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[Tooth movement of an impacted lower 2nd premolar in the root developmental stage--a follow-up radiographic observation on the root formation].

A 9 year old girl presented an impacted lower right 2nd premolar which not only was in horizontal position, but its crown was directed lingually. As a lower right 2nd premolar was in such a position that normal eruption was impossible, the deciduous predecessor was extracted at 9 years of age, and then sufficient space had been created for the lower right 2nd premolar to be erupted, and the eruption of it was observed for about 2 years. 2 years later, radiographic indication showed that no spontaneous eruption of a lower right 2nd premolar was to be expected. At 11 years of age, surgical exposure and traction of a lower right 2nd premolar was attempted. When the lower right 2nd premolar was upright, its root formation was in the 1st stage of root developmental stages according to Moorrees et al. Follow up radiographic observations on surgical exposure and traction of a lower right 2nd premolar 3 years later revealed the following results: 1. The root development went on to amount to about 90 percent of the root formation of the other tooth concerned without the curvature of the root. 2. Lamina dura and periodontal space were normal. The continued root formation was narrowing the root apex and the pulpal tissue of apical foramina was continuous with the periodontal space surrounding the root. 3. Bone deposition occurred at the alveolar crest and the latter was recontoured normally. The interdental and inter-radicular trabecula were good. As based on these results, normal development of the root of a lower right 2nd premolar with normal periodontium can be anticipated. Clinically, the lower right 2nd premolar had completely erupted and was in normal position on the arch and in occlusion. Color, vitality and mobility were normal. Periodontal support was good. The above-mentioned findings give support to the possibility that "early treatment" enables the impacted tooth to correct.

Bicuspid↗

[The combination of a fused tooth and a supernumerary central incisor: a possible treatment plan].

An 8-year old boy was referred to the orthodontic department because of a fused tooth. The clinical and radiological examination showed that - besides the double tooth at the region of the 21 - there was a normal tooth 22 in eruption as well. Moreover a still impacted supernumerary tooth was present in the right upper front region. The treatment included the extraction of the fused tooth and an autotransplantation of the supernumerary tooth to the extraction site of the fused tooth. During the follow-up period the pulp showed a progressive obliteration starting at the crown level with a conservation of the vitality. Apexification of the root of the transplanted tooth proceeded successfully. Furthermore a review of the literature is given in this article on the aetiology and treatment of fused teeth and on the application of autotransplantation.

Child↗

Management of a maxillary central incisor impacted by a supernumerary tooth.

Supernumerary teeth in the maxillary midline are common and can present both esthetic and pathologic problems that can be extremely difficult to solve. Early detection of the mesiodens is most important if such complications are to be avoided. This case required both surgical and orthodontic treatment to bring an unerupted, impacted maxillary central incisor into position. Using a combination of conservative surgical treatment and careful orthodontic management, the tooth was brought into good position in the dental arch and injury to root structure and surrounding oral tissues was avoided.

Child↗

The visual analog scale in multiple-dose evaluations of analgesics.

A double-blind, randomized trial was carried out in patients suffering from pain after removal of an impacted lower wisdom tooth. The analgesic effects of a codeine preparation (Staralgin), a dextropropoxyphene preparation (Doleron novum), and paracetamol were compared in a multiple-dose study of 94 patients. The assessments of pain were made hourly on a visual analog scale, and the evaluation was carried out according to a method which takes into account both duration of effect and number of tablets taken. The most pronounced pain reduction and the highest proportion of pain-free patients were reached with the dextropropoxyphene preparation. The reported side effects were few and equally distributed among the treatment groups. The method of evaluation is discussed, and it was noted that the pain score at tablet intake might be of significant importance in comparison of analgesics.

Acetaminophen↗

Multiple doses of paracetamol plus codeine taken immediately after oral surgery.

A double-blind randomized analgesic trial was carried out in 180 patients undergoing surgical removal of an impacted lower wisdom tooth. The patients received the first dose of either paracetamol 1000 mg plus codeine 60 mg, paracetamol 500 mg plus codeine 30 mg or placebo immediately after surgery during the effect of the local anaesthetic. The mean pain intensity, the duration of effect and the number of patients needing additional analgesics were all significantly dose related. In the evaluation procedure a pain intensity index was defined which took into account both the efficacy and the duration of effect. In addition, the analgesic efficacy was calculated over a 12 hour period after first medication and thereby including the efficacy of a second dose, if taken. Paracetamol 1000 mg plus codeine 60 mg followed by paracetamol 500 mg plus codeine 30 mg after around 5 hours was a very effective treatment and over 40% of these patients did not need any further pain relief during the evaluation period. In conclusion, an effective analgesic taken immediately after oral surgery reduces the total pain and diminishes the need of analgesics.

Acetaminophen↗

Paracetamol plus supplementary doses of codeine. An analgesic study of repeated doses.

A double-blind, multicentre analgesic trial was carried out in patients suffering from pain after removal of an impacted lower wisdom tooth. 266 patients were evaluated after random allocation to treatment with paracetamol 500 mg, paracetamol 500 mg plus codeine 20 mg, paracetamol 500 mg plus codeine 30 mg, or paracetamol 500 mg plus codeine 40 mg. On the day of surgery the patients assessed their own pain intensity hourly on a visual analogue scale. The analysis of the results was carried out according to the method which considered repeated dose intake. A statiscally significant dose-response relationship was obtained between the supplementary doses of codeine and analgesic efficacy. In the comparison of side effects, their frequency increased with increasing amounts of codeine. In clinical practice codeine 30 mg appeared to be the optimal supplement for paracetamol 500 mg.

Acetaminophen↗

Analgesic efficacy of an ibuprofen-codeine combination in patients with pain after removal of lower third molars.

A double-blind, randomised analgesic trial was carried out in 165 patients undergoing surgical removal of one impacted lower wisdom tooth. In a two-dose regimen, the analgesic efficacy of the combination ibuprofen-codeine 200 mg : 30 mg was compared with that of acetylsalicylic acid-codeine 500 mg : 30 mg and codeine 30 mg. Each dose was taken when the patient needed pain relief. The intensity of the pain was measured on a visual analogue scale during the 10-h period after the first dose. The mean pain reduction by Dose 1 in patients on ibuprofen-codeine, acetylsalicylic acid-codeine and codeine was 64%, 45% and 26%, respectively, and the mean duration of effect was 8.3, 6.3 and 5.6 h. According to the pain reduction, duration of effect and pain reduction index after Doses 1 and 1 + 2, there was a significant difference between ibuprofen-codeine and the other two drugs. The maximum pain reduction within 4 hours was 84% with ibuprofen-codeine. This was significantly different from the reduction achieved both with acetylsalicylic acid-codeine (64%) and codeine (35%). Seventeen patients reported adverse events: 5 on ibuprofen-codeine, 4 on acetylsalicylic acid-codeine and 8 on codeine. The most common events were tiredness and vertigo. It is concluded that the combination ibuprofen-codeine 200 mg : 30 mg had greater analgesic efficacy compared to the combination acetylsalicylic acid-codeine 500 mg : 30 or codeine 30 mg in patients with pain after removal of the lower third molars.

Adolescent↗

Clinical and anatomical study of retromolar foramen and canal.

PURPOSE: The retromolar canal is a rare anatomic variation of the mandible. The neurovascular content of the mandibular retromolar canal is very important for surgical procedures involving the retromolar area and there has been a lack of information on this subject. This study consists of anatomic research of the retromolar foramen and canal, planned after an impacted third molar tooth extraction operation in which we encountered a retromolar neurovascular bundle. MATERIALS AND METHODS: Eighty sides of 40 mandibles were evaluated and the presence of the retromolar foramen and its relation to the last teeth, the transverse and sagittal distances of the retromolar trigone, and the distance of the retromolar foramen to the last socket of the arch were measured. RESULTS: The neurovascular bundle includes striated muscle fibers, thin myelinated nerve fibers, numerous venules and a muscular artery. Of the 40 mandibles included in this study, retromolar foramens were found in 10 (25%). The presence of the retromolar foramen is not dependent on the last teeth of the arch. The dimensions of the retromolar trigone were measured and the presence of the retromolar foramen was found to be nonrelevant to the dimensions of the retromolar trigone. Retromolar foramen distance from the distal edge of the last socket of the arch was found to be 11.91 +/- 6.71 mm and 4.23 +/- 2.30 mm, respectively, from the second and third molars. CONCLUSIONS: This study therefore clearly establishes the incidence and importance of the retromolar canal. This study shows that the retromolar foramen and canal can be seen occasionally in routine dental surgery. Due to the neurovascular bundle passing through it, the retromolar canal and foramen must be kept in mind in all anesthetic and surgical approaches regarding the retromolar area and mandible.

Adult↗

Multiple osseous dysplasia arising from impacted teeth: report of a case associated with odontogenic lesions.

We report a case of osseous dysplasia (OD) showing extremely rare clinical features. A 37-year-old Japanese woman was referred to our clinic complaining of a left alveolar bony swelling at an impacted canine. Radiographic examinations revealed a mixed radiopaque lesion involving the impacted left canine and also revealed an impacted left wisdom tooth with a cystic change and a clear radiopaque lesion suspected to be odontoma. All the extracted upper teeth and odontoma showed hypercementosis and the canine was fully involved in it. Histopathologically, they showed the same features and were diagnosed as OD. The findings of multiple OD from incompletely erupted teeth and odontoma in our case may well show that OD can arise from any tooth with periodontal ligaments and that focal OD can show expansive growth like the ossifying fibroma.

Adult↗

An evaluation of analgesic efficacy and clinical acceptability of intravenous tramadol as an adjunct to propofol sedation for third molar surgery.

This article details a double-blind, randomized, placebo-controlled pilot study evaluating the analgesic efficacy and clinical acceptability of intravenous tramadol in patients undergoing surgical removal of an impacted third molar tooth under local anesthesia and intravenous sedation with propofol. Forty-five ASA status 1 dental outpatients were randomly allocated to 2 groups of 22 (group A) and 23 (group B) patients each (n = 45). Group A (T/P) received intravenous tramadol 1.5 mg/kg injected over 2 minutes, followed by a bolus dose of intravenous propofol 0.4 mg/ kg. Maintenance consisted of a continuous infusion of propofol 3 mg/kg/h, with an additional bolus dose of 0.4 mg/kg intravenously 2-3 minutes prior to the infiltration of the local anesthetic solution. Group B (P/P) patients received no tramadol but instead a saline placebo solution and an identical amount of propofol. Overall, in this study, postoperative pain was much better controlled in the group receiving tramadol 1.5 mg/kg intravenously despite there being no significant difference in the dose of propofol administered in both groups. Intravenous tramadol, when given with propofol, did not affect the cardiovascular, respiratory, and sedative effects of propofol. Following tramadol, despite being an opioid, no nausea and vomiting were reported in the early postoperative period, indicating the value of using tramadol with propofol. Thus, this pilot study demonstrated the potential use of intravenous tramadol with propofol in day-case dento-alveolar surgery.

Adult↗

Bilateral dens invaginatus involving impacted supernumerary teeth.

The occurrence of bilateral dens invaginatus in the supernumerary teeth is rare. In the patient described in this report the supernumerary teeth were palatally impacted. The tip of one tooth had emerged through the palatal mucosa, and this tooth had pulpal and periapical infection. Both were extracted.

Adult↗