Impacted Mandibular Molars Research Articles

Effectiveness of Resorbable Surgical Gelatin Sponge Following Impacted Mandibular Tooth Extraction: A Prospective Split Mouth Comparative Investigation

Background: Post-operative pain is common complication following surgical extraction of impacted mandibular teeth. Absorbable Surgical Gelatin sponge is a hemostatic Agent commonly used in controlling bleeding in oral surgery. The specific aim of this study is to understand the efficacy and efficiency of absorbable surgical gelatin sponge in reducing post-operative complication after surgical extraction of impacted mandibular molars.

Coronectomy of impacted mandibular third molars: a clinical and radiological retrospective case series study with 2-9 years of follow-up.

Impacted mandibular third molars occasionally are in intimate relation to the inferior alveolar nerve (IAN). Coronectomy has been proposed as a good alternative to prevent injury of the IAN. The present study evaluates the clinical and radiological outcomes of impacted mandibular third molars presenting radiographic signs associated with a high risk of IAN injury, and which were treated with the coronectomy technique. A retrospective case series evaluated the outcomes of coronectomies of impacted mandibular third molars. The inclusion criteria were: available preoperative, immediate postoperative and two-year panoramic radiographs, preoperative cone-beam computed tomography (CBCT), and a complete case history. The clinical evaluation comprised intraoperative complications (mobilized fragments of root and damage to adjacent structures), short-term complications (sensory alterations and postoperative infection), and long-term complications (infection or oral exposure). The IAN position with respect to the roots, root shape, eruption status, third molar position, radicular-complex migration and bone above roots were radiographically evaluated as well. Approximately a total of 2000 mandibular third molars were removed from 2011 to 2022. Of these, 39 molars in 34 patients were partially extracted using the coronectomy technique. The mean age was 36 years (range 22-77), and the mean follow-up was 28 months (range 24-84). There were two short-term postoperative infections. One of them was resolved through reintervention to remove the roots after antibiotic treatment, while the other required hospital admission and removal of the roots. One case of short-term transient lingual paresthesia was also recorded. Two long-term oral exposures were detected, and the root fragments had to be extracted. There were no permanent sensory alterations. In our case series of 39 impacted mandibular molars in intimate contact with the IAN and treated with the coronectomy technique, the number of complications was low (two infections and a single case of transient lingual paresthesia), and no permanent sensory alterations were observed. Prospective studies, especially randomized clinical trials, are needed to compare this technique with conventional extraction.

Influence of L-PRF Topical Application on Bone Tissue Healing after Surgical Extraction of Impacted Mandibular Third Molars: Randomized Split-Mouth Clinical Study

The beneficial effect of autologous blood products in the post-extraction period has been proven regarding acceleration of soft tissue healing, pain reduction, swelling and trismus, but data concerning bone healing are contradictory. The objective of this study was to evaluate the effect of L-PRF on bone tissue healing after third mandibular molar extraction. Extractions of bilateral, symmetrical, impacted mandibular molars were performed in 30 patients, in a prospective split-mouth, randomized, double-blind clinical trial. L-PRF was applied to one alveolus, while the other alveolus was left to heal spontaneously. A sample of 60 extraction alveoli (the control and experimental groups, with 30 alveoli each) was analyzed. Two CBCT images were performed immediately after the surgery and eight weeks postoperatively to reconstruct the healing site and analyze the volume of the extraction defect and bone density. The depth of the periodontal pocket on the adjacent tooth was clinically measured 7 days and 8 weeks after extraction. The results show that the minimum and maximum values of the monitored parameters in the alveoli in both the control and experimental groups are within the expected range. Based on p = 0.826 (MANOVA; for I measurement) and p = 0.499 (MANOVA; for II measurement), it was concluded that no significant difference and clearly defined boundary between the groups were observed. Considering that p > 0.1 (VOL, bone density, periodontal pocket) is for both I and II measurement, no significant difference was observed between the groups regarding the wound volume, bone density and periodontal pocket.

Inter-Rater Reliability to the Assessment of Ramus Relationship of Mandibular Impacted Third Molar Among Denitsts: An Orthopantomographic Study

Objective: To find the inter-rater reliability to the assessment of ramus relationship of mandibular impacted third molar among denitsts. Methodology: A cross sectional comparative study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore after obtaining ethical clearance from ethical committee of Sharif Medical Research Centre (SMRC) in which dentists from three different specialties namely; Oral Pathology, Endodontics and Prosthodontics were included as raters. The study was conducted from December 2020 to February 2021. A total of 21 Orthopantomograms were assigned to each rater for assessing the ramus relationship of impacted third molar. The classification for angle of impaction used was Winter`s classification. The raters were provided with the OPGs and a proforma for recording their observations. Results: The level of agreement regarding the ramus relationship of impacted third molars observed on the Orthopantomograms between rater 1 and rater 2 was fair (κ=0.366 ,p=0.022). The agreement was also fair between rater 1 and rater 3 (κ=0.300, p=0.094). Conclusion: There was a fair agreement in assessment of ramus relation of the impacted mandibular molars of rater 1 with rater 2 and 3 where majority of the class 2 and class 3 relations were rated similarly by both the raters as Keywords: Inter-rater reliability, Cohen Kappa, Impacted third molar, Orthopantomogram, Ramus relationship

Pattern of mandibular third molar impaction: a cross-sectional CBCT study

Objective: This study aimed to describe the mandibular third molar's impaction classifications in three dimensions by using cone beam computed tomography (CBCT). These classifications might help oral and maxillofacial surgeons in making a clinical choice about when to extract a tooth or prepare another treatment strategy. Methods: A total of 259 CBCT scans were found eligible for inclusion in the study. Impacted mandibular third molars were radiographically assessed for Pell and Gregory's classification (impaction), Winter's classification (angulation of the impaction), and the relation of the impacted mandibular molar to the buccal and lingual bone (horizontal relation). Results: Mesioangular angulation constituted 55.6% of all angulations, with horizontal angulation constituting 21.62% and vertical angulation 16.22%. The most frequent horizontal relation was lingual impaction. The most prevalent level of impaction was level A, and the most prevalent ramus relationships were class II at 52.51%. Both men and women were classified similarly, and there was no discernible difference between the right and left sides of the mouth (p > 0.05). Conclusion: Additional research with a bigger sample size is required to assess the Saudi Arabian third mandibular molar impaction pattern.

Clinical and Radiological Correlation with Surgery of Third Mandibular Impacted Molars

Overview :Tooth extraction is one of the most common procedures in dentistry and oral maxillofacial medicine. Vigilant investigation of the condition and an accurate preoperative assessment, planning, evaluating indications and contraindications, is needed in all the cases. The objective : The aim of this study is to evaluate the role of radiographic examinations in diagnosis and surgery planning of lower third molar extraction. Materials and methods : Review of literature; on pubmed, medline, embase, sciencedirect, and the Cochrane library, using key words of impacted molars, third molars, mandibula, alveolar, dentistry, oral maxillofacial. Results: During dental and oral maxillofacial daily clinical practice is quite often to face impacted third lower molars, a condition that can lead to a close relation with important anatomical structures. Radiographic examinations are useful in the diagnosis and subsequently in the surgery planning and must submit to principle of justification and optimization. Intraoral radiography and orthopantomography hardly permit to evaluate the buccal or lingual position of the inferior alveolar nerve so to better predict the risk of complications. There are some radiographic signs that suggest the necessity to perform a more accurate radiographic investigation that provides a three-dimensional view of the images. The three-dimensional radiographic methods, by means of sagittal, frontal and axial views, are used to determine anatomical location, proximity, and possible contact of the third molar with the mandibular canal, blood vessels and nerves branches. The beginning of Cone Beam Computed Tomography (CBCT) has reduced the equipment cost but then again above all the radiation exposure for the patients. Conclusions: In the past few years three-dimensional reconstructive technologies were introduced: besides advantages, in addition to the potential benefit in the reduction of complications related to the patient, also resides in the different approach of the surgeon: stress and duration of dental and oral maxillofacial surgical procedures significantly is reduced because the respective medical specialist know exactly the position of anatomical structures. This information will help the surgeon to determine a possible post-operative paresthesia and plan the better surgical technique. Keywords : Impacted molars, third molar, surgery, inferior alveolar nerve, OPT, CBCT DOI: 10.7176/ALST/95-04 Publication date: November 30 th 2022

Impacted Mandibular Third Molars Associated Pathologies

Purpose: The purpose of this research was to identify the most common and severe types of pathologic diseases surrounding impacted mandibular third molars using radiographic imaging. Cases and procedures: An analysis of past patients who had impacted mandibular molars extracted at Oral & Maxillofacial Surgery of Cat D Hospital Gara Tajik Peshawar. Impacted mandibular third molar radiographic lesions, patient age and gender were used as the study's outcome measures. Caries, pericoronal radiolucent areas, periapical radiolucent areas, odontomes, and external resorption of the roots of adjacent mandibular second molars were also noted on radiographs of the impacted third molar. Histopathology confirmed the presence of bone marrow in all radiolucent regions. Results: There were 2,832 mandibular third molars that had been impacted and were studied from 1,397 individuals; 49.4 percent of the impacted teeth had associated radiographic abnormalities. Dental cavities were the most prevalent abnormality detected by panoramic radiography. Other examples of this type of radiolucency can be found at the periphery of the cortex and at the tip of the apex. Histological analysis confirmed that chronic periapical inflammation was the primary cause of most periapical radiolucent regions. Histological examination revealed that all radiolucent spots located around the corona were malignant cysts or tumours. Dentigerous cysts were the most common type of cyst, while ameloblastomas were the most common type of tumour. Conclusion: A large proportion of the patients with a third molar impaction in the mandible also had an underlying pathologic condition. Keywords: Mandibular, Radiolucent, Panoramic, Tumor

Torqued and conventional cantilever for uprighting mesially impacted molars: A 3-dimensional finite element analysis

The objective of this study was to evaluate the effects of the torqued cantilever (TC) and conventional tip-back cantilever (CC) made of stainless steel (SS) and titanium-molybdenum alloy (TMA) on the uprighting of mesially impacted mandibular molars using three-dimensional finite element analysis. The 3-dimensional mandibular model included part of the mandible with mesially tipped and impacted mandibular second molar, periodontal ligament (PDL), molar tube, mini-implant, and cantilevers. Four finite element method models (TC-SS, TC-TMA, CC-SS, and CC-TMA) were created to simulate different skeletally anchored uprighting mechanics. CC mechanics involved a known 0.019 × 0.025-in helical cantilever acting on a buccal molar tube. TC mechanics included a 0.019 × 0.025-in cantilever capable of producing mesial root torque by acting on a tube positioned on the molar disto-occlusal surface with the slot in a buccolingual direction. Three-dimensional molar displacement and stress distribution on the molar PDL were recorded. The SS cantilever produced almost twice as much molar displacement as the TMA. TC mechanics showed more evident mesial displacement of the molar root apexes. CC mechanics had greater molar rotation. TC uprighting moment produced greater molar mesial extrusion and greater intrusion of the distal root apex. The dual deflection system of the TC mechanics induced the lowest stress on the PDL, regardless of the metallic alloy. TC delivered a more efficient uprighting moment to the molar with less unwanted tooth movement and stress on the PDL and a more accessible site for bonding the molar tube.

Surgical Management of Impacted Bilateral Mandibular Molars Adjacent to Inferior Alveolar Nerve to Avoid Paresthesia of Lower Lip

The extraction of impacted 3rd molar is most frequently performed surgery now-a-days as it can lead to infections, cysts, tumors, neuralgiform pain, and disturbances of occlusion, masticatory dysfunctions and myoarthropathies. Damage to inferior alveolar nerve leads to impairment of sensation in the lower lip, which is most unpleasant postoperative complication. For surgical removal of impacted mandibular molars, relative position of inferior alveolar nerve with mandibular 3rd molar is of utmost importance. There are number of positions in which inferior alveolar nerve is located in relation to impacted 3rd molar which, either in a direct contact with the 3rd molar or has no contact at all. While performing surgical procedures in the vicinity of 3rd molar, Inferior Alveolar Nerve can be damaged but with high expertise and precision the operator can spare the nerve without any injury. In this case report, we discuss about the surgical management of a case with bilateral impacted 38, 47, near the Inferior alveolar nerve to avoid paraesthesis of lip.

CHARACTERISTICS OF FIRST DAY COMPLICATIONS AFTER ODONTECTOMY OF IMPACTED MANDIBULAR THIRD MOLAR IN GENERAL ANESTHESIA

Introduction: Odontectomy is the most common procedure performed by oral and maxillofacial surgeons. The consideration of odontectomy cases in general anesthesia with certain factors, such as patient anxiety, mental or physical disorders, degree of difficulty in impacted teeth, disoriented patients, number of teeth performed odontectomy, and duration of surgery. Some complications after odontectomy, including swelling, trismus, and paresthesia often occur from the first day after odontectomy. The purpose of this study was to determine the characteristics of the complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia at Dr. Hasan Sadikin General Hospital during January – June 2020. Methods: This study was a cross-sectional retrospective using medical record data of patients diagnosed with class I, II, and III mandibular molar impaction based on clinical and panoramic x-rays and performed odontectomy of mandibular third molar impaction in general anesthesia at Dr. Hasan Sadikin Hospital for the period January - June 2020. Results: The obtained data were 186 cases from 98 patients. Data were obtained from secondary data through medical records of mandibular third molar impaction odontectomy patients in general anesthesia who were treated at the inpatient installation of RSUP Dr. Hasan Sadikin for the period during January to June 2020 to determine the characteristics of complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia based on age, gender, and the classification of mandibular third molar impactions. The percentage of complications on the first day after odontectomy of impacted mandibular M3 in general anesthesia at Dr. Hasan Sadikin General Hospital for the period during January - June 2020 showed that the largest number was found in complications of swelling as many as 41 people (54%), followed by trismus as many as 33 people (43%) and paresthesia were 2 patient (3%). Conclusion: The most common complications were swelling and trismus, where these complications were classified as mild and normal complications from odontectomy of impacted mandibular third molars. Meanwhile, the rarest complication was paresthesia. Keywords: Complications, Post-odontectomy, Impaction of mandibular third molar

Intraosseous Ewing's sarcoma associated with impacted mandibular molars: Clinicopathological correlation and immunohistochemical analysis

Intraosseous Ewing's sarcoma associated with impacted mandibular molars: Clinicopathological correlation and immunohistochemical analysis

PREDICTION OF VERTICAL IMPACTION OF LOWER WISDOM TOOTH ACCORDING ORTHOPANTOMOGRAPHY OF LOWER JAW

Topic relevance. The dental surgeon often is left alone with the dilemma: to save or remove the third lower molars. The justification of indications for tooth extraction must have objective criteria. It should be noted that a patient with this problem does not always have the opportunity to receive comprehensive advice from an orthodontist. In view of this, the solution to this problem requires the search for radiological data, which are the most available today and would help to justify treatment tactics for preservation or removal of the tooth.
 The conditions of tooth preservation in the dentition are most favorable with a slight medio-distal inclination and a vertical position of the third lower molars. However, this does not exclude the possibility of tooth impaction, which is often accompanied by periodic inflammatory phenomena in the tissues adjacent to the tooth and motivates both the patient and the dental surgeon to solve this problem.
 The aim of our study was to research of radiographic indicators of orthopantomography of the mandible to predict the vertical retention of the third lower molars.
 Material and methods of research. The platforms of Google Scholar, Research Gate and PubMed are used for research and analysis of the scientific literature on the application of objective criteria of mandibular orthopantomography data in the prediction of vertical impaction of the third lower molars.
 Impaction of mandibular molars is the result of a number of factors, including heredity, racial characteristics, muscle function, the nature of the food consumed, insufficient growth of the mandible, the size of the retromolar space. The accurately determination the positions of the molars and the size of the retromolar space of the mandible by available methods of X-ray diagnosis (the most common of which is the method of orthopantomography of the jaws) are necessary to prediction of tooth retention. The accuracy of imaging and measurements on orthopantomograms of the jaws was studied by both domestic and foreign authors.
 The angle of inclination of lower wisdom tooth, the size of the retromolar space of the mandible and the mesiodistal size of the teeth are determined on OPTG of jaws in the vast majority of publications. The age aspect of patients is also important for prediction of tooth impaction. In particular, most researchers state the fact that up to 20 years of life there is a significant probability of changing the position of the teeth during their eruption and therefore it is quite appropriate to wait.
 To predict the nature of the impaction of the third lower molars, the authors provide indicators of the angle of the tooth, the structure of their roots, the degree of impact and age of the patient.
 The publication of Maria Mersedes Gallas-Torreira and co-authors, which compared two methods of linear measurements on OPTG – Olive-Basford’s and Olmos ’methods have greatest interest. Both methods can be used to predict of impaction of lower wisdom tooth. However, if the prognostic estimate is based on orthopantomogram data rather than cone-beam computed tomography, the Olmos` method demonstrates a lower error rate and a more plausible prediction.
 To substantiate the algorithm for predicting the vertical retention of third lower molar in order to improve treatment tactics for the preservation or removal of the tooth which based on the obtained search data and the results of our own clinical observations and it is planned in the future.

Comparison of tramadol and Ketorol in management of pain after third molar surgery

Aims: To evaluate the comparison of analgesic efficacy of preoperative intravenous (IV) ketorolac versus tramadol in preventing postoperative pain after mandibular third molar surgery. Methodology: Hundred patients in the age group of 20–40 years with asymptomatic impacted mandibular molars were randomly allocated into one of the two groups. All the patients underwent third molar surgery under local anesthesia. Group I received IV ketorolac 30 mg and Group II received IV tramadol 50 mg preoperatively. The difference in postoperative pain was assessed by five primary parameters: pain intensity being measured hourly by Wong Baker pain assessment scale for 6 h, onset of analgesia, duration of action, total number of analgesics consumed, and patient’s global assessment. Results: Throughout the 6 h investigation period, patients reported significantly lower pain intensity scores, longer duration of action, lesser postoperative analgesic consumption, and better global assessment in ketorolac when compared to tramadol group. Patients in the ketorolac group significantly performed better than the tramadol group in terms of all parameters except onset of analgesia. Conclusion: The result of the present study shows that preoperative IV ketorolac 30mg is more effective than tramadol 50mg for postoperative pain following third molar surgery.

PREDICTION OF EXTRACTION DIFFICULTY FOR INFERIOR THIRD MOLAR

Inferior third molar impaction remains an actual topic of discussion in modern dentistry due to the frequent complications and treatment contraindications. According to Rock and Elsey inferior third mandibular molar impaction occurs in 73% of young people. Many theories of impaction of inferior 3rd molar have been proposed, but the most popular is the insufficient development of retromolar space. Some authors claim that M3 extraction should only be performed when complications may occur, others say that M3 should be extracted if there are no contraindications, but Martin Kunkel is the advocate of the prophylactic extraction of the inferior third molar. In order to achieve the proposed goal, the frequency of impaction of mandibular third molar and their relationship with neighboring anatomical structures was evaluated. There were statistically processed data of medical records and radiographic examination. This study was made based on 320 patients treated in the University Dental Clinic nr.2, SUMPh ,,Nicolae Testemițanu”. Of these, 147 patients were selected: 58 patients with impacted inferior 3rd molar and 89 patients with inferior 3rd molar apparently erupted in the correct position. The most common complication caused by M3 was pericoronitis, followed by second molar caries.

Efficacy of platelet-rich fibrin on pain, edema, and healing in mandibular third molar surgery: A split-mouth randomized study

Context: The postoperative sequelae after third molar surgery include pain, swelling and trismus, distal bone loss along with prolonged sensitivity due to root exposure or increased probing depth. Platelet rich fibrin (PRF) appears to accelerate physiologic healing due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodelling and reduced incidence of infectious events. The mechanism of action of PRF on pain and edema is not fully understood and it is possible that this effect could be a reflection of better and faster healing of the socket.Aim: The aim is to assess the influence of PRF on pain, edema, and wound healing of the socket after surgical extraction of mandibular third molars.Settings and Design: This randomized controlled study was conducted on 60 patients with bilateral impacted mandibular third molars, reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral).Subjects and Methods: Surgical removal of the impacted mandibular molars of both sides was planned with a gap of 4 weeks between the two sides and appointments were given accordingly. Study side-Surgical extraction followed by placement of PRF in socket and closure and control side-Surgical extraction followed by closure.Statistical Analysis: Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, and gray level histogram values of orthopantomograph was subjected to statistical analysis. The normality of data was analyzed using the Kolmogorov–Smirnov test. The Mann–Whitney U and Wilcoxon Signed-Rank tests were used to check mean differences.Results: We observed a reduction in pain and swelling with improvement in interincisal and greater reduction in pocket depth distal to the second molar on the PRF side. Soft-tissue healing index scores and gray level histogram values for the study side were higher compared to the control side.Conclusions: Further clinical studies to evaluate and assess the applications of PRF in maxillofacial surgery are needed.

Tramadol versus ketorolac for pain management after third molar surgery.

Objectives:To compare the analgesic efficacy of preoperative intravenous (IV) ketorolac versus tramadol in preventing postoperative pain after mandibular third molar surgery.Methodology:Two hundred patients in the age group of 18–40 years with asymptomatic impacted mandibular molars were randomly allocated into one of the two groups (100 in each group) and underwent third molar surgery under local anesthesia. Group I received IV ketorolac 30 mg and Group II received IV tramadol 50 mg preoperatively. The difference in postoperative pain was assessed by five primary end points: pain intensity being measured hourly by Wong-Baker pain assessment scale for 6 h, onset of analgesia, duration of action, total number of analgesics consumed, and patient's global assessment.Results:Throughout the 6 h investigation period, patients reported significantly lower pain intensity scores, longer duration of action, lesser postoperative analgesic consumption, and better global assessment in ketorolac when compared to tramadol group. Patients in the ketorolac group significantly performed better than the tramadol group in terms of all parameters except onset of analgesia. All the drug-related complications were mild and did not require any investigation.Conclusion:The result of the present study shows that preoperative IV ketorolac 30 mg is more effective than tramadol 50 mg for postoperative pain following third molar surgery.

Assessment of Pain, Swelling, Trismus Following Impacted Lower Third Molar Surgery, With Pre-Operative Single Dose Oral Dexamethasone: A Prospective, Randomized Double Blind Controlled Clinical Trial

Background: The removal of the lower impacted third molar teeth is always associated with varying degrees of inflammation that may have a social impact for the patients. To control these symptoms associated, it is necessary to provide an adequate anti-inflammatory therapy. The present study was undertaken to evaluate the therapeutic effect of pre-operative single dose of 8 mg oral Dexamethasone on pain, swelling, trismus following impacted lower third molar surgery. Materials and Methods: This study was conducted at MGPGI puducherry. Hundred patients with bilateral mandibular molar impaction were included in the study. Patient was allocated randomly as study and control group. Study group received 8 mg oral Dexamethasone one hour prior the surgical extraction. Patients with contraindication to the use of steroids were excluded from the study. Pain, facial contour and mouth opening were measured preoperatively and at 2nd and 5th days postoperatively.Results: On 2nd post-operative day, no statistically significant differences were noted in pain for both the groups. However, low pain scores were obtained with the use of Dexamethasone compare to placebo group. Dexamethasone group showed shows statistically significant reduction in swelling and trismus compared with the control group at all intervals.Conclusion: Dexamethasone 8 mg given orally one hour preoperatively is effective in minimizing pain, swelling, and trismus after removal of impacted lower third molar teeth.

External Root Resorption and Caries of Mandibular Second Molar in Association with Third Molar Impaction Status

Impaction status of a mandibular third molar (M3) leads to some pathological conditions. Objective: Thisretrospective study was conducted to compare the effect of erupted (e-M3) and impacted mandibular third molars(i-M3) on caries in the adjacent second molar and external root resorption (ERR). Methods: We used cone beamcomputed tomography (CBCT) images of 200 patients with a mean age of 28.19 ± 8.3 years who had an e-M3on one side of the mandible and an i-M3 on the other side of the mandible. All the images were evaluated for theexistence of caries and ERR. Results: Caries was detected in 32.5% of cases of i-M3 and in 21% of cases of e-M3(p = 0.01). ERR was present in 18.5% of cases of i-M3 and no resorption was observed in cases of e-M3 (p = 0.00).Conclusions: Caries and ERR in cases of i-M3 can be reliably identified via CBCT scan. Among patients withcaries in the i-M3 group, the degree of caries was significantly lower on the other side of the mandible. Instead ofprophylactic removal of e-M3, periodic clinical and radiologic examinations are advised.

Uprighting of impacted second mandibular molars using skeletal anchorage

Uprighting of impacted second mandibular molars using skeletal anchorage

Does the Angulation of an Impacted Mandibular third Molar Affect the Prevalence of Preoperative Pathoses?

Statement of the Problem: The removal of a third molar tooth associated with a pathological condition is usually an easy decision. However, it is necessary for clinicians to know about the prevalence of preoperative pathologies associated with impacted mandibular third molars to the identification of the prophylactic approach to be applied to symptom-free impacted third molars.Purpose: The objective was to investigate the effect of the angulation of impacted mandibular third molars on the prevalence of associated pathologies. Materials and Method: In this retrospective study, we examined the panoramic radiographs of 954 patients referred for impacted third molar surgery. A total of 1598 impacted mandibular third molar teeth were included in the study. Pathological conditions included the caries on distal surface of the adjacent second molar, caries on impacted mandibular third molars, bone loss distal to the adjacent second molar, the radiolucent area distal to the impacted mandibular third molar were determined. Results: Caries were observed more in the impacted third molar (18.9%) compared to the adjacent second molar (15.8%). The radiolucent area on distal surface of the impacted mandibular molar was 11%, while the periodontal bone loss distal to the adjacent second molar was 4.9%. Mesioangular-impacted mandibular third molars had high risk of caries development on second and third molar. The prevalence of periodontal tissue damage to the adjacent second molar was higher in horizontal and mesioangular angulation. Vertical and distoangular-impacted mandibular third molars had high risk for bone loss at distal aspect. Conclusion: The prevalence rate of pathological conditions in mesioangular impacted teeth was higher.