• Imaging Science in Dentistry
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• v.39 no.4
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• pp.209-212
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• 2009

Bifid mandibular canal can be an anatomic variation. This condition can lead to complication when performing mandibular anesthesia or during extraction of lower third molar, placement of implants and surgery in the mandible. Four patients underwent preoperative imaging for extraction of third molars using CBCT (CB Mercuray, Hitachi, Japan). The axial images were processed with CBworks program 2.1 (CyberMed Inc., Seoul, Korea). The branches for supplying the lower third molar were identified mainly on cross-sectional and panoramic images of CBCT. Since the location and configuration of mandibular canal variations are important in any mandibular surgical procedures, we report 4 cases of bifid mandibular canal with panoramic and the CBCT images.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.5
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• pp.407-408
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• 2021

Extraction of impacted third molars is a routine procedure performed by oral and maxillofacial surgeons. However, extractions in middle-aged or elderly individuals are not easy, and there are several factors that need to be considered. These factors include decreased healing potential and the risk of complications increasing with age. In addition, third molars can often be fully or deeply impacted in middle-aged individuals, and pathologic changes, such as cysts, caries, or periodontitis of the adjacent second molar, can develop. Furthermore, the rate of ankylosis and systemic disease increases after middle age. It is considered that these factors acting alone or in combination increase the difficulty of extraction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.370-375
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• 1999

To evaluate the efficacy of antibiotic administration in the impacted mandibular third molar extraction the author investigated 107 patients requiring extraction of the lower third molar who visited at the Department of oral and maxillofacial Surgery, Chosun Dental Hospital and were healthy without medical problems and had no signs and symptoms of infection around the lower third molar. The patients were divided into 4 groups according to the method of antibiotics administration: 13 patients without antibiotics administration(group 1), 30 patients with only intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure(group 2), 39 patients with intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure and oral administration of follow-up dosages of $Augmentin^{(R)}$ for 1 day(group 3), and 25 patients with intravenous injection of $Cefazoline^{(R)}$ 2.0g 30 minutes before the procedure and oral administration of follow-up dosages of $Augmentin^{(R)}$ for 3 day(group 4). Infection rates after extraction were calculated and compared according to gender, the age of the patients, the level of impaction, and also compared between four groups. The results were as follows. 1. The overall infection rate was 8.4%. 2. The infection rate was higher in male(11.9%) than in female(4.2%), but there were statistically no significant differences between them. 3. Infection rate was lower in patients under age 30(7.2%) than in patients over age 30(12.5%), but there were statistically no significant between them. 4. Infection rate was higher in patients with complete bony impacted tooth(11.1%) than in patients with partial bony impacted tooth(6.5%), but there were statistically no significant differences between them. 5. Infection rate was 7.7% in group 1, 10.0% in group 2, 10.3% in group 3, 4.0% in group 4 and there were statistically no significant differences between groups. In summary, it is more important to extract the impacted lower third molar under aseptic condition and to minimize the injury of tissue if possible than to administer the preventive antibiotics in reducing the infection rate in healthy patients without medical problems who had no signs and symptoms of infection around the lower third molar.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.597-599
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• 2010

Subcutaneous emphysema and pneumomediastium is a relatively uncommon phenomenon. Most case of pneumomediastium are caused by iatrogenic injury on the cervical region and chest during tracheostomy. It is also well known that emphysema may occur secondary to dental treatment using high-speed air turbine handpiece, but there have been few cases of emphysema extended to involving the mediastinum. These complications are reported to occur mainly in patients after dental procedures, in particular during mandibular third molar extraction. Early recognition and conservative treatment of these problems is essential in preventing life-threatening complications such as airway obstruction, mediastinitis, pneumothorax and cardiac failure. As we report a case of 25-year-old woman with subcutaneous emphysema and pneumomediastium after mandibular third molar extraction using high-speed air turbine handpiece.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.11-19
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• 2019

Hyaluronic acid (HA) has long been studied in diverse applications. It is a naturally occurring linear polysaccharide in a family of unbranched glycosaminoglycans, which consists of repeating di-saccharide units of N-acetyl-D-glucosamine and D-glucuronic acid. It is almost ubiquitous in humans and other vertebrates, where it participates in many key processes, including cell signaling, tissue regeneration, wound healing, morphogenesis, matrix organization, and pathobiology. HA is biocompatible, biodegradable, muco-adhesive, hygroscopic, and viscoelastic. These unique physico-chemical properties have been exploited for several medicinal purposes, including recent uses in the adjuvant treatment for chronic inflammatory disease and to reduce pain and accelerate healing after third molar intervention. This review focuses on the post-operative effect of HA after third molar intervention along with its various physio-chemical, biochemical, and pharmaco-therapeutic uses.

• Journal of Oral Medicine and Pain
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• v.44 no.1
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• pp.40-44
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• 2019

Third molar extraction, one of the important surgical treatments commonly practiced in dentistry, presents various symptoms after surgery ranging from temporary or mild symptoms to permanent or severe complications. However, oral burning pain, dysesthesia, parageusia, dry mouth, headache and pain in multiple teeth are not the common symptoms that patients often complain after dental extraction. Here, the authors report two cases who presented acute neuropathic symptoms mentioned above in the orofacial regions following third molar extraction. At the initial examination, the healing of the tooth sockets of two patients was normal. One patient was diagnosed as megaloblastic anemia associated with Vitamin $B_{12}$ deficiency and was referred to the Department of Hematology for assessing the underlying etiology of anemia. The laboratory test for the other patient revealed microcytic anemia related to iron deficiency. The patient with iron deficiency anemia was successfully treated with iron supplement. These two cases suggest that anemia, as an underlying systemic disease, may be a rare etiology explaining acute onset of peripheral neuropathy in the orofacial regions after third molar extraction and should be considered in the assessment of patients who report neuropathic symptoms after dental extraction.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.4
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• pp.213-220
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• 2023

Background: Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. Methods: A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. Results: In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. Conclusion: The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

• Journal of Periodontal and Implant Science
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• v.38 no.2
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• pp.225-230
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• 2008

Purpose: Many clinical studies have reported that higher success rates are achieved with teeth that have immature roots than other autotransplanted teeth that have more immature root. However, based on date published recently, the success rate of autotransplantation of teeth with complete root formation was higher. The purpose of this study was to examine the long term(2 to 6 years follow-up) success rate of autotransplantation of third molar with complete root formation and to discuss some conditions and prerequisites for success. Materials and Methods: 26 sites of 24 patients aged 26 to 55 (mean age 40.8) were autotransplanted with third molars with complete root formation. These cases were followed for 2 to 6 years after surgery. The success criteria included (1) no discomfort during functioning (2) absence of progressive root resorption and alveolar bone resorption. Result: Of 26 teeth 5 teeth were failed, therefore success rate is 81%(21/26 teeth). The results suggested that higher success rate is acquired from (1) extraction socket due to dental caries (2) mandibular recipient site (3) patient younger than 40 years old. Autotransplantation of third molar to replace molars with advanced periodontal disease also showed considerably high success rate(84%). Conclusion: With appropriate case selection, autotransplantation of third molar with complete root formation remains a viable alternative for replacing a missing molar tooth.

• Imaging Science in Dentistry
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• v.46 no.1
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• pp.1-7
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• 2016

Purpose: This study assessed the accuracy of age estimates produced by a regression equation derived from lower third molar development in a Thai population. Materials and Methods: The first part of this study relied on measurements taken from panoramic radiographs of 614 Thai patients aged from 9 to 20. The stage of lower left and right third molar development was observed in each radiograph and a modified Gat score was assigned. Linear regression on this data produced the following equation: Y=9.309+1.673 mG+0.303S (Y=age; mG=modified Gat score; S=sex). In the second part of this study, the predictive accuracy of this equation was evaluated using data from a second set of panoramic radiographs (539 Thai subjects, 9 to 24 years old). Each subject's age was estimated using the above equation and compared against age calculated from a provided date of birth. Estimated and known age data were analyzed using the Pearson correlation coefficient and descriptive statistics. Results: Ages estimated from lower left and lower right third molar development stage were significantly correlated with the known ages (r=0.818, 0.808, respectively, $P{\leq}0.01$). 50% of age estimates in the second part of the study fell within a range of error of ${\pm}1year$, while 75% fell within a range of error of ${\pm}2years$. The study found that the equation tends to estimate age accurately when individuals are 9 to 20 years of age. Conclusion: The equation can be used for age estimation for Thai populations when the individuals are 9 to 20 years of age.

• Imaging Science in Dentistry
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• v.37 no.2
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• pp.83-86
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• 2007

Purpose : To evaluate the efficacy of panoramic radiography by comparing the results of clinical examination with radiographic findings. Materials and Methods: We studied 190 patients (20 men and 170 women; mean age, 40 years; range, 22 to 68 years) who visited the health promotion center of Korea Medical Science Institute and were examined both clinically and by panoramic radiography. We compared results from both examinations. Treatment options by clinical examination were described as "no treatment indicated", "treatment of dental caries", "removal of calculus", "treatment of periodontal disease", "prothodontic treatment" and "extraction of the third molar". Findings taken from the panoramic radiography were: dental caries, periapical lesion, alveolar bone loss, calculus deposition, retained root, impaction of the third molar, disease of maxillary sinus, bony change of mandibular condyle, etc. Results: The prevalence of panoramic findings were: 37.9% of dental caries, 17.4% of periapical lesions, 44.7% of alveolar bone losses, 62.6% of calculi deposition, 7.9% of retained roots, 26.8% of third molar impactions, 6.3% of diseases of maxillary sinus, 2.1 % of bony changes of mandibular condlye and 35.8% of miscellaneous lesions. Abnormal conditions revealed by panoramic radiography which had not been discovered on clinical examination were: 24.2% of the patients had dental caries, 17.4% had periapical lesions, 7.4% had calculi deposition, 5.3% had retained roots, 15.3% had third molar impactions. The opposite cases were: 5.2% had dental caries, 12.6% had calculi deposition, and 9.5% had third molar impactions. Conclusion: The use of panoramic radiography as a supplement to the clinical examination might be a valuable screening technique.