Impacted Mandibular Third Molars Research Articles

Panoramic radiography and cone-beam computed tomography findings in preoperative examination of impacted mandibular third molars.

BackgroundPreoperative radiographic examination of impacted mandibular third molars (IMTM) is essential to prevent inferior alveolar nerve injury during extraction. The purpose of this study was to evaluate the correlation between cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) findings in preoperative examination of IMTM.MethodsThis retrospective study included 298 teeth in 191 individuals. The relationship between the inferior alveolar canal (IAC) and the IMTM (buccal, lingual, interradicular or inferior), the position of the IMTM with respect to the IAC (contact, no contact), the morphologic shape of the mandible in the IMTM region (round, lingual extended, lingual concave), the type of IMTM (vertical, horizontal or angular) and the number of roots of the IMTM were evaluated on CBCT images. DPR images were evaluated for the number of roots of the IMTM and for the most common radiographic findings indicating a relationship between the IAC and the IMTM (darkening of the roots, diversion of the IAC, narrowing of the IAC and interruption of the white line). Data were statistically analyzed with Cramer V coefficient, Kappa statistic, chi-square and Fisher’s exact test.ResultsThere was a significant difference in number of roots detected on DPR versus CBCT images. There was a significant association between the type of IMTM and the morphologic shape of the mandible on CBCT images. Darkening of the roots and interruption of the white line on DPR images were significantly associated with the presence of contact between the IMTM and the IAC on CBCT images.ConclusionsPanoramic radiography is inadequate, whereas CBCT is useful to detect multiple roots of IMTM. When darkening of the roots and interruption of the white line are observed on panoramic images, there is increased likelihood of contact between the IMTM and the IAC. CBCT is required in these cases.

A Case of Horizontal Impaction of the Bilateral Mandibular Second and Third Molars

We report a case of horizontal impaction of the bilateral second and third molars, associated with a unilateral dentigerous cyst. A 20-year-old male complaining of an uncomfortable feeling in the mandibular left molar region was examined in our department. X-ray imaging revealed horizontal impaction of the bilateral mandibular second and third molars, and radiolucency around the crown of the mandibular left second molar. The bilateral mandibular and maxillary second and third molars were extracted and cystectomy was performed under general anesthesia.This patient had no previous medical history, exhibited no evident abnormality in jaw development or facial morphology, and a dentigerous cyst was present, suggesting that the impaction had been caused by local factors. The probable cause of the impaction was considered to be that tooth germs for the bilateral second molars were located at a low level and mesial inclination was pronounced, leading to impaired eruption, and that the left second molar was more deeply impacted than the right due to the dentigerous cyst. Combined use of orthodontic treatment and surgery was considered, but based on the patient's preferences regarding treatment, the decision was made to extract all the teeth at once and perform cystectomy under general anesthesia.

Incidence of Mandibular Third Molar Impaction in Patients Visiting a Private Dental College

The study aims to evaluate the incidence of types of impaction of mandibular third molars. Since mandibular third molars are the most common teeth to get impacted, it is important to know the incidence and prevalence in a particular community. The study is done using radiographic records of patients visiting the department of oral and maxillofacial surgery, with a diagnosis of an impacted third molar that has the need to undergo extraction. The sample size was of 100 patients, all above 16 years of age. The orthopantomogram and intra oral periapical radiographs of the patients were interpreted to analyze the pattern of impacted mandibular third molars. The type of impaction was determined using Winter's Classification of Impacted Teeth (1926). Based on these values the incidence of type of impaction was determined. Keywords: Impaction, Incidence, Mandibular third molars.

Ectopic impaction of mandibular third molars

Ectopic impaction of a tooth is a rare occurrence. If occurs with mandibular third molars (M3), it is commonly associated with pathologic lesions. Asymptomatic impactions go undetected. The associated lesions, if any, can grow to a considerable size and cause significant morbidity. Since few numbers of cases detected and reported, the etiology of such impactions remains unclear. Similarly, the unusual anatomy of the mandibular canal (inferior alveolar canal) is extremely rare and probably is because of the jetting effect, immediately following canal constriction due to ectopically placed M3.

The use of piezosurgery for mandibular third molar extraction

Introduction. Extraction of impacted mandibular third molars is often accompanied by intraoperative and postoperative complications such as damage of the inferior alveolar nerve, prolonged difficulty in mouth opening, alveolitis, pain and swelling in the region of surgery. The aim of this study was to compare two surgical techniques (standard and piezo) in the extraction of mandibular third molars and to assess their postoperative complications. Material and Methods. Study included 16 patients (8 male and 8 female) age 17 to 32 years treated in the period from 2012 to 2014. All patients had both mandibular molars impacted. One third molar was extracted using classical technique while the other one using a piezo device. Preoperative preparation was the same for all patients and included radiological analysis and verification of teeth by ortopan tomography (OPG) and CT. Patients were assessed one, seven and 14 days after the procedure. Results. After the extraction, all patients were followed for postoperative symptoms: pain, swelling and paresthesia of the inferior alveolar nerve. The results confirmed advantages of piezosurgery in the removal of impacted mandibular third molars. Average duration of the intervention was 18 minutes with standard technique while the duration with piezo technique was 23 minutes. According to the visual-analog scale (VAS) the average pain in the standard group was 9 whereas in the piezo group it was 6. Postoperative swelling was 10 mm (pronounced) the first day after the procedure in the standard group while in the piezo group it was 6 mm (moderate). Conclusion. The use of piezo technology for the extraction of impacted wisdom teeth is reliable method which reduces the risk of the most common postoperative complications following mandibular wisdom teeth removal.

Effects of intra-space injection of Twin mix versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study

A prospective randomised double-blind study was undertaken to compare the effects of intra-space injection of 'Twin mix' versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery. A randomised double-blind clinical trial was conducted on 60 patients with class II position B impaction of mandibular third molars. Sixty transalveolar extractions were performed prospectively with ten patients randomly allocated to each of the six study groups (group T: intra-space injection of Twin mix; group S: submucosal dexamethasone; group M: intramuscular dexamethasone; group V: intravenous dexamethasone; group O: per-oral dexamethasone; group C: control group, no dexamethasone). A ten-point visual analogue scale was used to assess the overall pain intensity/patient discomfort, and specific facial measurements were recorded to assess the post-operative facial swelling. Maximal mouth opening was compared pre and post-operatively to assess the trismus. Mean operative visual analogue scale scores did not show statistical variation, and post-operative visual scores indicated better patient comfort in the steroid groups with statistically significant difference between group T and the control group on the first, third and the seventh post-operative day. Mean increase in distances between tragus and soft tissue menton to assess facial swelling showed strong statistically significant difference between the first and the third post-operative day between the control group and group T (p value <0.0001). Association of trismus was found less with the steroid treatment groups when compared to the control group. Steroid groups had a better clinical outcome with improved quality of life post-operatively when compared to the nonsteroid study group. Intra-space injection of dexamethasone in pterigomandibular space as Twin mix was found to have similar clinical effects as conventional methods of administering steroids via intraoral-submucosal, intramuscular, intravenous and per-oral routes. This, however, is a small study which would now benefit from larger numbers.

Effect of premolar extraction on mandibular third molar impaction in young adults

To test the null hypothesis that orthodontic therapy with or without premolar extraction does not result in any difference in third molar impaction. Two groups were formed: 22 patients in one group with first premolar extractions and 22 patients in the other group without extractions. All patients were nongrowing subjects who had normal gonial angles and were skeletal Class I at the beginning of treatment. The available space for third molars, inclination of second and third molars, and angle between the second and third molars were evaluated. Also, the correlation of measured parameters and type of orthodontic therapy with the eruption of third molars was evaluated. Of the third molars, 81.8% were impacted in the nonextraction group and 63.6% were impacted in the extraction group. Impaction of mandibular third molars was significantly correlated to the pretreatment and posttreatment inclination of third molars and the angle between the second and third molars. In the extraction therapy group, the retromolar distance increased significantly with a mean of 1.30 ± 1.25 mm. When the inclination of the third molar is inconvenient, the tooth may remain impacted even if there is enough retromolar space.

A prospective randomized double-blind study to assess the latency and efficacy of Twin-mix and 2 % lignocaine with 1:200,000 epinephrine in surgical removal of impacted mandibular third molars: a pilot study

A prospective randomized double-blind study was conducted to assess the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:200,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae of surgical extraction of impacted mandibular third molars. The study was conducted as a prospective randomized double-blind clinical trial on 20 patients with bilateral impaction of mandibular third molars. A total of 40 interventions were included for the study, 20 with 2% lignocaine with 1:200,000 epinephrine (study group C, control) and 20 with the twin-mix (study group T, twin-mix), with a gap of 1 month between two interventions in a single patient. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia, and the need to re-anesthetize the surgical site were recorded. A 10-point visual analog scale (VAS) was used to assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. pH of the test anesthetic solutions was also determined using a pH meter. Twin-mix was found to be more basic than 2% lignocaine with 1:200,000 epinephrine. Mean VAS value for the pain/sting on local anesthetic injection/block was less in study group T. Time of onset of the local anesthetic was significantly less for the study group T, 51 ± 17.5 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more sever swelling and reduction in mouth opening in the postoperative period. The addition of dexamethasone to lignocaine and its administration as an intra-space injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

Pattern of mandibular third molar impaction in the Indian population: a retrospective clinico-radiographic survey

The objective of this study was to study incidence of type of impaction of mandibular third molars in the Indian population. Data of 1200 patients examined during a 5-year period were reviewed, which included status of mandibular third molar for inclination, emergence in oral cavity, and prevalence of caries. Radiographically, angulation of tooth, level of occlusal surface of third molar with respect to second molar, relationship between ascending ramus of mandible and distal surface of third molar, and proximity to inferior alveolar nerve were studied. Of 1200 patient data reviewed, 620 (51.77%) were of men and 580 (48.3%) were women in the age group of 20 to 40 years (26.3 years). Mesioangular impaction was most prevalent followed by distoangular. A strong statistical significance was found between gender and ramus relationship. Fifty percent of cases showed proximity to the inferior alveolar nerve, which was more frequent in males (58.3%). Our study highlights mesioangular impaction as the most frequently encountered angulation in impacted teeth.

Prevalence of Mandibular Third Molar Impaction and Agenesis: A Radiographic South Indian Study

Aims and objective: To evaluate the prevalence of (i) impaction of mandibular third molar, (ii) agenesis of mandibular third molar and (iii) angulation of impaction radiographically. Materials and methods: The sample size consists of 1,005 patients above 18 years. The orthopantomograph of the patients are interpreted for eruption/pattern of impaction/agenesis of mandibular third molar. Conclusion: Bilateral impaction of mandibular third molar is common than unilateral impaction. Agenesis of mandibular third molar is seen in 12.2 to 12.5% of patients. Mesioangular is the commonest pattern of impaction. No sex predisposition is in prevalence of impaction. Agenesis is seen more commonly in females than males.

Multiple unerupted mandibular permanent molar teeth: a case report

The multiple impacted teeth at jaws are a rare condition that frequently associated with syndromes, metabolic disorders or trauma. A 48-year old male patient was referred to our clinic, with complaint of pain on right retromolar region while chewing. The patient had facial asymmetry and restricted mouth opening. Clinical and radiographic examination revealed the impaction of mandibular first, second and third molar and an abnormal condyle and coronoid process. All of the impacted teeth were extracted. Because the patient refused other treatment procedures no surgical intervention was performed for the asymmetry and restricted mouth opening. Six months clinic and radiographic follow up were satisfactory.

Is Adjuvant Laser Therapy Effective for Preventing Pain, Swelling, and Trismus After Surgical Removal of Impacted Mandibular Third Molars? A Systematic Review and Meta-Analysis

To assess the efficacy and safety of low-level laser energy irradiation (LLEI) for decreasing pain, swelling, and trismus after surgical removal of impacted mandibular third molars (IMTMs). MEDLINE, EMBASE, and the Central Register of Controlled Trials of the Cochrane Library were searched from their inception, and conference proceedings, cross-references, and gray literature were searched for the last 5 years for randomized and quasi-randomized controlled trials that evaluated the effects of any type of LLEI, compared with active or inactive treatments, in patients undergoing surgical removal of IMTMs. Risk of bias in included studies was assessed by 2 independent evaluators using the Cochrane Risk of Bias tool. A random-effects model meta-analysis was used to estimate the mean difference of trismus between the groups. Heterogeneity was assessed using Cochran χ(2) and I(2). Ten eligible trials were included in this systematic review. The included studies overall had a moderate risk of bias. Because of heterogeneity in the intervention and outcomes assessments, pain and swelling outcomes were only qualitatively summarized and indicated no beneficial effects of LLEI over placebo. Patients receiving LLEI had an average of 4.2 mm (95% confidence interval, 1.2 to 7.2) and 5.2 mm (95% confidence interval, 1.8 to 8.2) less trismus than patients receiving no active treatment on the second and seventh day after the surgery, respectively. There was no benefit of LLEI on pain or swelling and a moderate benefit on trismus after removal of IMTMs. It is necessary to standardize the intervention and outcomes assessment and to conduct adequately powered, well-designed trials to evaluate the efficacy of LLEI.

Radiographic study of mandibular angular cortical thickness in relation to the presence and eruption status of mandibular third molar

Background: Mandible is one of the largest and strongest facial bones but there are some areas which are physically weak and fractured easily, i.e., angle and condyle. Recent studies demonstrated the correlation of the risk of mandibular angle fractures to the presence of the mandibular third molars. The aim of the present study was to evaluate the mandibular angular cortical thickness in relation to the presence and eruption status of mandibular third molar to verify if the mandibular third molar represent a risk factor for angle fracture or not. Materials and methods: The angular cortical thickness was measured using tracing elements and panoramic radiograph of 160 Iraqi subjects aged from (20-28) years, they were divided equally into four groups according to the status of mandibular third molar which were: Subjects with agenesis of mandibular third molar, subjects with completely erupted mandibular third molar, subjects with complete bony impacted mandibular third molar and subjects with extracted mandibular third molar. Results: Subjects with agenesis registered the greatest value in the mean angular cortical thickness followed by subjects with extracted, completely erupted and complete bony impacted mandibular third molar respectively. Extraction of mandibular third molar improved the angular cortical thickness and this effect had a strong positive linear correlation with the extraction duration. Conclusion: The measurement of the angular cortical thickness was greatly affected by the presence and eruption status of mandibular third molar, such measurements registered its highest values in subjects with third molar agenesis and its lowest values in subjects with complete bony impacted third molar.

Clinical analysis of extraction methods of impacted mandibular third molars 486 cases report

Objective To investigate the indication of turbine technique or hammer and chisel technique removral of impacted mandibular third molars.Methods 486 impacted mandibular third molars patients were randomly divided into two treatment groups.One group received turbine technigue of 199 cases.while another group received hammer and chisel technique of 287 cases.Both the duration of operation and complications were compared.Results The average duration of the operation with turbine technique was(10 ～ 45)min,while with hammer and chisel technique was(12 ～ 90)min,respectively(P ＜ 0.05)in the removal of impacted mandibalar third molars.there were significant differences between two groups.The standardized rate of complication with tubine tehnique was 28.8％,while with hammer and clisel technique was 55.1％ in the remoral of impacted mandibular third molars.Conclusion Extraction of impacted mandi-bular third molars with air turbine hand piece could reduce complication during operation,and risperidone showed better results.It is worth for clinical use. Key words: Tooth extraction; Tooth, Impacted; Postoperative complications

Management of unilaterally deep impacted first, second, and third mandibular molars

Simultaneous impactions of first, second, and third permanent molars comprises a very rare clinical situation with diverse therapeutic approaches and is a difficult challenge for dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of a teenager with severe impaction of right mandibular first, second, and third molars, which hinders the masticatory function and dental arch integrity. A decision-making process and a simple orthodontic technique are described. To shorten the treatment time and simplify the procedures, the impacted right mandibular third and second molars were orthodontically uprighted with an innovative tip-back cantilever. Subsequently, the deeply impacted right mandibular first molar was extracted with minimal obstacles. The combined surgical-orthodontic approach resolved a challenging clinical problem and eliminated the need for prosthetic or dental implant replacement of the impacted molars. Good occlusion, normal function, and a healthy periodontium of the patient were also achieved.

STUDY OF CORRELATION BETWEEN HEALING AFTER IMPACTED THIRD MOLAR SURGERY AND THE DEGREE OF IMPACTION

Background: The mandibular third molar is the most common tooth to become impacted than other teeth, often causing more complications in the process of growing, influence to the lives of patients. Removal of wisdom teeth is one of the most common dental surgical procedures, is an invasive intervention caused significant injury to the bone and soft tissue, so hard to avoid possible complications after surgery. Understand the relationship between degree of impaction and healing after mandibular wisdom tooth surgery will bring many benefits to surgeons and patients. The purpose of this study is to evaluate the degree of impaction of mandibular third molar and explore the relationship between healing after mandibular wisdom tooth surgery with the degree of impaction. Materials and method: The study consisted of 40 patients, average age 29.38 ± 9.8 a impacted mandibular third molar and cause complications, tooth extraction is indicated. All are to be attended to, determine the degree of impaction, wisdom tooth surgery. Evaluate the healing through pain, swelling, limited mouth open after 2 days, 1 week and 2 weeks. Result: Correlation of wisdom teeth to ramus and adjacent teeth mainly type I (45%) and type II (35%), type III accounted for the lowest rates (20%). Relative depth of wisdom teeth in the bone mainly position A (45%), B position also accounts for a significant proportion (35%), positions C (20%). Correlation of wisdom teeth axis to adjacent teeth: mesioangular impactions (50%) and horizontal (30%), distoangular impaction (2.5% and 5%), vertical impaction (12, 5%). Pain, swelling, limited mouth open only happen the first two days in groups I and II, group III of symptoms until a week after surgery. Conclusion: There is correlation between the degree of impaction and healing after mandibular wisdom tooth surgery. Degree of as much impaction, the level of pain, swelling, limited mouth open higher. Key words: mandibular third molar; impaction

Secondary versus primary closure techniques for preventing postoperative complications following removal of impacted mandibular third molars (IMTM): a systematic review and meta-analysis of randomized controlled trials

Secondary versus primary closure techniques for preventing postoperative complications following removal of impacted mandibular third molars (IMTM): a systematic review and meta-analysis of randomized controlled trials

Tecnica osteotomica piezoelettrica e rotante nella chirurgia dei terzi molari inferiori inclusi: comparazione delle sequele postoperatorie

Objectives The aim of this study was to compare the outcomes of surgery for impaction of mandibular third molars performed with piezoelectric or high-speed rotatory osteotomy technique. Materials and methods One hundred fifty patients with impacted mandibular third molars were included in the study. Seventy-five were treated with a piezoelectric osteotomy technique (group A) and 75 patients were treated with high-speed rotatory osteotomy (group B). The treatment protocol was the same for both groups. Twenty-four hours after surgery, facial swelling and trismus were evaluated in both groups. Results Mean procedure duration was 22.65 minutes in group A and 17.56 minutes in group B. Mean facial swelling was 4.44 mm in group A and 6.67 mm in group B; trismus was 12.28 mm in group A and 17.28 mm in group B. Statistical analysis revealed significant reductions (p < 0.001) in postoperative facial swelling and trismus in group A, but the duration of the surgical procedure in this group was also significantly increased (p < 0.001 vs group A). Conclusions Compared with high-speed rotatory osteotomy, piezoelectric osteotomy produces less facial swelling and trismus 24 hours after surgery, but it also increases the duration of surgery.

Unerupted lower third molars and their influence on fractures of the mandibular angle and condyle

Our aim was to assess the influence of the presence and state of impaction of mandibular third molars on the incidence of fractures of the mandibular angle and condyle. We designed a retrospective study of patients who presented for the treatment of mandibular fractures from January 2006 to April 2011. The independent variables were the presence and degree of impaction of lower third molars, and the outcome variables were the incidence of fractures of the mandibular angle and condyle. The information was acquired from hospital records and panoramic radiographs. Personal data included age, sex, mechanism of injuries, and number of fractures of the mandibular angle and condyle. We studied 110 fractures of the mandibular condyle and 80 of the angle. The incidence of fractures of the mandibular angle was higher in the group with incompletely erupted third molars (37/80, p<0.001) and that of condylar fractures was higher in the group without (67/110, p<0.001). An incompletely erupted third molar reduces the risk of condylar fractures and increases the risk of fractures of the mandibular angle.

Pilot clinical study of the dental cone beam CT examination before the impacted mandibular third molar extraction

To evaluate the diagnostic accuracy of the cone beam computed tomography (CBCT) in judging the relationship between the impacted mandibular third molar (IMTM) and the inferior alveolar canal (IAC). Sixty IMTM superimposing on the canal partially or touching the canal in line on panoramic radiograms were examined by CBCT. All CBCT images of these cases were observed by two dentists respectively. Then, all these IMTM were extracted by minimally invasive surgery, and the conditions of the IMTM sockets were observed. Two dentists observed the CBCT images independently and reached a consensus. Diagnosis test was performed in this study. Eight IMTM sockets were bleeding during the extracted operation, and whether the IAC wall was broken could not be judged. The other 52 IMTM sockets were clear and the walls of IAC were broken in 29 IMTM extractions. The sensitivity, specificity, Youden index, positive predictive value and negative predictive value of CBCT were 82.8%, 87.0%, 88.9% and 80.0% respectively. The diagnostic accuracy judged by the two dentists and Kappa coefficient were calculated as 84.6% and 0.800. The CBCT examination had good authenticity and reliability, and it was very helpful in predicting the actual relationship between the IMTM and IAC.