Identification of Specific Panoramic High-Risk Signs in Impacted Third Molar Cases in Which Cone Beam Computed Tomography Changes the Treatment Decision

PURPOSE

The aim of this study was to investigate the treatment decisions of oral-maxillofacial surgeons in the management of impacted lower third molars (M3s) according to panoramic radiography (PR) and cone beam computed tomography (CBCT) risk analysis.

PATIENTS AND METHODS

Ten surgeons analyzed 40 deliberately selected M3 cases showing 1 or more panoramic high-risk signs: 1) darkening of the root, 2) interruption of the white line, 3) diversion of the inferior alveolar canal (IAC), 4) narrowing of the IAC, and 5) 2 or more signs occurring simultaneously (including darkening and/or interruption of the IAC). After evaluating the PR images, the observers analyzed the patients' CBCT images. The treatment decision (extraction vs coronectomy) and surgical technique (number of planned tooth sections) were recorded.

RESULTS

On the CBCT coronal slices, direct contact between the M3 and IAC, together with narrowing and/or fenestration of the IAC, was observed most frequently when 2 or more panoramic signs were seen simultaneously on the PR images (odds ratio [OR], 7.2; P = .021). CBCT findings led to a significant decrease in the number of coronectomy decisions (23% vs 14.5%, P = .002), which was most prominent in the groups showing panoramic signs of darkening (approximately 50%, P = .007) and narrowing (approximately 66%, P = .044). A significant number of extraction decisions were modified to coronectomy when 2 or more panoramic signs occurred together (OR, 7.9; P < .001). However, there were no significant differences regarding the number of planned hypothetical tooth sections.

CONCLUSIONS

The results showed that the surgeons' confidence in the treatment decision increased after CBCT imaging, resulting in fewer coronectomy decisions. CBCT information that changed a previous coronectomy decision to extraction was most frequently observed in cases showing darkening and narrowing PR signs. The chance of changing an extraction decision to a coronectomy decision after evaluating the patient's CBCT images was the highest when 2 or more PR signs were observed simultaneously.

Tooth sectioning for coronectomy: how to perform?

OBJECTIVES

The aim of this study was to determine the increase in heat production, preparation time, and cutting surface quality of conventional, high-speed rotating instruments and piezoelectric preparation for coronectomy procedures.

MATERIALS AND METHODS

One hundred intact extracted molars were sectioned horizontally, sub-totally, 1 mm under the cemento-enamel line with five methods: (1) tungsten carbide torpedo (TcT), (2) round (TcR) drills using a conventional speed surgical straight handpiece (< 40,000 min^-1), (3) tungsten carbide fissure (TcF), (4) diamond torpedo (DT) drills using a surgical high-speed, contra-angle handpiece (~ 120,000 min^-1), or (5) a saw-like piezoelectric tip (PT). Temperatures, preparation times, and cutting surface irregularities were registered and the differences were analyzed with ANOVA, Tukey's HSD post hoc test (temperature, time) and with chi-square test (irregular surface).

RESULTS

Rotating instruments produced a maximal temperature increase of less than 1 °C. TcF produced the least heat (ΔT = - 3.92 °C to the baseline), while PT produced significantly the highest temperature increases (ΔT = 12.38 °C, p < 0.001). Tungsten carbide drills were the fastest for coronectomy (from 55.9 to 64.3 s), while DT (169.7 s) while PT (146.8 s) were significantly slower. TcT and TcR drills produced an irregular root surface more frequently.

CONCLUSIONS

During coronectomy, rotating instruments produced entirely acceptable heat, while PT produced unacceptable temperatures. Tungsten carbide drills performed coronectomies effectively, but the diamond torpedo and PT seemed clinically questionable. Considering heat, speed, and the cutting surface quality simultaneously, TcF in a surgical high-speed handpiece seems to be the best choice for coronectomy.

CLINICAL RELEVANCE

The correct insert can significantly reduce excessive heat and operation time during coronectomy procedures.

[Giant sialolithiasis: Diagnosis and management. Case reports]

Sialolithiasis is one of the most frequent form of calcifications in the maxillofacial area. 0.45% of the population is affected by symptoms caused by salivary calculi, though the estimated frequency including asymptomatic form may exceed 1% in adult population. Radiographs presenting a large portion of the maxillofacial region (panoramic radiography, computed tomography) could detect salivary calculi with high accuracy. The size of the sialoliths is usually less than 10 mm in diameter. Salivary calculi larger than 15 mm (considering the largest diameter) are classified as giant sialoliths and most of them are located in the submandibular gland or in its duct. Two unusually large submandibular salivary calculi cases are represented (diameters of 27 and 34 mm), whereas in one of the cases development and dimensional changes of the calculus are described via a seven years period. This case report represents diagnostic and therapeutic consequences in giant sialolithiasis and demonstrates possible differential diagnostic difficulties. Orv. Hetil., 2016, 157(49), 1967-1972.

[Dental and oral surgical treatment of medication-induced bleeding patients: Audit of the national guideline in Hungary]

INTRODUCTION

In 2015 a new Hungarian guideline was published regarding dental treatment and management of anticoagulated patients in agreement of the Hungarian Association of Oral and Maxillofacial Surgeons and the Dental Implantology Association of Hungarian Dentists.

AIM

The aim of the authors was to evaluate the efficiency and safety of local hemostatic measures recommended by the guideline in anticoagulated patients.

METHOD

In these patients, postoperative bleeding episodes were examined after dental and oral surgical treatments, retrospectively.

RESULTS

Overall 263 bleeding risk cases were treated; 138 patients with vitamin K antagonists, 97 patients with antiplatelet therapy and 6 patients with novel oral anticoagulants. Six patients (2.3%) had minor postoperative bleeding after the "one hour control", while one patient needed a night duty support (0.5%). In contrast, 86 patients who were treated in rural practices neglecting the guideline attended the night duty with postoperative bleeding (3 patients treated with vitamin K antagonists, 24 patients taking low molecular weight heparin, 30 patients receiving antiplatelet therapy and one patient on novel oral anticoagulant therapy.

CONCLUSIONS

The Hungarian guideline can be applied safely, without increasing the risk of postoperative bleeding, however, rural dental practices are frequently unprepared for these treatments. Orv. hetil., 2016, 157(43), 1722-1728.

[Sunitinib and zoledronic acid induced osteonecrosis of the jaw]

The tendency for bisphosphonate and non-bisphosphonate (eg.: antiresorptive or anti-angiogenesis drugs) induced osteonecrosis is increasing. Treatment of these patients is a challenge both for dentists and for oral and maxillofacial surgeons. Cooperation with the drug prescribing general medicine colleagues to prevent osteonecrosis is extremely important. Furthermore, prevention should include dental focus elimination, oral hygienic instructions and education, dental follow-up and, in case of manifest necrosis, referral to maxillofacial departments. Authors outline the difficulties of conservative and surgical treatment of a patient with sunitinib and zoledronic acid induced osteonecrosis. The patient became symptomless and the operated area healed entirely six and twelve months postoperatively. A long term success further follow-up is necessary to verify long-term success.

[Dental and oral surgical treatment of a B haemophilic patient with high inhibitor level. Case report]

More than 1000 hemophilic male patients are registered in Hungary, from which only a trace number suffers from factor IX inhibitory hemophilia. For correct dental and oral surgical treatment of these patients mandatory cooperation is required among medical specialties, exerting multi-staged haemostatic principles. Authors represent in this case report the dental and oral surgical treatment of a B hemophilic patient with high inhibitor level and describe possible local haemostatic measures.

[The specific panoramic radiographic signs and their relation with inferior alveolar nerve injuries after mandibular third molar surgery]

The aim of the authors was to describe the classic specific panoramic signs (indicating a close spatial relationship between dental canal and third molar's root) on panoramic radiographic images and determine their role in the risk assessment, predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal. The authors represented an informative case, where the IAN was visible during the surgery. The exact knowledge of classic panoramic radiographic signs should help the determination of "high risk" cases predicting IAN paresthesia after mandibular third molar removal. The authors keep panoramic radiography rather a routine than the most superior diagnostic tool in third molar surgery.