• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.207-213
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• 1998

Purpose : This study attempted to relate the incidence of fractures at the mandibular angle with the presence and state of eruption of lower third molars, and to find out the real risk factors for angle fractures in the states of lower third molars. Materials and Methods : Medical records and radiographs of 395 patients with mandibular fractures were retrospectively reviewed. The presence and states of third molars were assessed for each patients and related to the occurrence of angle and other mandibular fractures. Results : Of 395 patients with mandibular fractures, 142 had angle fractures. The incidence of angle fractures was found to be significantly greater when partial erupted lower third molars were present and it had a definite role for risk factors for angle fractures. But there were no clear relationship between the incidence of angle fracrtures and states of without, fully erupted lower third molars. Furthermore, the states of patial and unerupted lower third molar had an effect on bony segment displacement. Conclusions : This study provides clinical evidence to suggest that patial erupted third molar teeth weaken the mandibular angle both quantitatively and qualitatively.

• The Journal of the Korean dental association
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• v.52 no.12
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• pp.753-761
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• 2014

Purpose: This study was performed to examine distribution of accessory mandibular canal and its characteristics in mandibular third molars. Materials and methods: A total of 251 subjects (166 males and 85 females) having mandibular third molars bilaterally were included in the study. Cone-beam computed tomographic images were reviewed for bifid or trifid accessory mandibular canal. The prevalence of accessory mandibular canal was evaluated according to gender, side and its branching type. Proximity and crosssectional position of accessory mandibular canal to mandibular third molar was analyzed. Results: Accessory mandibular canals were found in 66 (26.3%) of 251 patients and 86 (17.1%) of 502 hemi-mandibles. Gender and sides showed no statistically significant differences in prevalence. Retromolar canal (46.1%) was the most common branching type. Proximity of accessory canal to mandibular third molars showed mean distance of 2.8 mm from third molar and a statistically significant difference was found among types of accessory canal. Dental canal was the closest to tooth among branching types and closer to tooth than main canal. On cross-sectional view, accessory canal was generally located on buccal side of mandibular third molar. Conclusion: Accessory mandibular canal was common and well detected with cone-beam computed tomography. Their localization is significant in all anesthetic and surgical procedures involving mandibular third molars.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.30.1-30.7
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• 2015

Background: The inferior alveolar nerve (IAN) may be injured during extraction of the mandibular third molar, causing severe postoperative complications. Many methods have been described for evaluating the relative position between the mandibular third molar and the inferior alveolar canal (IAC) on panoramic radiography and computed tomography, but conventional radiography provides limited information on the proximity of these two structures. The present study assessed the benefits of three-dimensional computed tomography (3D-CT) prior to surgical extraction of the mandibular third molar, to prevent IAN damage. Methods: This retrospective study included 4917 extractions in 3555 patients who presented for extraction of the mandibular third molars. The cases were classified into three groups, according to anatomical relationship between the mandibular third molars and the IAC on panoramic radiography and whether 3D-CT was performed. Symptoms of IAN damage were assessed using the touch-recognition test. Data were compared using the chi-square test and Fisher's exact test. Results: Among the 32 cases of IAN damage, 6 cases were included in group I (0.35 %, n = 1735 cases), 23 cases in group II (1.1 %, n = 2063 cases), and 3 cases in group III (0.27 %, n = 1119 cases). The chi-square test showed a significant difference in the incidence of IAN damage between groups I and II. No significant difference was observed between groups I and III using Fisher's exact test. In the 6 cases of IAN damage in group I, the mandibular third molar roots were located lingual relative to the IAC in 3 cases and middle relative to the IAC in 3 cases. The overlap was ${\geq}2mm$ in 3 of 6 cases and 0-2 mm in the remaining 3 cases. The mean distance between the mandibular third molar and IAC was 2.2 mm, the maximum distance 12 mm, and the minimum distance 0.5 mm. Greater than 80 % recovery was observed in 15 of 32 (46.8 %) cases of IAN damage. Conclusions: 3D-CT may be a useful tool for assessing the three-dimensional anatomical relationship and proximity between the mandibular third molar and IAC in order to prevent IAN damage during extraction of mandibular third molars.

• Imaging Science in Dentistry
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• v.43 no.4
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• pp.289-293
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• 2013

Purpose: This study was performed to determine the relationship between the stage of tooth eruption (both vertical and mesio-angular) and chronological age. Materials and Methods: Indirect digital panoramic radiographs were used to measure the distances from the dentinoenamel junction (DEJ) of the second molars to the occlusal plane of the second molar teeth and of the adjacent third molars in 264 Thai males and 437 Thai females using ImageJ software. The ratio of those distances was calculated by patient age, and the correlation coefficient of the ratio of the third molar length to the second molar length was calculated. Results: The correlation between the height of the vertically erupted upper third molar teeth and age was at the intermediate level. The age range of ${\geq}15$ to <16 years was noted to be the range in which the correlation between the chronological age determined from the eruptional height and actual chronological age was statistically significant. The mean age of the female subjects, in which the position of the right upper third molar teeth was at or above the DEJ of the adjacent second molar but below one half of its coronal height was $19.9{\pm}2.6$ years. That for the left side was $20.2{\pm}2.7$ years. The mean ages of the male subjects were $20.1{\pm}3.3$ years and $19.8{\pm}2.7$ years for the right and left sides, respectively. Conclusion: It might be possible to predict chronological age from the eruption height of the wisdom teeth.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.5
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.3
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• pp.103-106
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• 2018

Objectives: The goal of the study was to investigate the clinical effects of amoxicillin-clavulanic acid (500+125 mg) with metronidazole 400 mg administered three times daily (Group I) versus azithromycin 500 mg administered once daily and with metronidazole 400 mg three times daily (Group II) for the prevention of postoperative infection following mandibular third molar surgical removal. Materials and Methods: The study design was a single-center prospective study. Patients who reported to the Department of Oral and Maxillofacial Surgery between February 2015 and January 2017 for removal of mandibular third molar were screened, and 108 patients were chosen. One surgeon carried out all procedures. Patients were prescribed antibiotics until the two groups contained a similar number of cases. Results: Our data showed that Group II had fewer incidences of surgical site infection, but with no statistical significance. Conclusion: Although both treatments are used routinely after removal of the mandibular third molar, neither is significantly better than the other.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.15-19
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• 2021

Objectives: The aim of this study was to evaluate correlations between anxiety and preoperative pressure pain assessments and postoperative pain and analgesic requirements in impacted lower third molar tooth surgery. Materials and Methods: This prospective study enrolled 60 patients who underwent impacted lower third molar surgery. The preoperative State-Trait Anxiety Inventory-I (STAI-I), pressure pain threshold, and pressure pain tolerance scores were measured. At 2, 4, 6, 12, and 24 hours, and at 6 days following surgery, the patients scored their pain on the visual analogue scale and recorded their analgesic drug usage. The data were evaluated, and the results were statistically analyzed. Results: Of the 60 patients, 38 were female. Mean age was 24.62±7.42 years. The study found no relationship between preoperative pressure pain assessments and postoperative pain (P>0.05). There was also no relationship observed between preoperative STAI-I scores and postoperative pain (P>0.05). However, there was a positive correlation between operation time and total medication taken (P<0.05). Conclusion: Preoperative pressure pain threshold, pressure pain tolerance, and anxiety level had no significant effects on postoperative pain and analgesic requirements in impacted lower third molar surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.213-221
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• 2020

Background: Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. Methods: The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. Results: The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. Conclusion: Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.137-146
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• 2020

Background: Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. Methods: This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. Results: The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. Conclusion: It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.5
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• pp.313-323
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• 2020

Background: Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. Methods: Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. Results: A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. Conclusions: Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.