scholarly journals Cone Beam Computer Tomography and Histological Evaluation of Dental Follicle of Impacted Lower Third Molar Germs in Teens: A Histo-Radiographic Correlation Study in a Case Series

2021 ◽  
Vol 11 (12) ◽  
pp. 5682
Author(s):  
Giacomo D’Angeli ◽  
Francesca Zara ◽  
Alessio Belloni ◽  
Francesco Maria D’Angeli ◽  
Michele Dello Spedale Venti ◽  
...  

The dental follicle (DF) is the tissue that surrounds the crown of the developing tooth. In X-ray, images it appears as a radiolucent area. The removal of an impacted mandibular third molar is a common procedure in oral surgery. The radiographic evidence of pathology, commonly defined as a pericoronal radiolucency measuring at least mm 2.5 mm in any dimension, is accepted for the extraction of impacted mandibular third molars. Mesioangular impactions are usually more closely placed to the inferior alveolar canal, and the use of cone beam computer tomography (CBCT) before the removal of impacted mandibular third molars has been reported to be appropriate in these cases. The aim of this study was to evaluate the microscopic features of radiographically normal DFs associated with mesioangular impacted mandibular third molars examined through CBCT. Thirteen mesioangular impacted third molars from ten patients (5 males and 5 females, mean age ± SD: 15.1 ± 1.66) with a maximum width of the DF <2.5 mm, as digitally established by CBCT, were included in this study. All the DFs associated with the removed third molars were examined histologically through the analysis of different variables. The mean (±SD) and range of the maximum width of the DFs were 1.35 (±0.47) mm and 0.71–2.21 mm, respectively. Nine (69.23%) DFs showed odontogenic remnants, five (38.46%) showed focal squamous metaplasia and eight (61.53%) mild mesenchymal myxoid degeneration. The maximum width of the DF failed to show any significant correlation with all the histological variables considered in this study. Aware of the limited number of patients included in this study, the histo-radiographic correlation in our case series confirm data in the literature, according to which normal pericoronal imaging may be associated with DF tissue changes/variations that in turn are potentially associated with the development of pathologies including odontogenic cysts and tumors. Whether these changes/variations are enough to make prophylactic germectomy of impacted third molars the standard by themselves remains to be established. However, they require accurate correlations with the radiographic data for the appropriate histologic assessment of a DF.

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Hani Arakji ◽  
Mohamed Shokry ◽  
Nayer Aboelsaad

The purpose of this study was to test the effect of the surgical removal of impacted mandibular third molars using piezosurgery versus the conventional surgical technique on postoperative sequelae and bone healing.Material and Methods.This study was carried out as a randomized controlled clinical trial: split mouth design. Twenty patients with bilateral mandibular third molar mesioangular impaction class II position B indicated for surgical extraction were treated randomly using either the piezosurgery or the conventional bur technique on each site. Duration of the procedure, postoperative edema, trismus, pain, healing, and bone density and quantity were evaluated up to 6 months postoperatively.Results.Test and control sites were compared using pairedt-test. There was statistical significance in reduction of pain and swelling in test sites, where the time of the procedure was statistically increased in test site. For bone quantity and quality, statistical difference was found where test site showed better results.Conclusion.Piezosurgery technique improves quality of patient’s life in form of decrease of postoperative pain, trismus, and swelling. Furthermore, it enhances bone quality within the extraction socket and bone quantity along the distal aspect of the mandibular second molar.


2020 ◽  
Vol 3 (2) ◽  
pp. 352-355
Author(s):  
Mabel Okiemute Etetafia ◽  
Ese Anibor ◽  
Martins Obaroefe

Introduction: Diagnosis and management of impacted mandibular third molars call for a cogent appraisal and treatment choice both for the sick person and the dental practitioner. This academic work scrutinized the pattern as well as treatment of impacted mandibular third molars at the Teem Clinic and Dental Centre, Ekpan, Delta State, in Nigeria.Materials and Methods: This cross-sectional survey involved 131 cases who reported impacted mandibular third molars. The age, gender, impacted tooth, type of impaction, pathological conditions, and treatment proffered were recorded.Results: The male to female ratio was 0.8:1, with an age range of 10 to 40 years. Of the lower third molar impactions 58 (42.0%) were mesioangular, 5 (3.6%) horizontal, 18 (13.0%) vertical and 57 (41.3%) were distoangular. A total of 47 (34.1%) quested for dental attention following varying degrees of pain induced by pericoronitis. Teeth removal was accomplished for 76 (55.0%) owing to carious lesions on the impacted teeth, proximate tooth, or both. Surgical extraction was the option taken in 69 (50.0 %) with caries on the impacted teeth while 3 (2.2%) had to pull out of their teeth done owing to carious lesions on the bordering second molars. In 3 (2.2%) both the impacted third molar and the proximate second molar were decayed. Conclusions: The prevailing indication for pulling out impacted mandibular third molars was acute pericoronitis. Mesioangular sort of impaction was most recurrent and ought to be considered for theplausibility of frequentness of complications.


2021 ◽  
Vol 7 ◽  
pp. 18-22
Author(s):  
Sushmitha Mohan ◽  
Annamalai Thangavelu ◽  
Aravindraj

Objectives: The objective of the study is to revisit the forgotten art of Lingual split bone technique during the COVID pandemic as a Standard Operating Procedure (SOP) for the surgical removal of impacted mandibular third molars. It was originally introduced in early 90’s by Sir William Kelsey Fry and also we have compared its advantages over the bone guttering technique. Materials and Methods: Twenty seven cases were operated during COVID pandemic in our institution using Davi’s modified lingual split technique under strict COVID protocol. Results: All impacted mandibular third molars were successfully removed. With regards to post-operative complication; 3 patients had nerve injury (11%), 2 patients had lingual paraesthesia (7.6%), 1 patient had alveolar osteitis (3.8%), 2 patients had postoperative infection (7.6%), 3 patients had trismus (19%). The overall success rate was 100%. Also the results of a comparison between bone guttering and chisel-mallet technique were stated. Conclusion: The use of lingual split bone technique deserves consideration during this COVID time as an alternate for bone guttering in surgical removal of third molar as it ensures minimal cross infectivity rate among both dentists and patients. Thus, patient care can be delivered with confidence even during pandemic.


2020 ◽  
pp. 1-7
Author(s):  
Kiran Shubha ◽  
Ravi Narula ◽  
Navneet Kaur

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.


Author(s):  
Neeraj ◽  
Banshilal Beniwal ◽  
Padmanidhi Agarwal ◽  
Vikas Berwal ◽  
Richa Malik

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.


2018 ◽  
Vol 2 (6) ◽  
pp. 146-149
Author(s):  
Pranay Ratna Sakya ◽  
Dipti Shreshta ◽  
Reena Kumari Shrestha ◽  
Khushboo Singh ◽  
Ravneet Malhi

INTRODUCTION: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction by another tooth or development in an abnormal position.MATERIAL AND METHODS: A cross sectional descriptive study was conducted on 945 patients (males=591, females=354) aged between 18- 50 years of age who had mandibular third molars impacted. The difficulty index for mandibular third molar for angulation and depth was based on Winter’s classification (1926).RESULTS: The most common type of impaction seen was Mesio- angular with (32%) followed by horizontal 264 (27.8%), then followed by other types. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0CONCLUSION: Impacted third molars are a common observation in routine dental practice. The impaction rate of third molars is higher as compared to other teeth in the dentition. The high prevalence found in the present study, with more than half of these Nepalese adult patients having at least one impacted third molar.


Author(s):  
Seyed Alireza Parhiz ◽  
Pegah Bakhtiary ◽  
Farzaneh Mosavat ◽  
Mohammad Javad Kharazifard

Objectives: This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans. Materials and Methods: Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey’s test. Results: In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth. Conclusion: Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.


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