Germectomy. The germ of the third mandibular molar in children: remove or preserve?

Third molars are often removed in order to prevent complications and various other problems associated with impacted third molars and their removal. Abortion of mandibular third molars is a procedure carried out at an early age in those subjects where there is insufficient room for the eruption of the third molars. On the other hand one can also decide to remove the second molars and to annexate orthodontically the third molars in the arch.     

Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?

Removal of third molars is the most common procedure in oral surgery. It may be associated with complications, such as sensory damage , dry socket, infection and iatrogenic damage. A case of mandibular angle fracture during third molar extraction in a 37-year-old female is reported. Literature review on the possible etiologies and ways of prevention were recorded. The reason is believed to be multifactorial and include: age, gender, degree of impaction, relative volume of the tooth in the jaw, preexisting infection or bone lesions, failure to maintain a soft diet in the early postoperative period and the surgical technique. It is possible to reduce the risk of this complication by adoption of preventive measures.     

Darkening of third molar roots on panoramic radiographs: is it really predominantly thinning of the lingual cortex?

This study investigated the exact intra-alveolar aetiology of a panoramic high-risk sign, darkening of the third molar roots. 83 mandibular third molar surgical removals demonstrating dark bands on the third molar roots in preoperative radiographs were included in this prospective study. Exposure of the inferior alveolar nerve (IAN), the root morphology of the third molar (e.g. groove or hook) and the integrity of the mandibular canal or lingual cortical wall were observed. Differences between single (increased radiolucency alone) and multiple darkening cases (increased radiolucency with accompanying ‘high risk’ signs) and between IAN exposure and groove formation were analysed. In 38 cases (45.8%), the IAN was visible during the operation. Groove was present in 37.4% of cases. 26.5% of the cases showed lingual cortical thinning, while specious root conformation explained the formation of darkening on the radiographic images of an additional 9.6% of the cases. IAN exposure (P < 0.001) and groove formation (P < 0.001) were significantly more frequent in multiple darkening cases than in single darkening cases. According to these findings, darkening of the third molar roots is more often the result of fenestration of the inferior alveolar canal wall or groove formation of the root than lingual cortical thinning.     

Distal cervical caries in the mandibular second molar: an indication for the prophylactic removal of the third molar?

AIMS: Distal cervical caries (DCC) in mandibular second molar teeth are responsible for the removal of up to 5% of all mandibular third molars. Our aim was to identify the clinical features of these patients. METHODS: We evaluated the records of 100 patients who had 122 mandibular third molars removed because of distal cervical caries in the second molar. RESULTS: Eighty-two percent of third molars had a mesial angulation of between 40 degrees and 80 degrees. The peak age for removal of third molars was 5 years later than in other studies and patients had better dental health than average. The incidence of distal cervical caries DCC has been shown to increase with age. CONCLUSION: Distal cervical caries is a late phenomenon and has been reported only in association with impacted third molars. The early or prophylactic removal of a partially erupted mesio-angular third molar could prevent distal cervical caries forming in the mandibular second molar.     

Distal cervical caries in the mandibular second molar: an indication for the prophylactic removal of third molar teeth? Update

In 2005 we reported the clinical findings of 100 patients who had mandibular third molars removed because of distal cervical caries in the mandibular second molar. The aim of this follow-up study was to find out whether the findings in a new group of patients corroborate those of our previous study. We report on the clinical features of 239 patients (mean (SD) age 32.1 (7.85) years, range 20–65) who had 288 mandibular third molars removed because of distal cervical caries in the second molar. Patients had better dental health than average, and 67% had a DMF (decayed, missing, or filled) score of 5 or less. In 89% of third molars the mesial angulation was between 40° and 80°. Distal cervical caries in second molars is a late complication of third molar retention. The prophylactic removal of a partially erupted mesioangular third molar will prevent distal cervical caries forming in the second molar tooth.     

The presurgical workup before third molar surgery: how much is enough?

PURPOSE: We sought to assess the indications for patient referral for computed tomography (CT) scan before third molar extraction. The influence of the data obtained from the CT scans on the surgical outcome and morbidity was also evaluated. PATIENTS AND METHODS: There were 189 patients in the study (120 females and 69 males). Sixty-five patients were referred to receive CT and formed the study group. The remaining patients were included in the control group. RESULTS: There were no statistically significant differences between the groups with regard to demographic data and tooth and root angulations. Indications for tooth extraction such as pain, swelling, pericoronitis, caries, endodontic problems, pathology, and prosthetic considerations were similar. The proximity of the tooth root to the inferior alveolar canal was the only statistically significant difference between the 2 groups (P <.001). The treatment plan outcomes for extraction, surgical extraction, and follow-up were comparable. The surgeon changed the initial decision from "surgical extraction" to "follow-up" in only 1 case after CT scan. CONCLUSIONS: Within the limits of the present study, it can be concluded that the main reason for CT scan referral is the proximity of the third molar root to the inferior alveolar canal (<1 mm). The data obtained from the CT scan had minimal effect on the final surgical outcome. The routine use of CT scan in cases of third molar extractions cannot be recommended.     

Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

OBJECTIVE: This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars. PATIENTS AND METHOD: Two hundred and sixty seven women, aged 17 - 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis). RESULTS: Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017). CONCLUSIONS: The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.     

Is it worth applying self-irrigation after third molar extraction? A randomised controlled trial

In this study, we aimed to examine the effectiveness of self-irrigation following the extraction of mandibular third molars. A randomised controlled clinical trial was conducted with 155 patients who had undergone extraction of a mandibular third molar. The irrigation group was instructed to self-irrigate the extraction socket with tap water using a syringe three times a day, starting seven days after the tooth extraction. The incidence of complications and mouth opening, halitosis, plaque/gingival index, and oral health-related quality of life (OHRQoL) were measured. The irrigation group showed a lower incidence of complications than the non-irrigation group. The halitosis, plaque, and gingival scores were lower by mean (SD) 19.66 (5.19), 0.58 (0.06), and 0.62 (0.08), respectively, in the irrigation group than in the non-irrigation group (p = 0.0001). A greater amount of food packing was associated with higher halitosis, plaque, and gingival scores and poorer OHRQoL (p < 0.05). Further, more frequent irrigation was associated with lower halitosis, plaque, and gingival scores and better OHRQoL (p ≤ 0.016). Self-irrigation of the extraction socket using a syringe containing tap water is a very effective method for keeping the extraction socket clean. This technique reduced halitosis, improved plaque and gingival indices, and increased OHRQoL.     

What information do patients recall from the third molar surgical consultation?

The aim of this study was to determine whether the use of a professionally prepared educational video on third molar extraction enhances comprehension and retention of general and informed consent information. A prospective cohort study of adult patients undergoing consultation followed by extraction of third molars in the Oral and Maxillofacial Surgery Clinic, University of Illinois at Chicago was completed. At the initial consultation, the subjects viewed an educational video and received specific verbal individual information about their case. A written examination (group 1) was then completed; a subgroup of the subjects (group 2) was selected randomly to complete the same examination at the next visit prior to the procedure. The primary predictor variable was utilization of the video. The primary outcome variable was comprehension of information regarding third molars, assessed by examination scores. The secondary outcome variable was retention of the information, assessed by repeat examination scores. One hundred adults (34 male, 66 female; group 1) completed the examination at least once; 54 (19 male, 35 female) completed both examinations (group 2). Correct responses ranged from 64% to 100% in group 1 and from 37% to 100% in group 2. In group 2, all questions answered incorrectly at the first visit were answered correctly at the second visit, without any additional information being provided. Patient comprehension and retention of pertinent pre-surgical information is poor, despite use of an educational video to supplement the usual verbal consultation. These results confirm those of prior studies and may have medico-legal implications regarding the informed consent process for third molar surgery.     

Pulp capping: conserving the dental pulp--can it be done? Is it worth it?

Emphasis has shifted from the "doomed" organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of calcium hydroxide (CH) products. The sequence of events leading to dentinal bridge formation with various CH formulas is detailed. Those factors usually considered liabilities to direct pulp capping (pulps cariously exposed, contaminated by saliva, previously carious or restored, periodontally involved, or from older patients and primary teeth) are disputed. Those factors that must be considered to improve the success rate of pulp capping are emphasized: control bleeding, make certain the CH contacts vital-pulp tissue, minimize dentinal chip invasion, avoid embolization of CH particles, and be aware of the depth of penetration of the chemical cautery effect.     

Do antibiotics reduce the frequency of surgical site infections after impacted mandibular third molar surgery?

Surgical removal of impacted third molars remains the most common procedure performed by oral and maxillofacial surgeons. Given the abundance of host bacteria within the operative sites, surgical site infections are among the most common complications of third molar removal, with an estimated frequency of 1% to 30%. In this setting, significant controversy has surrounded the use of prophylactic antibiotics in the surgical management of impacted third molars. This article provides a comprehensive review of the available data on antibiotic prophylaxis in impacted third molar surgery and offers specific recommendations on antibiotic use.     

Is the mandibular third molar a risk factor for mandibular angle fracture?

OBJECTIVES: The objective of this study was to evaluate the association of mandibular angle fractures with the presence and state of the eruption of the mandibular third molar (M3). METHODS: The medical records and panoramic radiographs of 615 patients with mandibular fractures were examined. The presence or absence and degree of impaction of the M3 were assessed for each patient and related to the occurrence of fracture of the mandibular angle. Data were also collected for age, sex, mechanism of injury, number, and location of mandibular fracture. Data were analyzed by a chi-square statistic test and Student t test. RESULTS: The incidence of mandibular angle fracture was found to be significantly greater when an unerupted M3 was present (P <.05). Of the 426 patients with an M3, 127 (29.8%) had angle fractures. Of the 189 patients without an M3, 25 (13.2%) had angle fractures. CONCLUSIONS: The results of this study showed that the mandibular angle that contains an impacted M3 is more susceptible to fracture when exposed to an impact than an angle without an M3.