Maxillary Wisdom Tooth Research Articles

A Rare Complication in the Oral Local Infiltration Anesthesia.

The present report describes a rare complication named Kuhn anemia, which happened during local infiltration anesthesia of maxillary wisdom tooth. A 24-year-old male was referred for residual crown of left maxillary wisdom tooth and therefore required extraction. Oral examination revealed a buccal impacted left maxillary wisdom tooth (28), severe caries affecting the dental pulp, and pain with percussion. This case was diagnosed as impacted wisdom tooth 28 and pulpitis. Thus, the authors performed an extraction of the 28. After injection of articaine hydrochloride (68mg:1.7mL) containing epinephrine (1:100,000) as local anesthetic, the patient felt pain and heat in the left cheek, and an irregularly shaped pale area appeared on the left cheek. The authors stopped the surgery and comforted him. After a 30-minute break, the cheek turned normal, and abnormal sensation was no longer felt.

Evaluation of a New Simplified Approach for Upper Superficial Impacted Third Molar Extraction-A Retrospective Split-Mouth Study.

A new access technique was developed to reduce postoperative adverse events after the extraction of impacted maxillary wisdom teeth. Hence, this study aimed to assess the occurrence of adverse events after the extraction of maxillary impacted wisdom teeth using a traditional access (TA) or a new technique (NT). Two different surgical incision designs were used for bilateral wisdom tooth extractions in 30 patients. The traditional incision was performed distal to the second molar in the center of the tuberosity, followed by a buccal releasing incision. After the tooth extraction, the wound was secured by sutures. The new technique consists of an oblique incision from the distal palatal aspect of the tuberosity towards the buccal aspect of the second molar. After the tooth extraction, cyanoacrylate glue was used on the wound. Lower pain was reported by patients at the site treated with the new technique (p < 0.01). Edema, postsurgical bleeding, and hematoma were similar in both groups. The surgical time was shorter for the new technique (p < 0.01). The new technique applied for the extraction of impacted maxillary wisdom teeth reduced postsurgical pain and the duration of surgery.

Masticatory muscle tendon-aponeurosis hyperplasia that was initially misdiagnosed for polymyositis: a case report and review of the literature

BackgroundMasticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a relatively newly identified clinical condition that manifests as trismus with a square-shaped mandible. Herein, we report a case of MMATH that was initially misdiagnosed for polymyositis due to trismus and simultaneous lower limb pain, with literature review.Case presentationA 30-year-old woman had a history of lower limb pain after exertion for 2 years. Initial physical examination had been performed at the Department of General Medicine in our hospital. There was also redness in the hands and fingers. Although polymyositis was suspected, it was denied. The patient visited our department for right maxillary wisdom tooth extraction.Clinical examination revealed that the patient had a square-shaped mandible. The maximal mouth opening was 22 mm. There was no temporomandibular joint pain at the time of opening. Furthermore, there was awareness of clenching while working. Panoramic radiography revealed developed square mandibular angles with flattened condyles. Computed tomography showed enlarged masseter muscles with high-density areas around the anterior and lateral fascia. Magnetic resonance imaging also showed thickened tendons and aponeuroses on the anterior surface and inside bilateral masseter muscles. Finally, the patient was diagnosed with MMTAH. Bilateral aponeurectomy of the masseter muscles with coronoidectomy and masseter muscle myotomy was performed under general anesthesia. The maximum opening during surgery was 48 mm. Mouth opening training was started on day 3 after surgery. Histopathological examination of the surgical specimen showed that the muscle fibers were enlarged to 60 μm. Immunohistochemistry testing for calcineurin, which was associated with muscle hypertrophy due to overload in some case reports, showed positive results. Twelve months after surgery, the mouth self-opening and forced opening were over 35 mm and 44 mm, respectively.ConclusionsHerein, we report a case of MMATH. Lower limb pain due to prolonged standing at work and overload due to clenching were considered risk factors for symptoms onset of MMATH.

Prevalence and Pattern of Maxillary Wisdom Tooth Impaction and Angulation in Relation to the Maxillary Sinus among Yemeni Students

The goal of this study was to determine the prevalence of maxillary third molar impaction and angulation, as well as its relationship to the maxillary sinus, in a group of Yemeni students. Panoramic x-rays were used to assess 200 students, 102 men and 98 females, in this retrospective investigation. Chi-square tests were used to assess age, gender, maxillary sinus approximation to maxillary third molar roots, depth of impaction, and angulation. A total of 327 maxillary third molars were examined; the most congenitally missing maxillary third molar was on the right side, and females (10.25%) had more maxillary third molars engaged in the maxillary sinus than males (8.0%) (4.9%). Type A (52.9%) was the most common according to Pell and Gregory's classification, although vertical angulations of the maxillary third molar were seen more frequently (85.32%). Congenitally missing maxillary third molars are more common in females, and position A was the most common among the maxillary third molars on a vertical level.

A case of maxillary wisdom tooth extraction with a complication of chipped carbide bar straying into the maxillary sinus

A case of maxillary wisdom tooth extraction with a complication of chipped carbide bar straying into the maxillary sinus

A Case of Peritonsillar Abscess Triggered by a Maxillary Fracture During Extraction of a Maxillary Wisdom Tooth

A Case of Peritonsillar Abscess Triggered by a Maxillary Fracture During Extraction of a Maxillary Wisdom Tooth

A case of bilateral maxillary wisdom teeth extraction in a patient with congenital factor V deficiency

A case of bilateral maxillary wisdom teeth extraction in a patient with congenital factor V deficiency

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial.

BackgroundLignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique.MethodsThis was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure.ResultsThe onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate.ConclusionRopivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal?

In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction. Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT. A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation. The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation

ObjectiveTo provide information on the prevalence and clinical features of impacted third molar teeth in the South-Western region of Saudi Arabia. Material and methodsIn this cross-sectional study, 1200 panoramic radiographs (50% males and 50% females) were retrieved from the electronic clinical records of patients at the College of Dentistry, Jazan University from December 2014 to December 2016, and impacted third molars were evaluated. Data on clinical and radiographic presentation were analyzed. ResultsOverall, there were 291 (24.3%) patients with impacted third molars among 1200 radiographs. The distribution of impacted third molars according to the number of impacted teeth was as follows: one impaction in 121 (41.6%); two impactions in 90 (30.9%); three impactions in 42 (14.4%); and four impactions in 38 (13.1%) patients. There was a high prevalence of all impaction types among females (54.5%). Maxillary vertical angulation was most common (50%) followed by mandibular mesioangular angulation (48.3%). The depth of impaction in maxillary teeth was higher than in mandibular teeth. Pain was uncommon (4.5% of patients). DiscussionClinically, vertical impaction in the maxilla was present in 50% of patients because of limited posterior space, and mesioangular angulation in the mandible was present in 48% of patients because of inadequate space between the ramus and the second molar. These findings are similar to other reports. Vertical impaction of the maxillary wisdom tooth is mostly related to the discrepancy between the mesiodistal size of the tooth crown and the limited retromolar space. ConclusionNoiseless presentation of an impacted third molar requires raising the population’s awareness about the need for diagnosis and treatment of the problem to avoid any further complications. The study can be to guide surgical procedures. This study documented the prevalence, pattern, and clinical features of impacted third molars in South Western region of Saudi Arabia.

Comparison of the anesthetic effects of articaine adrenaline injection and lidocaine injection in wisdom tooth extraction

Objective To compare the anesthetic effect of atocaine adrenaline injection and lidocaine injection in wisdom tooth extraction. Methods 220 patients with wisdom teeth were selected as the research subjects.According to the random table method, the patients were randomly divided into research group 110 cases (a total of wisdom teeth 132, maxillary wisdom teeth 47, mandibular wisdom tooth 85) and the control group 110 cases(a total of wisdom teeth 129, maxillary wisdom teeth 51, mandibular wisdom tooth 78). The research group received atocaine adrenaline injection, the control group received lidocaine hydrochloride injection.The effects of anesthesia, VAS score and adverse reactions in the two groups were observed. Results The total effective rate of maxillary wisdom tooth anesthesia in the research group(100.00%) was significantly higher than that in the control group(90.20%), and the difference between the two groups was statistically significant(χ2=6.358, P<0.05). The total effective rate of mandibular wisdom tooth anesthesia in the research group(100.00%) was significantly higher than that in the control group(92.31%), and the difference between the two groups was statistically significant(χ2=6.788, P<0.05). The VAS score of maxillary wisdom tooth anesthesia in the research group[(2.57±0.65)points]was significantly lower than that in the control group[(2.87±0.63)points], and the difference between the two groups was statistically significant(t=2.319, P<0.05). In the control group, there was 1 case of hematoma caused by blood vessels, and no complications occurred in the research group. Conclusion The anesthetic effects of articaine adrenaline injection in wisdom tooth extraction is better than lidocaine hydrochloride injection, without any complications, it is worthy of clinical promotion. Key words: Teeth extraction; Anesthesia; Atocaine adrenaline injection; Lidocaine hydrochloride injection

Anatomic (positional) variation of maxillary wisdom teeth with special regard to the maxillary sinus.

The removal of wisdom teeth is one of the most common interventions in oral surgery. In order to avoid complications, a profound knowledge of the anatomy of teeth and adjacent tissues is crucial. In the case of maxillary wisdom teeth, their relationship to the maxillary sinus, to the pterygoid fossa, to the maxillary tuber and the adjacent venous plexus is particularly important. Three-dimensional (3D) imaging, for example by means of cone beam computed tomography (CBCT), is increasingly utilized in practice. However, the necessity of CBCT imaging is still a matter of intensive debate. The aim of this study was to describe the anatomic (positional) variation of maxillary wisdom teeth and, based on these findings, to elucidate the additional benefit of such imaging. A retrospective case study was performed using patients examined by means of CBCT imaging in the Department of Dento-Maxillofacial Radiology during the period from 2008 to 2013. Primary study variables comprised the spatial relationship of the teeth to the maxillary sinus, the degree of retention and root development, the covering of the root with bone and mucosa, the root configuration, and the developmental stage of the tooth. In addition, the association of the inclination of teeth in the transversal and sagittal plane with the above variables was evaluated. Descriptive statistical parameters were calculated for all results of the examination. In total, CBCT recordings of 713 maxillary wisdom teeth from 430 patients were evaluated. Their mean age was 29.8 years, and the proportion of male patients slightly prevailed (54.4%). Most teeth exhibited fully developed roots (64.1%). Overall 22.9% of third molars were impacted, 32.3% were retained, and 6.5% were erupting. In more than a third of the patients, wisdom teeth were in occlusion. The inclination of the third molars both in the transversal and sagittal plane was significantly associated with the distance of the root from the maxillary sinus as well as with the bony covering of the root. Owing to the possibility of evaluating preoperatively the relationship of a wisdom tooth to the maxillary sinus and to other anatomic structures, we recommend the use of CBCT, whenever conventional radiography fails to provide adequate information about the critical anatomic circumstances of maxillary third molars. However, CBCT should, at least nowadays, not be utilized as the standard radiographic examination.

A unique post‐operative complication

AbstractAimTo highlight the importance of pre‐ and post‐operative examination of instruments used in exodontiaMaterial and MethodsThis case report concerns a fractured elevator tip following removal of a maxillary wisdom tooth, which dislodged from the socket approximately 8 weeks following the extraction. During this period, the patient remained asymptomatic.Results and ConclusionsThe reported incidence of fractured instruments during operative procedures is not a common occurrence in dentistry. The vast majority of cases reported in the literature occur during endodontic treatment, and this is an accepted common risk within the endodontic speciality. However, there is very little literature regarding instrument fracture and management of cases following simple or complex exodontia. Although this is a rare incident, it reinforces the importance of checking instruments pre‐ and postsurgery by both the dental surgeon and assistants.

Anatomic (positional) variation of maxillary wisdom teeth with special regard to the maxillary sinus.

The removal of wisdom teeth is one of the most common interventions in oral surgery. In order to avoid complications, a profound knowledge of the anatomy of teeth and adjacent tissues is crucial. In the case of maxillary wisdom teeth, their relationship to the maxillary sinus, to the pterygoid fossa, to the maxillary tuber and the adjacent venous plexus is particularly important. Three-dimensional (3D) imaging, for example by means of cone beam computed tomography (CBCT), is increasingly utilized in practice. However, the necessity of CBCT imaging is still a matter of intensive debate. The aim of this study was to describe the anatomic (positional) variation of maxillary wisdom teeth and, based on these findings, to elucidate the additional benefit of such imaging. A retrospective case study was performed using patients examined by means of CBCT imaging in the Department of Dento-Maxillofacial Radiology during the period from 2008 to 2013. Primary study variables comprised the spatial relationship of the teeth to the maxillary sinus, the degree of retention and root development, the covering of the root with bone and mucosa, the root configuration, and the developmental stage of the tooth. In addition, the association of the inclination of teeth in the transversal and sagittal plane with the above variables was evaluated. Descriptive statistical parameters were calculated for all results of the examination. In total, CBCT recordings of 713 maxillary wisdom teeth from 430 patients were evaluated. Their mean age was 29.8 years, and the proportion of male patients slightly prevailed (54.4%). Most teeth exhibited fully developed roots (64.1%). Overall 22.9% of third molars were impacted, 32.3% were retained, and 6.5% were erupting. In more than a third of the patients, wisdom teeth were in occlusion. The inclination of the third molars both in the transversal and sagittal plane was significantly associated with the distance of the root from the maxillary sinus as well as with the bony covering of the root. Owing to the possibility of evaluating preoperatively the relationship of a wisdom tooth to the maxillary sinus and to other anatomic structures, we recommend the use of CBCT, whenever conventional radiography fails to provide adequate information about the critical anatomic circumstances of maxillary third molars. However, CBCT should, at least nowadays, not be utilized as the standard radiographic examination.

A case of marked mouth-opening disturbance due to chronic inflammation of the pterygoid muscle caused by pericoronitis of a maxillary wisdom tooth

A case of marked mouth-opening disturbance due to chronic inflammation of the pterygoid muscle caused by pericoronitis of a maxillary wisdom tooth

The most common complications after wisdom-tooth removal: part 2: a retrospective study of 1,562 cases in the maxilla.

The possible complications of wisdom-tooth removal must be considered, because it is the most common surgical intervention in dental practices. This retrospective study assessed the complications occurring during the removal of 1,562 maxillary wisdom teeth in 1,212 patients. A total of 543 cases of surgical removal and 1,019 cases of non-surgical removal were analyzed. In all cases, a pre-operative panoramic radiograph was taken. Anatomical and clinical parameters were included in the evaluation. 106 complications occurred in 92 patients (5.9%) of the total 1,562 operations. Of these complications, 5.1% were intra-operative and 0.8% postoperative. An oroantral fistula (OAF) was found in 38 cases (2.4%), and alveolar osteitis occurred post-operatively in 6 cases (0.4%). The risk of OAF correlated with increasing patient age (p=0.0368). Root fractures also increased the risk of OAF. On the basis of the analysis of pre-operative panoramic radiographs, it was shown that radiological projection of the root tips to the sinus floor is a reliable criterion to assess the risk of OAF.

The most common complications after wisdom-tooth removal: part 2: a retrospective study of 1,562 cases in the maxilla.

The possible complications of wisdom-tooth removal must be considered, because it is the most common surgical intervention in dental practices. This retrospective study assessed the complications occurring during the removal of 1,562 maxillary wisdom teeth in 1,212 patients. A total of 543 cases of surgical removal and 1,019 cases of non-surgical removal were analyzed. In all cases, a pre-operative panoramic radiograph was taken. Anatomical and clinical parameters were included in the evaluation. 106 complications occurred in 92 patients (5.9%) of the total 1,562 operations. Of these complications, 5.1% were intra-operative and 0.8% postoperative. An oroantral fistula (OAF) was found in 38 cases (2.4%), and alveolar osteitis occurred post-operatively in 6 cases (0.4%). The risk of OAF correlated with increasing patient age (p=0.0368). Root fractures also increased the risk of OAF. On the basis of the analysis of pre-operative panoramic radiographs, it was shown that radiological projection of the root tips to the sinus floor is a reliable criterion to assess the risk of OAF.

The influence of impaction on the rate of third molar mineralisation in male black Africans

One of the main criteria used in dental age diagnostics in living adolescents and young adults is assessment of the mineralisation stage of the third molars. In the case of Europid populations, it has been established that impaction status has an influence on the rate of mineralisation of the third molars. In view of this, a study was undertaken to determine whether the chronological process of wisdom tooth mineralisation is dependent upon impaction status in black Africans too. Orthopantomograms (553) of 437 male and 116 female black South Africans with verified birth dates in the age group between 10 and 26years were studied. Mineralisation stage and impaction status were determined for all third molars. Statistical measures were calculated for the mandibular wisdom teeth at stages F, G and H and for the maxillary wisdom teeth at stage H in the male gender for both impacted and non-impacted third molars. It was ascertained that the minimum age in persons with impacted third molars, depending on the wisdom tooth observed, was 0.19-2.57years higher than in those with non-impacted wisdom teeth. Test persons with impacted mandibular wisdom teeth at stage F or G were on average between 0.32 and 1.88years older than those with non-impacted mandibular wisdom teeth. The 50% probability values of impacted wisdom teeth at stage H were 1.85-3.31years higher than those in non-impacted wisdom teeth. The conclusion was drawn that in male black Africans, impacted mandibular wisdom teeth mineralise more slowly than non-impacted lower third molars. The presence of impacted mandibular wisdom teeth in mineralisation stage H in male black Africans does not, however, furnish proof of completion of the 18(th) year of life beyond reasonable doubt.

Maxillary Third Molar: Patterns of Impaction and Their Relation to Oroantral Perforation

The objectives of this study were to examine 1) the patterns of the impacted maxillary wisdom tooth and 2) the proximity of the impacted maxillary wisdom tooth to the maxillary sinus in relation to oroantral perforation during the removal of a maxillary wisdom tooth. This retrospective study reviewed the clinical records and dental pantomograms of patients who underwent the removal of maxillary wisdom teeth under general anesthesia over a 6-month period. Using a modified version of the Archer classification of impacted maxillary wisdom teeth, types of impaction were classified according to depth, angulation of impaction, and proximity to the floor of the sinus. Clinical records showed the occurrence of oroantral perforation. In total, 845 maxillary wisdom teeth were removed; 66.8% were by routine extraction and 33.2% were removed surgically. The most common type of impaction was vertical followed by mesioangular. Most impacted teeth were at the level between the occlusal and cervical level of the adjacent second molar. Only 7 of the 278 excised wisdom teeth produced an oroantral perforation. Only 0.9% of all cases with a close sinus approximation showed an oroantral perforation. Statistical analysis with the Fisher exact test showed statistically significant associations of depth of impaction (P < .001), eruption status (P = .001), and long-axis position (P < .001) to the occurrence of an oroantral perforation. Sinus approximation showed no association with the occurrence of an oroantral perforation (P = 1.000). The depth of impaction of the maxillary wisdom tooth is a possible predictor of the possibility of oro-antral perforation if removal of the tooth is required. Due to the limitation of the radiograph, it is not a reliable to use radiographic close proximity of the sinus to predict the occurrence of oro-antral perforation when the maxillary wisdom tooth is removed.

Use of Glubran 2 and Glubran tissue skin adhesive in patients with hereditary bleeding disorders undergoing circumcision and dental extraction

Patients with bleeding disorders are at a high risk of bleeding complications during surgical procedures. Cyanoacrylates have been used successfully in many procedures and surgeries. This study was undertaken to evaluate the effectiveness of Glubran 2 and Glubran tissue skin adhesive (Glubran Tiss) in patients with hereditary bleeding disorders who underwent circumcision or dental extraction. Seven patients with congenital bleeding disorders who underwent circumcision or dental extraction were evaluated during 2009. A historical control group was considered for comparison. Glubran 2 acrylic glue was applied in cases of dental extraction and Glubran Tiss in circumcision. The patients were followed up for 6 months to detect complications. Five patients had hemophilia A, one patient had hemophilia B, and one patient had Bernard-Soulier syndrome; six were boys or men and one was a girl. Mean age was 15±8 years (range 5 to 25 years). The results in all patients under circumcision were good with significantly less factor consumption (P=0.043). But in patients who underwent dental extraction, Glubran was effective only in a 5-year-old girl with mandibular premolar tooth extraction, but not successful in a 21-year-old man with extraction of maxillary wisdom tooth. After 6 months of follow-up, no complications were observed in any patients. Our experiences in this small series of patients suggest that adjunct use of Glubran Tiss, in addition to systemic replacement therapy, can be effective in the control of bleeding in patients with hemophilia who undergo circumcision, and helps to lessen factor consumption. But, further studies with larger sample size are needed. However, our experience in using Glubran in dental extraction was not successful.