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2.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 39(5): 598-604, 2021 Oct 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34636210

RESUMO

OBJECTIVES: This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars. METHODS: Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests. RESULTS: The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (P>0.05). CONCLUSIONS: The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.


Assuntos
Dente Serotino , Dente Impactado , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Estudos Prospectivos , Extração Dentária , Dente Impactado/cirurgia
3.
Niger J Clin Pract ; 24(10): 1430-1437, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34657006

RESUMO

Background: Dental treatment of anxious patients induces stress due to the patients' expectation of pain. This may prolong treatment due to such patients' inability to cooperate during treatment. Aim: The aim of the study was to determine the effect of dental anxiety on surgical time of mandibular third molar (M3) disimpactions at a Nigerian hospital. Subjects and Methods: A prospective study was conducted at the Oral Surgery clinic of Aminu Kano Teaching Hospital, Kano, between October 2016 and September 2017 to assess the effect of dental anxiety on surgical time of M3 disimpactions using the Modified Dental Anxiety Scale (MDAS). The Patients' biodata, clinical and M3 radiologic data were recorded. Surgical durations were also recorded. Data were analyzed with Statistical Package for Social Sciences for Windows (IBM statistics 23 software). Results: One hundred and sixteen subjects (64 males, 52 females) were studied. Forty-two subjects (36.2%) were mildly anxious, 67 (57.8%) were moderately anxious, and 7 (6.0%) were highly anxious. The females were more anxious and the overall surgical time (OST) of disimpaction correlated with the anxiety levels of the subjects. The OST increased by approximately 0.8 min with every unit rise in the anxiety score. Other factors that affected OST in the study were M3 depth, type of impaction, and root curvature. Conclusion: The patients' dental anxiety increased the surgical time of M3 disimpactions. Clinicians should consider the patients' anxiety among the factors that affect the surgical time of M3 disimpactions. Verbally soothing anxious patients and administering anxiolytic when necessary, may help to reduce the patients' anxiety, and hence, prevent surgical time prolongation.


Assuntos
Ansiedade ao Tratamento Odontológico , Dente Serotino , Dente Impactado , Ansiedade ao Tratamento Odontológico/epidemiologia , Feminino , Humanos , Masculino , Dente Serotino/cirurgia , Nigéria , Duração da Cirurgia , Estudos Prospectivos , Dente Impactado/cirurgia
4.
Dent Clin North Am ; 65(4): 805-814, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34503668

RESUMO

The most common oral and maxillofacial surgical procedure in adolescents is excision of impacted third molars. Adolescent patients should be evaluated for third molars starting around age 16 years unless symptomatic at an earlier age. The dental examination should include panorex imaging to assess development, pathologic condition, and possibility of eruption versus impaction. Various classification systems are available to identify the position and difficulty of the proposed surgical procedure. Retained impacted teeth increase the patient's risk of various morbidities including recurrent infection, damage to adjacent teeth, cysts and other lesions, and unexplained pain.


Assuntos
Dente Impactado , Adolescente , Humanos , Mandíbula , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Radiografia Panorâmica , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia
5.
Biomed Res Int ; 2021: 7492852, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527743

RESUMO

Background: The aim of the present study is to compare the dental anxiety levels between two outpatient clinics. Methods: Two hundred and seventy patients treated in two different clinics of minor oral surgery and dental extraction polyclinic in the Dental Faculty of Eskisehir Osmangazi University were included in the study. The impacted third molar surgery group and conventional dental extraction group consisted of 101 and 169 patients, respectively. The Modified Dental Anxiety Scale (MDAS) and Dental Fear Scale (DFS) were used to measure anxiety levels in patients treated in both clinics. Tests were made in an isolated room preoperatively. The differences in anxiety levels according to education status and gender were also evaluated. Results: The impacted third molar surgery group showed a significant increase in dental anxiety measured with DFS questionnaire (p < 0.05). However, MDAS revealed that there was no difference between anxiety levels between the impacted third molar surgery and conventional dental extraction groups (p > 0.05). There was also no difference in anxiety levels between patients with different education status (p > 0.05). Female patients demonstrated higher levels of anxiety in both MDAS and DFS indexes (p < 0.05). Conclusion: Dental anxiety may be higher in patients treated with impacted third molar surgery compared with conventional dental extraction. The education status of patients may not affect dental anxiety. Female patients may show increased levels of dental anxiety in conventional dental and impacted third molar extractions.


Assuntos
Ansiedade ao Tratamento Odontológico/psicologia , Dente Serotino/cirurgia , Dente Impactado/psicologia , Adulto , Instituições de Assistência Ambulatorial , Escolaridade , Feminino , Humanos , Masculino , Fatores Sexuais , Inquéritos e Questionários , Extração Dentária/efeitos adversos , Extração Dentária/métodos , Dente Impactado/cirurgia , Turquia
6.
BMC Oral Health ; 21(1): 428, 2021 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482829

RESUMO

BACKGROUND: Juxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with IAN injury in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. METHODS: Of an initial sample of 545 mandibular third molars, a total of 75 JAR+ and 75 JAR- teeth were evaluated by CBCT. We assessed the relationship between the presence of JAR in cone-beam computed tomography (CBCT) images and the presence of IAN injury after mandibular third molar surgeries. Moreover, we investigated whether the presence of IAN injury is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. Descriptive statistics, Chi-square test, and Fisher's exact test were performed for statistical analysis. RESULTS: A significant relationship was found between JAR and temporary IAN injury (P = 0.036). However, there was no case of permanent IAN injury. IAN injury showed no significant relationship with the tooth angulation, position to IAN and proximity to the mandibular canal, lingual cortical plate thinning, sex, and age. CONCLUSIONS: JAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary IAN injury. JAR may increase the risk of nerve injury during the surgical removal of third molars.


Assuntos
Dente Serotino , Dente Impactado , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Radiografia Panorâmica , Estudos Retrospectivos , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia
7.
BMC Oral Health ; 21(1): 462, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556118

RESUMO

BACKGROUND: How to prevent pain after the extraction of impacted teeth is a serious challenge for all patients. The purpose of this clinical trial was to investigate whether pre-emptive low dose of etoricoxib can reduce postoperative pain in patients undergoing third molars surgery. METHODS: Patients were randomised to receive etoricoxib 60 mg or placebo 30 min before surgery. Post-operative pain was recorded using a visual analogue scale during 24 h within the post-operative period. The total dose of ibuprofen rescue intake was recorded. Kaplan-Meier curves and log-rank analyses were used to evaluate the proportion of patients without rescue analgesic. RESULTS: Scores for the post-operative pain in the etoricoxib group were significantly lower than those in the placebo group during first 12 h (p < 0.05). The number of patients without analgesic rescue medication was significantly lower in the etoricoxib group than in the placebo group. The average amount of rescue medication in the etoricoxib group (0.4 ± 0.9 dose) was lower than that in the placebo group (1.1 ± 0.9 doses, p = 0.004). Etoricoxib resulted in the long-term survival of patients without rescue analgesic (p < 0.001). CONCLUSIONS: This study revealed that etoricoxib has a substantial pre-emptive analgesic effect, resulting in the reduced use of analgesics after third molar removal. TRIAL REGISTRATION: Registered on ChiCTR1900024503. Date of Registration: 13/07/2019.


Assuntos
Dente Serotino , Dente Impactado , Método Duplo-Cego , Etoricoxib , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia
8.
Acta Clin Croat ; 60(1): 146-152, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34588736

RESUMO

Odontomas are benign odontogenic tumors formed from epithelial and mesenchymal cells. They are mostly associated with disorders of tooth eruption, causing impaction and/or delayed tooth eruption, and are an accidental finding on routine radiological examination. The aim of this paper is to present current findings in the etiology and treatment of odontomas, as well as the clinical and radiographic features, describing a case that is rarely found in the literature. A case of multiple complex odontoma in the mandible of an 11-year-old boy is presented, causing impaction of the first permanent right molar, 46. The treatment consisted of surgical enucleation of the multiple complex odontoma with preservation of the impacted tooth, monitoring clinically and radiologically its spontaneous eruption followed by final orthodontic alignment. Odontomas are not an everyday part of clinical practice and given that they are most commonly associated with permanent tooth impaction, it is extremely important to have knowledge of their clinical and radiological features. Early diagnostics and appropriate treatment result in better diagnosis, thus increasing the possibility of preserving the impacted teeth.


Assuntos
Odontoma , Dente Impactado , Criança , Humanos , Masculino , Odontoma/diagnóstico por imagem , Odontoma/cirurgia , Radiografia , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia , Resultado do Tratamento
9.
Int J Comput Dent ; 24(3): 253-262, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34553890

RESUMO

AIM: Most of the intra- and postoperative patient discomfort related to complex mandibular third molar (M3M) extraction is proportional to the invasiveness of the surgery. This can be minimized through the support of dynamic navigation (DN) technology, which can be successfully applied in dental implantology. Materials and methods: Three patients, one female (aged 25 years) and two males (aged 18 and 51 years, respectively) underwent the DN-supported extraction of partially impacted M3Ms with a flapless approach that required minimal bone removal. The patients' discomfort and the speed of recovery were considered to be proof of the quality of the adopted procedure. RESULTS: No postoperative discomfort such as pain or swelling was recorded in the immediate postoperative period, and no complications were reported within a month of the surgery. No medications were prescribed. The procedure lasted no longer than 20 min in all cases. CONCLUSION: Using DN technology, the real-time 3D monitoring of the clinical situation in each surgical phase enabled the surgeon to avoid soft tissue detachment as well as limit bone loss and intraoperative bleeding, thanks to a precise multi--section of the tooth and important nearby anatomical structures, respectively.


Assuntos
Dente Serotino , Dente Impactado , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Dente Serotino/cirurgia , Tecnologia , Extração Dentária , Dente Impactado/cirurgia
10.
J Am Dent Assoc ; 152(10): 842-854.e1, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34579810

RESUMO

BACKGROUND: Results from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis. METHODS: The authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence. RESULTS: Patients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, -3.94 to -1.56) and at 7 days (95% CI, -1.67 to -0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of -0.44 at 24 hours, 0.63 at 72 hours, and -0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, -1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, -0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, -1.34 to 4.18; 4 studies, 133 patients). PRACTICAL IMPLICATIONS: Evidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.


Assuntos
Ozônio , Dente Impactado , Edema/etiologia , Edema/prevenção & controle , Humanos , Dente Molar , Dente Serotino , Ozônio/uso terapêutico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Qualidade de Vida , Extração Dentária , Dente Impactado/cirurgia
11.
JNMA J Nepal Med Assoc ; 59(239): 678-682, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508508

RESUMO

INTRODUCTION: Third molar impaction is a common patient complaint in dentistry. Common symptoms are localized pain, swelling, bleeding, and difficulty in mouth opening. Since dental students deal with patients early in their education, for better skill, they should have knowledge of various teeth impactions. Hence, the objective was to find out the knowledge of impacted teeth among undergraduate dental students of a medical college. METHODS: A descriptive cross-sectional study was conducted among bachelor in dental surgery students of a medical college from November 30, 2020 to April 3, 2021. Data collection was done by convenience sampling after receiving ethical clearance from Institutional Review Committee (Reference 1208202006). A structured questionnaire in Google Forms was sent to 221 participants via Viber. Out of 213 responses received, 144 were analyzed in Excel after discarding for duplication and other errors. Descriptive statistics such as mean, standard deviation, frequency, and percentage were analyzed. RESULTS: Out of the total of 144 participants, only 81 (56.3%) (47.89-91.4 at 95% Confidence Interval) had known about the term 'impacted teeth' before joining Bachelor in Dental Surgery course. The source of information was mostly the internet 27 (18.8%) followed by dentist 23 (16%). Most students 116 (80.6%) were familiar with third molar impactions, 62 (43.1%) knew about types of impacted teeth/impaction, and 100 (69.4%) were aware of the complications of not removing impacted teeth. CONCLUSIONS: Dental students should be provided with appropriate 'impacted teeth' education supported by practical experience. More detailed information regarding impacted teeth should be included in the curriculum for better understanding.


Assuntos
Dente Impactado , Estudos Transversais , Currículo , Humanos , Dente Serotino/cirurgia , Estudantes de Odontologia , Dente Impactado/epidemiologia , Dente Impactado/cirurgia
12.
J Evid Based Dent Pract ; 21(3): 101582, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34479679

RESUMO

PURPOSE: The present study aimed to assess differences in postoperative morbidity between prophylactic and symptomatic third molar removals, and to assess the effect of age on the recovery of the patient. METHODS: Patients admitted for third molar removal were prospectively followed up four times during treatment in context of the M3BE study. Data were collected through pre-, peri and postoperative surveys (days 3 and 10). Uni- and multivariable logistic regression was used to assess the probability of postoperative symptoms of discomfort on day 3 and day 10 according to several patient- and surgery-related predictive factors (age, gender, indication for removal, method of extraction, anesthesia and number of extracted maxillary and/or mandibular third molars). RESULTS: In total, 6010 patients with a mean age of 25.2 (± 11.2) underwent 6347 surgeries to have 15,357 third molars removed. Frequently observed symptoms of postoperative discomfort were pain, trismus and swelling, all of which were transient in nature with steep decreases from postoperative days 3 to 10. Increasing age was associated with an enhanced risk of persistent pain, trismus and swelling and a significantly higher risk of iatrogenic injury to the inferior alveolar nerve. Symptomatic indications for removal were more common in patients over age 25 years, but these pre-existing pathologies did not compromise the postoperative recovery process. Other factors related to postoperative morbidity were female gender, intraoperative osteotomy and the number of extractions. CONCLUSION: The results of this study suggest that there are convincing patient- and surgery-related factors that favor timely third molar removal, preferably before the age of 25, especially in order to avoid persistent morbidity and nerve complications.


Assuntos
Dente Serotino , Dente Impactado , Adulto , Feminino , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Morbidade , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controle
13.
BMC Oral Health ; 21(1): 393, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380473

RESUMO

BACKGROUND: Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. METHODS: A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. RESULTS: The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). CONCLUSION: The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. TRIAL REGISTRATION: NCT04889781 ( https://clinicaltrials.gov/ ), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1.


Assuntos
Dente Serotino , Dente Impactado , Dexametasona/uso terapêutico , Edema/etiologia , Edema/prevenção & controle , Humanos , Injeções Intramusculares , Mandíbula/cirurgia , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controle
14.
Artigo em Inglês | MEDLINE | ID: mdl-34443998

RESUMO

Due to the frequent development of non-infectious complications after surgical removal of the third lower impacted tooth, many techniques are used to reduce their severity. Among them is the technique of applying platelet-rich fibrin to the post-extraction alveolus. The study included 90 consecutively enrolled patients. Eligible patients were randomly assigned to two groups: patients with and without platelet-rich fibrin introduced into the postoperative alveolus. Pain, swelling, trismus, and temperature were evaluated after the procedure. Pain intensity was significantly higher in the control group than in the study group at 6 h, 1, and 3 days after surgery. PRF application did not significantly affect the intensity of swelling. Body temperature was significantly higher in the control group than the study group on day two after surgery. The trismus was significantly higher in the control group than in the study group at one, two, and seven days after surgery. Application of the PRF allows for a faster and less traumatic treatment process. It will enable for speedier recovery and return to active life and professional duties.


Assuntos
Fibrina Rica em Plaquetas , Dente Impactado , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia
15.
Medicina (Kaunas) ; 57(8)2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34440987

RESUMO

Background and Objectives: The aim of this systematic review was to summarize currently available data of published articles that have investigated the post-treatment status of impacted maxillary central incisors (ICI) treated by the surgical-orthodontic approach. Materials and Methods: MEDLINE, Scopus, Cochrane Oral Health Group's Trials Register, and ScienceDirect electronic databases were systematically searched with no publication date restrictions up to January 2021. Data assessing the status of ICI after combined surgical-orthodontic treatment and forced eruption duration were extracted, and the quality of the studies was evaluated. Results: In total, 7074 studies were identified, of which 42 articles were assessed for eligibility through full-text evaluation. Seven included studies (five retrospective studies, one randomized clinical trial, and one prospective clinical trial) met the inclusion criteria, representing 211 patients with unilaterally impacted maxillary incisors. The risk of bias ranged from moderate to high. The results show that the root length of immature ICIs increased significantly but remained shorter than that of homonym teeth at post-treatment. Periodontal parameters of treated ICIs were in a clinically acceptable range. Measurements of the alveolar bone showed a reduction of bone thickness and support. The average forced eruption duration ranged from 8.0 ± 4.5 to 14.41 ± 4.03 months. Conclusions: Based on existing evidence, it is reasonable to conclude that the surgical-orthodontic treatment affected the post-treatment status of ICI; however, the current literature is insufficient to draw concrete conclusions. Further well-conducted multi-center randomized studies with a large sample are needed to confirm this statement.


Assuntos
Incisivo , Dente Impactado , Humanos , Maxila/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Dente Impactado/cirurgia
16.
Head Face Med ; 17(1): 33, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34389020

RESUMO

BACKROUND: This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle. METHODS: In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies. RESULTS: In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest. CONCLUSIONS: Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.


Assuntos
Dente Impactado , Traumatismos do Nervo Trigêmeo , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Nervo Mandibular/diagnóstico por imagem , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Radiografia Panorâmica , Estudos Retrospectivos , Extração Dentária/efeitos adversos , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia , Traumatismos do Nervo Trigêmeo/prevenção & controle
17.
Niger J Clin Pract ; 24(7): 1028-1036, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34290179

RESUMO

Background: Third molar impaction, if left untreated, has the potential to cause several complications. The evaluation of surgical difficulty of impacted third molar extraction aids in better formulation of treatment plan by minimizing surgical complications. Objective: This study aimed to determine the prevalence of third molar impaction and related pathologic conditions in a cohort of patients living in North-eastern Peninsular Malaysia. Methods: In this retrospective study, 490 orthopantomograms (OPGs) of patients who were referred to the Oral and Maxillofacial Surgery department between January 2010 and December 2019 were assessed. Data including age, gender, ethnicity, frequency of third molar impactions, their angulations and levels of eruption, retromolar space, and associated pathologic conditions were collected. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.0. The significance level was set to P < 0.05. Results: A total of 490 patients with a mean age of 28.87 years (range: 20-64) demonstrated 1957 impacted third molars (1022 mandibular + 935 maxillary). Impacted third molars were more likely present in females than males (1:2.20) (p < 0.05); and in Malay-ethnic (44.49%) patients followed by Chinese (34.45%) and Indians (21.02%). Mesioangular was the most common angulation of impaction both in the maxilla (24.68%) and mandible (18.34%). The most common pattern of third molar impaction was IIA (61.67%), and the retromolar space was significantly larger in males (13.6 mm; P < 0.05) than females (11.6 mm). The most frequently occurring pathological condition associated with third molars impaction is dental caries in the second or third molar (15.38%). Conclusions: This study highlights mesioangular impaction with their occlusal plane at the same level as the occlusal plane of the adjacent tooth being the most prevalent pattern of third molar impaction in North-eastern Peninsular Malaysia.


Assuntos
Cárie Dentária , Dente Impactado , Adulto , Feminino , Humanos , Malásia/epidemiologia , Masculino , Mandíbula , Pessoa de Meia-Idade , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Estudos Retrospectivos , Dente Impactado/diagnóstico por imagem , Dente Impactado/epidemiologia , Dente Impactado/cirurgia , Adulto Jovem
18.
J Contemp Dent Pract ; 22(4): 412-421, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267012

RESUMO

AIM: To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. BACKGROUND: Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. CASE DESCRIPTION: A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. CONCLUSION: Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. CLINICAL SIGNIFICANCE: This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.


Assuntos
Anquilose Dental , Dente Impactado , Adulto , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Dente Canino , Feminino , Humanos , Mandíbula , Anquilose Dental/diagnóstico por imagem , Anquilose Dental/cirurgia , Técnicas de Movimentação Dentária , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia , Adulto Jovem
19.
Indian J Dent Res ; 32(1): 87-91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34269243

RESUMO

Introduction: The way postoperative care instructions are presented by the professional (verbal and/or written) is the key element that influences quality of treatment. Hence, the aim of the present study was planned to assess the patient's compliance with postoperative care instructions given in different forms following the surgical removal of impacted lower third molars. Materials and Methods: Forty patients scheduled to undergo surgical extraction of impacted lower third molars under local anesthetic were randomly assigned to one of two groups. Before surgery, basic demographic data about age, gender, deleterious habits were recorded. Group A (verbal postoperative care instructions) and Group B (verbal + pictorial postoperative care instructions) were given with a prescription of medication after the surgical removal of impacted lower third molars. Patient were recalled on 7th postoperative day for suture removal and asked to fill the closed-ended questionnaire. Results: Out of 20 patients in each group, one patient from Group A was eliminated as the patient did not turn for the follow-up visit. Therefore, result was based on 39 patients (19 males and 20 females) of age 28-41 years with a mean of 33.2 years (SD ± 3.3). The significance level was set at P < 0.05. The compliance of patients regarding gargling with lukewarm water and mouth opening exercises was seen more significantly in Group B (Pictorial + Verbal). Conclusion: Verbal instructions are inadequate due to difficulty in retention. Hence, a pictorial form of delivering postoperative instructions increases information retention which significantly increases pain relief without extending the analgesic consumption.


Assuntos
Dente Serotino , Dente Impactado , Adulto , Analgésicos , Feminino , Humanos , Masculino , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Cooperação do Paciente , Extração Dentária , Dente Impactado/cirurgia
20.
Artigo em Inglês | MEDLINE | ID: mdl-34205078

RESUMO

Classifications of impacted teeth allow defining the type and degree of retention, as well as assessing the degree of difficulty of the procedure. The aim of this study was to conduct retrospective analysis of the degree of retention and difficulty in the surgical removal of impacted mandibular third molars in the clinical material of the Department of Oral Surgery in 2013-2018. This study included 1585 dental panoramic radiographs of patients of the Department of Oral Surgery, who reported in 2013-2018, in order to perform surgical removal of the impacted mandibular third molar. Based on dental panoramic radiographs, the degree of retention was determined based on classifications according to Winter, according to Pell and Gregory, according to Tetsch and Wagner, and according to Asanami and Kasazaki. The difficulty of the procedure was also assessed based on the Pederson index. The most common types of lower wisdom tooth impaction are as follows: in Winter's classification, mesial-angular impaction; in Tetsch and Wagner's classification, oblique medial-angular impaction; in Pell and Gregory's classification, impaction grade 2A; and in Asanami and Kasazaki's classification, 3A and anterior inclination. In most cases of surgical removal of an impacted tooth, the anticipated difficulty of the procedure was rated as very difficult.


Assuntos
Dente Serotino , Dente Impactado , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Dente Molar , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Estudos Retrospectivos , Dente Impactado/diagnóstico por imagem , Dente Impactado/epidemiologia , Dente Impactado/cirurgia
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