Knowledge, attitudes, and practices among patients with combined dentition defect and non-functional impacted teeth toward tooth autotransplantation.

BACKGROUND: Tooth autotransplantation (TAT) is a surgical procedure involving the extraction of a tooth from one location and its subsequent transplantation into another alveolar socket within the same individual. This innovative treatment approach holds significant promise. Nonetheless, the potential recipients exhibit a limited level of awareness and understanding of this procedure. This study investigated the knowledge, attitudes, and practices (KAP) among patients with combined dentition defects and non-functional impacted teeth toward TAT. METHODS: This web-based cross-sectional study was conducted between December 2022 and February 2023 at one hospital. A self-designed questionnaire was developed to collect demographic information of the patients and assess their knowledge, attitudes, and practices toward TAT. RESULTS: A total of 533 valid questionnaires were collected. The mean knowledge, attitude, and practice scores were 5.55 ± 2.38 (possible range: 0-10), 26.82 ± 2.46 (possible range, 8-40), and 27.45 ± 7.40 (possible range, 9-45), respectively. CONCLUSION: The participants had insufficient knowledge, negative attitudes, and passive practices toward TAT. Targeted interventions should be implemented to improve the understanding and practice of TAT among patients with dentition defects.

Effect of force direction and impaction angulation during dilaceration impacted central incisor traction: a finite element analysis.

BACKGROUND: The effects of traction forces at different angles on impacted central incisors(ICI)with varying inverted angles (IA) may be different. The objective of this study was to analyze the biomechanical effects of different force directions (FD) on developmentally inverted ICI with multi-angle variations and to offer insights and guidance for the treatment of inverted ICI. METHODS: Three-dimensional finite element method was employed to simulate clinical scenarios of inverted ICI traction. As such, 0.2 N of force (direction: antero-superior angles of 90°, 100°, 110°, 120°, and 130° relative to the long axis of the inverted ICI crown) was applied to the inverted ICI with inverse angles (IA) of 40°, 30°, 20°, 10° and 0°. Inverted ICI apical displacement and Von Mises stress on periodontal ligament (PDL) and alveolar bone were compared. RESULTS: IA and FD showed minimal influence on the stress distribution in the PDL, as higher stresses were concentrated in the apical region. The higher stresses in the alveolar bone are focused on the cervical and apical regions of the tooth. In particular, IA exerts a more significant impact on stress distribution in the alveolar bone than FD. The influence of IA on the apical displacement of inverted ICI is larger than that of FD. CONCLUSIONS: To promote the health of the root and periodontal tissues, it is recommended to use an angle of 100°-110° relative to the long axis of the ICI crown when dealing with a large IA (> 20°) developmentally inverted ICI. Conversely, an angle of 110°-120° can be used.

[Postoperative risk of bleeding after removal of third molars in healthy patients - a prospective observational clinical study]. / Nabloedingsrisico na verwijdering derde molaar bij gezonde patiënten; een prospectief observationeel klinisch onderzoek.

Removal of third molars in healthy patients is considered a procedure with a low risk of bleeding. However, exactly how low the incidence of postoperative bleeding is remains unclear due to the heterogeneity of available studies. To determine the exact postoperative risk of bleeding after the removal of third molars in healthy patients, a prospective observational multicentre study was conducted. A total of 1,035 patients with complete follow-up was included. Of these, 329 patients reported subsequent bleeding, but did not consult their attending physician. A total of 15 patients visited the hospital, 8 of whom required minimally invasive (re)treatment. No hospitalizations were necessary. There was a large difference between the incidence of postoperative bleeding reported by patients and postoperative bleeding requiring clinical examination and/or treatment. To reduce this difference in future, patients should be given detailed information about what degree of postoperative bleeding is considered normal after removal of a third molar.

Optimal tooth sectioning using a surgical handpiece and elevator: a finite element study of horizontally deeply impacted mandibular third molars.

OBJECTIVES: To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators. METHODS: CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1-5 mm), tooth section fissure width (1-3 mm), elevator depth in fissure (2-6 mm), elevator position (buccal, lingual, central), elevator width (2-5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue. RESULTS: Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width (~ 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M. CONCLUSIONS: Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process. CLINICAL SIGNIFICANCE: These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.

Treatment and genetic analysis of multiple supernumerary and impacted teeth in an adolescent patient.

BACKGROUND: Multiple supernumerary teeth, combined with numerous impacted teeth, can lead to various malocclusions, posing significant treatment challenges. While certain genes associated with syndromic cases of multiple supernumerary and impacted teeth have been identified, the etiologies of non-syndromic cases still largely remain elusive. CASE PRESENTATION: Here, we report a treatment of a 12-year-old boy who presented with 10 supernumerary teeth and 6 impacted teeth, accompanied by a genetic analysis to explore the underlying etiology. During the treatment, fifteen teeth were extracted, and various skilled techniques, including the closed-eruption technique and the application of by-pass arches, were utilized. Post-treatment, traction was successful for all the impacted teeth, without any tooth mobility or reduction in gingival height. Space closure, well-aligned teeth, and excellent functional occlusion were achieved. Furthermore, comprehensive genetic analysis was conducted through whole-exome sequencing on the patient and his parents, which revealed a potential link between the patient's numerous supernumerary teeth and abnormal mineralization. Notably, the p.Ser496Pro variant in the TCF7L2 gene was identified as a potential candidate variant in this patient. CONCLUSIONS: Overall, our findings not only report the treatment of a rare case involving multiple supernumerary and impacted teeth but also offer valuable insights into the molecular basis of supernumerary teeth.

Assessment of the pre-emptive effect of photobiomodulation in the postoperative period of impacted lower third molar extractions: A randomized, controlled, double-blind study protocol.

Photobiomodulation is a safe option for controlling pain, edema, and trismus when applied postoperatively in third molar surgery. However, administration prior to surgery has been under-explored. This study aims to explore the effectiveness of pre-emptive photobiomodulation in reducing postoperative edema in impacted lower third molar extractions. Two groups of healthy individuals undergoing tooth extraction will be randomly assigned: Control group receiving pre-emptive corticosteroid and simulated photobiomodulation, and Photobiomodulation Group receiving intraoral low-intensity laser and extraoral LED cluster application. The primary outcome will be postoperative edema after 48 h. The secondary outcomes will be pain, trismus dysphagia, and analgesic intake (paracetamol). These outcomes will be assessed at baseline as well as two and seven days after surgery. Adverse effects will be recorded. Data will be presented as means ± SD and a p-value < 0.05 will be indicative of statistical significance.

Is there a relationship between the presence of external root resorption in second molars adjacent to impacted mandibular third molars with awake bruxism and masticatory muscle activity?

OBJECTIVES: This study aimed to assess whether awake bruxism and masticatory muscle activity could be related to external root resorption (ERR) in second molars adjacent to impacted mandibular third molars. MATERIALS AND METHODS: Sixty patients, with requests for a cone-beam, computed tomography, were divided into two groups: ERR (patients with ERR in the second molar, n = 30), and control group (n = 30). Awake bruxism was assessed through the Oral Behaviors Checklist (OBC) and an ecological momentary assessment (EMA). Surface electromyography (EMG) was used to assess the masseter and anterior temporal muscle function. Normality and homogeneity of variances were demonstrated. Descriptive analysis was performed, using the T-test and Chi-square test to compare the characteristics of the groups. A multiple regression model was performed. RESULTS: The ERR group presented more non-functional oral activities related to awake bruxism than the control group, according to OBC (p = 0.027) and EMA (p = 0.035). In addition, the ERR group had higher EMG activity than the control group in rest and isotonic protocols (p < 0.05). CONCLUSIONS: Awake bruxism and greater masticatory muscle activity seem to be related to the presence of ERR in second molars adjacent to impacted mandibular third molars. CLINICAL RELEVANCE: The results of the present study can reinforce the theory that triggering ERR in the second molars adjacent to impacted mandibular third molars may be related to mechanical forces coming from the masticatory function.

Comparison of perineural and systemic dexamethasone use in impacted third molar surgeries in terms of anesthesia duration and postoperative complaints: a controlled, randomized observational study.

BACKGROUND: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited. METHODS: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant. RESULTS: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups. CONCLUSIONS: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries. TRIAL REGISTRATION: This study was conducted at Ahmet Kelesoglu Faculty of Dentistry with the permission of Karamanoglu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).

Impacted Mandibular "Double" Third Molar: Fusion or Gemination? A Case Report.

Dental fusion is defined as an abnormality in tooth shape caused by developmental tooth disturbances that produce an intimate union of dental tissues. This case report discusses treatment of a mandibular impacted "double" third molar in a 21-year-old patient that could have been related to either gemination or tooth fusion. Radiological examination allowed for careful analysis of the tooth's shape and root development, relation to the inferior alveolar nerve, and 3-dimensional position. After evaluation of therapeutic options and risks, and with the patient's consent, the authors opted to extract the tooth in question. Such favorable conditions as the incomplete development of the roots and the relatively young age of the patient, combined with the use of an antibiotic and antiseptic prophylaxis as well as a standard surgical approach, enabled a successful result to be achieved with no related complications.

Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. MATERIALS AND METHODS: Patients aged 11-30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). RESULTS: Surgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. CONCLUSIONS: The application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. CLINICAL TRIAL REGISTRATION NUMBER: NCT05909254. CLINICAL SIGNIFICANCE: Computer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Risk factors for distal caries of second molars adjacent to mesioangular or horizontal partially erupted mandibular third molars: a cross-sectional study.

Introduction Impacted mandibular third molars can be asymptomatic or cause some pathologies, such as distal caries and odontogenic cysts and tumours. This study investigates the prevalence of distal caries of the mandibular second molar adjacent to the mesioangular or horizontally partially erupted mandibular third molar and its relationship regarding decayed, missing and filled teeth (DMFT) risk group, age, side (left-right) and sex.Methods The study included patients who had an appointment for mesioangular or horizontally positioned and partially erupted mandibular third molar surgery. Before the surgery, the DMFT score, age, sex and side were recorded. After extraction, the second molar was clinically examined for distal caries. The prevalence of distal caries and the correlation between the DMFT risk group, age, sex and side were determined.Results The study was conducted on 514 patients and involved 639 teeth. Men and patients in the moderate- or high-risk group are significantly prone to developing distal caries of the second molar. No statistically significant relationship exists regarding age group, side and position.Conclusion Sex and DMFT risk groups affect the prevalence of distal caries in second molars adjacent to the mesioangular or horizontally partially erupted third molars. The prophylactic extraction should be considered in men and patients in the moderate- or high-risk group.

Occlusal contact characteristics of molar teeth with food impaction: Insights from a new digital technique.

OBJECTIVES: The objective of this study was to analyze the occlusal contact characteristics of the food-impacted teeth using a new digital technique. METHODS: A 3D occlusal analysis method was developed for studying the occlusal contact characteristics of teeth affected by food impaction. In this self-controlled study, food-impacted molars from 20 participants constituted the experimental group. The corresponding healthy teeth on the opposite side served as the control group. Variables such as occlusal force (OF), occlusal contact area (OCA), and the number and distribution of occlusal contact points (OCN) in the mesio-distal directions were measured and compared between the two groups. RESULTS: There was no statistical significant difference in the values of OF, OCA and OCN between the food-impacted molars and the healthy control molars (P > 0.05). However, paired T-tests indicated significant difference in the proportion of mesial OF, OCA, and OCN in the second molars of the experimental group (0.22, 0.28 and 0.28, respectively) and the control group (0.66, 0.63, and 0.63 respectively) (P < 0.001). CONCLUSIONS: The abnormal distribution of occlusal contacts in the second molar, primarily characterized by excessive occlusal contact in the distal direction may contribute to the occurrence of food impaction. CLINICAL SIGNIFICANCE: The present study identified variations in the distribution of occlusal contacts and occlusal component force in food-impacted teeth. These findings can assist dentists in making more targeted occlusal adjustments, or applying other treatment modalities, to effectively address food impaction.

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.

Preventive Efficacy of Antibiotics after Impacted Mandibular Third Molar Surgery.

OBJECTIVE: To explore the preventive efficacy of antibiotics following surgical removal of the impacted mandibular third molars and screen the potential risk factors. STUDY DESIGN: A cohort trial. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China, from August 2021 to 2022. METHODOLOGY: Cases with impacted mandibular third molar were divided into two groups based on antibiotics use. The primary outcome variable post-operative infection, secondary clinical parameter analgesics intake, and other variables (the operative time, the history of pericoronitis, and wound closure) were documented. RESULTS: The post-operative infections occurred in 3.64% (n = 12) of the 330 cases (n = 330); 3.01% in the antibiotic group (n = 166) and 4.27% in the control group (n = 164, OR = 1.44, 95% CI: 0.49 to 4.06; p = 0.54). Concerning secondary outcome measures, the analgesics that the antibiotic group took was 5.40, and the control group took was 5.95 (95% CI = -0.21 to 1.30; p = 0.16). For those with post-operative infections, the average operative time was 22.83 minutes, whereas for those without post-operative infections it was 14.87 minutes (95% CI = -0.26 to 15.67; p = 0.04). When the operative time was greater than or equal to 15 minutes, it was related to more analgesics use (95% CI: -0.43 to 1.93; p <0.05), also was the history of pericoronitis (95% CI = 0.04 to 1.54; p = 0.04). CONCLUSION: Antibiotics are unnecessary for preventing post-operative infections or minimising analgesic requirements following extraction of the impacted mandibular third molars; operative time and pericoronitis showed a suppressive influence on post-operative recovery. KEY WORDS: Impacted molars, Antibiotics, Analgesics, Operative time, Pericoronitis.

Frequency of Inferior Alveolar Nerve Injury During Third Molar Extraction.

OBJECTIVE: To determine the frequency of inferior alveolar nerve injury during third molar extraction and the associated factors. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan, from July to December 2021. METHODOLOGY: A total of 163 patients with third molar surgery were included. Patients were followed up after one week, one month, and three months of duration. The frequency of inferior alveolar nerve injury was determined as well as its relationship with other surgical variables like age, gender, type of impaction, buccal flap retraction, bone cutting, tooth splitting, and duration of surgery via Chi-square test. RESULTS: The frequency of inferior alveolar nerve injury was found to be 1.2% (n = 02). None of the surgical variables had a statistically significant association with it (p >0.05). CONCLUSION: The frequency of nerve injury of the inferior alveolar nerve during extraction of the third molar was 1.2%. Proper treatment planning, using advanced radiography, experienced surgeon, and proper technique can help in lowering nerve injury risk. KEY WORDS: Inferior alveolar nerve injuries, Molar, Tooth extraction, Paraesthesia.

The effect of gender and menstrual cycle phase on patients undergoing impacted third molar surgery: a cross-sectional study.

BACKGROUND: Achieving the best outcomes in surgical procedures requires optimizing all patient-related psychological and physiological factors. This study was carried out to evaluate the preoperative anxiety and fear levels, and postoperative symptoms in patients undergoing impacted third molar surgery, and to compare the relevant psychological and physical findings between genders and between women in different menstrual cycle phases. MATERIAL AND METHODS: The population of this prospective and clinical study consisted of patients who applied to faculty of dentistry for the extraction of impacted third molars. The menstrual cycles of the female patients included in the study ranged from 26 to 32 days. The female patients included in the study were divided into three groups according to the first day of the menstrual cycle and bleeding status. All patients were administered Spielberger State-Trait Anxiety Inventory Short Version (STAI-S), Dental Fear Survey (DFS), Modified Dental Anxiety Scale (MDAS) preoperatively, and postoperative satisfaction and complication questionnaires. RESULTS: The mean age of the 128 patients included in the study was 27.04±4.62 years. Of these patients, 79 (61.7%) were female and 49 (38.3%) were male. Female patients had significantly higher STAI-S, MDAS and DFS scores than male patients (94 vs. 53; 16 vs. 9; 58 vs. 27; p<0.001, respectively). In parallel, female patients had significantly higher complication rates, thus significantly lower satisfaction levels than male patients (116 vs. 51; 40 vs. 13; p<0.001, respectively). STAI-S, MDAS and DFS scores were high in women during the secretory phase (p<0.001). In the secretory phase, complications were high and satisfaction was low (p<0.001). CONCLUSIONS: The findings of the study reveal that women have a harder time getting through the operation process and that timing is important in reducing preoperative anxiety and fear levels and increasing postoperative satisfaction levels and complication rates.

Is serum BDNF level reliable parameter in detecting of dental anxiety before impacted third molar surgery?

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is a factor that implicate in the pathophysiology and treatment of depression and anxiety. The aim of this study was to determine the relationship between dental anxiety and BDNF serum level through impacted third molar surgery. MATERIAL AND METHODS: In this randomized, double-blind, cross-sectional study, the sample included patients who had been admitted for the impacted third molar extraction under local anesthesia between January to November 2020. The primary predictor variable was serum BDNF level and the second predictor variable was dental anxiety scores before and after operation in patients. The primary outcome variable was the correlation between anxiety scores (APAIS, MDAS, STAI, VAS) and serum BDNF level. The sample included 55 patients (22 Male, 33 Female) aged 18 to 42 (24,2+5,55). RESULTS: Comparison of pre-operative scores (APAIS, MDAS, STAI, VAS and BDNF) and post-operative scores were statistically significant (P < .05). Post-operatively, MDAS and VAS scores decreased, while BDNF levels and STAI scores increased compared to the preoperative scores. BDNF was not correlated with APAIS, MDAS, STAI, and VAS preoperatively and postoperatively. CONCLUSIONS: There may be a relationship between serum BDNF level and dental anxiety scale, but, no correlation was found between them.