PREDICTION OF VERTICAL IMPACTION OF LOWER WISDOM TOOTH ACCORDING ORTHOPANTOMOGRAPHY OF LOWER JAW

Topic relevance. The dental surgeon often is left alone with the dilemma: to save or remove the third lower molars. The justification of indications for tooth extraction must have objective criteria. It should be noted that a patient with this problem does not always have the opportunity to receive comprehensive advice from an orthodontist. In view of this, the solution to this problem requires the search for radiological data, which are the most available today and would help to justify treatment tactics for preservation or removal of the tooth. The conditions of tooth preservation in the dentition are most favorable with a slight medio-distal inclination and a vertical position of the third lower molars. However, this does not exclude the possibility of tooth impaction, which is often accompanied by periodic inflammatory phenomena in the tissues adjacent to the tooth and motivates both the patient and the dental surgeon to solve this problem. The aim of our study was to research of radiographic indicators of orthopantomography of the mandible to predict the vertical retention of the third lower molars. Material and methods of research. The platforms of Google Scholar, Research Gate and PubMed are used for research and analysis of the scientific literature on the application of objective criteria of mandibular orthopantomography data in the prediction of vertical impaction of the third lower molars. Impaction of mandibular molars is the result of a number of factors, including heredity, racial characteristics, muscle function, the nature of the food consumed, insufficient growth of the mandible, the size of the retromolar space. The accurately determination the positions of the molars and the size of the retromolar space of the mandible by available methods of X-ray diagnosis (the most common of which is the method of orthopantomography of the jaws) are necessary to prediction of tooth retention. The accuracy of imaging and measurements on orthopantomograms of the jaws was studied by both domestic and foreign authors. The angle of inclination of lower wisdom tooth, the size of the retromolar space of the mandible and the mesiodistal size of the teeth are determined on OPTG of jaws in the vast majority of publications. The age aspect of patients is also important for prediction of tooth impaction. In particular, most researchers state the fact that up to 20 years of life there is a significant probability of changing the position of the teeth during their eruption and therefore it is quite appropriate to wait. To predict the nature of the impaction of the third lower molars, the authors provide indicators of the angle of the tooth, the structure of their roots, the degree of impact and age of the patient. The publication of Maria Mersedes Gallas-Torreira and co-authors, which compared two methods of linear measurements on OPTG – Olive-Basford’s and Olmos ’methods have greatest interest. Both methods can be used to predict of impaction of lower wisdom tooth. However, if the prognostic estimate is based on orthopantomogram data rather than cone-beam computed tomography, the Olmos` method demonstrates a lower error rate and a more plausible prediction. To substantiate the algorithm for predicting the vertical retention of third lower molar in order to improve treatment tactics for the preservation or removal of the tooth which based on the obtained search data and the results of our own clinical observations and it is planned in the future.

Third Molar Surgery: Risk Factors and Complications after Removal of Third Molars

Objective: There is a need for this research because it aims to identify characteristics that increase the likelihood of negative outcomes following the removal of third molars. Study Design: Observational/transversal study Place and Duration: Dental College HITEC-IMS Taxilla/ Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Nov 2020-June 2021 Methods: A total of 180 male and female participants were included in this study. The patients ranged in age from 20 to 50. Pericoronitis and tooth impaction were among the complaints of the patients included in the study. The oral and maxillofacial department operated on all of the patients who requested the removal of their third molars. All patients provided written consent before having their personal data collected, including their age, gender, BMI, kind of impaction, and location of their third molar. Various operative variables were employed. In our research, we looked at post-operative complications and risk variables. The whole data was analyzed with SPSS 23.0. Results: 110 (61.1%) patients were males and 70 (38.9%) cases were females. 28.17±9.47 years were the mean age with mean BMI 24.11±3.65 kg/m2. Most of the teeth impacted in left side found in 102 (56.7%) patients. Most common type of impaction was mesioangular among 90 (50%) cases followed by distoangular 45 (23.7%) cases. Majority of the third molars were fully impacted 120 (66.7%), 38 (21.1%) were partially impacted and frequency of erupted tooth was 22 (12.2%). All the third molars were removed by buccal guttering technique under local anesthesia. Post-operative infection was the most common complication found in 80 (44.4%) cases followed by gingival defect in 27 (15%) radicular fractures in 24 (13.3%) cases. Location of the third molar and bone removal was the most common factor found. Conclusion: There was an increased risk of problems with tooth sectioning, bone removal, and/or tooth localization in patients above the age of 22. Both the evaluation of the indications for the removal of third molars and the process of informed consent should reflect this information. Keywords: Third Molars, Surgery, Anesthesia, Complications, Impactions

Misdiagnosis and Mismanagement of an Infectious Impacted Canine: A Case Presentation

: Tooth impaction is defined as a partial or complete eruption of a tooth regarding the eruption time. Hereby, we present an infectious canine in a 38-year-old man that primarily presented with chest pain and dyspnea. After two days, he demonstrated a painful swelling and erythema of the face, severe perspiration, nasal congestion, and pleural effusion. The patient was diagnosed with acute bronchitis, mucormycosis, and nasal septum abscess, leading to unnecessary antibiotic therapy and lack of treatment response. After oral and maxillofacial surgery consultation, cone-beam computed tomography (CBCT) revealed an impacted and infectious canine that was surgically extracted. Due to lack of desired response to treatment, he underwent CBCT after oral and maxillofacial surgery consultation. An impacted and infectious canine was detected, which was surgically extracted. Three days later, his symptoms significantly improved, and he was discharged with a stable general condition.

Odontomas and imaging diagnosis: the concise systematic review

Introduction: Odontomas are tumors of odontogenic origin. They represent on average 70% of all odontogenic tumors found. Early diagnosis and treatment prevent the loss of tissue element, tooth impaction, bone malformations, and displacement of bone structures, differentiating their types through panoramic radiographic images. Objective: To carry out a concise systematic review of the characteristics of odontomas, differentiating their types through panoramic radiographic images. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 84 articles were found. A total of 36 articles were evaluated in full and 17 were included and evaluated in the present study. A total of 3 Studies with a High Risk of Bias and 1 Study with Uncertain Risk. Radiographic examination is extremely important for the study and diagnosis of odontomas. Odontomas present a characteristic radiographic appearance. In complex odontomas, radiopacity is not specifically determined, showing itself as an irregular and disorganized mass surrounded by a narrow radiolucent zone. In the composite type, the radiographic image is pathognomonic. In the radiopaque image, dozens of denticles simulate small teeth surrounded by a thin radiolucent area. Composite odontoma, on the other hand, consists of the same calcified structures arranged in an orderly and related manner, similar to normal teeth contained in a fibrous capsule. The differential diagnosis of complex odontoma includes osteomas and condensing osteitis. Conclusion: Radiographic and/or tomographic examination is the best way to obtain an accurate diagnosis, precisely delimiting the lesion and nearby and involved structures.

Prevalence of Impacted and Semi-Impacted Teeth and Determination of Impaction Angle of Teeth in Patients of Tooba Clinic, Sari, Iran in 2013-2019

Introduction: Impaction is one of the most common tooth abnormalities which has multiple pathological consequences. The purpose of this study is to assess the prevalence of impacted and semi-impacted teeth and to determine the impaction angle of different teeth in patients referred to the maxillofacial radiology department of dental school, Mazandaran University of medical sciences in years 2013-2019. Material and Methods: The panoramic radiographs of patients who were referred to oral and maxillofacial radiology department of Mazandaran dental school were observed. Impaction or semi-impaction angle of third molars were determined by Winter’s classification. Statistical analysis were conducted by using Chi-square test, Fisher’s exact test, Mann Whitney U test and Spearman correlation test (a= 0/05). Results: 3200 panoramic radiographs were analyzed, and the prevalence of impaction, complete impaction and semi-impaction were calculated to be 25/8%, 3/7% and 23/6% respectively. The mesioangular impaction (48/3%) was the most prevalent kind of impaction. Statistically, age was correlated with the jaw involving tooth impaction (P=0/01), this correlation wasn’t observed about sex (P=0/161). Conclusion: Impacted teeth were observed in approximately one third of the radiographs. Impaction was more common in the mandible and the most prevalent kind of impaction was determined to be the mesioangular impaction. As the impacted tooth can cause problems we conclude that they must be extracted at an early age.

Long term radiographic evaluation of a potentially impacted and dilacerated tooth into complete transposition

Background: Anomalies such as ectopic tooth eruption and transposition are challenging situations that may complicate the orthodontic treatment. Some of these anomalies can only be diagnosed and managed by accurate long-term radiographic examination. Delayed diagnosis could impede simple preventive orthodontic measurements and cause more costly and consuming future complicated orthodontic treatment.Case Description: We described in detail the long term follow-up of a young female patient referring with a unilateral ectopic eruption. The patient was under close observation and regular orthodontic treatment to guide a unilateral ectopic eruption into a complete transposition of an upper left canine and first premolar. The long term follow-up revealed stables results.Practical Implications: Early diagnosis and preventive measurements in patients suffering from anomalies such as ectopic eruption is crucial in order to avoid further complications such as tooth impaction and dilaceration formation and adopting the best choice of treatment.

The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population

Classifications of impacted teeth allow defining the type and degree of retention, as well as assessing the degree of difficulty of the procedure. The aim of this study was to conduct retrospective analysis of the degree of retention and difficulty in the surgical removal of impacted mandibular third molars in the clinical material of the Department of Oral Surgery in 2013–2018. This study included 1585 dental panoramic radiographs of patients of the Department of Oral Surgery, who reported in 2013–2018, in order to perform surgical removal of the impacted mandibular third molar. Based on dental panoramic radiographs, the degree of retention was determined based on classifications according to Winter, according to Pell and Gregory, according to Tetsch and Wagner, and according to Asanami and Kasazaki. The difficulty of the procedure was also assessed based on the Pederson index. The most common types of lower wisdom tooth impaction are as follows: in Winter’s classification, mesial-angular impaction; in Tetsch and Wagner’s classification, oblique medial-angular impaction; in Pell and Gregory’s classification, impaction grade 2A; and in Asanami and Kasazaki’s classification, 3A and anterior inclination. In most cases of surgical removal of an impacted tooth, the anticipated difficulty of the procedure was rated as very difficult.

Association of Polymorphic and Haplotype Variants of the MSX1 Gene and the Impacted Teeth Phenomenon

It is known that genetic factors determine odontogenesis; furthermore, studies have revealed that various genes in humans can regulate the development of different types and generations of teeth. In this study it has been assumed that tooth impaction—at least to some extent—also depends on the presence of specific genetic markers, especially allelic variants of the MSX1 gene. The primary objective of the study was to evaluate the suitability of selected molecular markers located within the MSX1 gene for the determination of the risk of tooth impaction in particular patients. The study participants were divided into two groups: (1) the study group—at least one secondary tooth was impacted in the jaws; (2) the control group—no impacted tooth in the jaws. Real-Time PCR and TaqMan probes were used to detect selected polymorphisms in the analyzed genes. Two single nucleotide polymorphisms of MSX1 were analyzed. After the two subgroups of patients were distinguished in the study group based on the number of impacted teeth, statistically significant differences in the frequency of genotypes described for rs12532 in the MSX1 gene were found.

The influence of wisdom tooth impaction and occlusal support on mandibular angle and condyle fractures

This study aimed to analyze the relationship of the occlusal support together with the lower third molars to the mandibular fractures of the angle and condyle among patients in our medical institutions. This was a retrospective study that reviewed the medical records and radiographs of all patients treated for mandibular fractures from 2015 to 2019. The data collected by using picture archiving and communicating system. Only records with mandibular angle or condyle fractures were included. The dependent variable was the presence of the fractures of the mandibular angle or condyle. The independent variables were epidemiological data, third molar characteristics, existence or absence of occlusal support. The data was analyzed through Univariate logistic regression and multivariate logistic regression. From a total of 187 mandibular fractures, 44 presented mandibular angle fracture and 29 shown condyle fractures. The average age was 40.34 ± 13.47 years. The absence of occlusal support increased the chance of condyle fractures by 5.1 times (95% CI 1.61–17.29). The lack of occlusal support is more associated with condyle fractures than the presence of occlusal support, regardless of third molar presence and characteristics and other variables evaluated.

Association between Dental Anomalies and Orofacial Clefts: A Meta-analysis

Objectives: To conduct a systematic review and meta-analysis to assess whether individuals with nonsyndromic orofacial clefts (OCs) display a higher frequency of dental anomalies (DAs) when compared with individuals without OCs. Methods: A literature search of indexed databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and LILACS) was conducted without language restriction up to and including February 1, 2020. Cross-referencing was used to further identify articles. Several cleft teams across the United States and Europe were contacted to obtain unpublished data. The eligibility criteria were observational studies with original data that statistically compared individuals with OC without syndromes and those without OC on any type of DA in primary and/or permanent dentition. Random effects meta-analysis through the Mantel-Haenszel estimator was used to evaluate the association between OC and DA based on odds ratios (ORs) with 95% confidence intervals (CIs). Results: The literature search generated 933 records, and 75 full-text articles were reviewed. Twenty-six studies encompassing 15,213 individuals met the inclusion criteria. The meta-analysis revealed statistically significant associations between OC and agenesis (OR, 14.2; 95% CI, 9.4 to 21.3), supernumerary teeth (OR, 5.7; 95% CI, 3.3 to 9.7), developmental enamel defects (OR, 5.6; 95% CI, 3.5 to 9.0), microdontia (OR, 14.8; 95% CI, 4.0 to 54.6), peg-shaped anterior teeth (OR, 12.2; 95% CI, 3.6 to 41.2), taurodontism (OR, 1.7; 95% CI, 1.0 to 2.7), tooth malposition and/or transposition (OR, 5.6; 95% CI, 2.8 to 11.5), tooth rotation (OR, 3.2; 95% CI, 1.3 to 8.2), and tooth impaction (OR, 3.6; 95% CI, 1.1 to 12.2). The OR estimates of the reviewed studies exhibited significant heterogeneity ( P < 0.0001). No association was observed between OC and fusion and/or gemination. Conclusion: Within the limitations of this study, the available evidence suggests that individuals with OCs are more likely to present with a range of DAs than their unaffected peers. Knowledge Transfer Statement: The findings of the current review suggest that individuals with orofacial clefts (OCs) are more likely to present with a range of dental anomalies than their unaffected peers. Understanding the association between OCs and dental anomalies is essential in guiding clinicians during treatment-planning procedures and is important in raising our awareness of the possible need for future dental treatment for patients with OCs.