A retrospective analysis of the patient journey for children with an unerupted maxillary central incisor

BACKGROUND

Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress.

AIM

To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB).

DESIGN

A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021.

RESULTS

Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%).

CONCLUSION

Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption.

Role of αENaC in root resorption of adjacent teeth due to entirely impacted mandibular third molars

BACKGROUND

Entirely impacted mandibular third molar (EIM3M) concerns the pathological external root resorption (ERR) of the adjacent mandibular second molar (M2M) and formation of granulation tissue between two molars. The study aimed to clarify the effect of αENaC, a mechano-sensitive molecule, to explore the mechanical mechanism in this scenario.

METHODS

The force EIM3M exerted on M2M was proved by finite element analysis. αENaC expressions were tested by real-time polymerase chain reaction (PCR), immunoblotting and immunofluorescence. Inflammatory and epithelial-mesenchymal transition (EMT)-related molecules expressions were also detected by real-time PCR. The correlation was analyzed by Spearman's correlation analysis, and receiver-operator characteristic (ROC) curve was further exhibited.

RESULTS

The force was concentrated in the ERR area. αENaC was upregulated, positively correlated with ERR degree and localized to the fibroblasts in ERR granulation tissues. Moreover, αENaC was respectively and positively associated with elevated TNF-α and N-cadherin in ERR granulation tissues. More importantly, ROC analysis verified αENaC as a novel indication of the incidence of this disease.

CONCLUSIONS

Our finding revealed the force from EIM3M causing ERR of M2M, and elucidated the expression and localization of αENaC and its positive correlation with inflammation, EMT and disease severity, suggesting a novel indication in this disease.

3-dimensional analysis of nasal soft tissue alterations following maxillary Lefort I advancement with and without impaction using 3D photogrammetry scanner

PURPOSE

This study was designed to investigate the changes in nasal soft tissue following maxillary Lefort I advancement with and without impaction in subjects presenting a skeletal class III malocclusion, using a 3D photogrammetry scanner.

MATERIALS AND METHODS

Patients with class III malocclusion undergoing Lefort I advancement with and without impaction and bilateral sagittal split osteotomy with the standard technique were included in this study. Patients were divided into two groups: maxillary Lefort I advancement alone (group 1) and combined with impaction (group 2). Facial soft tissue landmarks of the nose including nasal height (NH), nasal length (NL), nasal tip projection (NTP), alar width (AW), alar base width (ABW), subalar width (Sbal), nasolabial angle (NLA), nasofrontal angle (NFA), and columella inclination (CI) before and at least 4 months after surgery were obtained by a 3D scanner.

RESULTS

Twenty-one patients were included in this study (Group 1: 11 and Group 2: 10). NH, NTP, and NL decreased significantly in both groups following surgery. In addition, Sbal decreased only in group 2. On the other hand, NLA and CI increased significantly in group 2. The inter-group comparison revealed a statistically significant difference in the alterations in NH, NL, and CI between the two groups.

CONCLUSION

Changes in the nose soft tissue occurred after both surgeries, but their type and extent were different. Actions taken to reduce unwanted changes need to be further investigated. To evaluate the changes, 3D photogrammetry scan is a feasible imaging technique that can be used, providing numerous benefits.

New complementary alternatives in third molar autotransplantation: A systematic review

BACKGROUND

Dental autotransplantation (DAT) is defined as the replacement or direct transfer of an impacted, semi-impacted or erupted tooth to a donor site, either to a post-extraction socket or to a surgically created socket within the same individual. The use of new technological advances, such as 3-D dental models based on computer-aided design, among others, have been reported to improve the success rate of DAT. Therefore, we aimed to perform a systematic review to explore the possible benefits that the use of these innovative techniques can provide when applied to DAT.

MATERIAL AND METHODS

The literature search was conducted in PubMed, Scopus, and Web of Science databases following the PRISMA guidelines. The research question was: "Are computerized technological advancements a useful tool for improving the success of third molar autotransplantation technique?

RESULTS

The initial literature search identified 195 articles, of which only 11 were included for qualitative analysis. All studies used 3D dental models based on computer-aided design data. Surgical guides and stereolithographic models were used by 4 and 1 study respectively. A total of 91 transplanted teeth were evaluated, out of which only 88 were considered within the parameters of clinical success (96.7%). Only 7 out of the 11 articles reported the specific autotransplanted tooth, being mandibular third molars the most prevalent autotransplanted teeth.

CONCLUSIONS

Although the application of new technologies for DAT increases the success rate of this technique, further primary studies are still needed to address long-term teeth survival rates and complications. The cost and availability to implement the integration of these techniques to DAT may be a variable to consider, as this can be a limitation for some patients or for low-income countries.

Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies

BACKGROUND

Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children.

AIM

The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice.

DESIGN

The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation.

RESULTS

Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability.

CONCLUSION

The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.

[Three-dimensional radiographic features of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor]

OBJECTIVE

To analyze the three-dimensional radiographic characteristics of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography (CT) and cone-beam computed tomography (CBCT).

METHODS

Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst (COC) and 16 consecutive patients with calcifying epithelial odontogenic tumor (CEOT) were retrospectively acquired, and radiographic features, including location, size, expansion, internal structure and calcification, were analyzed.

RESULTS

Among the 19 COC cases (12 males and 7 females, with an average age of 27 years), 89.5% (17/19) of the lesions originated from the anterior and premolar areas, 100.0% of them exhibited cortex expansion, and 78.9% had discontinued cortex. Among the 16 CEOT cases (3 males and 13 females, with an average age of 36 years), 81.3% (13/16) of the lesions were in the premolar and molar areas, 56.3% of them exhibited cortex expansion, and 96.8% had discontinued cortex. According to the distribution of internal calcifications, these lesions were divided into: Ⅰ (non-calcification type): absence of calcification; Ⅱ (eccentric marginal type): multiple calcifications scattered along one side of the lesion; Ⅲ (diffused type): numerous calcifications diffusely distributed into the lesion; Ⅳ (plaque type): with a ≥ 5 mm calcified patch; Ⅴ (peri-coronal type): multiple calcifications clustered around impacted teeth. Calcifications were present in 73.7% of COC lesions, including 9 type Ⅱ, 3 type Ⅲ and 2 type Ⅳ lesions, and 42.8% of CEOT lesions had calcification images, including 2 type Ⅲ and 5 type Ⅴ lesions. Six COC lesions had odontoma-like images. Moreover, 8 of 9 type Ⅰ CEOTs were histologically Langerhans cell-rich subtype, which had a smaller size (with an average mesiodistal diameter of 17.8 mm) and were not associated with impacted teeth.

CONCLUSION

COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expansion, and were sometimes associated with odontoma. CEOT commonly occurred in the posterior jaw and had discontinued cortex. Two lesions had significantly different calcification map. Over 70% of COC lesions had calcification images, which were mostly scattered along one side of the cysts, far from the impacted teeth. Approximately 60% of CEOT lesions exhibited smaller size and non-calcification, and the remaining CEOT cases often had calcification images clustered around the impacted teeth.

[Nonimpacted third molars and the periodontal homeostasis of their adjacent second molars]

Due to the limitations of eruption time and space, third molars (M3s) are often impacted and induce a variety of oral diseases, bringing adverse effects on the health of their adjacent second molars (M2s). For a long time, a large number of studies have focused on the harm of impacted M3s (I-M3s) to the health of their adjacent teeth, while less attention has been paid to nonimpacted M3s (N-M3s) that have already erupted. In recent years, however, a growing number of studies and evidences have shown that the existence of N-M3s is also an important risk factor for various diseases of their adjacent teeth, whose hazard has not been taken seriously by dentists and patients. Based on the latest results of both domestic and international researches as well as our group, this review summarizes and explains the effects of N-M3s on the periodontal homeostasis and periodontal health of adjacent M2s, so as to provide reference for clinical decision-making of N-M3s and the healthy maintenance of their adjacent teeth.

The use of panoramic radiographs to address the oral health needs of vulnerable Canadian populations

Background

The high demand for oral health care services among vulnerable individuals combined with limited available resources requires a rethinking of the provision of oral health services. This study aimed to determine the usefulness of the dental panoramic radiograph (DPR) as an imaging tool to assess oral health and prioritize dental interventions in vulnerable patients.

Methods

This observational and retrospective study evaluated charts of patients who attended Public Health Dental Clinics (PHDC), Alberta Health Services (AHS), in Calgary, Canada, between January 2018 and December 2019. Data collected included sex and age at the time of image acquisition. The following radiographic findings were gathered: the number of missing, present, decayed, restored, and impacted teeth; periapical lesions; retained root; periodontal bone loss; odontogenic and non-odontogenic lesions in the jaws; carotid calcification; and incidental radiographic findings with clinical relevance.

Results

Of the 526 DPRs evaluated, 57.4% were from male patients and 42.6% were from female patients, with a mean age of 38.5 years. The average number of present teeth in females and males was 23.7 and 22.6, respectively. The most prevalent dental-related finding was periodontal bone loss (81.5%), followed by periapical lesions (59.6%) and impacted teeth (27%). Among non-dental findings, osseous lesions of the jaws were found in 10.4% of the patients, and carotid atheroma had a frequency of 3.2%.

Conclusion

The DPR is a useful adjunct to the clinical exam in this specific population. It provides an opportunistic overview of their oral health and necessary support to establish priorities in oral health care in a public health setting.

Premature loss of primary molars in children: space recovery through molar distalisation. A literature review

AIM

The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early.

METHODS

The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars.

CONCLUSION

The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Deep learning driven segmentation of maxillary impacted canine on cone beam computed tomography images

The process of creating virtual models of dentomaxillofacial structures through three-dimensional segmentation is a crucial component of most digital dental workflows. This process is typically performed using manual or semi-automated approaches, which can be time-consuming and subject to observer bias. The aim of this study was to train and assess the performance of a convolutional neural network (CNN)-based online cloud platform for automated segmentation of maxillary impacted canine on CBCT image. A total of 100 CBCT images with maxillary canine impactions were randomly allocated into two groups: a training set (n = 50) and a testing set (n = 50). The training set was used to train the CNN model and the testing set was employed to evaluate the model performance. Both tasks were performed on an online cloud-based platform, 'Virtual patient creator' (Relu, Leuven, Belgium). The performance was assessed using voxel- and surface-based comparison between automated and semi-automated ground truth segmentations. In addition, the time required for segmentation was also calculated. The automated tool showed high performance for segmenting impacted canines with a dice similarity coefficient of 0.99 ± 0.02. Moreover, it was 24 times faster than semi-automated approach. The proposed CNN model achieved fast, consistent, and precise segmentation of maxillary impacted canines.

Effect of mandibular third molars on crowding of mandibular teeth in patients with or without previous orthodontic treatment: a systematic review and meta-analysis

OBJECTIVES

To assess the scientific evidence related to the role of the mandibular third molars on the late crowding of the lower anterior teeth in patients with or without previous orthodontic treatment. The secondary outcomes included changes in mandibular arch width and arch length.

MATERIALS AND METHODS

The databases PubMed, Scopus, ProQuest, and Google Scholar were searched from inception until April 2022. The included papers were studies evaluating the role of mandibular third molars on crowding of mandibular anterior teeth in patients of any age and gender, with mandibular third molars impacted or semi-impacted or erupted. Predetermined and prepiloted data collection forms were used to record the necessary information.

RESULTS

Thirteen observational studies were included in the present systematic review. Most of them were assigned an overall risk of bias of moderate risk while the rest of them were at high risk. Four studies found an association between the presence of mandibular third molar and mandibular incisor crowding. Finally, seven studies were included in the quantitative analysis. Three different meta-analyses were conducted: for patients (a) with or (b) without previous orthodontic treatment and (c) in combination for patients with and without previous orthodontic treatment. According to the pooled results of all three meta-analyses, random effects model yielded a significant benefit for those without third molars compared to those with third molars regarding crowding, mean Little's irregularity index and mean arch length.

CONCLUSIONS

Lower third molars may contribute to mandibular crowding and lower arch constriction. Further prospective research of high quality is needed to clarify the impact of third molars on anterior mandibular crowding.

The Showcases of Dental History - A Time Machine in Miniature at the University of Puerto Rico: Part I

The evolution of 20-year-old dental museum-like showcases located in the lobby and the main hallway of the School of Dental Medicine, Puerto Rico (PR) are described along with important professionals who impacted on this development.

Prognostic factors, outcomes, and complications for dental autotransplantation: an umbrella review

BACKGROUND

Dental autotransplantation (DAT) is a biological way of replacing missing or compromised teeth for patients. The techniques often necessitate a multi-disciplinary approach. The prognosis and success of the procedure may be impacted by variable factors in varying degrees.

OBJECTIVE

Evaluating outcomes and complications of DAT, including prognostic factors using an umbrella review.

SEARCH METHODS

Six databases were searched for all relevant systematic reviews published up to 30 June 2022. No restrictions were applied to language or publication date.

SELECTION CRITERIA

Systematic reviews and meta-analyses of DAT studies.

DATA COLLECTION AND ANALYSIS

Identification, screening, eligibility, and quality assessment using the AMSTAR 2 tool were performed independently by two authors (M.C. and S.A.). Two studies (20%) scored moderate, six studies (60%) scored low, and two studies (20%) scored critically low. Data were analysed using a random effects meta-analysis, and meta-regression was performed to investigate the effect of open and closed apices on the dependent variables. The results were summarised as relative risk ratios.

RESULTS

A total of 310 studies were eligible for inclusion, of which 20 studies were selected for full-text evaluation. Ten systematic reviews were included, 9 of which had a meta-analysis. Overall findings suggest that DAT offers favourable success and survival rates. Meta-regression results indicate that a closed apex increased the proportion of ankylosis and resorption, reduced survival but had no effect on success during the observational period.

LIMITATIONS

A varying degree of heterogeneity and bias was present in all systematic reviews. The samples of donor teeth included in the systematic reviews also varied morphologically.

CONCLUSIONS

DAT is a technique-sensitive procedure requiring a multidisciplinary team, vigilant case assessment and thorough consideration of the respective prognostic factors involved. Despite methodological limitations reported across studies, DAT shows favourable success and survival rates, with a distinctive advantage of bone induction and soft tissue thickness preservation, and should, therefore, be considered as a viable treatment modality. Standardisation of clinical guidelines and practice are highly recommended.

REGISTRATION

CRD42020202484.

Knowledge, attitudes, and practice of non-medical students regarding impacted teeth: a cross-sectional study

OBJECTIVES

To explore the knowledge, attitudes, and practice (KAP) of non-medical students regarding impacted teeth and the factors associated with KAP.

MATERIALS AND METHODS

This cross-sectional study enrolled non-medical students at two universities (Northeastern University and Shenyang Conservatory of Music) in northeastern China between December 2022 and February 2023. Scores > 70% were defined as adequate knowledge, positive attitudes, and proactive practice.

RESULTS

A total of 519 non-medical students participated in this study. Most participants were male (54.72%), ≤ 20 years of age (72.83%), and freshmen (36.03%). The mean knowledge score was 4.98 ± 3.46 (possible range: 0-10), indicating poor knowledge (49.80%). The multivariable analysis showed that having impacted teeth were independently associated with adequate knowledge (OR = 3.114, 95% CI: 1.589-6.103, P = 0.001). The mean attitude score was 24.65 ± 3.78 (possible range: 7-35), indicating favorable attitudes (70.43%). The knowledge (OR = 1.182, 95% CI: 1.116-1.251, P < 0.001), junior grade (OR = 0.541, 95% CI: 0.327-0.895, P = 0.017), senior grade and above (OR = 0.477, 95% CI: 0.274-0.829, P = 0.009), and a history of impacted tooth extraction (OR = 2.386, 95% CI: 1.048-5.436, P = 0.038) were independently associated with the good attitudes. The mean practice score was 21.45 ± 5.64 (possible range: 6-30), indicating positive practice (71.50%). The knowledge (OR = 1.074, 95% CI: 1.017-1.133, P = 0.010) and female (OR = 1.501, 95% CI: 1.052-2.141, P = 0.025) were independently associated with the proactive practices.

CONCLUSIONS

Non-medical students had poor knowledge but favorable attitudes and good practice toward impacted teeth. Non-medical students require additional education and awareness about the importance of early detection and management of impacted teeth.

CLINICAL RELEVANCE

The study highlights the need for improved education and awareness among non-medical students regarding impacted teeth.

Radiographic assessment of unerupted permanent maxillary canines and their relationship to the phases of dentition in mixed dentition Spanish children: a retrospective cross-sectional study

PURPOSE

Evaluate if there is a significant association between the position and inclination of the unerupted maxillary canine measured on a panoramic radiograph, and their relationship to gender, age of the patient and stage of dentition.

METHODS

138 panoramic radiographs were examined for this retrospective cross-sectional investigation. Only patients living in Madrid, Spain with mixed dentition were included. These measurements were performed on radiographs, considering the inclination and position of the maxillary canines with regards to the midline, and height with respect to the occlusal plane. Spearman's correlation coefficient was used to analyze the relation among the canine angle and height. p < 0.05 was considered to be significant.

RESULTS

The prevalence of patients with an altered canine angle was 10%, while 43.5% had an apparently abnormal position (overlapping at least half of the adjacent lateral incisor root). No statistically significant association was found between these two variables. In 5% of the patients, the maxillary canine was with an anomalous angle and position. Significant differences were obtained when comparing canine height between children with ectopic canines and normal canines (p = 0.032).

CONCLUSION

No significant association was found between the position and inclination of the unerupted maxillary canine in our sample. Ectopic maxillary canines had a higher incidence in girls, although we did not find statistically significant differences between genders. We observed a higher prevalence of abnormal position and inclination of the permanent maxillary canine in early mixed dentition. Maxillary canines were significantly elevated, further from the occlusal plane, in children with ectopic canines.

Statistical shape analysis of maxillary palatal morphology in patients with palatally displaced canines

OBJECTIVE

Maxillary morphology has long been a subject of interest due to its possible impact on palatally and labially displaced canines. This study aims to conduct a comparison of the palate morphology between individuals with palatal and labially displaced canines and control subjects using statistical shape analysis on a coronal cross-sectional of CBCT images.

MATERIALS AND METHODS

Patients aged between 12 and 43 years with palatally or labially displaced canines referred to Hamadan School of Dentistry between 2014 and 2019 were recruited for this retrospective study. The sample included 29 palatally displaced canines (PDC), 20 labially displaced canines (LDC), and 20 control groups (CG). Initially, the maxillary palate coronal section was acquired and landmarked in the region between the right and the left first molar. Procrustes and principal component analyses were used to identify the primary patterns of palatal shape variation. Statistical tests were then performed to examine both shape and size differences.

RESULTS

According to the results of Hotelling's T2 test, there is a significant difference between the mean shape of palate in PDC and CG (P = 0.009), while the difference between the PDC-LDC and LDC-CG groups is not significant. The longest full Procrustes distance was observed between PDC and CG (distance = 0.043), and the shortest full Procrustes distance was observed between LDC and CG (distance = 0.029). The first two principal components accounted for 84.47% of the total variance. The predictive accuracy of the discriminant analysis model showed that 72.46% of cases were correctly classified into the three study groups.

CONCLUSIONS

In terms of centroid size, there was no significant difference in the sectional area between the three groups, but the difference between the mean shape of palate in the PDC and CG groups was significant. The PDC group showed more prominent mid-palatal area in the molar region.

Prevalence, Severity, and Description of Dental Anomalies in Children Treated for Acute Lymphoblastic Leukemia

Purpose: To assess the prevalence and severity of and describe dental anomalies in children treated for acute lymphoblastic leukemia (ALL) under recent Dana-Farber Cancer Institute (DFCI) protocols. Methods: Patients aged between 14 and 25 years old having received a diag- nosis of ALL before the age of 11 years and after September 2000 received clinical and radiographic oral examinations. Results: Dental anomalies were observed in 26 (51.0 percent) of 51 subjects. Microdontia was the most prevalent dental defect (39.2 percent). Impacted permanent second molars were observed in five (9.8 percent) patients. Being age five years or younger at diagnosis significantly increased the prevalence and severity of dental anomalies (P<0.001). Conclusions: Recent DFCI protocols showed a decreased prevalence of dental disturbances. The anomalies observed may still alter the development of the dental arches and occlusion in pediatric ALL survivors. Further research is needed to confirm the association between ALL treatment and permanent second molar impaction.

Assessment of gubernacular canal frequency with CBCT in a group of Turkish population

OBJECTIVE

The aim of this study is to investigate the frequency of the gubernacular canal observed on cone-beam computed tomography (CBCT) images in a group of Turkish populations according to age and gender.

MATERIALS AND METHODS

CBCT images of 500 cases were evaluated retrospectively, and a total of 117 impacted or erupting teeth were included in the study, and the presence of gubernacular canal was recorded according to age, gender and eruption status of the tooth. SPSS program was used for statistical analysis.

RESULTS

The mean age of 117 buried/continuing patients was 17 ± 15.32, 55 (47%) were female and were 62 (53%) male patients. Presence of gubernacular canal was observed in 91 (77.8%) cases and this duct was not detected in 26 (22.2%) cases. While 40.2% of female were found to have canals, 37.6% of male had canals. When the presence of canals was examined, the presence of canals was found to be significantly higher in the erupting teeth. A significant difference was found when analyzed according to the mean age.

CONCLUSIONS

CBCT is a useful method of detecting the gubernacular canal. The presence of gubernacular canal was significantly higher in erupting teeth.

Three-dimensional evaluation of social smile asymmetry in patients with unilateral impacted maxillary canine: a 3D stereophotogrammetry study

OBJECTIVE

This study aimed to evaluate social smile asymmetry in patients with unilateral impacted maxillary canine on 3D stereophotogrammetric images.

MATERIAL AND METHODS

The 3D social smile images of participants with unilateral impacted maxillary canine (n:20) and without impaction as a control group (n:20) were included. The images were recorded with a hand-held 3D stereophotogrammetry device (Fuel3D® Scanify®) and Geomagic Essentials 2 reverse engineering software were used for analyses. After the orientation process of the 3D records, the tissues around the smile area were divided into five morphological regions: cheek, upper lip lateral and medial, and lower lip lateral and medial. The deviation margins in the negative and positive directions for the 95% mesh rate and the total percentages of meshes between - 0.5- and + 0.5-mm deviations were calculated. ICC, paired samples t test, independent samples t test, and the Mann-Whitney U test were used for statistical analyses.

RESULTS

In individuals with impacted canine, the amount of maximum positive deviation in the upper lip medial was 5.64 mm ± 1.46 and maximum negative deviation was - 4.6 mm ± 1.17. In the control group, mean of deviation limits for all parameters was less than 1.19 mm ± 2.62, while in individuals with unilateral impacted maxillary canine, the maximum value was 8.34 mm ± 2.23. The mesh percentage between - 0.5 and 0.5-mm deviations was over 95% in all morphological areas in the control group, while in the impacted canine group, the number of meshes within the specified deviation limits was less than 95%.

CONCLUSION

Individuals with unilateral impacted maxillary canine exhibit greater asymmetry in social smile compared to the control group, with the asymmetry being most prominent near the corners of the mouth and cheeks.

CLINICAL RELEVANCE

Amount of asymmetry was higher in impaction group compared to the control group in social smile. The quantification of a possible smile asymmetry due to the impacted canine is crucial for the diagnosis and treatment planning of orthodontic and/or orthognathic cases for ideal aesthetic results. Hence, smile asymmetry should not be overlooked and should be considered in diagnosis and treatment planning.

Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography

OBJECTIVES

To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference.

METHODS

CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05).

RESULTS

The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN.

CONCLUSIONS

The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal.

CLINICAL RELEVANCE

Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks.

Can ChatGPT be used in oral and maxillofacial surgery?

OBJECTIVE

The aim of this study is to assess the usability of the information generated by ChatGPT in oral and maxillofacial surgery. This assessment will have two components: Firstly, to measure the quality of patient information provided, and secondly, to measure the quality of educational information in this field.

MATERIALS AND METHODS

Commonly asked questions by patients about oral and maxillofacial surgical procedures and technical questions for training purposes were selected to be posed to ChatGPT. The questions were divided into two categories, consisting of 60 Patient Questions and 60 Technical Questions. The specific topics covered were Impacted Teeth, Dental Implants, Temporomandibular Joint Diseases, and Orthognathic Surgery. ChatGPT provided responses to these questions on February 23, 2023. The answers were evaluated by oral and maxillofacial surgeons using a modified global quality scale.

RESULTS

The study involved 33 participating surgeons. The mean score for the answers to the Patient Questions was 4.62±0.78, while the mean score for answers to the Technical Questions was 3.1 ± 1.49. The difference in scores between the two question categories was found to be statistically significant (P<0.001). There was no significant difference between the quality of the answers given to the questions across the different topics (P>0.05).

CONCLUSIONS

ChatGPT has significant potential as a tool for patient information in oral and maxillofacial surgery. However, its use in training may not be completely safe at present. Surgeons should exercise caution when using ChatGPT and consider it as a supplement to their clinical knowledge and experience.

ResMIBCU-Net: an encoder-decoder network with residual blocks, modified inverted residual block, and bi-directional ConvLSTM for impacted tooth segmentation in panoramic X-ray images

OBJECTIVE

Impacted tooth is a common problem that can occur at any age, causing tooth decay, root resorption, and pain in the later stages. In recent years, major advances have been made in medical imaging segmentation using deep convolutional neural network-based networks. In this study, we report on the development of an artificial intelligence system for the automatic identification of impacted tooth from panoramic dental X-ray images.

METHODS

Among existing networks, in medical imaging segmentation, U-Net architectures are widely implemented. In this article, for dental X-ray image segmentation, blocks and convolutional block structures using inverted residual blocks are upgraded by taking advantage of U-Net's network capacity-intensive connections. At the same time, we propose a method for jumping connections in which bi-directional convolution long short-term memory is used instead of a simple connection. Assessment of the proposed artificial intelligence model performance was evaluated with accuracy, F1-score, intersection over union, and recall.

RESULTS

In the proposed method, experimental results are obtained with 99.82% accuracy, 91.59% F1-score, 84.48% intersection over union, and 90.71% recall.

CONCLUSION

Our findings show that our artificial intelligence system could help with future diagnostic support in clinical practice.

Is it safe and effective to extract impacted maxillary tooth adjacent to maxillary sinus via submaxillary sinus membrane space approach?-a randomized controlled trial

OBJECTIVE

To evaluate the clinical outcomes following extraction of impacted maxillary tooth adjacent to maxillary via submaxillary sinus membrane space approach.

MATERIALS AND METHODS

Seventy-two patients were enrolled in our study. The positions of the maxillary impacted tooth were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the "submaxillary sinus membrane space approach" was applied in the new method (NM) group, and the conventional "avoid maxillary sinus membrane exposure" strategy was executed in the traditional method (TM) group. The clinical and follow-up data were recorded.

RESULTS

The duration of the procedure in the TM group was significantly longer than those in the NM group (P < 0.05). Four teeth were accidentally displaced into the maxillary sinus with MSM perforation. The MSM perforation rate was slightly higher in the TM group than in the NM group, however, without significant difference between the two groups (8/36 vs. 3/36, P = 0.19). The maxillary sinus membrane perforation was associated with the displacement of tooth into the maxillary sinus (OR = 16.2, P = 0.026). The root tip exposure of the adjacent tooth was significantly higher in the TM group than in the NM group (10/36 vs. 1/36, P = 0.006). The incidence of reduced pulp vitality of the adjacent tooth was significantly higher in the TM group (10/36 vs. 1/36, P = 0.006), and it was associated with the exposure of the root tip intraoperatively (OR = 456.5, P < 0.001). The incidence of external root resorption was significantly lower in the NM group, and there was no significant association with the root exposure intraoperatively (OR = 3.7, P = 0.47).

CONCLUSIONS

Submaxillary sinus membrane space approach is a safe and efficient approach in extraction of impacted maxillary tooth. It is an alternative way for cases which are in close proximity to the maxillary sinus.

CLINICAL RELEVANCE

A novel method to extract impacted maxillary tooth adjacent to maxillary sinus.

Anterior tooth autotransplantation: a case series

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. It is relatively common for the anterior segment of the mouth to be affected by traumatic tooth injuries, impacted and/or congenitally missing permanent teeth. Autotransplantation of teeth into the anterior dental arch can provide unrivalled biological solutions when such issues arise in this critical aesthetic zone, particularly for adolescent patients. The combination of meticulous pre-surgical assessment, synergistic interdisciplinary collaboration and carefully performed anterior tooth autotransplantation has been demonstrated to achieve impressive outcomes, with respect to both transplant survival and clinical success. © 2023 Australian Dental Association.

The efficacy of supervised learning and semi-supervised learning in diagnosis of impacted third molar on panoramic radiographs through artificial intelligence model

OBJECTIVES

The aim of the study was to evaluate the efficacy of traditional supervised learning (SL) and semi-supervised learning (SSL) in the classification of mandibular third molars (Mn3s) on panoramic images. The simplicity of preprocessing step and the outcome of the performance of SL and SSL were analyzed.

METHODS

Total 1625 Mn3s cropped images from 1000 panoramic images were labeled for classifications of the depth of impaction (D class), spatial relation with adjacent second molar (S class), and relationship with inferior alveolar nerve canal (N class). For the SL model, WideResNet (WRN) was applicated and for the SSL model, LaplaceNet (LN) was utilized.

RESULTS

In the WRN model, 300 labeled images for D and S classes, and 360 labeled images for N class were used for training and validation. In the LN model, only 40 labeled images for D, S, and N classes were used for learning. The F1 score were 0.87, 0.87, and 0.83 in WRN model, 0.84, 0.94, and 0.80 for D class, S class, and N class in the LN model, respectively.

CONCLUSIONS

These results confirmed that the LN model applied as SSL, even utilizing a small number of labeled images, demonstrated the satisfactory of the prediction accuracy similar to that of the WRN model as SL.

The usefulness of cone beam computed tomography according to age in cleft lip and palate

The current study aimed to evaluate the usefulness of cone beam computed tomography (CBCT) examination in cleft children and adolescents, the age of the first CBCT exposure, and the criteria that justified the first CBCT exposure. A number of 229 non-syndromic cleft subjects aged between 0–22 years receiving treatment in the same specialized surgical center in orofacial cleft treatment were studied. A cleft group of 64 cleft lip and palate (CLP) children with at least one CBCT exposure was identified based on CBCT records. Parameters related to diagnosis and treatment planning in cleft deformity were considered dental anomalies and bone morphology changes. The examiners assessed whether the treatment option was necessary, not necessary, or could not be evaluated at the age of CBCT exposure. A number of thirty-nine unilateral clefts and fifteen bilateral clefts were identified. Posterior palatal cleft was present in six children (mean age: 15.03±5.55 years; male/female ratio: 1/0.8). Alveolar bone morphology changes were found in 90.58% of cases; jaw relationship changes in 71.82%; nasal fossa morphology changes in 74.99%; airway obstruction in 49.98% and maxillary asymmetry in 87.48%. Orthodontic planning was necessary for 85.93% of CLP patients, and orthognathic surgery in 39.05%. The usefulness of CBCT in patients with CLP varied with age, with reduced value for the evaluation of impaction and root resorption under the age of ten.

[Early orthodontic treatment of malocclusion in the mixed dentition]

Children in the mixed dentition grow rapidly, and various types of malocclusion often appear in this period. At the same time, there are many environmental factors affecting the development of the occlusion at this stage. Functional abnormalities related to lip, tongue, articulation and breathing, and impacted teeth should be actively intervened and blocked to avoid the continued development of the deformity. Appropriate orthopedic devices should be used in patients with skeletal malocclusion, if necessary, for growth modification and the influence of congenital factors and the prognosis of treatment should be fully evaluated. Over-intervention of the temporary malocclusions in the mixed dentition should be avoided. In conclusion, early orthodontic treatment in the mixed dentition requires a comprehensive assessment of the treatment need, risks, timing, cost and the ultimate benefit of the patient. The timing of orthodontic treatment is not the sooner the better. The indications must be strictly controlled, and the necessity and limitations must be carefully considered.

Potential role of active decompression and distraction sugosteogenesis for the management of ameloblastomas: Report of two cases and review of the literature

Ameloblastomas are aggressive odontogenic entities well-known for their high tendency to recur. Clinical presentation includes lesions discovered on routine examination or radiographs, pathologies causing facial swelling, pain, cortical expansion, tooth mobility, root resorption, and paresthesia. Radiographic findings comprise large unilocular or multilocular radiolucencies with well-defined borders associated to an impacted tooth. Ameloblastomas are classified as unicystic, multicystic/solid, and peripheral. Treatment options include marsupialization, decompression, enucleation, or curettage with or without adjuvant measures such as Carnoy's solution, marginal resection, and segmental resection. Recently, active decompression with distraction sugosteogenesis (ADDS) was introduced for the conservative management of odontogenic cystic conditions. The purpose of this paper is to present 2 cases of a conventional ameloblastoma treated by means of ADDS. The purpose of this novel approach is to significantly reduce the amount of time required to decompress cystic-like lesions. In these cases, ADDS proved to be a viable treatment because it demonstrated a reduction in size of the initial lesion by new osseous formation within 2 weeks of placement of the device. The cases presented in this paper demonstrate that ADDS could be a valuable treatment modality for this type of ameloblastoma, although further research is necessary to validate this philosophy.

Orthodontic traction of an impacted maxillary third molar through a miniscrew-anchored cantilever spring to substitute the adjacent second molar with severe root resorption

BACKGROUND

An orthodontic traction technique with a miniscrew-anchored cantilever spring was used for the traction of a deeply impacted maxillary third molar to substitute its adjacent second molar with severe root resorption.

CASE DESCRIPTION

A 30-year-old woman sought multidisciplinary treatment planning for a second molar with severe root resorption caused by a deeply impacted third molar. Panoramic radiographs and cone-beam computed tomographic images showed that the third molar was located on the apical and palatal side of the second molar and that the second molar had severe root resorption. The second molar was removed, and the impacted third molar was orthodontically tractioned occlusally with the aid of a miniscrew-anchored cantilever spring. After 12 months of orthodontic treatment, the maxillary left third molar was successfully tractioned occlusally and well aligned with adjacent teeth for the substitution of the second molar. The patient was satisfied with the treatment outcome.

PRACTICAL IMPLICATIONS

A palatal miniscrew-anchored cantilever spring is an effective and viable technique for the orthodontic traction of deeply impacted third molars to substitute second molars with severe root resorption.

Autotransplantation: a lost art worthy of revival in the era of implants

While synthetic implants represent a significant contribution to the advancement of dental medicine, they are associated with high costs, potential complications, and time delays. With autotransplantation, the patient is both donor and recipient of a living tooth; in the ideal case, this procedure transfers a healthy, nonfunctional tooth to a functional position. The aim of this article is to review the literature surrounding autotransplantation and present a successful case with the hope of increasing awareness of this approach to tooth replacement. A 20-year-old patient presented with a maxillary right second molar showing poor prognosis for restoration, and the patient's financial difficulties rendered extraction the only treatment option. The patient's fully soft tissue-impacted maxillary right third molar was atraumatically extracted and transplanted as a replacement for the second molar. The autotransplantation technique was enhanced via use of bone allograft to adapt the distal portion of the socket to the transplant, immediately reestablishing a healthy bony anatomy. In addition to reviewing the biologic basis, high success rate, and advantages of tooth autotransplantation, this article introduces a naming convention for transplanted teeth.

RUNX2 Nonsense Mutation Associated with Cleidocranial Dysplasia with Unusual Dental Features

Purpose: The purpose of this case report is to describe a RUNX2 nonsense mutation associated with cleidocranial dysplasia (CCD) with unusual dental features. The patient was a 12-year-old Brazilian girl who sought dental care due to over-retention of primary teeth and absence of erupted permanent teeth. Clinical and radiographic examinations revealed multiple impacted permanent teeth, a prominent cingulum of the permanent impacted maxillary incisors and enamel defects (hypoplasia and hypomineralization) in addition to skeletal abnormalities. No supernumerary teeth were present. The diagnostic hypothesis of CCD was raised and the patient was refer- red to the genetic medical service, where the diagnosis was cofirmed. After RUNX2 genetic screening, including polymerase chain reaction and sequencing of both DNA strands, a heterozygous nonsense mutation was identified in exon 2 (c.193 C>T [Q65X]). This article reports unusual dental features in a patient with CCD.

Compression of the Inferior Alveolar Canal by Mandibular Third Molar among Images Taken from Patients Visiting Dental Imaging Centres of Kathmandu: A Descriptive Cross-sectional Study

INTRODUCTION

Third molars are common teeth to be impacted. The position of mandibular third molar is such that it is in close contact with inferior alveolar canal which may lead to nerve damage during its removal. So, this study was conducted to find out the prevalence of compression of inferior alveolar canal by mandibular third molars.

METHODS

This descriptive cross-sectional study was conducted on images collected from Dental Imaging Centers of Nepal from 25th June 2020 to 15th February 2021 after obtaining ethical clearance from Nepal Health Research Council (Reference number: 2100). A convenience sampling method was used to collect 433 cone-beam computed tomography images showing the relation between the third molars and inferior alveolar canal. Data were analyzed using the Statistical Package for the Social Sciences version 16. Point estimate at 95% confidence interval was calculated along with frequency and proportion for the binary data.

RESULTS

Out of 433 images, 135 (31.17%) (26.80-35.53 at 95% Confidence Interval) images showed compression of inferior alveolar nerve by mandibular third molar. The study result indicated that 16 (11.85%) buccally placed, 50 (37.03%) lingually placed and 69 (51.11%) inferiorly placed inferior alveolar canal were compressed by apices of mandibular third molars.

CONCLUSIONS

The prevalence of compression of inferior alveolar canal by mandibular third molar was found to be similar to other studies done in similar settings. Compression of the canal was more evident when inferior alveolar canal is situated lingually.

Alveolar bone changes after molar protraction in young adults with missing mandibular second premolars or first molars

OBJECTIVES

To assess the changes in alveolar bone of the mandibular second molars following molar protraction and investigate the factors associated with the alveolar bone changes.

MATERIALS AND METHODS

Cone-beam computed tomography of 29 patients (mean age 22.0 ± 4.2 years) who had missing mandibular premolars or first molars and underwent molar protraction were reviewed. Alveolar bone level was measured as the distance from the cementoenamel junction at six points, buccal, lingual, mesiobuccal (MB), mesiolingual (ML), distobuccal (DB), and distolingual (DL), of the second molars at pretreatment (T0) and after molar protraction (T1). Factors associated with alveolar bone changes at the distal and mesial of the second molars were assessed.

RESULTS

Mean alveolar bone changes ranged from -1.2 mm (bone apposition) to 0.8 mm (bone resorption). The presence of a third molar impaction at T0 (P < .001), third molar angulation at T0 (P < .001), and Nolla's stage of third molar at T0 (P = .005) were significantly associated with alveolar bone level changes distal to the second molars. Treatment duration (P = .028) was significantly associated with alveolar bone level changes mesial to the second molar.

CONCLUSIONS

Patients with impacted third molars, third molars at an earlier stage of development, and mesially angulated third molars at pretreatment may have less alveolar bone resorption distal to the second molars following protraction. Patients with increased treatment time may have reduced alveolar bone resorption mesial to the second molars.

Navigation in bone-impacted premaxillary supernumerary tooth removal: a preliminary clinical trial

AIM

The present clinical trial aimed to preliminarily assess whether navigation could help to position impacted supernumerary teeth (STs) and reduce surgical trauma.

MATERIALS AND METHODS

Subjects with an impacted supernumerary tooth (ST) in the premaxillary area were enrolled in the study and randomly distributed into a navigation group and a control group. In the navigation group, STs were positioned and extracted under real-time optic navigation. In the control group, STs were extracted depending on the surgeon's experience. Subjects were followed up for 12 to 24 weeks postsurgery. Operating time, futile bony trauma, and the positioning precision of the STs were the major outcomes assessed. Multivariate correlation analysis was performed.

RESULTS

In 24 subjects, 32 STs were removed and no severe complications occurred in either group. The proportion of ST exposure at the planned access point was 100% in the navigation group and 68.75% in the control group (χ² = 5.926, P = 0.015). Futile length, futile width, and the distance between the point where the ST was initially exposed and the bony point planned for accessing it were related to both navigation/control grouping and bone thickness in the access side. For challenging STs with bone thickness of > 0.5 mm in the access side (N = 22), the futile length in the navigation group (0.0 [0.0, 4.0] mm) was significantly smaller than that in the control group (3.0 [0.0, 8.0] mm, P = 0.028). Similarly, the futile width in the navigation group (0.0 [0.0, 2.0] mm) was significantly smaller than that in the control group (2.0 [0.0, 4.0] mm, P = 0.018).

CONCLUSIONS

Navigation helped to position impacted STs precisely and reduced surgical bony trauma to some extent, especially in challenging cases in which the bone in the access side was thicker than 0.5 mm.

Early replacement of ankylosed first molar via mesial root movement facilitates bone formation and normal eruption of the third molar

Ankylosis of a molar during active growth leads to a significant vertical bone defect, extrusion of the opposing molar, and inclination of adjacent teeth. Treatment timing is an essential factor for the patient's quality of life. Early extraction of the ankylosed molar and protraction of the second molar is challenging because of the difficulty of tooth movement and the uncertainty of the normal eruption of the third molar. In view of the uncertainty of eruption of the mandibular third molar, it is essential to assess the potential for eruption according to the developmental stage of the third molar and to secure sufficient space for eruption. In this case report, a girl with an ankylosed right mandibular first molar and an advanced vertical bone defect was treated via early extraction of the ankylosed molar along with the intrusion of the maxillary molar and mesial root movement of the second molar before the initiation of third molar root formation. Restoration of the vertical bone defect was noted at the end of treatment. In addition, spontaneous eruption of the third molar was observed, which was in contrast to the mesioangular impaction of the contralateral third molar. This case emphasizes the importance of treatment timing to increase the chance of utilization of the third molar.

Dentigerous cyst in a young child: a case report

Dentigerous cysts are one of the most common developmental types of odontogenic cysts occurring in the oral cavity and often manifest as incidental findings on dental radiographs and/or as asymptomatic swellings. These cysts develop from remnants of reduced enamel epithelium around the crown of an unerupted or impacted tooth, attached at the level of the cementoenamel junction. Most are considered developmental. However, in young clients they may be inflammatory in origin, the result of caries in the primary dentition. This short communication highlights a case of an asymptomatic dentigerous cyst identified in a 4-year-old child and subsequent enucleation under general anesthesia. A thorough clinical and radiographic assessment of the oral cavity in pediatric clients merits a review of dentigerous cysts by the dental hygienist.

Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal?

OBJECTIVES

The present study aimed to assess whether anatomical variations of the mandibular canal are associated with neurosensory disturbances of the inferior alveolar nerve (IAN) following mandibular third molar removal.

METHODS

Two observers compared the detection of third molar root-nerve relations and bifurcations of the mandibular canal on panoramic radiographs and CBCT images of 201 patients undergoing removal of 357 mandibular third molars. Potential neurosensory disturbances of the IAN were surveyed ten days after surgery. Fisher's Exact was performed to correlate presence of canal variations to postoperative neurosensory disturbances. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR + , LR-) were calculated.

RESULTS

Thirteen patients reported postoperative altered sensation of the lower lip, with 2 of them having mandibular canal bifurcations on the ipsilateral side of the injury. Fisher's Exact showed that the studied mandibular canal variations were not related to postoperative neurosensory disturbances. CBCT was superior in visualization of anatomical variations of the mandibular canal. Prevalence of bifurcations was 14% on CBCT and 7% on panoramic radiographs. In both imaging modalities and for all parameters, PPVs were low (0.04 - 0.06) and NPVs were high (0.92 - 0.98), with LR ranging around 1.

CONCLUSION

In the present study, the assessed mandibular canal variations had limited predictive value for IAN neurosensory disturbances following third molar removal.

CLINICAL RELEVANCE

While a close relation between the third molar and the mandibular canal remains a high risk factor, mandibular canal variations did not pose an increased risk of postoperative IAN injury after third molar removal.

IMPREGNATION OF ORAL MUCOSA OVER IMPACTED TEETH BY SUBPOPULATIONS OF MACROPHAGES M1 AND M2

OBJECTIVE

The aim: Of the study is to research quantitative parameters of mucous membrane macrophages populations M1 (CD68+) and M2 (CD163+) over vestibularly and palatally impacted teeth.

PATIENTS AND METHODS

Materials and methods: A group of 21 people aged from 10 to 16 years was formed to conduct the research. Clinical situation according to diagnostic criteria was identical in all the patients. The group was divided into two groups - control and experimental, which in their turn were fragmented into two subgroups. Immunohistochemical studies of mucosal biopsies were performed in accordance with the recommendations for selection.

RESULTS

Results: Study of ratio of CD68+/CD163+ cells revealed imbalance in individuals with vestibularly impacted teeth due to higher infiltration density of CD163+ (p<0,05), compared to CD68+ of control group. In individuals with palatally impacted teeth, ratio of CD68+/CD163+ increased 3,6 times, as well as compared with control group, but due increased infiltration density of CD68+.

CONCLUSION

Conclusions: In the epithelium of oral mucosa located over impacted teeth, both on vestibular and palatal surface, number of CD 68+ and CD163+ cells had no significant differences compared to control group. In biopsies of the lamina propria of mucosa over vestibularly impacted teeth, the ratio M1/M2=0,91±0,11 (p<0,05) decreases, with predominance of macrophages CD163+ subpopulation activity, and over palatally impacted teeth balance of M1/ M2 macrophages elevated (M1/M2= 2,10 ± 0,32, p<0,05), due to increased infiltration density of CD68+.

Is the extraction of third molars a risk factor for the temporomandibular disorders? A systematic review

BACKGROUND

The aim of this study was to evaluate through a systematic review the extraction of third molars as a risk factor for temporomandibular disorders (TMDs).

TYPES OF STUDIES REVIEWED

Randomized and nonrandomized controlled clinical trials where patients underwent third molar extraction and with qualitative evaluation of TMDs before and after extraction were included.

RESULTS

After applying the inclusion criteria, seven nonrandomized clinical studies were included. QUIPS tool showed that four articles presented a moderate and three a high risk of bias (RoB). Six studies reported that TMDs presented higher level after removal of third molars ranging from OR, 1.81 to 2.15/RR, 2.1. However, one study showed no significant association. GRADE showed heterogeneity in relation to general results, which means that confidence in the estimated effects varied from low to moderate GRADE. The quality of clinical recommendations decreased especially due to the risk of bias in some of the included studies evaluated with the QUIPS tool.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Third molar extraction can be associated with the development of TMD signs and symptoms. Furthermore, TMD can be aggravated according to the third molar location, the degree of impaction and surgical difficulty, age, and gender. This systematic review highlights the need to perform randomized clinical trials with diagnostic criteria and standardized surgical procedures.

Complex odontoma at the upper right maxilla: Surgical management and histomorphological profile

BACKGROUND

Odontomas are hamartomatous developmental malformations of the dental tissues. Usually asymptomatic, their presence is often revealed on routine radiographs. The study aimed to establish the efficacy of this conventional approach in treating odontomas, analysing clinical outcome, follow-up, and histomorphological profile.

CASE REPORT

A case is presented with a review of the international literature. The patient, aged 8 years, had a complex odontoma localised on the front upper jaw. She was treated following the conventional surgical procedure. Post-operative course and healing were uneventful. Orthodontic treatment was necessary to realign the teeth. At the 12-month follow-up there was no recurrence or failure. Healing was excellent.

CONCLUSION

Variations in normal tooth eruption are a common finding, but significant deviations from established norms should alert the clinician to further investigate the patient's health and development.

Pixel gray measurement for the diagnosis of dental ankylosis in cone beam computed tomography images

OBJECTIVE

The aim of this study was to investigate dental ankylosis in unerupted or partially erupted teeth by using cone beam computed tomography (CBCT) to quantify pixel intensity.

STUDY DESIGN

In total, 157 CBCT images from individuals with a total of 206 unerupted or partially erupted teeth with suspected ankylosis were evaluated. CBCT images were analyzed for the presence of ankylosis by 2 oral radiologists by quantifying mean pixel intensities (analysis 1) and variations in pixel intensities (analysis 2) in normal and ankylosed regions. The association between ankylosis and demographic and tooth-related factors was also examined.

RESULTS

Ankylosis was diagnosed in 57 teeth (27.7%). The diagnosis was established with all 3 multiplanar reconstruction views in 22 of these teeth (38.6%). In analysis 1, a higher pixel intensity was observed in areas with ankylosis compared with normal periodontal ligament (PDL) density as a result of bone deposition in this region, which is characteristic of ankylosis (P < .001). In analysis 2, reductions in pixel intensity were greater in the PDL areas than in the ankylosed areas. Ankylosis was significantly associated with the anterior teeth, the maxillary arch, single-rooted teeth, and impacted teeth (P ≤ .026).

CONCLUSIONS

Our results suggest that CBCT measurement of pixel intensity may be useful for the diagnosis of ankylosis.

Effect of audiovisual eyeglasses on intraoperative pain, anxiety, and hemodynamic changes during mandibular third molar extraction: a randomized controlled clinical trial

OBJECTIVES

To determine the effect of audiovisual eyeglasses in terms of anxiety relief, hemodynamic changes, and intraoperative pain in patients undergoing surgical removal of a mandibular third molar.

METHOD AND MATERIALS

A randomized controlled clinical trial with two parallel groups was carried out in patients undergoing mandibular third molar extraction. Fifteen patients watched a video with multimedia eyeglasses during the surgical procedure, whereas 15 controls had their eyes covered during extraction. The patients completed anxiety questionnaires before and after surgery. Hemodynamic changes, intraoperative pain, duration of the surgery, and overall satisfaction were recorded.

RESULTS

Thirty patients were analyzed. Intraoperative pain and the need for supplemental anesthesia were significantly more frequent in the control group (53.3% versus 13.3%; P < .05). The surgical procedure was also briefer when the eyeglasses were used (17.2 versus 28.1 minutes). Overall satisfaction was similar in both groups. No significant differences were found between the two study groups in terms of anxiety and hemodynamic parameters.

CONCLUSIONS

The use audiovisual eyeglasses should be routinely considered during mandibular third molar extraction since these devices allow reduction of intraoperative pain and surgery time. However, patient anxiety level and hemodynamic parameters seem to remain unaltered.