Biomedical subjects
Publications and source records attributed to C F Kugelberg.
There have been significant advances in the diagnosis and treatment of impacted third molars with special emphasis on periodontal health in the second molar area adjacent to the extraction site. A thorough discussion addresses these advances and their impact on treatment planning of asymptomatic impacted third molars.
The effects of impacted lower 3rd molar surgery on periodontal tissues in the adjacent 2nd molar area have been investigated in a prospective study comprising 176 cases from 2 age groups: less than or equal to 20 years (n = 93) and greater than or equal to 30 years (n = 83), respectively. The preoperative and 1-year postoperative examinations included both clinical and radiographic variables. All patients were subjected to a standardized surgical procedure and optimal plaque control pre-, intra- and postoperatively. Early removal of impacted lower 3rd molars with large angulation and close positional relationship to the adjacent 2nd molar proved to have a beneficial effect on periodontal health.
A multifactorial approach has been used to identify some predictors of postoperative intrabony defects (IBD) on the distal surface of the adjacent second molar (M2) after impacted lower third molar (M3) surgery. The material consisted of 215 lower third molar removals, performed on 144 persons (age range 16-53 years; mean 27.2 years). The postoperative examination took place 2 years after impaction surgery and included both clinical and radiographic variables. Statistically significant (5% significance level) predictors of IBD found in stepwise multiple regression analyses were: (1) preoperative intrabony defect M2 distal; (2) age at the time of surgery; (3) size of contact-area M3/M2; (4) root resorption M2 distal; (5) probing dept distal surface of adjacent first molar postoperatively; (6) pathological follicle M3. The regression model with IBD as regressand produced a total R2 of 0.45. When the regressand was the difference between IBD and the preoperative intrabony defect, the regression analysis explained 62% of the variance (R2 = 0.62). These regression models explained the variance in terms of the size of the remaining postoperative intrabony defect as well as in terms of periodontal healing after impacted lower third molar surgery.
The long-term effects on periodontal tissues of impacted lower 3rd molar surgery have been investigated in a retrospective study comprising 51 cases. The postoperative examinations took place 2 and 4 years after the surgical treatment and included both clinical and radiographic variables. Assessments were made regarding the oral hygiene status, gingival condition and periodontal tissue breakdown in terms of increased probing depths and intrabony defects. Comparing the results of the two examinations, no significant changes of the incidence of plaque and gingivitis were seen on the distal surface of the 2nd molar, nor any significant change concerning the probing depth. The proximal bone level distal to the second molar was recorded by radiographic examination with a cut-off periodontal probe as indicator. Two years postoperatively, 16.7% of the cases aged less than or equal to 25 years showed intrabony defects exceeding 4 mm, compared with 40.7% in the age group greater than or equal to 26 years. At the 4-year re-examination, the corresponding figures were 4.2% and 44.4%, respectively. The improvement concerning the alveolar bone level was mainly seen in individuals under 25 years. Some factors affecting the periodontal healing after impacted lower 3rd molar surgery are discussed.
The main objective of this series of investigations was to study periodontal health of the adjacent second molars (M2) in cases of impacted lower third molars (M3) and after impacted lower third molar surgery. An epidemiological study, comprising 693 dentate individuals, was undertaken in order to obtain the prevalence, impaction and positional relationship of third molars in a normal Swedish population. The prevalence of all third molars in individuals aged 20 years was 77.0%. One in four of the vertically positioned third molars, three in four of the mesioangular, nine in ten of the distoangular and all those horizontally placed were impacted to some extent. 68.5% of the impacted third molars were in close proximity to the root of the adjacent second molars. In order to evaluate the precision and accuracy of the radiographic assessment of intrabony defects (IBD), i.e. the distance between the cemento-enamel junction and the bottom of the pocket to firm osseous contact, on the distal surface of M2, a methodological study was performed on 25 subjects. Using conventional free hand technique, intraoral radiographs were taken in the deepest part of IBD with and without a probe as indicator. Comparing the two sets of radiographs, the deviation was 1 mm or less in 87.9% of the cases. The radiopaque marker enhanced the accuracy of assessment of IBD to 96.7%. The effects of impacted lower third molar surgery on periodontal tissues of the M2 area were investigated in a retrospective clinical study comprising 215 subjects. The results two years postoperatively showed a higher prevalence of plaque, gingivitis and periodontal pockets on the distal surface of M2 than on other surfaces of the two molars adjacent to the extraction site. IBD greater than or equal to 4 mm were registered in 32.1% of the cases. The long term effects on periodontal tissues after impacted lower third molar surgery was investigated in a comparative retrospective study, two and four years postoperatively, comprising 51 cases. The improvement concerning postoperative IBD, between the two examinations, was mainly seen in individuals less than or equal to 25 years of age. No case in this age group increased in depth, while 29.6% of postoperative IBD deteriorated in individuals greater than or equal to 26 years. A multiple regression analysis was used to identify some predictors of postoperative IBD, and the material consisted of the 215 cases from the retrospective study.(ABSTRACT TRUNCATED AT 400 WORDS)
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The effect of periodontal tissues of impacted lower 3rd molar surgery has been investigated in a retrospective study comprising 215 cases, 2 years postoperatively. In order to evaluate the precision and accuracy of the radiographic assessment of intrabony defects on the distal surface of the lower 2nd molar using conventional free hand technique, a methodological study was performed on 25 patients. The error variance due to variability in the radiographic reproduction and examiner inconsistency was between 3 and 4% of the total variance. In order to evaluate the radiographic assessment of intrabony defects, intraoral radiographs were taken in the deepest part of the intrabony defect with and without a probe as an indicator. Comparing the 2 sets of radiographs, the deviation was 1 mm or less in 87.9% of the cases. The radiopaque marker enhanced the accuracy of assessment of intrabony defects to 96.7%. The study shows the intraoral freehand technique to be sufficiently reliable as regards radiographic reproduction of the mandibular molar area. It also demonstrates that the radiographic method describes the depth of postoperative intrabony defects on the distal surface of the lower 2nd molar more accurately than probing depth measurements alone.
The effect on periodontal tissues of lower third molar surgery, due to impaction or semi-impaction, has been investigated in a retrospective study comprising 215 cases. The post-operative examination took place 2 years after the surgical treatment and included both clinical and radiographic variables. Clinical registrations included the amount of plaque, and presence of gingivitis and periodontal pockets. The results showed a higher incidence of plaque, gingivitis and pockets on the distal surface of the second molar than on other surfaces of the first and second molars. The alveolar bone level distal to the second molar was registered by radiographic examination with a periodontal probe as indicator. 2 years post-operatively, 43.3% of the cases exhibited pocket depths exceeding 7 mm and 32.1% showed intrabony defects exceeding 4 mm. Some factors affecting the periodontal healing after lower third molar surgery are discussed.