Impacted Mandibular Molars Research Articles

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Pericoronal radiolucency surrounding an impacted mandibular molar.

Pericoronal radiolucency surrounding an impacted mandibular molar.

Bupivacaine for surgical removal of impacted mandibular third molar: A comparative evaluation with lignocaine

Background: Removal of impacted molar teeth is the most frequent oral surgical procedure often followed by mild to severe postoperative pain, and it has a significant impact on the patient’s postoperative quality of life. The use of long-acting local anesthetics is a promising strategy to improve postoperative analgesia. The study aimed to compare the efficacy of bupivacaine with that of lignocaine, which has already proven its efficacy. Materials and Methods: The study was conducted on 50 subjects requiring the surgical removal of impacted mandibular molar teeth. A total of 25 subjects received 2% lignocaine with 1:80,000 adrenaline, whereas the remaining 25 received 0.5% bupivacaine with 1:200,000 adrenaline. The time of onset of action and duration of anesthesia were recorded. The intensity of postoperative pain was determined using the visual analog scale. The data obtained were statistically analyzed. Results: The mean time of onset of action was 2.5min and 5min for lignocaine and bupivacaine, respectively. The longer duration of action and lesser pain intensity were observed with bupivacaine, which was statistically significant. Conclusion: Bupivacaine provides better and prolonged anesthesia and analgesia postoperative to surgical removal of the impacted mandibular third molar. Hence, the use of bupivacaine in the surgical removal of the impacted third molar is desirable.

Buccal bifurcation cyst as an incidental finding in cone beam computed tomography scans

ABSTRACT Buccal bifurcation cyst is an unusual inflammatory odontogenic cyst of unknown etiology which occurs at the buccal region of the permanent mandibular first molars in children and adolescents aged 6-15 years old. The aim of this manuscript is to present two clinical cases of buccal bifurcation cyst incidentally detected in adolescents referred for tomographic exams (CBCT) as part of the treatment planning for the management of impacted mandibular molars. The first case is very interesting due to the proximity of the lesion to the inferior alveolar canal. In the second case the inferior alveolar canal was not in close proximity to the lesion, but in contact with the mesiobuccal root of the second molar. The diagnosis of Buccal bifurcation cyst is of utmost importance in order to avoid complications during surgical procedures. In addition, the present case reports have highlighted the importance for dental practitioners to be aware of the possibility of a buccal bifurcation cyst being present as an incidental finding in CBCT images, especially in young patients.

Posterior Available Space for Uprighting Horizontally Impacted Mandibular Second Molars Using Orthodontic Microimplant Anchorage.

Treatment of horizontally and deeply impacted mandibular molars is challenging for both orthodontists and oral surgeons because of the limited access and anchorage control. We report on two patients who had horizontally and mesially impacted mandibular second molars (MM2s). Both patients were treated by a surgical orthodontic approach, and the crowns of the impacted teeth were brought into the arches by closed forced eruption. Mesially impacted MM2s were uprighted with orthodontic microimplants, inserted in the retromolar area, and then moved into their ideal position. The first patient was in an active growing stage, while the second patient was beyond the active growing stage. Therefore posterior available space (PAS) should be analyzed before treatment of impacted MM2s to prevent periodontal problems after uprighting of impacted teeth. If PAS is not enough for uprighting impacted MM2s, alternative treatment should be considered based on the stage of growth.

Prosthetic management of dentigerous cyst associated with impacted mandibular molar

Dentigerous cysts are benign odontogenic cysts occurring from the dental follicle of an unerupted or developing tooth. This cyst is usually asymptomatic but has the potential to attain a large size and become aggressive. These lesions are usually associated with the impacted third molars and canines. The treatment for this cyst is the extraction of the impacted tooth and enucleation of the cyst. A prosthodontist should be involved in the restoration of the lost structure from the point of diagnosis to establish proper function and improve the quality of life for the patient. We present a case report of a dentigerous cyst associated with an impacted mandibular molar which was surgically removed, and the defect was closed by an obturator fabricated before the surgical procedure.

Factors affecting spontaneous eruption of impacted mandibular first molars after surgical exposure

ObjectivesThe purpose of this study was to investigate factors, such as the status of impaction, root developmental stage, depth of impaction, tooth angulation and eruption space, which can influence the spontaneous eruption of impacted mandibular first molars after surgical exposure. Material and methodsClinical dental records and panoramic radiographs of children aged 6 years or older were studied. In total, 59 impacted mandibular first molars of 54 children had undergone surgical exposure to induce eruption and were followed for more than 6 months. Fisher's exact test and independent-sample t-tests were used for analysis. ResultsThe failure rates of tooth eruption in type I and type II cases were significantly higher than those in type III and IV cases (p = 0.012). Regarding the degree of root development, the failure rate of spontaneous eruption increased as root formation approached completion, but this trend was statistically insignificant (p = 0.275). Failure rate was higher in the cases of shallow impaction than cases of deep impaction (p = 0.011). The angulation of impacted teeth did not influence the spontaneous eruption after surgical exposure (p = 0.394). Spontaneous eruption failure was significantly more likely when the eruption space between the adjacent second premolar and the second molar was smaller than the crown width of the impacted tooth (p = 0.002). ConclusionThe results showed that spontaneous eruption by surgical exposure occurred well when the impaction type was distally angulation, the depth of the impaction was deep, or eruption space was sufficient.

Pre-Emptive Effect of Dexamethasone and Diclofenac Sodium Associated With Codeine on Pain, Swelling, and Trismus After Third Molar Surgery: A Split-Mouth, Randomized, Triple-Blind, Controlled Clinical Trial

We aimed to compare the effect of dexamethasone, 8mg, and diclofenac sodium, 50mg, associated with codeine, 50mg, on the control of pain, swelling, and trismus after extraction of impacted third molars. Fifteen healthy patients with a mean age of 22.8years (SD, 12.62years) received a single oral dose of either drug 1hour before each surgical procedure (left and right teeth). At 24, 48, and 72hours after surgery, swelling was determined by use of linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a numerical rating scale at 24-hour intervals for a period of 72hours. Data analysis involved descriptive statistics and Shapiro-Wilk, Wilcoxon, and paired t tests (P<.05). Dexamethasone controlled pain (P=.016) and edema (P=.08) within 48hours better than diclofenac sodium associated with codeine. No statistically significant differences were found between drugs regarding trismus and consumption of rescue analgesics (acetaminophen). The results of this study suggest that pre-emptive administration of dexamethasone, 8mg, showed better control of pain and swelling in bilateral extractions of third impacted mandibular molars.

MANDIBULAR SECOND MOLAR IMPACTION - LITERATURE REVIEW AND CASE REPORTS

Aim: To assess the incidence of mandibular second molar impaction and the treatment methods for this condition. Materials and Methods: A retrospective review of the cases of patients diagnosed with impaction of mandibular molars at the Department of Oral Surgery of the Faculty of Dental Medicine - Plovdiv during the past 11 years was performed. Results: 962 patients with impaction of mandibular molars were operated on in the analyzed period. This diagnosis is relatively rare in second mandibular molars and represents 0.94% of all cases. Most often, diagnosis is based on clinical evidence of missing molars and on panoramic radiographs. In the cases described by us, only surgical treatment was used. Conclusion: The treatment of this condition is a challenge which requires an individual approach to each case and an assessment to determine what treatment approach is to be used - surgical or orthodontic.

Assessment of pain, swelling and trismus following impacted third molar surgery using injection dexamethasone submucosally: A prospective, randomized, crossover clinical study

Background: Corticosteroids are known to reduce inflammation, fluid transudation, and edema. Secreted from the adrenal glands, these compounds have a significant role in maintaining metabolism. One of the essential roles played by steroids is their anti-inflammatory role. Aims and Objectives: This prospective, randomized, crossover, clinical study was conducted with the following aims and objectives: (a) to assess pain, swelling and trismus in patients undergoing surgical removal of impacted third molars, (b) to compare the pain, swelling and mouth opening with injection of submucosal dexamethasone 4 mg administered preoperatively, and (c) to compare the results with similar studies conducted elsewhere. Materials and Methods: The study sample involves 20 patients (40 impacted teeth-split arch) with the following inclusion criteria: Patient's reporting for surgical removal of symptomatic impacted mandibular third molars aged between 18 and 45, impacted mandibular third molar with similar anatomical position, and similar surgical difficulty (Pell-Gregory classification was followed), no allergies to medicines prescribed in the postoperative period, patients who are nonsmokers, nonalcoholics and without any systemic diseases, and not systemically compromised or not under long-term steroid therapy. Syndromic patients, patients with periapical pathologies were excluded from the study. Results: The results of the present study suggest that there is a significant reduction of pain, swelling and improvement in mouth opening following submucosal injection of dexamethasone at the end of the 1st postoperative day and the results are statistically significant. Conclusion: (a) Corticosteroids decrease pain, edema and swelling by exerting their anti-inflammatory role, (b) there is statistically significant difference in reduction of pain, swelling and improvement of mouth opening at the end of 1st postoperative day, (c) submucosal injection of dexamethasone is less traumatic, less painful and is effective in limiting postoperative discomfort to the patient, and (d) a similar prospective study is suggested comparing the efficacy of intravenous dexamethasone versus submucosal administration of dexamethasone.

The Buccal Lid Approach for Removal of Impacted Mandibular Molars—When, How and Why?

Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.

A rare case report of orthokeratinized odontogenic keratocyst associated erupting complex odontome with impacted mandibular molar

Odontogenic keratocyst is a cyst of dental origin with an aggressive clinical behavior, having high recurrence rate. Odontomas are hamartomatous lesions composed of mature enamel, dentin, and pulp and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. They are the most common benign odontogenic tumors, constituting 22% of all odontogenic tumors of the jaw. We present a case report of a 19-year-old female with infected odontogenic keratocyst associated with the impacted mandibular second molar with the odontome and a submandibular space infection. However, there are very few case reports in the literature of the simultaneous occurrence of these two lesions, and hence this case is very rare. It is unclear whether the two lesions were just coincidental or were actually related to each other.

Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars - A Split Mouth Prospective Controlled Clinical Study.

The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects. To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars. Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the 'LAA' group while the 'LAK' group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days. Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05). The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.

Tooth multi-sectioning with the use of magnification, for extraction of a deeply impacted lower second molar with entrapment of the inferior alveolar nerve: Report of a case

Inferior alveolar nerve injury is one of the most serious complications of mandibular molar surgery and may lead to litigation for mal-practice. Entrapment of the inferior alveolar nerve to roots of an impacted mandibular molars is extremely rare. The aim of this case report is to stress the importance of tooth multi-sectioning with the use of magnification for the safe removal of a deeply impacted second molar with entrapment of the inferior alveolar nerve in its proximal root.

Prevalence and Difficulty Index Associated with the 3 rd Mandibular Molar Impaction among Malaysian Ethnicities: A Clinico- Radiographic Study

The mandibular third molars (3Mms) are the most common impacted teeth in the human dentition and their prevalence ranges from 27-68.8% in various parts of the world. The assessment of surgical difficulty of 3Mms extraction helps in better formulation of treatment plan by minimizing postoperative complications. The aim of this retrospective study was to investigate the prevalence and pattern of 3Mm impaction in patients between 20-44-year-old among Malaysian's ethnicities attending Oral Health Center/ SEGi University, Faculty of dentistry. This study reviewed 1249 orthopantomograms (OPGs) of subjects aged 20 to 44 years of three Malaysian ethnic groups. Of the study population 918 OPGs were considered for the study. Patient's details include age, gender and ethnicity were extracted from the patient's clinical record and all details related to impaction were obtained from patient's panoramic radiograph that was individually examined by two investigators. The data collected was statistically analysed using SPSS 16. This study found that Chinese female recorded the highest number of patients with "very difficult" category of impacted mandibular third molars. The most common age group involved was 20-24 years, mesioangular impaction, deep occlusal level and no ramus space for impacted mandibular third molars (3ms) were the most common findings observed. The present study suggests that predicting the level of difficulty preoperatively for impacted 3m surgery will help in formulating the better treatment plan, thereby minimizing the postoperative complication for the ultimate benefit of the patient.

Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

Etiological factors in second mandibular molar impaction.

Objectives: The impaction of the second mandibular molar (MM2) has recently become more prevalent. Several etiological hypothesis have been proposed to investigate the association between skeletal features and impaction of MM2. The aims of this study were to analyze the skeletal features in patients with MM2 impaction and the association between arrested eruption of MM2 and the presence of the third mandibular molar (MM3). Study Design: In this retrospective study 48 subjects from 3,530 Caucasian orthodontic patients with MM2 impaction were included in a study group (SG) and compared to a control group (CG) of 200 subjects without MM2 impaction. Panoramic radiographs evaluated the presence or absence of the MM3 germ. Cephalometric analysis was performed to evaluate linear and angular skeletal values. For the statistical analysis, descriptive statistics, Student’s t-test, χ2 test and odds ratio (OR) were used. Results: The paired comparisons between SG and CG showed in cephalometric analysis both a reduced mandibular gonial angle (ArGoMe) and lowered Jarabak’s polygon value with a statistically significant difference (P≤ 0.05). MM3 was statistically significant associated (P≤ 0.05) with MM2 impaction but it is not a risk factor (OR 0.817). Conclusions: Subjects with MM2 impaction show a vertical condylar growth direction. MM3 is not a risk factor for MM2 impaction. Key words:Impacted mandibular second molar, skeletal features, orthodontic.

Incidence of impacted mandibular third molars in population of Bosnia and Herzegovina: a retrospective radiographic study

Introduction: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction byanother tooth or development in an abnormal position. The mandibular third molar is the most frequently impacted tooth. The incidence varies from 9.5% to 68% in different populations.Methods: The study was conducted in Department of Oral Surgery, Faculty of Dentistry, University in Sarajevo. Study represents retrospective analysis of panoramic radiographs (orthopantomograms) of patientsreferred to Department of Oral Surgery from January 2010 to February 2013 with indication for surgical removal of impacted third molars.Results: Of the 2000 radiographs, 761 presented with at least one impacted third molar (38%). A total of 1034 impacted mandibular third molars were present (51.7%). The most common age group was thirddecade (61.2%). Signifi cant statistical difference in incidence of third molar impaction was found between females and males (p&lt;0.05), but there was no statistical difference in incidence in urban and suburbanpopulation (p=0.374). Vertical angulation was the most common pattern of impaction (65%). Frequency of third molars erupted into their normal position (class IA) was 42%. Impacted mandibular molars wereassociated with periodontal pockets in 134 (6.5%) cases and with dentigerous cysts in 5 cases (0.2%).Conclusion: The present study provides useful data regarding the clinical status of third molars in population of Bosnia and Herzegovina.

The "Red Line" Conundrum: A Concept Beyond Its Expiry Date?

Introduction George Winter attempted to assess the depth and difficulty of extracting impacted mandibular wisdom molars by describing three imaginary lines drawn on an intra-oral radiograph. Of these lines, the red line is the only one which is measured and great importance is attached to its actual length. Method The authors of this short paper describe the difficulty in drawing this red line accurately through examples. Conclusion The authors believe that Winter's lines and their interpretation are only of historical value and have no place in contemporary texts on oral surgery.

Frequency and Distribution of Dental Anomalies in Iran: A Radiographic Survey

ABSTRACT Aim Many epidemiological studies have been performed around the world in order to determine the frequency of different types of dental anomalies. There are regional and ethnic variations in the prevalence of dental anomalies. To determine the prevalence of developmental and acquired dental anomalies in Iran, study was done from 2011 to 2012. Materials and methods A total of 1,000 digital panoramic radiographs of patient were evaluated which consisted of 424 (42/4%) male and 576 (57/6%) female. Data were analyzed by Chi-square and Fisher exact tests. Results Wisdom tooth impaction was the most prevalent anomaly (41.4% in females and 36% in males) followed by missing (8.7% male, 7/3% female), microdontia (3.2%), dilacerations (2.2%), macrodontia (1%), supernumerary teeth (0.8%), fusion and taurodontism (0.2%). A case of bilateral second mandibular molar impaction was observed. Germination, transposition and concrescence were not observed. Among the acquired anomalies, hypercementosis (0.6%) and internal resorption (0.4%) were the most prevalent respectively. External resorption was not observed. Conclusion Comparison of these results with those of other studies, showed that the frequency of these disorders were different in countries and communities around the world. Knowledge about these anomalies may facilitate the endodontic, prosthodontics, periodontics and surgical management of such teeth. How to cite this article Tofangchiha M, Azimi S, Neirizi M. Frequency and Distribution of Dental Anomalies in Iran: A Radiographic Survey. Int J Experiment Dent Sci 2013;2(1): 14-17.