL AND METHODS: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. RESULTS: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. CONCLUSIONS: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty.

Técnica del acceso apical con injerto simultáneo de tejido conectivo subepitelial para el tratamiento de una fenestración del tejido blando peri-implantario: descripción de la técnica y presentación de un caso clínico / Apical access technique with simultaneous grafting of subepithelial connective tissue for the treatment of peri-implant soft tissue fenestration: description of the technique and presentation of a clinical case

Cuando hablamos de defectos sobre implantes y tejidos blandos lo asociamos principalmente a dehiscencias del tejido blando. Generalmente estamos cada vez más acostumbrados a tratar este tipo de patologías. Sin embargo, en la practica clínica diaria encontramos otras preocupaciones estéticas sobre el tejido blando que requieren estudio y tratamiento. Desde este punto de vista, este informe de caso clínico tuvo como objetivo describir un abordaje quirúrgico mediante la técnica del acceso apical para el tratamiento de una fenestración estética sobre los tejidos blandos periimplantarios. La selección de la técnica bilaminar mediante un acceso apical con injerto de tejido conectivo simultaneo, parece ofrecer resultados prometedores para el tratamiento de deformidades del tejido blando periimplantario. (AU)

When we talk about implant and soft tissue defects we mainly associate them with soft tissue dehiscence. Generally, we are more and more accustomed to treating this type of pathology. However, in daily clinical practice we find other aesthetic concerns about soft tissue that require study and treatment. From this point of view, the aim of this clinical case report was to describe a surgical approach using the apical access technique for the treatment of an aesthetic fenestration on the peri-implant soft tissues. The selection of the bilaminar technique using an apical access with simultaneous connective tissue grafting seems to offer promising results for the treatment of peri-implant soft tissue deformities. (AU)

Technology at the service of surgery in a new technique of autotransplantation by guided surgery: a case report.

BACKGROUND: The aim of this case report was to use a surgical technique for autotransplantation of tooth using virtually planned 3D printed surgical templates for guided osteotomy preparation of the recipient of donor tooth. CASE PRESENTATION: An 18-year-old male patient received autotransplantation of the right mandibular third molar to replace an included right second molar. This procedure was based on guided implant surgery methods by superimposition of DICOM files and 3D data sets of the jaws. In order to design a 3D-printed template with the aid of a fully digital workflow; the third molar was conserved in PRGF during the surgical procedure and the tooth socket was prepared with a template and the help of a 3D-printed donor tooth copy in order to prevent iatrogenic damage to the donor tooth. This template and replica were manufactured using 3D-printing techniques. The transplanted tooth was placed in infra-occlusion and fixed with a suture splint and root canal therapy was performed 15 days later. The intervention was be accomplished by performing preplanned virtual transplantations with guided osteotomies to ensure accurate donor tooth placement in the new recipient site. The 24 months follow-up showed physiological clinical and radiologic results compatible with healing periradicular tissues. CONCLUSIONS: This approach enables the planning and production of a 3D printed surgical template using the latest diagnostic methods and techniques of guided implant surgery. These accurate virtually predesigned surgical templates and printed analogues of the donor tooth could facilitate autotransplantation, ensuring an atraumatic surgical protocol.