Mandibular M3 Research Articles

Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction

BackgroundThird molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PurposeThe study purpose was to measure and compare differences in pain, swelling, trismus, wound healing and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. Study design, setting and sampleThis study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. Predictor variableThe predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiologic saline) side. Primary outcome variableThe primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening (MIO), were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. CovariatesThe covariates included age, sex and operation time. AnalysesThe Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P <0.05. ResultsThe study included 60 patients (mean age: 25.81 ± 4.91;23 (38%) males, 37(62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < 0.001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < 0.001), MIO (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P<0.001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P <0.001) and swelling (6.86 ± 0.70 mm, 7.15±0.80 mm, day 3, P=0.006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ±2.14, day 3, P<0.001). ConclusionThe application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative quality of life.

Beyond the ARCH: Examining mandibular third molar movements in response to premolar and single incisor extractions in orthodontic practice

Mandibular third molars have been the interest of the orthodontic professionals, not only because of their Position Eruptive pattern, also because of their possible role in the development of late incisor crowding. The impaction rate of the third molars (mandible &amp;#62; maxilla) is high compared to any other teeth. The impaction incidence of M3s may be lower in patients with orthodontic premolar extraction due to mesial movement of the posterior teeth. In this study angular and positional changes of mandibular 3 molars will be evaluated with premolars as well as single incisor extraction.: This study includes 30 Pre-treatment and post-treatment orthopantomogram (OPG) of patients seeking orthodontic treatment with extractions of premolars, single incisor are categorized into 2 groups -Group I includes premolar extractions, Group II includes single incisor extractions.The study concluded that extracting premolars or single incisors did not result in improved mandibular M3 angulation on both left and right sides during the observation period.The insignificant change in angulation suggests that there are other factors that play a role in the process of alteration of third molar angulation

Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

BackgroundSeveral measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF). PurposeThis study compared the effects of three modifications of PRF (Leukocyte-PRF, Advanced-PRF, and Advanced-PRF+) on the side effects of impacted M3 removal. Study design, setting, and sampleThis double-blinded randomized controlled trial was conducted at the Oral Surgery department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease. Independent variableThe independent variable was the PRF product grouped into four categories (control, leukocyte-PRF, advanced-PRF, and advanced-PRF+). Study subjects were randomly distributed among the four groups. Main outcome variablesThe main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 post-surgery. CovariatesAge, sex, duration of surgery, and side of surgery were the covariates. AnalysesChanges at different time points were analyzed using repeated-measures ANOVA. Pairwise comparisons were performed if significant. P-values≤.05 were considered statistically significant. ResultsThe sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P>.05). A-PRF and A-PRF+ had significantly better healing index than L-PRF on the third day (P=.02, P=.01). All the study groups significantly reduced VAS pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF+ had significantly lower VAS scores than L-PRF on the second day (P=.003, P=.02). No significant difference was found in maximum mouth opening during follow-up sessions (P=.2). Study groups had less facial swelling on days 2 and 3 than the control group (P<.05). ConclusionL-PRF, A-PRF, and A-PRF+ can improve postoperative outcomes after M3 removal, but may not impact trismus. A-PRF and A-PRF+ may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF+ have comparable results.

Effect of Advanced Platelet-Rich Fibrin (A-PRF) on Postoperative Level of Pain and Swelling Following Third Molar Surgery

BackgroundPostoperative pain and swelling following third molar (M3) removal can be debilitating, and there is interest in using advanced platelet-rich fibrin (A-PRF) to reduce their severity. PurposeThis study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal. Study design, setting, sampleThis split-mouth, single-blinded, randomized controlled trial was completed at the Oral Surgery clinic of University of Otago between November 2020 and July 2021. Patients aged between 16–40 years, with bilateral impacted mandibular M3 of similar Pederson index difficulty and deemed to be American Society of Anesthesiologists (ASA) I or II comprised the study sample. Predictor/exposure/independent variableThe exposure variable was M3 socket management. One socket received A-PRF and 1 gelatin dressing, while the other received 2 gelatin dressings. Main outcome variable(s)The outcome variables were postoperative pain and swelling over 7 days. Pain was measured using the visual analog scale, and swelling using stereophotogrammetry. CovariatesDemographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates. AnalysesThe two sides were compared using cross-tabulations and the McNemar test for categorical and paired t-tests for continuous variables. Statistical analysis used IBM SPSS Statistics for Windows (Version 28). Alpha level was at 0.05. Results76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 (65.7% female; age range 16-30 years) were included in the analysis. Mean VAS scores showed no statistically significant difference between the A-PRF and control sides, being 29.6 (95% CI 23.9, 35.3) and 29.5 (95% CI 23.5, 35.5) on day 2, and falling to 12.6 (95% CI 8.7, 16.5) and 14.2 (95% CI 10.0, 18.4) by day 7. Likewise, mean peak facial swelling on day 2 was recorded as 6.3cm3 (95% CI 4.9, 7.7) and 6.6cm3 (95% CI 5.5, 7.7), and by day 7 they were 1.1cm3 (95% CI 0.5, 1.7) and 1.0cm3 (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively. Conclusions and RelevanceA-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.

Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial

BackgroundPostoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient’s quality of life. PurposeThe study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field therapy (PEMF) following M3 removal and compare it to patients who did not receive PEMF. Study design, setting, sampleThe single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography (CT). Predictor/exposure/independent variablesThe predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. Main outcome variablesThe pain was quantified using a 100 mm visual analog scale (VAS) and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the VAS scale and the number of analgesic tablets taken. CovariatesThe study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. AnalysesA t-student test was used, placing the statistical significance for p-value values < 0.05. The primary planned analysis was a two-group, continuity-corrected, chi-square test of equality of proportions. ResultsThe study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a p-value = 0.0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a p-value = 0.0062). Conclusions and RelevanceThe study’s results attest to the effectiveness of PEMF therapy in pain control after third molar surgery.

Assessment of relationships between condylar fracture pattern and mandibular third molar position by panoramic radiography and computed tomography: A retrospective comparative study.

Although previous studies have revealed the influence of the mandibular third molar (M3) on mandibular condylar fracture risk and that the presence of M3 could result in different incidences of condylar and angle fractures, there have been no analyses of the influence of M3 on fracture patterns. Moreover, evaluations of M3 position using panoramic radiography have shown insufficient accuracy. This study investigated the relationship between condylar fracture patterns and M3 position using panoramic radiography and computed tomography. This retrospective study included 280 patients with unilateral mandibular condylar fractures and ipsilateral M3 admitted to West China Hospital of Stomatology between January 2016 and June 2022. Patient medical records, panoramic radiographs, and computed tomography images were collected. The vertical and horizontal positions of M3 were classified using the Pell and Gregory system. M3 angulation was defined as the angle between the long axis of M3 and the mandibular occlusal plane. Condylar fracture patterns were classified as intracapsular (Types A-C) or extracapsular (neck and base). Data were analyzed using McNemar-Bowker test, Pearson chi-squared test, and Fisher's exact test. Classification of M3 position differed significantly between panoramic radiography and computed tomography images (p < .05). There was a significant association between the mandibular condylar fracture pattern and M3 horizontal position on computed tomography (p < .05). Class I M3 position on computed tomography was associated with a higher incidence of intracapsular than extracapsular fractures, along with a higher incidence of Type B than base fractures; the opposite relationships were observed for Class II. No such association was identified on panoramic radiography. Mandibular condylar fracture patterns were presumably influenced by M3 horizontal position on computed tomography. The imaging modality affected the classification of M3 position and subsequent analyses. Computed tomography is recommended for future studies to improve accuracy and reliability.

Association of the Vertical and Sagittal Growth Patterns of Jaws with the type of Third Molar Impactions: A Radiological Analysis

Objective: To evaluate if the jaw growth patterns are associated with third molar impactions.&#x0D; Design: Cross-sectional study.&#x0D; Study setting: Orthodontics Department, Islamic International Dental College &amp; Hospital Islamabad, Jan to Jun 2018.&#x0D; Methods: We analysed the records of 300 mandibular and maxillary third molars with specific criteria. Orthopantomogram Xrays were used to identify impactions and were classified by Pell and Gregory (P&amp;G) and Winter lines. In addition, lateral cephalograms were assessed for sagittal classes and vertical growth patterns.&#x0D; Results: Angles of impaction (Winter lines) of mandibular M3s were significantly associated with sagittal growth patterns(p=0.021), with most mesioangular impactions found in Classes I and II. High-angle subjects resulted in the highest impactions in the vertical growth patterns. High angle was followed by low angle and normal angle in mandibular M3s and normal angle and low angle in maxillary M3s. Levels of maxillary M3s (P&amp;G) and vertical patterns showed a significant association (p=0.016), with the highest M3s at level C. The maximum number of impacted M3 coexisted with P&amp;G Class- II and level B for both jaws.Conclusion: Significant associations were found between mandibular M3 angles, sagittal patterns, and levels of maxillary M3s and vertical patterns. Results conclude that facial growth patterns and M3 impactions are not completely independent and may help predict impaction status in adolescence and aid in orthodontic treatment.

Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation.

The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic radiographs was conducted. Thirty-nine patients (51.3%) were orthodontically treated with M1 extraction and thirty-seven (48.7%) were treated without extraction. Angulations of M2 and M3 relative to the infraorbital (IOP) and the palatal planes (PP) were measured and compared between the groups before orthodontic treatment (T1) and after the completion of orthodontic space closure (T2). The prognosis of M3 eruptions was evaluated by assessing their horizontal and vertical position (inclination) using different classification systems. The angular (p < 0.001) and inclination improvement (p < 0.01) of the maxillary M3 was significant for the M1 extraction group. The mandibular M3 inclination significantly improved (p < 0.01), whereas the groups' angulation and vertical position were not significantly different. These findings suggest that extraction therapy has a favorable effect on the maxillary M2 and M3 angulation, but not on the mandibular. M1 extraction showed a signi- ficant effect on the horizontal position of M3 and thus may improve the eruption space and prognosis.

Use of third molar eruption based on Gambier's criteria in assessing dental age.

The biological aspects of determining the dental age of subadults represent an important interdisciplinary scientific link with applications in criminal law and in forensic anthropology and dentistry. In criminal procedural law, it is necessary to determine the exact age of an undocumented person in view of the application of the provisions on juvenile offenders and minor victims. Chronological age can be estimated from the development of the third molars, as these are the only teeth that develop at the age of 18. The aim of this study was to verify the applicability of the Gambier method based on the eruption of the third permanent molars in the mandible and maxilla, to contribute to forensic age assessment. The analyzed group that met the criteria consisted of 811 orthopantomograms (OPGs) (339 females and 472 males) between the ages of 13 and 25years. The OPGs were retrospectively analyzed according to the method of Gambier et al. (Int J Legal Med 133:625-632, 29), which refers to the eruption stages of the third molar. Differences between eruption stages of maxillary and mandibular third molars were statistically significant in both biological sexes. Intersexual differences in mean age were significant only at stage 3 for any M3 tooth and at stage 1 for mandibular M3. There were no statistically significant differences between the left and right mandibular and maxillary third molars, respectively. Differences between mandibular and maxillary M3 were significant only for stage 1 in males on the left side and for stage 2 in both sexes and sides. The method used allowed the best classification of individuals into minor and adult groups (based on phase D-90.41% of individuals, based on the third stage of the mandibular left third molar-86.29%). Based on the results obtained, we can assume that the method cannot be used alone in the initial examination of living individuals, since all four third molars must be assessed and there are no additional findings from practice.

Relationship Between Types of Information, Dental Anxiety, and Postoperative Pain Following Third Molar Surgery: A Randomized Study

Third molar (M3) extraction is an anxiety-provoking procedure. Information mode delivery may affect patients' anxiety level and postoperative sequelae. This study determined the relationship between information types, dental anxiety, and postoperative pain following mandibular M3 extraction. Patients (aged 18 to 35years) requiring M3 extraction under local anesthesia were recruited into this prospective randomized study conducted in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Patients were randomized to two groups; verbal or audiovisual depending on M3 extraction information received. Primary outcome variable (difference in anxiety between groups) was assessed with State-Trait Anxiety Inventory (STAI-S) and Modified Dental Anxiety Scale(MDAS). Pain recorded on postoperative days (PODs) 1, 3, and 7 using the Visual Analog Scale was the secondary outcome. Other covariables include biodata, impaction types, and difficulty indices. Data analysis was descriptive and bivariate using IBM/SPSS for Windows, version 23 (SPSS, Chicago, IL USA) with significance set at P<.05. Ninety patients referred for M3 extraction met the inclusion criteria, 45 patients in each group. The audiovisual group had significant increase in anxiety preoperatively measured by STAI-S (P=.002) and MDAS (P=.009) when compared with the verbal group. No significant differences in the STAI-S (P=.16) and MDAS (P=.216) scores were recorded at POD7. The progressive reduction in pain in both groups was not significant at POD7 (P=.746). Preoperative verbal information allayed anxiety compared to real life audiovisual information in M3 patients. These findings will provide a baseline reference data for subsequent research in our environment.

Postoperative Sequelae Following Surgical Extraction of Impacted Mandibular Third-Molar Extraction Using the Complete Closure Versus the Sutureless Techniques.

Wound closure techniques affect the severity of inflammatory complications that ensue following surgical extraction of the impacted mandibular third molar (M3). The choice of the technique remains a topic for discussion because reports regarding their associated sequelae are split. This study therefore compares the pain, swelling and trismus in the complete closure and the sutureless/non-closure techniques. This was a prospective, randomised clinical study carried out at the Dental and Maxillofacial Surgery department of a tertiary hospital. A total of 74 participants requiring impacted mandibular M3 extractions were randomised into a complete closure group and a sutureless technique group. They were subjected to the procedure under similar technique and conditions and followed up for a week to assess their experiences of pain, swelling and trismus. Variables were recorded and analysed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. The critical level of significance was set at P < 0.05. The sutureless group had statistically significantly higher postoperative pain on days 1, 3, 4 and 5 (P < 0.05) and lesser severity of trismus on day 7 (P < 0.05) than the complete closure group. There was no significant difference in swelling. Compared with the complete closure group, the sutureless group had similar severity of swelling, less trismus but had higher pain severity in the week following M3 surgery.

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

Assessment of Age at the Stages of the Eruption of Third Molar Teeth among the People of North-Eastern India.

Methods A cross-sectional descriptive and analytical study was undertaken with 1060 Assamese individuals (642 males and 418 females) aged 14–26 years and was subjected to a clinical, dental, and general physical examination from January 2014 to December 2018. The data were statistically analyzed using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS) version 22. The significant differences among variables were tested using the chi-square test and Student's t-test, considering a p value < 0.05 as significant. Results The carried-out research showed no eruption (NE) status of M3 with an overall mean (±SD) age at 17.39 (±2.273) years, although a significantly lower age among males with a mean age of 16.92 (±2.138) years (p value < 0.001) was observed. The mean age (overall) for the complete eruption (CE) was observed at 20.33 (±2.566) years, which was seen earlier in males. The mandibular M3 appears earlier compared to the maxillary M3. The third molar eruption (TME) on both left and right quadrants of the jaw was observed substantially earlier in the lower jaw, compared to the upper jaw (p value < 0.025). The earliest CE of M3 was marked at 15 years. The differences in the frequencies of TME in different chronological age groups were found significant (p value < 0.001). A significant association between gender and TME (p value < 0.045) in the current study is worth noting. Conclusion Thus, determined by TME as a valid method, age can be used for various purposes to establish a person's identity. Dental age estimated using third molar eruption status has a weighty association with chronological age. Thus, it should be utilized to determine the likely age of an individual.

A structural biorhythm related to human sexual dimorphism

Life on earth is regulated by biological rhythms, some of which oscillate with a circadian, monthly or lunar cycle. Recent research suggests that there is a near weekly biorhythm that may exert an influence on human skeletal growth. Evidence for the timing of this biorhythm is retained in tooth enamel as the periodicity of Retzius lines. Studies report that Retzius periodicity (RP) relates to adult human stature and enamel thickness. Adult human stature is sexually dimorphic, and so is enamel thickness of maxillary third molars (M3) but not mandibular M3. Yet, previous studies report sex differences in RP are apparent in some populations but not others, and it is unknown if dimorphism in enamel thickness relates to RP. To further our understanding of this biorhythm we analysed sex-related variation in RP and its relationship with enamel thickness in a sample of M3′s (n = 94) from adults in Northern Britain. Results reveal RP was significantly higher in our sample of female molars compared to those of males, which is consistent with the previously reported correlation between the biorhythm and adult stature. The RP of maxillary M3 related to sex differences in enamel thickness, but this relationship was not present in mandibular M3. Our results support previous findings suggesting that this biorhythm is sexually dimorphic and provide the first evidence that RP may be one factor influencing sex differences in enamel thickness. Our study also shows that correlations between RP and enamel thickness appear to be most readily detected for tooth types with sufficiently wide ranges of enamel thickness variation, as is the case for maxillary but not mandibular M3. Achieving a sufficient sample size was critical for detecting a sex difference in periodicity.

Risk factors for lingual plate fracture during mandibular third molar extraction.

The aim of this study was to predict the risk of lingual plate fracture during mandibular third molar (M3) extraction. Cone beam computed tomography (CBCT) data from 264 mandibular M3s (erupted and impacted) from 264 patients (104 males and 160 females; age range, 17-75years) were retrospectively analyzed. Lingual plate thicknesses at the levels of the mid-root and root apex of the M3s were measured and defined as "thicker" (bone thicker than 1mm), "thinner" (bone thinner than 1mm), or "perforated" (bone perforated by the M3 root). These measurements were correlated with potential risk factors for thinner and perforated lingual plates: tooth position of the mandibular M3, morphology of the lingual plate, and patient characteristics (age and sex). The mean thickness of the lingual plate was 1.49 ± 1.38mm at the mid-root of the M3s, and 2.35 ± 2.03mm at the root apex. Multivariate regression analyses revealed that mesioangularly and horizontally impacted M3s were significantly associated with thinner and perforated lingual plates at the mid-root (P < 0.001), whereas the M3s in infra-occlusion positions (in infra-occlusion when compared with the adjacent second molar) had thinner lingual bone at the root apex (P= 0.022 and P= 0.027, depending on the level of impaction). Female patients were less likely to have lingual plate perforation (P = 0.036). Mesioangulation, infra-occlusion, and male sex were risk factors for lingual plate fracture. When the risk of lingual plate fracture is high, a sufficiently large flap, osteotomy, and tooth section by bur or piezosurgery are recommended to create a good operative field and avoid excessive pressure on the lingual plate.

Evaluation of third molar agenesis associated with hypodontia and oligodontia in turkish pediatric patients.

To evaluate the association between third molar (M3) agenesis and hypodontia and oligodontia in pediatric patients by using panoramic radiography. Panoramic radiographs of 1,471 patients (899 females; 572 males) and 5,884 teeth were retrospectively evaluated. The age and gender of the patients were recorded. Patients ages 9-15 years old were included in the study. The mean age was 12.76. The agenesis of M3 teeth and the relationship between M3 agenesis and hypodontia and oligodontia were recorded according to findings from the upper and lower jaw, in both the right and left locations, along with the number of M3 with agenesis. Data were analyzed using chi-square and McNemar tests (p<0.05). A total of 1,319 (89.7%) patients had all M3 teeth present in the mouth, while the other 152 (10.3%) had congenital agenesis in one or more teeth. The number of teeth in which M3 agenesis was seen, in order of the number of missing M3 teeth, the percentages were 2.6% for one, 2.4% for two, 1.0% for three and 4.3% for four missing teeth.Hypodontia was detected in 37 patients and oligodontia was detected in 3 patients. The prevalence of M3 agenesis varies from one population to another. Two of the dental anomalies associated with M3 agenesis are hypodontia and oligodontia. In this study, M3 agenesis varied in terms of region and gender; hypodontia was also significantly higher in patients with missing mandibular M3.

Impaction of mandibular third molars after orthodontic treatment by the edgewise method: a retrospective study.

This study aimed to determine the incidence of mandibular third molar (M3) impaction after orthodontic treatment by edgewise appliances, and identify possible determinant factors of M3 impaction. A retrospective cohort study was conducted with 1154 patients. Complete orthodontic records were analyzed pretreatment and posttreatment, considering the following variables: type of Angle malocclusion, treatment with or without extraction of first premolars, overbite, stage of dentition, M3 prior angulation and duration of orthodontic treatment. Impaction was determined after radiographic evidence of total closure of the root apex. The chi-square test and Poisson regression (p < 0.05) were used for statistical analysis with a hierarchical approach. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Mandibular M3 impaction incidence was 17%. Overbite equal to or greater than 4 mm (RR = 1.23, 95%CI: 1.11-1.26, p < 0.001), prior mesial angulation of M3 (RR = 0.59, 95%CI: 0.52-0.68, p < 0.001), non-extraction of first premolars (RR=1.06, 95%CI: 1.01-1.12, P=0.019) and orthodontic treatment time equal to or less than three years (RR = 0.94. 95%CI: 0.90-0.99, p < 0.014) were significantly associated with impacted M3. There was no correlation between the type of Angle malocclusion and the risk of impaction. In conclusion, the incidence of mandibular M3 impaction was considered low. The main pretreatment factors directly involved in impaction were mesioangulation of M3 and overbite equal to or greater than 4 mm. Orthodontic treatment with extraction of first premolars and treatment time greater than 3 years reduce the risk of impaction.

Evaluation of residual bone mass of the mandibular third molar and the risk of mandibular fracture.

A quantification of the residual bone mass of the mandible (B/A) was utilized in this study to examine the correlation between mandibular fracture and residual bone mass. To improve the clinical utilization rate and reduce the incidence of iatrogenic mandibular fractures, the B/A ratio calculation should be simplified. Data were collected from the Yanbian University Hospital on 175 cases of mandibular fracture with third molar (M3), 67 normal cases without fractures and 20 cases of impacted teeth extraction. Twenty cases of iatrogenic mandibular fracture were collected, and the case records and panoramic radiographs of the patients were recorded. The average B/A ratio of mandibular angle fracture group was 0.61±0.10.The value of B/A was found to be statistically significant in terms of whether M3 emerged from alveolar bone (P = 0.001), location (horizontal P < 0.001, vertical P < 0.001), the degree of impaction (P < 0.001), the number of roots (P < 0.001), the difference in impaction (P < 0.001), and the fracture type (P = 0.002). The average B/A ratio of normal group was 0.62±0.10. In the statistical results of the B/A value of normal patients, M3 involving alveolar bone (P < 0.001), position classification (P < 0.05), degree of impaction (P < 0.001) and presence or absence of a root (P < 0.05) were statistically significant. The average B/A ratio of iatrogenic mandibular angle fracture group was 0.28±0.08. The average B/A ratio of the extraction group for impacted teeth was 0.62 ± 0.09. There is a high risk of mandibular angle fracture when the (B/A) value of the residual bone height (B) in the mandibular M3 area compared to the mandibular bone height (A) in the M3 area is less than 0.4.

Factors predictive of the intensity of local anesthesia in mandibular third-molar surgery: A cross-sectional study

IntroductionPrimarily, the intensity of local anesthesia (LA) in mandibular third-molar (M3) surgery is governed directly by lipid solubility of the local anesthetic drug and indirectly by other physical characteristics. However, a patient's demographic, anthropometric, behavioral, and surgical factors may affect these physical characteristics and, therefore, indirectly influence the clinical actions of the local anesthetic drug used. The aim of this study was to investigate patients’ demographic, anthropometric, behavioral, and surgical variables that may predict for the intensity of LA in mandibular M3 surgery among healthy adult patients. Material and methodsThis cross-sectional study included 141 patients with unilateral mandibular M3 teeth indicated for surgical extraction under LA. Patients’ demographic, anthropometric, behavioral, and surgical potential predictor variables were recorded. Lidocaine (2%) with epinephrine (1:100,000) was administered to provide block anesthesia for mandibular M3 surgery. The overall intra-operative pain (intensity of LA) was the outcome variable and was evaluated by the patient after surgery, using a visual analogue scale (VAS). Data were analyzed using univariate analysis and multivariate regression analysis. ResultsThe final study population comprised 126 participants: 80 women and 46 men (mean age±SD=29.2±12.3 year). With multivariate regression analysis, age, smoking quantity, and “amount of local anesthetic used” were the only significant (P<0.001) predictors of the intensity of LA in mandibular M3 surgery. ConclusionsThis study suggested that an increase in age, smoking quantity and “amount of local anesthetic used” would predict an increase in the intensity of LA in mandibular M3 surgery.

Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars.

The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction. Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters. Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0mm) and disto-lingual (T0-5.4/T1-3.2mm) sites. The average attachment gains at T1 were 1.9 and 2mm, respectively (P<0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD≥4mm at baseline healed at 6months recall without periodontal pockets. Older age (mean 55years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7mm was more likely to be associated with PPD ≥ 4mm 6months postextraction (P<0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4mm after healing (OR=41.4; 95% CI=10.9 to 156.5, P<0.05). Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.