Evaluation of the follicular space volume of lower third molars with different impaction positions and angulations: A cone-beam computed tomography and histopathological study

Ultrasonography as an additional tool to localize impacted canines

Canine impaction is a common dental anomaly that requires a multidisciplinary approach, from diagnosis to treatment. The regular two-dimensional (2D) radiographs are able to visualize if the tooth is impacted, but unable to specifically localize it, and determine if there are any root resorptions associated to it. The cone-beam computed tomography (CBCT) is able to three-dimensionally determine its location, aiding to the diagnosis and treatment plan. The major disadvantage is the amount of radiation that is added to the patient and can be even more significant in pediatric patients. The intra-oral ultrasound (io-US) is a new non-invasive and non-radiating real-time chairside imaging method that has the potential to aid in locating the impacted tooth. This paper presents 4 cases that required a CBCT for the location and treatment planning of impacted maxillary canines and were also scanned with intra-oral ultrasound. The images were then compared to the CBCT exam for validation of the new method. Through these cases, we highlight the capability of the io-US to locate the impacted canines. Other advantages of io-US might include evaluation of soft tissue thickness and vasculature that are important for surgical planning and execution.

A Combination of Beta-tricalcium Phosphate, Plasmogel, and Platelet-rich Plasma Improves Long-term Bone Tissue Restoration after Complicated Lower Third Molar Surgery: A Nonrandomized Controlled Trial

Background

A surgical removal of the lower third molars can lead to a number of complications, and bone restoration typically takes a large amount of time. The aim of the study was to investigate the effect of the combination of beta-tricalcium phosphate (β-TCP), plasmogel, and platelet-rich plasma on postsurgery bone tissue restoration by means of X-ray.

Subjects and Methods

A total of 200 patients who underwent a complicated removal of the lower third molars were nonrandomly assigned to the experimental (EXP, n = 100) or control (CTR, n = 100) group. In the EXP group patients, sockets were filled with a combination of β-TCP, plasmogel, and platelet-rich plasma. In the CTR group, sockets were not treated. X-ray examinations were performed 3, 6, and 9 months (T1, T2, and T3) postsurgery to define bone quality on the Misch scale. The Mann-Whitney U-test was used for between-group comparison.

Results

Aside from the overconsumption of sugars (more frequently in CTR) and marginally significant sex ratio difference (more females in CTR), the groups were equivalent. Although both groups improved on bone density with time, the EXP group demonstrated greater restoration at T1 (U = 3431, P < 0.001), T2 (U = 3190, P < 0.001), and T3 (U = 3505, P < 0.001) related to a greater percentage of D2 (dense thick porous cortical bone on the ridge and a coarse underlying trabecular bone).

Conclusion

A combination of β-TCP, plasmogel, and platelet-rich plasma, compared to no treatment, facilitates bone tissue restoration after complicated surgical removal of the lower third molars.

Histopathological Changes of Dental Follicles of Impacted Third Molars in Ibb Governorate

OBJECTIVE

There is a lack of data pertaining to the examination of dental follicles (DFs) in asymptomatic impacted lower third molars (ILTMs) using cone beam computed tomography (CBCT) and histopathological analysis in the Yemeni population. The objective of this study was to explore the DFs of asymptomatic ILTMs through radiological (CBCT) and histological analysis.

MATERIALS AND METHODS

This prospective study comprised 60 patients aged 18-50 years with ILTMs. The ILTMs in these patients exhibited a DF with measurements ranging between 3 and 5 mm. CBCT was employed to evaluate the maximum width of the DF surrounding the crown of ILTMs in horizontal, sagittal, and coronal sections. After the extraction, the DFs were examined for any pathological changes and categorized as normal, inflammatory, cystic, or neoplastic. The data analysis was performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the statistical significance was determined by employing chi-square tests with a significance level of 0.05.

RESULTS

In the study, a total of 60 patients were included, with 17 (28.3%) being male and 43 (71.7%) being female. The majority of the patients 26 (43.3%) fell within the age range of 26-35 years. Regarding the angulation of the ILTMs, most of them were mesioangular 45 (75%), followed by vertical 7 (11.7%), horizontal 4 (6.6%), buccoangular 3 (5%), and distoangular 1 (1.6%). Histopathological changes were observed in 44 of the samples (73.3%). The majority of histopathological changes identified in the DFs were dentigerous cysts 26 (59%) followed by odontogenic keratocysts 11 (25%). Thirty-six (81.8%) of histopathological changes were found in females, whereas in only eight samples (18.1%), histological changes were observed in males. This difference was statistically significant (p=0.004). However, there were no statistically significant differences observed in the occurrence of histopathological changes based on age, angulation, and follicle size (p>0.05).

CONCLUSION

Follicles in ILTMs varied significantly based on gender, with a higher occurrence in females, and tooth impaction angle, mainly in the mesioangular position. Furthermore, a follicular size of 3-5 mm was associated with a higher incidence of pathological changes. Hence, histopathologic examination is recommended for surgically removed ILTMs irrespective of the follicle size observed in radiographic images.