Lower Wisdom Tooth Research Articles

Efficacy of Submucosal versus Pterygomandibular Dexamethasone Injection in Surgical Extraction of the Impacted Lower Third Molar

Objectives: This study aimed to evaluate the efficacy and postoperative complications of preoperative submucosal dexamethasone injection compared to preoperative dexamethasone injection into the pterygomandibular space for surgical extraction of the impacted lower third molar. Study design and setting: This was a quasi-experimental, cross-sectional study conducted at the Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi, from April to July 2021. Methodology: The study sample consisted of 72 patients who reported surgical extraction of their lower wisdom teeth and consented to participate in this study. The patients were randomly divided into the submucosal injection group (SM) and the pterygomandibular space (PM) group. The injection time was recorded on the second and seventh postoperative days. Results: No significant differences in the duration of the intervention were observed between the two groups (23.08 min in PM, 23.07 min in SM). The postoperative facial swelling was significantly reduced transversely (ear lobe to the angle of the mouth) in both groups compared to their respective baselines on the first postoperative day. On the secondpostoperative day, significant changes were observed in the submucosal group in postoperative swelling. Conclusions: Using intraoral dexamethasone injections in third molar surgery significantly reduces conventional complications of surgery while avoiding the systemic side effects of steroids. Dexamethasone should be used regardless of the administration site when warranted, with less apprehension than is common in dentistry

Concomitant Extraction of Wisdom Teeth with Bilateral Sagittal Split Osteotomy (BSSO): A Case Series

Aim: Aim:To investigate the incidence of postoperative complications (including pain, nerve damage, swelling and infection) associated with the concomit an textraction of wisdom teeth at the time of bilateral sagittal split osteotomy procedures. Materials and Methods: A retrospective evaluation of eight patients who underwent concomitant removal of their lower wisdom teeth (either fully erupted, partially or fully bone impacted) at the time of their surgical procedure (Bilateral sagittal split osteotomy with/without LeFort 1 procedure/genioplasty). All patients presented to the Oral and Maxillofacial Surgery Department at Case Western Reserve University. Postoperative complications (including pain, nerve dysfunction, swelling and infection) were examined at regular follow-up appointments after their surgical procedure. Results: A total of eight patients were examined for post operative complications. All patients confirmed the presence of mild pain/discomfort/swelling in the short-term postoperatively.

A Rare Case of Superficial Temporal Space Abscess Arising from Lower Wisdom Tooth

A Rare Case of Superficial Temporal Space Abscess Arising from Lower Wisdom Tooth

Efficient removal technique of foreign body in the mandible with optimization of 3D simulation

AbstractBackgroundForeign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenic damage.Case PresentationWe describe a case of foreign body removal using a three‐dimensional reconstruction (3D) simulation application (ProPlan CMF™) involving a case of a 26‐year‐old male. The broken bur had been accidentally inserted when a lower wisdom tooth was extracted at a general dental office. The removal surgery was performed under preoperative simulation without complications (e.g., excessive bleeding and nerve paralysis).ConclusionThis case illustrates surgical techniques to safely remove foreign bodies in the mandible.

The Effect of Beech Bark Extract in the Reduction of Discomfort from Acute Pericoronitis

Pericoronitis is characterized by inflammation of the tissues surrounding an erupting tooth and occurs most commonly in lower wisdom teeth. The extent of inflammatory phenomena can significantly affect the patient’s quality of life because of the pain, bleeding, and discomfort caused by it. The treatment of pericoronitis is carried out locally by irrigation and debridement in the early stages, but also generally by antibiotic therapy, when purulent secretion is present under the operculum and in the periodontal area. This study aims to evaluate the effect of beech bark extract (BBE) in the treatment of pericoronitis of the lower third molar. Parameters evaluated were pain, trismus, and bleeding index in a clinic study. Four groups of 20 patients were evaluated and grouped according to the irrigation solution used during the treatment: chlorhexidine 0.2% (CHX), BBE and chlorhexidine mixture solution 0.2% (1:1), and BBE and saline solution (control). The evaluation was carried out before and after the irrigation. Following the assessment of pain and trismus, a significant decrease in pain and a significant increase in mouth opening after 3 days was observed in patients treated with BBE, CHX, and BBE + CHX (p = 0.00). In the case of control patients, no significant decrease in pain (p = 0.83) was observed after 3 days, nor was there a significant increase in the opening of the oral cavity (p = 0.157). The evaluation of the inflammation index showed a significant decrease in gingival bleeding after 3 days for most patients treated with tested solutions (p < 0.05). It was concluded that irrigation with BBE was more effective in reducing pain, trismus, and bleeding compared to the other solutions (control, CHX, BBE + CHX), and this natural extract can be a choice in case of pericoronitis debut.

COMBINED ORTHODONTIC AND SURGICAL TREATMENT IN PATIENT WITH CLASS III AND FACIAL ASYMMETRY

Severe skeletal Class III and facial asymmetry requires combined orthodontic and surgical procedure In order to correct of sagittal and transversal deviations between upper and lower jaw. Aim: The aim of this case was to present effects of combined orthodontic and surgical treatment on craniofacial morphology and whole facial aesthetics. Material and method: In this case a 17-year-old female patient years was treated. Patient had severe skeletal Class III caused by mandibular prognathism, latherognathism, open bite and crossbite. At the beginning of the treatment overbite was - 3.5mm and overjet - 6mm. Parameters on lateral cephalogram at the beginning of the orthodontic procedure were: SNA 83°, SNB 88°, ANB -5°, SN/SpP 9°, SN/MP 38°, SpP/MP 29°, sum of angles of Björk’s polygon 396°, Jarabak ratio 63.26%, I/SpP 47°, i/MP 98°. Orthodontic preparation for surgical treatment lasted 21 months with upper and lower fixed appliance. Surgical procedure was done on both jaws and lower wisdom teeth were extracted. Orthodontic treatment was finished 6 months after surgical intervention. Results and conclusion: Parameters on control lateral cephalogram at the end of treatment were: SNA 83°, SNB 85°, ANB -2°, SN/SpP 10°, SN/MP 32°, SpP/MP 22°, sum of angles of Björk’s polygon 394°, Jarabak ratio 64,20%, I/SpP 47°, i/MP 94°. Patient had stable occlusion in Class I with overjet 1.5mm and overbite 3mm. Both segment of treatment improved significantly facial aesthetics in profile and en face and provided correct occlusion in all three directions.

Contralateral Ocular Complication Following Dental Local Anaesthesia

Background: One of the most important aspects of dental surgery is the injection of local anesthetics, which control pain. Local anesthetics are administered close to certain nerves or fibers to block nerve transmission. Intraoral administration of local anesthetics, on the other hand, can affect other nerves, resulting in complications in the outside of the oral cavity. Ophthalmic problems are uncommon, accounting for about 0.04 to 0.1% of all complications Purpose: The purpose of this case is to discuss the unusual case of contralateral ocular complication following dental local anaesthesia. Case: We reported a 41 years old Malay male came to Kuching Armed Forces Dental Clinic for his appointment on surgical removal of impacted left lower wisdom tooth. After the minor oral surgery procedure under local anaesthesia has been done, the patient had a twitching right eye. Case Management: The patient's vital signs were checked to rule out the possibility of a stroke or anaphylactic shock. The patient was a sure to be calmed, laid down, and put cold compresses on both eyes with dim lighting. After 45 minutes of review, the patient was allowed to leave, followed by a two-week post-minor surgery check-up. Conclusion: Risk of complications from local anaesthesia can be reduced with the effective patient evaluation and anxiety management, correct injection technique, and sufficient knowledge of dental local anaesthesia.

Demirjian and Cameriere methods for age estimation in a Spanish sample of 1386 living subjects

Currently, human identification is a challenge. Migration due to war, economic crisis or other factors is frequent. The wisdom teeth are the last teeth to initiate and complete development therefore, are fundamental for determining the legal age of majority in different countries. The aim of the study is to determine the validity of two methods based on mineralisation of the third molar to predict the ages of majority of individuals in a Spanish population. Orthopantomographies of 636 men and 750 women (mean age, 16.5 years) were analysed. The Demirjian and Cameriere methods were used, and each tooth was assigned a value according to the degree of mineralisation and maturation. The level of significance used in the analyses was 5% (α = 0.05), with a power of 96.2%. The predictive ability of the Demirjian method to determine 18 years of age in the lower wisdom teeth 93%, respectively. The Cameriere method has a predictive capacity of 88%. There are no statistically significant differences between men and women. Stage H and a cut-off point of 0.08 were the guiding values for determining the age of majority of the study population. For other proposed age ranges (14 and 16 years), both methods were useful in determining the actual age of individuals, with the Demirjian method having a sensitivity of 97.5% with and Cameriere having a predictive capacity of 95%. Both methods can be used with high reliability to determine the age of individuals where reliable documentation is unavailable. Stage H with the Demirjian method and a cut-off point of 0.08 with the Cameriere method can determine the age of majority of the Spanish population. The combination of the two methods does not substantially increase predictive ability.

Iatrogenically Displaced Lower Wisdom Tooth Into Submandibular Space: A Case Report And Review On Retrieval Approaches

Accidental displacement of wisdom tooth and its elements are one of the uncommon complications. The common facial spaces involved during the displacement of lower wisdom teeth are Sub mandibular, Sublingual and Pterygomandibular spaces. Such complications have adverse physical and psychological impact over the patients. The management can vary from conservative observation to surgical retrieval; depending on the presenting clinical conditions, location and the relationship of the displaced elements with respect to the anatomic structures. Retrieval of a displaced root tip from these spaces may be complex due to poor visualization, limited access and under limited experience. This is a case report with a review on approaches for surgical retrieval, of a young male patient aged 28 years, who presented with a displaced mandibular third molar root into the Submandibular space during unsuccessful surgical removal by a general practitioner 2 weeks earlier. The presenting complaints were Limited mouth opening and pain during chewing on the right lower jaw. The case was managed surgically through extra oral approach under local anesthesia and MAC.

Radiological Shortening of the Ramus: A Reliable Guide for Diagnosis of Unilateral Mandibular Condylar Fracture

Aim: The aim of this study was to assess and compare the radiological shortening of the ramal height on an Orthopantomogram (OPG) x-ray and Lateral Cephalogram for the diagnosis of a unilateral condylar fracture.
 Study Design: Comparative Study.
 Place and Duration of Study: Department of Oral & Maxillofacial Surgery (OMFS), Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad over a period of 6 months.
 Methodology: The study included 100 patients coming to the OMFS department, 50 of them with unilateralcondylar fracture made up the patient group, and the other 50 for the extraction of lower wisdom tooth comprised the control group. Both groups were having the standardized OPGs alone with lateral cephalograms with them, age ranging from 18 and above of either gender. The following linear mandibular measurements were obtained in mm such as body length, ramal height and ramal shortening using both of the radiographs, respectively. Mean values of left and right sides of the OPG and the lateral cephalogram were calculated for both the parameters that is ramus height and body length. Comparison of the said parameters was also done, subsequently.The collected data was analyzed with the software SPSS 21.0 and Microsoft Excel.
 Results: A total of 100 patients had been assessed and compared on the basis of the radiological shortening of the ramal height on the OPG x-ray and Lateral Cephalogram. The obtained data showed that there was a decrease in the ramal height on OPG as well as Lateral Cephalogram of the fractured patients compared to the non-fractured side, but there was a decrease in the ramal height of patients in the control group as well without having any fracture.
 Conclusion: The shortening of ramal height measured on an OPG and Lateral Cephalogram cannot be relied upon to diagnose a unilateral condylar fracture.

Bispectral photodynamic therapy after the extraction of third molars

Findings obtained after the present trial have confirmed that in patients with extracted third molars reparative processes in wounds are more rapid if wound holes are treated with low-level bispectral laser light.Purpose: to confirm improved reparation, less pain syndrome, and less inflammatory reactions in wounds after the extraction of third molars if laser photodynamic therapy was used in the postoperative period.Material and methods. Given the extraction of eight teeth is a rather traumatic procedure, the authors proposed a technique for treating inflammatory processes in the mucous of maxillofacial area. To implement this technique in the postoperative period, they treated wound surface with photodynamic technique including a photoactive sensitizer. If upper and lower wisdom teeth were removed simultaneously, phototherapy with low-level laser light and bispectral nozzle was applied unilaterally on days 2, 3 and 5, while the other side was not treated at the rehabilitation period. To confirm the effectiveness of the proposed curative technique, scrapes from the wound surface of teeth holes were taken and examined cytologically on days 3, 7 and 12. Staining by Pappenheim and azur-eosin was applied. A randomized simple blind experiment was conducted; a double-blind experiment was a part of morphological examination.Results. Smears from the wound surface were examined on days 3, 7 and 12 to find qualitative and quantitative composition of cytological preparations. A statistically significant difference (p < 0.05) was found indicating that the performed physiotherapeutic care significantly improves reparative processes.

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.

Fusion of Maxillary Third Molar with Paramolar Tooth

A 35-years-old male was attended the Dental Teaching Clinic of the Department of Oral and Maxillofacial Surgery for surgical extraction of the right upper wisdom tooth. Intra and extra-oral clinical examination as well as orthopantomogram (OPG) interpretation were showed horizontal impacted right lower third molar and erupted upper right third molar with evidence of congenital fusion with the supernumerary (paramolar) tooth. Furthermore, no findings of other orofacial anomalies were noticed and alveolar bone was intact at both maxilla and mandible (Panel A). Under local anesthesia, surgical extraction of the congenital fusion of the maxillary third molar with a supernumerary tooth was done (Panel B). After surgery, the patient was given postoperative verbal instruction of the meticulous oral hygiene practice. The sutures were removed one week later and excellent healing was achieved. Congenital dental anomalies having many names including; germination, fusion, concrescence, double teeth, and twinning. A congenital fusion of teeth is the union of both teeth buds that are separated normally. The germination and/or fusion of the molars is uncommon. The prevalence ranges from 0.08% to 0.5%. The upper central incisors are the most frequent teeth involved in fusion and/or gemination (3.55%), followed by the lower wisdom teeth (mandibular third molars) (0.91%). Autosomal dominance probably is the genetic basis for this anomaly. At a one-month follow-up, there was complete healing of the wound without any evidence of complications.

Raising awareness of acute onset of swelling and lip paraesthesia in a teenage patient

We report a case of papillary renal cell carcinoma in a 19-year-old patient that manifested as ipsilateral numbness of the lower lip and swelling in the region of masseter insertion. Despite there being widespread metastatic disease at presentation, the diagnosis was delayed with false reassurance from a normal brain scan and the assumption that the symptoms were due to infection related to the lower wisdom tooth. Once the primary tumour site was established, the patient responded to the relatively new immunotherapy treatments for advanced renal cell carcinoma as advocated in the 2019 NICE guidance. There are no other documented case reports that discuss papillary renal carcinoma with metastatic spread to the mandible in teenagers. CPD/Clinical Relevance: This case highlights the importance of malignancy being a differential diagnosis of lip paraesthesia irrespective of age.

Estimation of time utilized in suturing of oral flaps post-surgical wisdom teeth removal using Negus knot pusher instrument (a comparative study)

Wisdom teeth were the most common teeth affected among the rest of the teeth, these teeth need accurate evaluation and diagnosis, surgical removal of impacted wisdom needs time for incision, bone removal and suture, so the use of any instrument helps to reduce this time is essential. Objective The objectives of this study were to estimate the time needed for the suture of oral flaps post-surgical removal of the lower wisdom teeth by using Negus knot pusher and compare it with the time used for stitching in conventional manual holding single stitching. Material and Methods: Data had been collected from thirty patients through history, clinical examination and radiographic assessment, followed by classical surgical removal performed on the same principles for all patients, at the suture level patients divided arbitrarily into two groups, control group 15 patients and 15 patients Negus pusher group, using Negus knot pusher, which is usually used to hold the stitch and stop bleeding post tonsillectomy operations by ligation, time elapsed for suturing with knot tying is calculated for both groups. Results: Among the 30 patients incorporated in the clinical study, control group mean was (1 minutes and 11 seconds and 70 milliseconds) while for the pusher group was (1 minutes and 32 seconds and 57 milliseconds), the comparison by means of T-test was not significant with the (0.424) value. Conclusion: the Negus pusher instrument can be used for the knotting stiches post wisdom teeth removal as an auxiliary tool and the time can be shortened by the use of a modified handling technique and more satisfaction for patients. Keywords Time; Suturing; Wisdom teeth; Negus knot pusher.

EVALUATION OF LOWER WISDOM TEETH SURGERY RESULTS AT THAI BINH MEDICAL UNIVERSITY HOSPITAL

Objective: Evaluation of lower wisdom teeth surgery results at Thai Binh Medical University Hospital.Subjects and methods: Progressive study on 143 subjects with lower wisdom teeth surgery at Thai Binh Medical University Hospital from November 2019 to June 2020.Results: Parant type II surgery accounted for the highest rate 44.76%. Surgery time from 30-60 minutes accounts for the majority of 48.25%. In the process of surgery, the most common accident isfracture/rupture of the bone in the lower wisdom teeth accounting for 57.34%, root fracture accounts for 11.89%, a case of mild late anesthetic allergy is recorded. Long-term bleeding complicationsaccounted for 11.19%; dry alveolar acupressure and wet alveolar acupressure accounted for 8.39% and 7.69% respectively.Conclusions: According to Parant dividing lower wisdom teeth surgery into 4 types, the rate of type II surgery, ie tooth extraction needs to open a part of the alveolar bone and cut the neck of the teethfor the majority.

Influence of the microbial factor in acute pericoronitis occurrence

Pericoronitis is an inflammatory disease that occurs after the eruption of the lower wisdom teeth and affects the surrounding tissues, with a complex microbial and traumatic etiology, manifested by an erythematous swelling and gum hyperemia in the retromolar area. The main goal was to determine the etiological spectrum of the microorganisms involved in acute pericoronitis and to evaluate the antibiotics, antiinflammatory drugs effect on pericoronitis treatment. The study included 30 patients (18 male, 12 female), aged between 18-45 years (27,8±8,2 years) with acute pericoronitis of the lower wisdom tooth. The study determined the severity of infection related to subjective and objective clinical symptoms (pain, swelling, congestion), the incidence of various streptococci; antibiotics resistance analysis was performed for in order to determine the sensibility and the rate between monomicrobial and polymicrobial cultures. 14 references, 4 figures.

Assess the Age of Majority Using Lower Wisdom Teeth

This article is signed by 27 authors from four continents led by Roberto Cameriere one of the most cited authors in the field of dental age assessment. Determining dental age is a very important segment in the forensic sciences because it gives the best results for an individual’s age.

SURGICAL EXTRACTION OF THIRD LOWER MOLARS IN COMPLEX TREATMENT OF CROWDED TEETH

The success of orthodontic treatment quite often depends on cooperation between the orthodontist and the dental surgeon. An integrated approach, including orthodontic treatment of dento-maxillary anomalies in combination with using the latest surgical techniques can provide quick defect correction of the maxillofacial region and ensure better stability of the results achieved; in most cases of teeth crowding, there is no alternative to the removal of the third lower molars. The purpose of this study was to analyze the surgical interventions performed on for surgical extraction of wisdom teeth for orthodontic reasons and the approach to their choice. Materials and methods. During 2016-2020 years, 158 patients were subjected to 241 surgical interventions for surgical extraction of the third lower molars for orthodontic reasons. We performed on 160 (66.4%) standard operations of atypical tooth extraction, 43 (17.8%) germectomies and 38 (15.8%) coronectomies. The patients' age ranged from 12 to 26 years. All patients were examined by applying the standard technique including orthopantomogram. In cases then it was impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of the superposition of their projections on the obtained pantomograms, we used computed tomography. Based on the data obtained from the examination of the patient, the optimal safest surgical intervention was chosen for removal: the surgical extraction of the wisdom tooth, germectomy, or coronectomy. Conclusions: 1. Operations on surgical extraction of the lower wisdom teeth require mandatory planning and an individual approach to each patient based on a thorough preliminary examination. 2. In cases when it is impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of overlapping their projections on the pantomograms, patients are recommended to undergo computed tomography, and then based on the assessment of CT findings to determine the topographic and anatomical relationship of the mandibular canal and roots. 3. The operation of surgical extraction of the lower wisdom tooth can be performed as a standard operation, germectomy can be recommended for patients with underdeveloped roots, coronectomy is a good option when the roots of the wisdom tooth are very close to the mandibular canal.

An Infected Ectopic Wisdom Tooth in the Ascending Ramus

Ectopic wisdom teeth are a rare occurrence. Furthermore, it is highly unusual to see lower wisdom teeth in the ascending ramus of the mandible. This case report is about a 41-year-old male patient with right sided facial swelling. Presenting initially as suspected right sided parotitis, the source of the infection was quickly identified as an ectopic wisdom tooth located in the ramus of the mandible.