• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권5호
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• pp.251-258
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• 2016

Objectives: The aim of this retrospective study was to investigate factors associated with increased difficulty in the surgical extraction of impacted lower third molars and to improve identification of difficult cases. Materials and Methods: A total of 680 patients who required 762 surgical extractions of impacted lower third molars from 2009 to 2014 were enrolled in the study. Demographic factors, clinical factors, radiographic factors, surgical extraction difficulty, and presumed causes of difficulty were collected. Data were statistically analyzed using IBM SPSS Statistics version 23. Results: Age, sex, depth of impaction, and blurred radiographic image influenced difficulty in surgical extraction. The position of the impacted tooth influenced surgical difficulty, especially when it was accompanied by other factors. Conclusion: It is challenging to design a reliable and practical instrument to predict difficulty in surgical extraction of impacted lower third molars. To identify very difficult cases, root investigation using computed tomography is advised when impacted tooth position suggests difficult extraction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권5호
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• pp.343-348
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• 2011

Introduction: Third molar extraction is one of the most common procedures in oral and maxillofacial surgery. The impacted third molar causes many pathological conditions, such as pericoronitis, caries, periodontitis, resorption of adjacent teeth, and cyst or tumors associated with impacted teeth. Extraction is often considered the treatment of choice for impacted lower third molars. On the other hand, imprudent extraction of deeply impacted third molars can cause permanent complications, such as inferior alveolar nerve damage. Therefore, guidelines for the extraction of lower third molars should be set to prevent embarrassing complications. This study examined the indication and current trends of the extracted lower third molars in the dental hospital of a dental college. Materials and Methods: 557 extracted third molars were evaluated at the department of oral and maxillofacial surgery of Yonsei University. The chief complaint, diagnosis, age and degree of impaction were analyzed to determine the tendency for the extraction of asymptomatic lower third molars. Results: The percentage of asymptomatic third molars was 40.8%. In cases of full impacted tooth or full erupted tooth, the percentage of asymptomatic teeth was more than 50% (52.4% and 54.3, respectively). Among those partially impacted teeth, 73.1% of them showed symptoms, such as pain, tenderness and swelling. In terms of age, pericoronitis was evident at a younger age, and dental caries/periodontitis was the main cause of removal in those aged over 50. Twenty nine cases (1.6%) had teeth associated with pathological changes Conclusion: The incidence of pathological changes to the lower third molar was relatively low. Surgical extraction is recommended in cases of partially impacted teeth. In Korea, the incidence of asymptomatic third molar extraction was relatively higher than in European countries. More careful attention would be desirable to consider the risks and benefits of lower third molar extraction.

• 대한치과교정학회지
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• 제11권2호
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• pp.77-83
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• 1981

The author analyzed the morphological pattern of mandibles and lower third molars in order to study and predict the impaction of the developmental third molars. The subjects consisted of 37 males and 87 females with malocclusion. The following results were obtained: 1. The mandible was shown to be shorter in the impacted third molar group than in the erupted group, both in over-all length and in body length. 2. The developmental mesial angulation of the third molar to the mandibular plane was higher in the impacted third molar group. 3. There was a tendency for impacted third molars to be slightly larger than those which erupted except Class II malocclusion in female. 4. In the available space for the eruption of the third molar, significant space deficiency was found in association with the impacted third molar group compared with the erupted group.

• Imaging Science in Dentistry
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• 제53권2호
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• pp.137-144
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• 2023

Purpose: This study aimed to evaluate the anatomic circle around the impacted lower third molar to show, document, and correlate essential findings that should be included in the routine radiographic assessment protocol as clinically meaningful factors in overall case evaluation and treatment planning. Materials and Methods: Cone-beam computed tomographic images of impacted lower third molars were selected according to specific inclusion criteria. Impacted teeth were classified according to their position before assessment. The adjacent second molars were assessed for distal caries, distal bone loss, and root resorption. The fourth finding was the presence of a retromolar canal distal to the impaction. Communication with the dentist responsible for each case was done to determine whether these findings were detected or undetected by them before communication. Results: Statistically significant correlations were found between impaction position, distal bone loss, and detected distal caries associated with the adjacent second molar. The greatest percentage of undetected findings was found in the evaluation of distal bone status, followed by missed detection of the retromolar canal. Conclusion: The radiographic assessment protocol for impacted third molars should consider a step-by-step evaluation for second molars, and clinicians should be aware of the high prevalence of second molar affection in horizontal and mesioangular impactions. They also should search for the retromolar canal due to its associated clinical considerations.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권2호
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• pp.131-136
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• 2016

Background: This study aimed to evaluate the patient's pain and quality of life after suture removal at either 3 or 7 days following the bilateral surgical extraction of impacted lower third molars. Methods: This study was a prospective, randomized controlled clinical trial carried out in 30 patients, who acted as their own control. Each patient required the bilaterally impacted mandibular third molars to be extracted. The impacted teeth were removed and the wound margins were approximated and sutured with black braided silk. The suture material was removed on day 3 on one side and on day 7 on the other. Each participant was asked to complete a questionnaire after the removal of the suture material on each designated day. Results: Regarding overall clinical symptoms, the mean VAS scores of male and female participants on day 3 were not significantly different from those on day 7. A significant difference was found in female participants, in that overall daily activity was better on day 7. There were significant differences in the ability to smile and laugh in both sexes and the ability to chew in the male participants was better on day 7. Conclusions: There were no significant differences in the patient's pain and quality of life between suture removal on day 3 or on day 7 following surgery to remove impacted lower third molars.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권1호
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• pp.69-77
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• 2001

PURPOSE : The Purpose of this study was to investigate the anti-inflammatory effect on combination dosage of dexamethasone and naproxen after removal of impacted 3rd molars. We evaluated postoperative pain, swelling, and mouth opening limitation quantitatively. PATIENTS AND METHODS : Removal of an impacted lower third molar was done under local anesthesia with 2% lidocaine to 239 healthy patients. We randomly gave experimental group 1.5mg dexamethasone and 200mg naproxen three times a day for postoperative 2days, and also gave control group 200mg naproxen alone three times a day for postoperative 2days. Swelling and pain were measured by visual analogue scale (VAS). Mouth opening limitation was measured by maximum interincisal opening length. We estimated these measurements in the first and second postoperative days. Differences between experimental and control group were investigated considering age, sex, BMI(body mass index), impacted type, surgical site(right or left), and operation time by independent student T-test. RESULTS : In general, swelling, pain, and mouth opening limitations were significantly reduced (p<0.01) by combination dose of dexamethasone and naproxen in postoperative one day. But there was no difference in pain on the second postoperative day. As variables being considered, in the postoperative pain, there was significant difference between experimental group and control group in only male, little bony removal group, left side extraction group. In case of postoperative swelling, there was no significant differences in male, adolescence, long operating time group (over 20 minutes), medium BMI group and right side extraction group. In case of postoperative mouth opening limitation, there was significant difference between only female and long operating time group (over 20 minutes). CONCLUSION : Variables being considered, postoperative swelling was more reduced by the combination dose of naproxen and dexamethasone than that of naproxen alone after removal of impacted 3rd molars. But there was varoius results in pain and mouth opening limitation.

• Imaging Science in Dentistry
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• 제53권4호
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• pp.303-312
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• 2023

Purpose: This study investigated the prevalence of developmental and acquired pathologic conditions associated with impacted third molars (3Ms) in a Southern Brazilian population and evaluated whether demographic and tooth characteristics were correlated with the presence of bone or tooth lesions. Materials and Methods: Panoramic radiographs were assessed for developmental (bone-related) or acquired (tooth-related) pathoses associated with impacted upper or lower 3Ms. Data on tooth positioning, tooth development, and patient demographics were collected. A trained, calibrated postgraduate student evaluated all images. Binary and multivariate logistic regression models were used to assess associations between outcomes and the demographic and radiographic variables. The threshold for statistical significance was set at 5% (P<0.05). Results: The sample comprised panoramic radiographs from 2054 patients, predominantly female (59.2%), with a mean age of 27.2±11.5 years. Overall, 4066 impacted 3Ms were evaluated, revealing 471 (11.6%) developmental and 710 (17.5%) acquired pathoses. Among the developmental pathoses, 460 (95.2%) were indicative of dentigerous cysts. Male sex, lower 3M location, vertical or distoangular positioning, and incomplete root formation were associated with an elevated likelihood of developmental pathology. Lower tooth position, complete root formation, and partial eruption were linked to an increased probability of an acquired pathology in the third or second molar. Conclusion: The prevalence of pathologic conditions associated with impacted 3Ms was low. Male sex, lower 3M placement, horizontal or distoangular positioning, and incomplete root formation were associated with developmental pathoses, while lower tooth position, complete root formation, and partial eruption were related to acquired pathoses.

• 대한치과교정학회지
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• 제17권2호
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• pp.321-333
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• 1987

The purpose of this study was to observe the changes of the lower 3rd molars following the extraction of the lower 2nd molars by Lateral Cephalograms and Orthopantomograms. The subjects consisted of twenty malocclusion, 7 males 13 females, were 19 year 5 month old at the removal of the lower 2nd molars, 19 year 1 month old at the end of the orthodontic supervision after the removal of the lower 2nd molars (mean age) The obtained results were as follows, 1 It is recommended to extract the lower 2nd molars when the lower 3rd molars are Nolla's Stage 4 or 5 2 With the pre-extraction variables obtained by factor analysis, it was possible to predict the long axis of the lower 3rd molars after 2nd molar extraction. 3 There were no impacted 3rd molars.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권1호
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• pp.29-35
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• 2017

Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

• 대한치과교정학회지
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• 제18권1호
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• pp.79-88
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• 1988

The purpose of this study was to investigate the factors which might be related to mandibular third molar eruption and to predict the possibility of whether or not it will be erupted. The material of this study was lateral cephalometric radiograms, pantomograms and dental casts obtained from 70 patients (19 males, 51 females) ranging in age from 18.0 to 32.1 years. They were devided into erupted group and impacted group of mandibular third molars. For the comparison of each group, a total of 20 measurement items were employed and the data were analyzed by means of computer statistical method. As a result of this study, the following conclusion can be made; 1. The longer mandibular body length and narrower mandibular ramus width, the higher eruption tendency of the lower third molar, but the degree of genial angle was not related to mandibular third molar eruption. 2. The lower percentage of posterior mandibular body height to anterior mandibular body height, the higher eruption tendency of the lower third molar. 3. The total tooth size, including the lower second molar, appeared to be larger in the impacted group than in the erupted group of the lower third molar. 4. The arch length discrepancy of the impacted group was more severe in contrast with the erupted group of the lower third molar.