SURGICAL EXTRACTION OF THIRD LOWER MOLARS IN COMPLEX TREATMENT OF CROWDED TEETH

The success of orthodontic treatment quite often depends on cooperation between the orthodontist and the dental surgeon. An integrated approach, including orthodontic treatment of dento-maxillary anomalies in combination with using the latest surgical techniques can provide quick defect correction of the maxillofacial region and ensure better stability of the results achieved; in most cases of teeth crowding, there is no alternative to the removal of the third lower molars. The purpose of this study was to analyze the surgical interventions performed on for surgical extraction of wisdom teeth for orthodontic reasons and the approach to their choice. Materials and methods. During 2016-2020 years, 158 patients were subjected to 241 surgical interventions for surgical extraction of the third lower molars for orthodontic reasons. We performed on 160 (66.4%) standard operations of atypical tooth extraction, 43 (17.8%) germectomies and 38 (15.8%) coronectomies. The patients' age ranged from 12 to 26 years. All patients were examined by applying the standard technique including orthopantomogram. In cases then it was impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of the superposition of their projections on the obtained pantomograms, we used computed tomography. Based on the data obtained from the examination of the patient, the optimal safest surgical intervention was chosen for removal: the surgical extraction of the wisdom tooth, germectomy, or coronectomy. Conclusions: 1. Operations on surgical extraction of the lower wisdom teeth require mandatory planning and an individual approach to each patient based on a thorough preliminary examination. 2. In cases when it is impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of overlapping their projections on the pantomograms, patients are recommended to undergo computed tomography, and then based on the assessment of CT findings to determine the topographic and anatomical relationship of the mandibular canal and roots. 3. The operation of surgical extraction of the lower wisdom tooth can be performed as a standard operation, germectomy can be recommended for patients with underdeveloped roots, coronectomy is a good option when the roots of the wisdom tooth are very close to the mandibular canal.

Download Full-text

DIFFERENTIATED APPROACH TO THE SURGICAL EXTRACTION OF WISDOM TEETH

Ukrainian Dental Almanac ◽

10.31718/2409-0255.4.2019.04 ◽

2019 ◽

pp. 24-28

Author(s):

A.I. Pankevych ◽

I.A. Kolisnyk ◽

A.M. Hohol

Keyword(s):

Classical Method ◽

Third Molar ◽

Mandibular Canal ◽

Tooth Crown ◽

Wisdom Tooth ◽

Patients Âgés ◽

Advantages And Disadvantages ◽

The Third ◽

Surgical Extraction ◽

Wisdom Teeth

Impaction and malposition of wisdom teeth and associated inflammatory and tumor-like complications occur in 35-50% of the able-bodied population. The operation of surgical extraction of the third molar of the mandible is indicated for these patients and this operation is one of the most common in surgical dentistry today.Alsoasignificant indication for wisdom teeth removaliscrowding of teeth. The classic operation of surgical wisdom tooth removal, even with careful planning, can be accompanied by different intraoperative and postoperative complications. Planning of removal of the third lower molar requires an individual approachwith mandatory consideration not only of the tooth position but also the topography of the causative tooth relative to the adjacent tooth and mandibular canal. Among the surgical procedures which are used to remove wisdom teeth, in addition to the classic surgery extraction, coronectomy and germectomy should be noted. The purpose of our study was to analyze the advantages and disadvantages of different techniques used for surgical extraction of impacted and malposition wisdom teeth. 208 operations regarding the removal of the third lower molars have been performedduring 2016-2019, of which surgical wisdom teeth removal were 213, coronectomies – 23 and germectomies – 29.Patients' ages ranged from 13 to 26 years. A germectomy was performed in 13-16 years old patient, usually at the stage of a fully formed tooth crown or at the beginning of root formation. The choice of surgery in patients with fully formed roots was dependent on the ratio of the root of the tooth and mandibular canal, which was evaluated after a preliminary computer examination, taking into account the complexity of the surgery and the prognosis of complications. Acoronectomy operation was performed with the close location of the roots of the wisdom tooth with the mandibular canal, taking into account the risk of the damage of lower alveolar nerve. Germectomy and surgery of wisdom teeth removal were performed according to the classical method with cutting of mucoperiostal flaps, preparation of bone, if necessary – separation of crown and roots with subsequent removal of the germ or tooth. The crown of wisdom tooth was separated with a coronectomy, (and cut in height with insufficient access) and the tooth crown was removed, leaving the roots in the jaw. Patients were observed on the next day after surgery, a week later, and as needed. The course of the postoperative period was evaluated: the presence of pain, swelling, complications. The duration of follow-up was up to 2 years. Conclusions: To the choice of surgery in patients with impaction and malposition of wisdom teeth should be approached in a differentiated manner, taking into account topographic and anatomical features, including the ratio of the roots of the teeth to the mandibular canal and assessing the risks of possible complications. Germectomy and coronectomy surgery can be recommended as surgery of choice for orthodontic indications in the treatment of patients with crowded teeth.

Download Full-text

Association between imaging and clinical findings in mandibular third molar surgeries

Revista da Faculdade de Odontologia - UPF ◽

10.5335/rfo.v23i1.8127 ◽

2018 ◽

Vol 23 (1) ◽

Author(s):

Marcelo Bonifácio da Silva Sampieri ◽

Danilo Da Silva Correa ◽

Francisca Lívia Parente Viana ◽

Thaís Sumie Nozu Imada ◽

Josfran Da Silva Ferreira Filho ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Statistical Significance ◽

Third Molar ◽

Panoramic Radiograph ◽

Mandibular Canal ◽

Clinical Findings ◽

Cone Beam ◽

The Third ◽

Close Relationship

Objective: it is important to evaluate the position andestablish the third molar relationship with the mandibularcanal to minimize the risk of nerve injury and assistin planning the extraction of this tooth. The panoramicradiograph is the standard diagnostic tool for this purpose.However, if it indicates a close relationship betweenthe third molar and the mandibular canal, furtherinvestigation using cone beam computed tomography(CBCT) may be recommended to check the three-dimensionalrelationship between the tooth and the mandibularcanal. Thus, this study aimed to correlate the clinicalfindings (observed in third molar surgeries) to imagingfindings (observed in panoramic radiographs andCBCT). Subjects and method: after the extraction of 20mandibular third molars, the panoramic radiograph andthe cone beam computed tomography were analyzed.Then, the surgical findings were correlated to the imagefindings. Results: It was observed that the radiographicfinding type 2 (darkening of roots) observed in the panoramicradiograph presented a greater relation to theabsence of cortical bone between the mandibular canaland the third molar (CBCT finding), with statistical significance(p

Download Full-text

Influence of Orthodontic Treatment with Premolar Extraction on the Spatial Position of Maxillary Third Molars in Adult Patients: A Retrospective Cohort Cone-bean Computed Tomography Study

10.21203/rs.3.rs-30799/v3 ◽

2020 ◽

Author(s):

Fangwei Pan ◽

Zhentao Yang ◽

Jian Wang ◽

Ruilie Cai ◽

Jialing Liu ◽

...

Keyword(s):

Computed Tomography ◽

Coordinate System ◽

Orthodontic Treatment ◽

Spatial Position ◽

Adult Patients ◽

Third Molars ◽

Premolar Extraction ◽

The Third ◽

Anterior Nasal Spine ◽

Space Coordinate

Abstract Background: Based on low-dose radiation Cone-bean computed tomography (CBCT) images, This study aims to establish a space coordinate system, which offers more precise and comparable evaluation on changes of maxillary third molars influenced by orthodontic treatment with premolar extraction in adults. The system suggests promising application prospect in future studies related to CBCT superimposition and evaluation for its feasibility and efficiency.Methods: Forty-nine maxillary third molars from 27 patients (mean age, 20.78 years) were included. CBCT images were obtained before and after orthodontic treatment with premolars extracted (mean treatment duration, 31.47 months). The changes in the position, angulation, and rotation of the third molars were evaluated with a space coordinate system using four landmarks: anterior nasal spine (ANS), posterior nasal spine (PNS), left and right orbitales.Results: After orthodontic treatment, the third molars moved forward (adjusted mean, 1.44 mm) (p < 0.001) and downward (adjusted mean, 2.87 mm) (p < 0.001) accompanied by outward rotation of the crowns (adjusted mean, 5.38°) (p = 0.001), while changes in angulation were insignificant.Conclusions: This was the first study to systematically investigate the spatial position change of maxillary third molars in adult patients who received orthodontic treatment with premolar extraction. During the process, maxillary third molars moved downward and forward accompanied by outward rotation of the crowns. Orthodontists should take tooth movement potential into consideration when making extraction plans.

Download Full-text

Reliability of cone beam computed tomography in locating and measuring the mandibular canal for planning of surgical techniques in the mandibular body

Revista Española de Cirugía Oral y Maxilofacial (English Edition) ◽

10.1016/j.maxile.2015.07.001 ◽

2015 ◽

Vol 37 (4) ◽

pp. 182-187

Author(s):

Francisco Azcárate-Velázquez ◽

Jorge Bertos-Quilez ◽

Francisco Marmesat-Guerrero ◽

Pablo Núnez-Arcos ◽

Federico Hernández-Alfaro ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Surgical Techniques ◽

Mandibular Canal ◽

Cone Beam ◽

Mandibular Body

Download Full-text

Influence of Orthodontic Treatment with Premolar Extraction on the Spatial Position of Maxillary Third Molars in Adult Patients: A Retrospective Cone-bean Computed Tomography Study

10.21203/rs.3.rs-30799/v1 ◽

2020 ◽

Author(s):

Fangwei Pan ◽

Zhentao Yang ◽

Jian Wang ◽

Jialing Liu ◽

Chenghao Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Orthodontic Treatment ◽

Spatial Position ◽

Adult Patients ◽

Third Molars ◽

Position Change ◽

Premolar Extraction ◽

The Third ◽

Anterior Nasal Spine ◽

Before And After

Abstract Background: The aim of this study was to evaluate the changes in position, angulation, and rotation of maxillary third molars in adults after orthodontic treatment with premolar extraction using a space coordinate system based on Cone-bean computed tomography (CBCT) images. Methods: Forty-nine maxillary third molars from 27 patients (mean age, 20.78 years) were included in the study. CBCT images were obtained before and after orthodontic treatment with premolars extracted (mean treatment duration, 31.47 months). The changes in the position, angulation, and rotation of the third molars were evaluated with a space coordinates system using four landmarks: anterior nasal spine (ANS), posterior nasal spine (PNS), left and right orbitales. Results: After orthodontic treatment, the third molars moved forward (mean, 1.44 mm) (p < 0.001) and downward (mean, 2.87 mm) (p < 0.001) accompanied by outward rotation (mean, 5.38°) of the crown (p = 0.001), but the changes in angulation were insignificant.Conclusions: This was the first study to systematically investigate the spatial position change of maxillary third molars in adult patients who received orthodontic treatment with premolar extraction. During the process, maxillary third molars moved downward and forward accompanied by outward rotation of the crown.

Download Full-text

Vestibular bone thickness of the mandible in relation to the mandibular canal—a retrospective CBCT-based study

International Journal of Implant Dentistry ◽

10.1186/s40729-019-0189-z ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Silvio Valdec ◽

Jan M. Borm ◽

Stephanie Casparis ◽

Georg Damerau ◽

Michael Locher ◽

...

Keyword(s):

Oral Surgery ◽

Mandibular Canal ◽

Mental Foramen ◽

Cortical Plate ◽

Bone Block ◽

Bone Thickness ◽

Surgical Interventions ◽

Wisdom Teeth ◽

Male Patients ◽

University Of Zurich

Abstract Background The aim of this study was to assess vestibular bone thickness of the mandible in relation to the mandibular canal and position of the mental foramen in relation to the neighbouring teeth. Measurements were performed on radiographic cone-beam computed tomography (CBCT) images. Methods This retrospective study analysed 314 CBCTs, having been taken at the Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, Switzerland. Results CBCTs from 168 female and 146 male patients (median age 40.2 years) were analysed. Median bone thickness lateral to the nerve canal to the buccal mandibular cortical plate was ~ 4 mm immediately posterior to the mental foramen, increased to ≤ 6 mm over the next 30 mm, then decreased to ~ 3 mm at the level of the mandibular foramen. In two thirds of cases, both mental foramina were located near the second premolar (66.2% right, 67.7% left). Bone thickness and the position of the mental foramen showed marked intra- and interindividual variance. Conclusions A preoperative CBCT is recommended for detailed planning of surgical interventions that may reach the mandibular canal (e.g. wisdom teeth removal, root resection, implant placement, bone block harvesting).

Download Full-text

Evaluation of the anatomical relationship between mandibular third molars and the mandibular canal using Cone Beam Computed Tomography

Research Society and Development ◽

10.33448/rsd-v10i6.15659 ◽

2021 ◽

Vol 10 (6) ◽

pp. e55710615659

Author(s):

Magno Vincíus Silva Batista ◽

Joel Motta Junior

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Statistical Significance ◽

Mandibular Canal ◽

Cone Beam ◽

Type I ◽

Third Molars ◽

Virtual Planning ◽

The Third ◽

Anatomical Relationship

Objective: This study aims to establish the anatomical relationship between the mandibular canal and the third molars, based on analysis by Cone Beam Computed Tomography. Methodology: Computed Tomography analysis of 67 third molars was performed using Blue Sky Plan 4 virtual planning software. The anatomical dispositions of the third molars and mandibular canal were evaluated, as well as the factors that favor the contact between these structures. Result: There was a prevalence of 76.1% for biradicular third molars, 52.2% for class 1 and 71.6% class A. Vertical and mesioangulated teeth had a higher prevalence, with 38.8% and 35.8% respectively. Sicher and Tandler's classification presented 41.8% of the canals as type I, while in the buccal-lingual positioning, 89.5% of the canals were located through the buccal. 44.8% of the teeth had contact with the canal and the factors with statistical significance were: female gender (p = 0.019), number of roots (p = 0.019), class 3 (p = 0.004) and C (p = 0.012) teeth and lingual positioning of the mandibular canal (p = 0.016). About the anatomical delimitations, the mean diameter of the canal was 3.14 mm and the distances related to the dental roots, lingual, buccal and inferior cortical bony were 2.77, 3.53, 4.56 and 8.32 milimeters, respectively. Conclusion: Therefore, the assessment of third molars by computed tomography is essential during preoperative planning, as it identifies anatomical relationships that favor contact between the tooth and the mandibular canal and helps to reduce the incidence of sensorineural disorders.

Download Full-text

Bifid mandibular canal: a rare or underestimated entity?

Clinics and Practice ◽

10.4081/cp.2016.881 ◽

2016 ◽

Vol 6 (3) ◽

Cited By ~ 1

Author(s):

Ibrahim Nasseh ◽

Georges Aoun

Keyword(s):

Nerve Block ◽

Inferior Alveolar Nerve ◽

Radiographic Finding ◽

Anatomical Variations ◽

Mandibular Canal ◽

Inferior Alveolar Nerve Block ◽

The Third ◽

Bifid Mandibular Canal ◽

Mandibular Molar ◽

Surgical Extraction

One of the rare anatomical variations that can be of significant importance for the dentist is the bifid mandibular canal. Many complications can occur from this condition such as failure of anesthesia when performing inferior alveolar nerve block, difficulties during the surgical extraction of the third mandibular molar, and during implants placement. Therefore, good knowledge of this condition is essential. In this report, we describe the radiographic finding of a unilateral bifid mandibular canal.

Download Full-text

Influence of orthodontic treatment with premolar extraction on the spatial position of maxillary third molars in adult patients: a retrospective cohort cone-bean computed tomography study

BMC Oral Health ◽

10.1186/s12903-020-01314-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Fangwei Pan ◽

Zhentao Yang ◽

Jian Wang ◽

Ruilie Cai ◽

Jialing Liu ◽

...

Keyword(s):

Computed Tomography ◽

Coordinate System ◽

Orthodontic Treatment ◽

Spatial Position ◽

Adult Patients ◽

Third Molars ◽

Premolar Extraction ◽

The Third ◽

Anterior Nasal Spine ◽

Space Coordinate

Abstract Background Based on low-dose radiation Cone-bean computed tomography (CBCT) images, This study aims to establish a space coordinate system, which offers more precise and comparable evaluation on changes of maxillary third molars influenced by orthodontic treatment with premolar extraction in adults. The system suggests promising application prospect in future studies related to CBCT superimposition and evaluation for its feasibility and efficiency. Methods Forty-nine maxillary third molars from 27 patients (mean age, 20.78 years) were included. CBCT images were obtained before and after orthodontic treatment with premolars extracted (mean treatment duration, 31.47 months). The changes in the position, angulation, and rotation of the third molars were evaluated with a space coordinate system using four landmarks: anterior nasal spine (ANS), posterior nasal spine (PNS), left and right orbitales. Results After orthodontic treatment, the third molars moved forward (adjusted mean, 1.44 mm) (p < 0.001) and downward (adjusted mean, 2.87 mm) (p < 0.001) accompanied by outward rotation of the crowns (adjusted mean, 5.38°) (p = 0.001), while changes in angulation were insignificant. Conclusions This was the first study to systematically investigate the spatial position change of maxillary third molars in adult patients who received orthodontic treatment with premolar extraction. During the process, maxillary third molars moved downward and forward accompanied by outward rotation of the crowns. Orthodontists should take tooth movement potential into consideration when making extraction plans.

Download Full-text