The Retromolar Space and Wisdom Teeth in Humans: Reasons for Surgical Tooth Extraction

Abstract Objective This article explores the problem of developing pathologies in the retromolar region. Findings can serve a framework for disease prevention and for the improvement of the quality of life of patients. The present study aims to justify the possibility of utilizing morphometric methods to foresee problems in the eruption of third molars. Materials and Methods A comprehensive morphometric study of the lower jaw and facial skeleton involves 100 skulls of Homo sapiens to identify the anatomical causes of problems with wisdom teeth eruption. All said skulls are divided in two groups: I: skulls with intact dentition; II: skulls with impacted third molars. Results This work allows detecting abnormalities in the eruption of the third molar with high probability of success. The abnormalities in point are considered not only those associated with the generally accepted parameters but also those that occur in the leptoprosopic face cases. Conclusions Face type and the structural features of the facial skeleton play a significant role in the abnormal eruption of the lower third molar.

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COMPARISON BETWEEN DEXAMETHASONE AND COOL JAW WRAP ON POSTOPERATIVE PAIN AFTER SURGICAL REMOVAL OF LOWER WISDOM TEETH

International Journal of Current Pharmaceutical Research ◽

10.22159/ijcpr.2017v9i4.20754 ◽

2017 ◽

Vol 9 (4) ◽

pp. 33

Author(s):

Nasma M. Al-fahad ◽

Wael Sheet Shallawe

Keyword(s):

Quality Of Life ◽

Postoperative Pain ◽

Third Molar ◽

Control Group ◽

Surgical Removal ◽

Life Questionnaire ◽

Quality Of Life Questionnaire ◽

Surgical Extraction ◽

Wisdom Teeth

Objective: The aim is to compare between the effect of cool jaw wraps and dexamethasone injection on postoperative pain and evaluate the quality of life after surgical removal of lower wisdom tooth.Methods: Extraction of impacted lower third molar will surgically operate (by the same difficulty of surgical extraction and same operator) on 30 patients, which divide into three groups, each group have 10 patients.We will instruct the patients in cool jaw wrap group to put cool jaw wrap after the operation. While the second group give dexamethasone injection after the operation. The last group which is the control group will left them with the usual instruction postoperatively.This study evaluates the facial pain, swelling, and trismus on days 1,2 and 7 postoperatively. Objective measurements of swelling, pain, and trismus were undertaken at days 1, 2 and 7. The quality of life questionnaire was estimated at day 7 postoperatively.Results: Cool jaw wrap showed no significant differences on the postoperative pain when it used after surgical removal of the lower third molar BUT have significant differences on the Quality of life of patients.Conclusion: Cool jaw face wrap can be recommended as a safe method that participates in some degree to reduce postoperative pain, it easy to handle, comfort, avoiding damage by freezing due to the barrier between cool jaw and skin and the patient can avoid the side effect of dexamethasone and the phobia from the injection.

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NICE and the third molar debate

Faculty Dental Journal ◽

10.1308/204268513x13776914744718 ◽

2013 ◽

Vol 4 (4) ◽

pp. 166-171 ◽

Cited By ~ 4

Author(s):

Louis McArdle

Keyword(s):

Third Molar ◽

Clinical Indication ◽

Third Molars ◽

Clinical Guidance ◽

The Third ◽

Nice Guidance ◽

Wisdom Teeth ◽

The Uk ◽

Disease Free

In 2000 the National Institute for Health and Care Excellence (NICE) published clinical guidance that advised against the removal of disease-free wisdom teeth (prophylactic removal).1 This was mainly driven by the perception in the UK that up to 44% of all removed third molars were disease free and consequently had no clinical indication for removal.1,2 But does the NICE guidance, which has become akin to scripture on this issue, have everything right?.

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A Radiograhic Study of the Third Molar Inclusion

ARS Medica Tomitana ◽

10.2478/arsm-2019-0016 ◽

2019 ◽

Vol 25 (2) ◽

pp. 74-77

Author(s):

Nagy-Bota Monica Cristina ◽

Păcurar Mariana ◽

Hălmaciu Ioana ◽

Suciu Bogdan-Andrei ◽

Brînzaniuc Klara

Keyword(s):

Pathological Condition ◽

Third Molar ◽

Third Molars ◽

Impacted Teeth ◽

Female Patients ◽

Wisdom Teeth ◽

Male Patients ◽

The Right ◽

Upper Third ◽

Lower Arch

Abstract Objective: The aim of this study is to determine the incidence of inclusion of lower and upper third molar in the population of Mures county. Materials and Methods: For this study, we examined the orthopantomograms (OPGs) of 243 patients (including 138 women and 105 men, aged 19-57 years old) who had impacted third molars and who presented to three Orthodontic Clinics in Tîrgu Mureș between 2015-2017. All impacted third molars were taken into consideration but which at the same time presented fully developed roots. We excluded from the study patients with pathological condition or craniofacial syndromes such as cleidocranial dysostosis and Down syndrome. Results: In both women and men, the most common cases were of one impacted molar (61,72%), then two (27,16%) and three (11,12%) impacted molars. Based on the evaluation of all radiographs, 363 impacted teeth were observed, with a higher proportion in women (54,27%) compared to men (45,73%). With regard to the location of the impacted teeth in the mandible or the maxilla, in both female and male patients, the incidence of mandibular impactions was higher (62,25%) than in the maxilla (37,75%). Regarding the link between the position on the arch (right and left side) and the localization of the impacted teeth, in female patients we can assert that while the mandible had the largest number of impacted teeth on the right side (69,35%), the impacted teeth in the maxilla were more numerous on the left side (60,27%) (p=0,00004). In male patients, regardless of whether the impactions were in the mandible or in the maxilla, they were more frequent on the right side (70,58% in mandible and 76,56% in maxilla) than on the left one. Conclusions 1. The incidence of impacted wisdom teeth is higher in females compared to males. 2. Impacted wisdom teeth are more common on lower arch than on upper arch. 3. In female patients, the prevalence of impaction is higher on the right side in the mandible and on the left side in the maxilla 4. In male patients, the prevalence of impaction on the right side is higher in both mandible and maxilla

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Third molar agenesis in modern humans with and without other tooth agenesis

10.21203/rs.2.15532/v1 ◽

2019 ◽

Author(s):

Maya Scheiwiller ◽

Elias S. Oeschger ◽

Nikolaos Gkantidis

Keyword(s):

Third Molar ◽

Control Group ◽

Tooth Agenesis ◽

Evolutionary Trend ◽

Third Molars ◽

Modern Humans ◽

Lower Jaw ◽

Third Molar Agenesis ◽

Evolutionary Aspects ◽

Control Study

Abstract Background The number of teeth in the human dentition attracts special interest both from developmental and evolutionary aspects. The present case-control study focused on the formation of third molars in modern humans aiming to shed more light in this long lasting enigma.Methods For this reason, we investigated third molar formation in a sample of 303 individuals with tooth agenesis other than in third molars (agenesis group) and compared it to a sex and age matched control group of 303 individuals without tooth agenesis other than in third molars.Results The prevalence of third molar agenesis in the agenesis group was 50.8%, which is significantly higher than the 20.5% in the control group (p < 0.001). The chance of a missing third molar in the agenesis group was increased by 38.3% (p < 0.001), after controlling for the other tooth agenesis factor. When considering the percentages of the number of missing third molars per individual, a clear tendency towards more missing third molars was evident in the agenesis group compared to the control group. The frequency of bilaterally missing third molars in the agenesis group was 29% in the upper as well as in the lower jaw, which is about three times higher than the frequency of unilaterally missing third molars (p < 0.001). In the control group, bilaterally missing third molars occurred in 8.6% in the upper and 8.9% in the lower jaw.Conclusion The present results indicate that genetic factors involved in certain tooth agenesis also affect the entire dentition as a whole. Furthermore, the third molars are more vulnerable to factors involved in other tooth agenesis and they are more often affected as a total. These findings seem to be associated with the evolutionary trend in humans towards reduced molar number.

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Coronectomy of the wisdom teeth: the dental extraction alternative

Journal of Stomatological Medicine ◽

10.53530/1857-1328.21.59.02 ◽

2021 ◽

Vol 3 (59) ◽

pp. 12-17

Author(s):

Sergiu Beliniuc ◽

◽

Gabriela Motelica ◽

Keyword(s):

Inferior Alveolar Nerve ◽

Third Molar ◽

Mandibular Canal ◽

Surgical Removal ◽

Third Molars ◽

Close Proximity ◽

Wisdom Teeth ◽

Low Incidence ◽

Upper Third ◽

Surgical Separation

Background. Coronectomy of the wisdom teeth is an alternative surgical procedure to tooth extraction, which aims to preserve the roots of the wisdom teeth in the dental socket after surgical separation of the crown, in order to avoid the injury of the inferior alveolar vascular-nervous bundle. Purpose. Minimizing the damage to the inferior alveolar nerve when extracting lower third molars caused by the intimate relationship between the nerve and the roots of the teeth, by using the technique of coronectomy, or intentional root retention. Material and Methods. Patients who reported to University Dental clinic during the period 2020–2021 for surgical removal of impacted L3M were screened for nerve–root relationship with OPG or CBCT. 15 patients underwent coronectomy as a procedure to remove the crown and upper third of the roots of a lower third molar to reduce the risk of damage to the inferior alveolar nerve. Results. 15 patients were enrolled in this study, with a total of 17 lower third molars. Sixteen sites healed primarily, but in 1 case the sockets on both sides opened and failed to close secondarily. In this case, the root fragments were later removed and found to be mobile. Conclusion. Coronectomies are safer to perform than complete extractions in situations in which the third molar is in close proximity to the mandibular canal. The technique appears to be associated with a low incidence of complications and the removal of remaining roots is required in around 6-7% of cases due to the mesial migration of the fragment and not any symptoms or reinfection.

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The prevention and management of distal cervical caries of the mandibular second molar

Dental Update ◽

10.12968/denu.2019.46.5.406 ◽

2019 ◽

Vol 46 (5) ◽

pp. 406-410

Author(s):

Louis W McArdle

Keyword(s):

Third Molar ◽

Direct Consequence ◽

Third Molars ◽

Second Molar ◽

Impacted Third Molar ◽

Simple Question ◽

Wisdom Teeth ◽

Molar Teeth ◽

Mandibular Second Molar ◽

Disease Free

Distal Cervical Caries (DCC) of the mandibular second molar has become a more frequent complication of third molar impaction as a direct consequence of the introduction of NICE's guidance on the management of wisdom teeth. NICE's tenet that disease free impacted third molars can be retained is contradicted by the development of DCC on the second molar as its diagnosis asks the simple question of why the impacted third molar was not removed before DCC occurred. This paper aims to address the features of DCC associated with the second molar and outlines how dentists should address its diagnosis but, more importantly, how to recognize those at risk and how patients should be managed. CPD/Clinical Relevance: Clinical management of impacted third molar teeth.

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Third Molar Agenesis and Craniofacial Morphology

The Angle Orthodontist ◽

10.2319/052008-276.1 ◽

2009 ◽

Vol 79 (3) ◽

pp. 473-478 ◽

Cited By ~ 19

Author(s):

María José Sánchez ◽

Ascensión Vicente ◽

Luis Alberto Bravo

Keyword(s):

Third Molar ◽

Craniofacial Morphology ◽

Control Group ◽

Third Molars ◽

Discrimination Analysis ◽

Third Molar Agenesis ◽

Mandibular Plane ◽

Wisdom Teeth ◽

Group 2 ◽

Mandibular Third Molars

Abstract Objective: To test the null hypothesis that agenesis of wisdom teeth is not related with any particular craniofacial morphology. Materials and Methods: Ninety-seven patients (aged 13–19 years) were selected and divided into three groups: (1) bilateral agenesis of maxillary third molars, (2) bilateral agenesis of mandibular third molars, and (3) control group without agenesis. Presence or absence of third molars was determined using ortopantomographs. Cephalometric analysis was carried out from lateral teleradiographs, which included linear, angular, and proportional measurements. When data obtained were distributed normally it was analyzed by means of single-factor variance analysis and the Scheffé test (P < .05). When data did not show normality, the Kruskal-Wallis test (P < .05) and the Mann-Whitney test were applied using Bonferroni correction (P < .017). Multivariance discrimination analysis was also carried out. Results: Values obtained for the mandibular plain of Groups 1 and 2 were significantly lower than those of the Control Group (P =.00 and P =.00, respectively). For Group 2 lower face height was significantly less than for the control group (P =.01), whilst the mandibular arch and the articular angle were significantly greater than in the Control Group (P =.000 and P = .02, respectively). Multivariance discrimination analysis obtained a correct classification in 58.8% of cases. Conclusion: The hypothesis is rejected. Agenesis of the maxillary third molars was related to a reduced mandibular plane angle. Patients with agenesis of the mandibular third molars showed a diminished lower third and a mandibular morphology characteristic of the brachyfacial pattern.

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Effect of Intraoral Drainage after Impacted Mandibular Third Molar Extraction on Non-Infectious Postoperative Complications

Journal of Clinical Medicine ◽

10.3390/jcm10204705 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4705

Author(s):

Grzegorz Trybek ◽

Joanna Jarzęcka ◽

Olga Preuss ◽

Aleksandra Jaroń

Keyword(s):

Postoperative Complications ◽

Sodium Alginate ◽

Third Molar ◽

Surgical Removal ◽

Third Molars ◽

Third Molar Extraction ◽

Mandibular Third Molar ◽

Wisdom Teeth ◽

Group B ◽

Mandibular Third Molars

Surgical removal of mandibular third molars is associated with non-infectious postoperative complications, including pain, swelling, trismus. Intraoral drains are noteworthy because of their ease of application, availability, and effectiveness. This study aimed to evaluate the use of latex and calcium–sodium alginate mouth flat drains on the severity of postoperative complications such as pain, trismus, and edema after surgical removal of mandibular third molars. Ninety patients who underwent surgical removal of wisdom teeth were studied. The patients were divided into three groups. Group A—with a latex flat drain, group B—with a sodium–calcium alginate (Kaltostat) flat drain, and group C—with a wound closed with knotted sutures. Patients were assessed for pain on a VAS scale every day from surgery to postoperative day 7. Before the procedure and on postoperative days 1, 2, and 7, the pain level, edema, and trismus were measured, respectively. Intraoral drainage with a flat drain after mandibular third molar removal does not significantly reduce pain, as measured by the VAS scale, or postoperative swelling, as measured by lines between craniometric points. Intraoral drainage with a latex drain after mandibular third molar removal does not significantly reduce trismus, while intraoral drainage with a calcium–sodium alginate drainage bag significantly increases trismus.

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Analysis of External Root Resorption of the Second Molar Associated with an Impaction of the Third Molar by the Application of CBCT

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2019-0053 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Stefan Velickovic ◽

Milos Zivic ◽

Zlata Rajkovic ◽

Dragana Stanisic ◽

Aleksandra Misic ◽

...

Keyword(s):

Surgical Intervention ◽

Root Resorption ◽

Third Molar ◽

Third Molars ◽

Second Molar ◽

Dental Tissues ◽

Impacted Third Molar ◽

External Root Resorption ◽

Lower Jaw ◽

Total Prevalence

Abstract External root resorption (ERR) of a tooth represents a process in which irreversible damage occurs to solid dental tissues, more precisely of the cement and dentin. External resorption occurs on the root surface or periodontal ligament, and it is manifested by the loss of cement and/or dentine. The prevalence of ERR of the second molar associated with an impacted third molar, based on retro-alveolar radiography and orthopantomography, ranges from 0.3% to 24.2%. The aim of this research was to analyze ERR of the upper and lower jaw associated with the impacted third molar by the application of the Come Beam Computed Tomography. This study included 96 third molars in the upper and lower jaw of a total of 46 analyzed patients’ images. Total prevalence of the second molar ERR associated with the impacted third molar was 8.82%. The second molar ERR was observed in 8 patients (7.84%). Frequency of the second molar ERR in the lower jaw is higher, and it is 8.2%, while in the upper jaw it is only 1% (r = 0.032). Impacted third molars associated with the second molar ERR were most frequently in horizontal (5.1%) and mesioangular (4.1%) position (p = 0.000). The second molar ERR could be avoided by the preventive extraction of mesioangular or horizontal third molars. An adequate decision on the extraction of impacted third molars must be made by the careful assessment of risks and benefits of this surgical intervention. Before the surgical intervention, an adequate care of the second molar, adequate restoration, endodontic treatment or root resection should be done if necessary.

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270 A Retrospective Analysis of The Impaction Status of Mandibular Third Molars as A Risk Factor for Fractures of Angle or Condylar Region of The Mandible

British Journal of Surgery ◽

10.1093/bjs/znab259.612 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Al-Harbawee

Keyword(s):

Third Molar ◽

Class Ii ◽

Class I ◽

Third Molars ◽

Mandibular Angle ◽

Wisdom Teeth ◽

Highly Correlated ◽

Mandibular Third Molars ◽

Angle Fractures ◽

Condylar Fractures

Abstract Background the position and angulation of mandibular third molars have both been found to influence the angle and condylar fractures. Objective: To identify whether there is an association between the depth and angulation of third molar impaction and the relative risk of fracture of the mandibular angle and condyle. Method Four-hundred and eighty-two panoramic dental radiographs were assessed for the period from January 2012 to June 2020. The study variables included the presence of mandibular third molars, position and angulation. The outcome variables were angle and condylar fractures. Results the mean age was 28.5 years (range 15-89) and 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted wisdom tooth (M3) ( p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with wisdom teeth classified as class II ( p = 0.026) and position B ( p = 0.05). In contrast, class I wisdom molars were more frequently associated with condylar fractures. With regards to the angulation of wisdom teeth, angles between 80 o – 100 o were highly correlated with angle fractures ( p = 0.020) whereas M3 angulations of 60 o – 80 o were related to condylar injuries (p = 0.025). Conclusions fractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I third molars were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80-100) and (60-80) respectively.

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