Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve

BACKGROUND Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve(IAN).AIM To proposes a method for the partial grinding of an impacted mandibular third molar(IMM3)near the IAN to prevent IAN injury during IMM3 extraction.METHODS Between January 1996 and March 2022,25 patients with IMM3 roots near the IAN were enrolled.The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3.After 6 months,when the root tips were observed to be away from the IAN on X-ray examination,the remaining part of the IMM3 was completely removed.RESULTS All IMM3s were extracted easily without symptoms of IAN injury after extraction.CONCLUSION Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

Neuroprotection by resveratrol-glucuronide and quercetin-glucuronide via binding to polyphenol-and glycosaminoglycan-binding sites in the laminin receptor

The dietary polyphenolic compounds resveratrol and quercetin prevent neurodegenerative diseases in experimental models;however, they reach the brain only in nanomolar concentrations in the glucuronidated and sulfated forms, and not as the aglycone parent form(Pasinetti et al.,2015).

Management of Mandibular Fractures in Children in Ivory Coast: Experience of the Stomatology and Maxillofacial Surgery Department at the University Hospital of Cocody from 2000 to 2019

Introduction: Mandibular fractures in children are becoming increasingly common. Treatment of these fractures is difficult due to their anatomical and physiological complexity. Therefore, there is a need for well-codified management. Our main aim was to develop a decision algorithm for the management of mandibular fractures in children based on our experience. Materials and Methods: This was a retrospective descriptive study carried out in the Department of Stomatology and Maxillofacial Surgery at the University Hospital of Cocody over a period of 20 years (2000-2019). Results: We enrolled 58 patients. The mean age of the patients was 9.35 ± 2.3 years with a sex ratio of 2.22. Traffic accidents were the main cause of mandibular fractures (60.35%). Condylar fractures were the most common (46.87%). Treatment was orthopedic in 45.76% of cases, mixed (orthopedic and surgical) in 24.14% and surgical in 5.17%. Patients were followed up weekly for 1 month, then monthly for 6 months and annually for 3 years, with panoramic radiographs of the maxilla starting at 21 days. We observed 2 cases of complications: temporomandibular ankylosis and gingival stomatitis. Conclusion: Mandibular fractures are common in children. Management is difficult due to anatomical and physiological peculiarities. The choice of treatment depends on several criteria.

Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies.These lesions can arise from various tissues,including bone,cartilage,and soft tissue,each presenting distinct challenges in diagnosis and treatment.While some pathologies exhibit characteristic imaging features that aid in diagnosis,many others are nonspecific.This overlap often necessitates a multimodal imaging approach,combining techniques such as radiographs,computed tomography,and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations.This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors,including updates on the 2022 World Health Organization classification of these tumors.The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Solitary intraosseous neurofibroma in the mandible mimicking a cystic lesion:A case report and review of literature

BACKGROUND Neurofibromas are benign tumors of a neurogenic origin.If these tumors occur without any other signs of neurofibromatosis,they are classified as isolated neurofibromas.Neurofibromas in the oral cavity mostly occur within soft tissues,indicating that solitary intraosseous neurofibromas in the mandible are rare.Due to the absence of specific clinical manifestations,early diagnosis and treatment of these tumors are difficult to achieve.CASE SUMMARY A 37-year-old female patient visited our hospital due to numbness and swelling of the gums in the right lower molar area that had persisted for half a month.The patient’s overall condition and intraoral examination revealed no significant abnormalities.She was initially diagnosed with a cystic lesion in the right mandible.However,after a more thorough examination,the final pathological diagnosis was confirmed to be neurofibroma.Complete tumor resection and partial removal of the right inferior alveolar nerve were performed.As of writing this report,there have been no signs of tumor recurrence for nine months following the surgery.CONCLUSION This case report discusses the key features that are useful for differentiating solitary intraosseous neurofibromas from other cystic lesions.

Clinical and Paraclinical Epidemiological Aspects of Multifocal Fractures of the Mandible in Chuo

Introduction: Multifocal fractures of the mandible are responsible for the modification of anatomy with functional and aesthetic repercussions. The aim of our work is to determine the clinical and paraclinical epidemiological aspects of multifocal mandible fractures. Materials and Methods: Retrospective, descriptive study conducted at the Department of Stomatology and Maxillofacial Surgery of the University Hospital of Owendo, from January 2018 to January 2021. All mandibular multifocal fractures with radiological images were included, while all incomplete records and monofocal fractures were not included. Data collection was done on a form from patient records. Age, sex, mode of transport, periodicity, mechanisms, etiologies, soft tissue lesions, dental joint disorder, sensitivity disorder, dental damage, radiological examination, the number and location of fracture features, and associated lesions were the variables studied. Results: 49 files collected;the average age of 28 ± 8.4 years;male predominance at 75.5%. Personal transport was used at 53%, November was the most accident-prone month, road accident was the dominant etiology at 59%, and direct mechanism at 88%. Stomatoragia predominated at 98%, and hypoaesthesia predominated at 30%. The lesional association with the facial massif was 20%. The CT scan was performed at 61%. The bifocal fracture was the most common at 84%. Discussion: According to Alexander violent assaults are the main cause but for Mala it is MVA. The dental panoramic is the basic examination. For Rocton and Mala, the bifocal fracture is the most frequent of the multifocal fractures. Conclusion: Multifocal fractures are the prerogative of the young subject and road accident is the dominant etiology.

Cemento-ossifying fibroma of the left mandible:A case report

BACKGROUND Ossifying fibroma is a type of benign fibro-osseous lesion.Most lesions affect the mandible region,particularly the molar and pre-molar areas.It predominantly affects females between the second to fourth decades of life.Larger ossifying fibroma tumors require more extensive resection.CASE SUMMARY A 39-year-old female complained of occasional pain and tumor enlargement on her left jaw for the 3 years prior to presentation.Intraoral examination revealed a firm swelling on her left lower gum.Extraoral examination revealed swelling on the left mandible body with no erythema and superficial ulcer.Computed tomography scan revealed a circular-shaped lesion on the patient’s left mandible body with a well-defined radiolucent border,sized 3.2 cm×2.8 cm×0.9 cm.The tumor was removed by marginal mandibulectomy.Biopsy from the resected tumor suggested cemento-ossifying fibroma(COF).CONCLUSION COF is often unnoticed,but this slow-growing tumor can cause significant symptoms regarding its distortion into adjacent structures.

Removal of nonimpacted third molars alters the periodontal condition of their neighbors clinically, immunologically, and microbiologically

Considering the adverse effects of nonimpacted third molars(N-M3s)on the periodontal health of adjacent second molars(M2s),the removal of N-M3s may be beneficial to the periodontal health of their neighbors.This study aimed to investigate the clinical,immunological,and microbiological changes of the periodontal condition around M2s following removal of neighboring N-M3s across a 6-month period.Subjects with at least one quadrant containing an intact first molar(M1),M2,and N-M3 were screened and those who met the inclusion criteria and decided to receive N-M3 extraction were recruited in the following investigation.M2 periodontal condition was interrogated before M3 extraction(baseline)and at 3 and 6 months postoperatively.Improvements in clinical periodontal indexes of M2s in response to their adjacent N-M3 removal,along with changes in inflammatory biomarkers among gingival crevicular fluid(GCF)and the composition of subgingival plaque collected from the distal sites of the M2s of the targeted quadrant were parallelly analyzed.Complete data of 26 tooth extraction patients across the follow-up period were successfully obtained and subsequently applied for statistical analysis.Compared to the baseline,the periodontal condition of M2s was significantly changed 6 months after N-M3 removal;specifically,the probing depth of M2s significantly reduced(P<0.001),the matrix metalloproteinase(MMP)-8 concentration involved in GCF significantly decreased(P=0.025),and the abundance of the pathogenic genera unidentified Prevotellaceae and Streptococcus significantly decreased(P<0.001 and P=0.009,respectively).We concluded that N-M3 removal was associated with superior clinical indexes,decreased GCF inflammatory biomarkers,and reduced pathogenic microbiome distribution within the subgingival plaque.Although the retention or removal of N-M3s continues to be controversial,our findings provide additional evidence that medical decisions should be made as early as possible or at least before the neighboring teeth are irretrievably damaged.

Clinical Effect of Resistance-free Removal of the Bone Embedded Mandibular Third Molar

[Objectives] To shorten the time of removal of the bone embedded mandibular third molar,reduce the complications of tooth extraction,and explore a surgery method of resistance-free removal of the mandibular third molar. [Methods] A total of 50 patients with bone embedded mandibular third molar needing to be removed were selected. A 45° elevation turbine and a long tungsten steel drill were used to remove the mesial,buccal,and distal resistances. When necessary,tongue side and root resistance was removed,and the third molar was removed when there was basically no resistance around it. The removal time was recorded,followed up for 10 d,and the postoperative reaction was observed. [Results] The bone embedded mandibular third molars were removed for all patients within 15 min,and there was no serious postoperative reaction,all patients showed high satisfaction. [Conclusions]The method of resistance-free removal of the bone embedded mandibular third molar can significantly shorten the removal time,reduce the fear of patients,and ease pain of patients.

Comparison of an alveolar expansion technique and buccal guttering technique in the extraction of mandibular third molar. A Pilot Study

Background: The over-ambitious use of surgical drills for almost every case of third molar impaction is on the increase in most established oral surgery centers. The purpose of this study was to assess and compare the severity of post operative symptoms of swelling and pain that accompany the use of surgical drill in the buccal guttering technique and the non application of drill in an alveolar expansion technique. Methods: Consecutive patients with bilateral impacted lower third molars not associated with pericoronitis were included in the study, a total of 10 patients were included in the study. Extraction of both impacted third molars was done consecutively on the same day under local anaesthesia. Post operative morbidities that were assessed clinically are swelling and pain. Results: A total of 10 patients, 70% were females and males were 30%. Age range was 27 - 35 yrs.Out of the eight patients that had the two different techniques, 7 preferred the use of the alveolar expansion technique in which drill was not used. There were statistically significant differences in swellings between these two techniques, (p 0.01). Conclusions: To avoid excessive swelling and pain from over-ambitious cut-ting of soft tissues and drilling of bone, alveolar expansion technique should be considered first in pa-tients with less dense bone.

Successful surgical extraction of an impacted mandibular third molar in a patient treated with head & neck radiotherapy and chemotherapy for oral cancer

Osteoradionecrosis(ORN),a pathological condition characterized by a nonvital bone occurring in the site of radiation injury,is one of the significant risks following extraction of highly impacted third molar teeth in patients treated with head&neck radiotherapy for oral cancer.Therefore,the surgery’s meticulous planning is essential to avoid such complications.This case report describes a 63-year-old male patient diagnosed with an impacted lower third molar(tooth#38)with concurrent basal cell carcinoma of the right ear and squamous cell carcinoma of the right vocal cord treated with radiotherapy.Taking into account the patient’s health status,a minimally invasive osteotomy and a corono-radicular separation procedure were performed.This procedure allowed us to reduce the risk of mandibular ORN.Three years later,the healing was complete,and the situation was stable.

The influence of the eruption of mandibular third molars on the craniofacial morphology in Han youth of North China

Teeth affect not only oral problems but also facial morphology.In China,there are few reports about the influence of the third molars on the craniofacial morphology of Han youths.Using in vivo imaging software,3D reconstruction of craniofacial CTs were performed on 32 Chinese Han youths without mandibular third molars and 25 Chinese Han youth with full mandibular third molars.The morphology of their mandible and mandibular tissue was measured to identify differences.Among the morphological characteristics of hard tissues,except for∠ANB,people with a full eruption of the mandibular third molars had statistically significantly larger angle indicators than people without the eruption of the third molars.The soft tissue indicators also showed statistically significant discrepancies in terms of morphological facial height,mouth to gnathion distance,lip height,and mouth breadth.The most influential index for mandibular third molars was length of symphysis,followed by the four indicators of soft tissue and mandible length and height.Morphology facial height,mouth to gnathion distance,lip height,and height of symphysis were moderately correlated.The experimental results show that among Han youth in North China,the third molar eruption has a widespread influence on mandibular morphology,especially in angle,length,and height indicators.It also has a certain influence on maxillofacial soft tissue morphology.These results can be applied to future clinical risk assessment of the wisdom teeth and forensic personal identification of the cranial and maxillofacial region.

Methylprednisolone injection following the surgical extraction of impacted lower third molars:A split-mouth study

Purpose: The purpose of the present study was to compare the effect of intramuscular masseter administration of methylprednisolone using a split-mouth design, as a single 20-mg dose, after removal of impacted lower third molars. Patients and Methods: A non-blind, cross-over, comparative, non-randomized, clinical trial was planned. The sample was composed of 32 patients requiring extraction under local anesthesia of two lower bony impacted mandibular third molars. The difficulty of extraction was similar in all cases. The patients received 20 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound on the right side. The left side received no intramuscular corticoid. Evaluations were made of postoperative pain and swelling. Results: A total of 32 subjects requiring surgical removal of two impacted mandibular third molars under local anesthesia were included in the present study. The patients administered methylprednisolone showed superior results after surgery in terms of pain and facial swelling parameters using self-evaluation, with statistically significant differences versus the control-side (p < 0.05). The results obtained show that 20 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling and pain. Conclusions: Injection of methylprednisolone is an effective therapeutic strategy to reduce swelling and pain after surgical removal of impacted lower third molars. It offers a simple, safe, painless, noninvasive, and cost effective therapeutic option for moderate and severe cases.

The Efficacy of 1% Chlorhexidine Gel on the Reduction of Dry Socket Occurence Following Surgical Third Molar Extraction—Pilot Study

Aim & Objectives: The aim of this prospective pilot-study was to assess the efficacy of intra alveolar application of 1% chlorhexidine gel (CHX) on the reduction of dry socket (DS) occurrence following surgical extraction of mandibular third molars. Materials and Methods: A randomized split-mouth-design study included twenty-five patients with bilaterally impacted lower third molars (partial or full bone) requiring full thickness mucoperiastal flap reflection for extraction. Following surgical extraction of third lower molar, 2 ml of gel containing 1% chlorhexidine digluconate (Chlorhexamed? Gel 1%) were placed in the experimental side, and saline solution was used for irrigation in the control side of extraction sockets, both followed by suturing of extraction site. The surgeries and follow up examinations were performed by the same surgeon. The follow up visits were performed at 48 hours and on day seven, post surgery where presence or absence of dry socket using the Blum criteria for diagnosis was evaluated and pain intensity by Visual Analogue Scale (VAS) 0 - 100 was observed. Results: In this pilot study, dry socket was present in 4.0 and 28.0% of cases in the experimental and control groups, respectively (P = 0.048). Fisher’s test revealed a statistically significant reduction of dry socket occurrence following the use of 1% CHX gel versus saline solution. Conclusion: The application of CHX gel 1% may significantly reduce the incidence of DS following third molar extraction. Prophylactic use of CHX gel 1% may be suggested in all patients, especially in the patients at risk of development of DS.

A Case Report of Kissing Molars Class II

Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.

Transfer learning-based super-resolution in panoramic models for predicting mandibular third molar extraction difficulty: a multi-center study

Background:This study aims to predict the extraction difficulty of mandibular third molars based on panoramic images using transfer learning while employing super-resolution(SR)technology to enhance the feasibility and validity of the prediction.Methods:We reviewed a total of 608 preoperative mandibular third molar panoramic radiographs from two medical facilities:the First Affiliated Hospital of Zhengzhou University(n=509;456 in the training set and 53 in the test set)and the Henan Provincial Dental Hospital(n=99 in the validation set).We conducted a deep-transfer learning network on high-resolution(HR)panoramic radiographs to improve the longitudinal resolution of the images and obtained the SR images.Subsequently,we constructed models named Model-HR and Model-SR using high-dimensional quantitative features extracted through the Least Absolute Shrinkage and Selection Operator method.The models’performances were evaluated using the receiver operating characteristic curve(ROC).To assess the reliability of the model,we compared the results from the test set with those of three dentists.Results:Model-SR outperformed Model-HR(area under the curve(AUC):0.779,sensitivity:85.5%,specificity:60.9%,and accuracy:79.8%vs.AUC:0.753,sensitivity:73.7%,specificity:73.9%,and accuracy:73.7%)in predicting the difficulty of extracting mandibular third molars.Both Model-HR(AUC=0.821,95%CI 0.687–0.956)and Model-SR(AUC=0.963,95%CI 0.921–0.999)demonstrated superior performance compared to expert dentists(highest AUC=0.799,95%CI 0.671–0.927).Conclusions:Model-SR yielded superior predictive performance in determining the difficulty of extracting mandibular third molars when compared with Model-HR and expert dentists’visual assessments.

Incidence of C-shaped root canal systems in mandibular second molars in the native Chinese population by analysis of clinical methods

The aims of the study were to investigate the incidence of C-shaped root canal systems in mandibular second molars in a native Chinese population using radiography and clinical examination under microscope and to compare the relative efficacies of these methods. For the recognition of C-shaped root canal system, 1 146 mandibular second molars were selected and examined. Teeth with C-shaped canal systems were categorized by using the radiographic classification criteria and the modified Melton＇s method. C-shaped canals were identified in 397 （34.64%） mandibular second molars by radiography （type I, 31.23%; type II, 38.29%; type III, 30.48%）. Clinical examination showed that 449 （39.18%） cases exhibited C-shaped canal systems （C1, 22.94%; C2, 48.11%; C3a, 15.59%; C3b, 13.36%）. As for the result of the radiographic and clinical combined examination, C-shaped root canals were found in 473 （41.27%） mandibular second molars （C1, 21.78%; C2, 45.67%; C3a, 16.70%; C3b, 15.86%）. The incidence of C-shaped root canal diagnosed by radiographic method was statistically different from that by clinical examination and the combined examination （P〈O.05）. The study indicated a high incidence of C-shaped canal system in a Chinese population. The combination of microscopic and radiographic examination is an effective method in identifying the C-shaped root canal system.

Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma

Background:The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible(RIOSM) has become a significant problem that can limit long-term survival.The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma(NPC).Methods:We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012.Of these patients,47 who developed RISOM and met inclusion criteria were included in this study.Two of these 47 patients refused treatment and were then excluded.Results:For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period,the total incidence of RIOSM after radiotherapy was 0.084%(47/53,760).Two patients(4.4%) had metastases at the diagnosis of RIOSM.Thirty-nine of the 45(86.7%) patients underwent surgery for RIOSM;most patients(24/39;61.5%) who underwent resection had gross clear margins,with 15 patients(38.5%) having either a gross or microscopic positive margin.All patients died.The 1-,2-,and 3-year overall survival(OS) rates for the entire cohort of 45 patients were 53.3%,35.6%and 13.5%,respectively.The independent prognostic factors associated with high OS rate were tumor size and treatment type.Conclusions:RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention.Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

Three-dimensional computed topography analysis of a patient with an unusual anatomy of the maxillary second and third molars

We present a case of a patient with rare anatomy of a maxillary second molar with three mesiobuccal root canals and a maxillary third molar with four separate roots, identified using multi-slice computed topography （CT） and three-dimensional reconstruction techniques. The described case enriched/might enrich our knowledge about possible anatomical aberrations of maxillary molars. In addition, we demonstrate the role of multi-slice CT as an objective tool for confirmatory diagnosis and successful endodontic management.

Stafne’s Bone Defect in Atypical Location: Between the Subcondylar Region and Neck of the Mandible Ramus

CONTEXT: Stafne’s bone defect is a benign lesion appearing on the image as a round radiolucent lesion within a cortical defect on the mandible. CASE REPORT: We attend one 46-year-old male patient came for diagnostic evaluation of a rounded and radiolucent lesion in the transition of the subcondylar region and neck of the left mandible ramus incidentally found by a dentist. Computed tomography and magnetic resonance imaging were performed in medical radiology and a Stafne’s cyst was diagnosed in an atypical location. CONCLUSION: We emphasize that Stafne’s bone defect is a benign lesion, whose imaging diagnosis can be conclusive, avoiding unnecessary surgical procedures.