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Positional changes and eruption of impacted mandibular third molars in young adults. A radiographic 4-year follow-up study.

OBJECTIVE: To measure changes in angular position and eruption status of mesially impacted mandibular third molars (M3) during 4-year follow-up period. STUDY DESIGN: Standardized panoramic radiographs were taken at the start of the study (the average age of the subjects was 19.7 years) and 4 years later. Angulation and degree of impaction of M3 were determined by their sagittal relationships to the adjacent second molars. The impacted M3 were either partially erupted or unerupted. RESULTS: Initial examination showed that among a total of 59 mesioangular M3, 49 (83%) had inclination between 5 and 30 degrees. The proportion of M3 that became upright (zero tilt) was 76% (13/17) with initial angulations of 5 to 10 degrees, 61% (11/18) with initial angulations of 15 to 20 degrees, and 14% (2/14) with initial angulations of 25 to 30 degrees. None of the M3 originally presented at 35 degrees or more became upright, but an average decrease of 12 degrees in angulation was registered. In total, 26 M3 of 59 (44%) became upright during the follow-up period. Initial examination of levels of eruption showed that among 59 M3, 13 (22%) were partially erupted and the rest were unerupted. Of the 46 M3 initially unerupted, 17 (37%) became fully erupted and 7(15%) erupted partially during the 4-year follow-up. Of the total sample, 25 (42%) had erupted to full occlusion during the observation period. CONCLUSION: A significant proportion of mesially impacted mandibular M3 had changed their angulation and became fully erupted by the time the individual reached 24 years of age. Positional changes and eruption of impacted M3 are unpredictable phenomena.

Adolescent↗

Supernumerary impactions of the mandibular cuspids and bicuspids. Case report.

A case involving the presence of supernumerary cuspids and bicuspids is described. The condition was probably an inherited one because of the family history and the bilateral incidence. The supernumerary teeth erupted because of alveolar resorption in which inflammatory factors probably played a role. Radiographic follow-up of the site of supernumerary impacted teeth and alveolar resorption should be undertaken.

Aged↗

A treatment difficulty index for unerupted maxillary canines.

The aim of this study was to produce a treatment difficulty index (TDI) for unerupted maxillary canines. Thirty treated cases, each with an unerupted unilateral maxillary canine, were graded by 14 consultant orthodontists in terms of perceived alignment difficulty, and the four main factors which had contributed to each grade were listed in order of importance. The relationship between the grade and the contributory factors was then examined using regression analysis, and weightings were derived. These were applied to each factor, in order to derive a difficulty score total for each case. Linear regression analysis of difficulty scores against consultant grades produced an R2 value of 54.7 per cent using the original equation and an R2 of 52.3 per cent using values rounded to the nearest half. Both indicated a moderate level of agreement between allocated difficulty grade and calculated difficulty scores. The index provides a useful treatment planning aid for the management of impacted maxillary canines.

Adolescent↗

A randomized, double-blind, parallel-group study comparing the analgesic effect of etoricoxib to placebo, naproxen sodium, and acetaminophen with codeine using the dental impaction pain model.

OBJECTIVE: To compare the overall analgesic effect, including time to onset, peak and duration of effect for etoricoxib 120 mg, a new COX-2 selective inhibitor, in patients with acute pain to that of placebo. Naproxen sodium 550 mg and acetaminophen/codeine 600/60 mg were the active comparators. METHODS: A total of 201 patients with moderate to severe pain following surgical extraction of > or = 2 third molars, of which at least the mandibular tooth was impacted, were randomly allocated to receive single oral doses of placebo (n = 50), etoricoxib 120 mg (n = 50), naproxen sodium 550 mg (n = 51), or acetaminophen/codeine 600/60 mg (n = 50). The endpoints included total pain relief over 8 hours (TOPAR8, primary end point), sum of pain intensity difference over 8 hours, patient's global evaluation, onset, peak, and duration of analgesia. RESULTS: Etoricoxib 120 mg had a significantly greater least squares (LS) mean TOPAR8 score than placebo (20.9 vs 5.4; P < 0.001) and acetaminophen/codeine 600/60 mg (20.9 vs 11.5; P < 0.001), and a similar LS mean TOPAR8 score to naproxen sodium 550 mg (20.9 vs 21.3). All three active treatments had rapid onset of analgesia, median time approximately 30 minutes. The duration of analgesic effect, defined as median time to rescue medication use, was >24 hours for etoricoxib, 20.8 hours for naproxen sodium, 3.6 hours for acetaminophen/codeine, and 1.6 hours for placebo. DISCUSSION: Etoricoxib is a new COX-2 selective inhibitor under development for treatment of osteoarthritis, rheumatoid arthritis, and acute pain. In this study, etoricoxib 120 mg provided rapid and long-lasting pain relief to patients with moderate-to-severe postdental surgery pain. Etoricoxib was generally well tolerated.

Acetaminophen↗

Double bilateral dens invaginatus in the maxillary incisor region.

Two cases of bilateral double dens invaginatus in the maxillary incisor region have been reported. One of the patients (Case 1), a 12-year-old boy, had double invaginations in both of the erupted teeth in the maxillary lateral incisor region. The other patient (Case 2), a boy 8 years of age, had double invaginations in each of the two partially developed supernumerary teeth that were impacted in the palate in the maxillary central incisor region. Double bilateral dens invaginatus would appear to be a most unusual occurrence.

Child↗

[Histological study of the resorbed dental crowns of impacted wisdom teeth].

Undecalcified sections of 31 impacted third molars are examined histologically for signs of resorption. Resorption starts at small spots in enamel, progresses to dentin and may even penetrate the pulp cavity. The incidence of such resorption processes increases after the age fifty. A prerequisite for resorption is the loss of reduced ameloblastic epithelium. Histological examination reveals multinuclear giant cells and apposition of spongious bone to destroyed dental substances. The results is dental ankylosis. Because partially resorbed teeth or ankylosed teeth may lead to serious surgical difficulties, impacted wisdom teeth without any clinical symptoms and without pathologic radiological findings should always be extracted at a young age.

Dental Enamel↗

Diagnosis and treatment planning for unerupted premolars.

Premolars rank third in frequency after third molars and maxillary canines in impacted or unerupted teeth. Failure to detect and analyze the problem may lead to unnecessary space loss, crowding, or collapse of the dental arch. A diagnostic scheme is presented to facilitate diagnosing and treating unerupted premolars. Important observations include: Diagnosing congenitally missing permanent teeth. Whether the condition is generalized or localized. Whether the succedaneous tooth has a viable form, eruptive potential, and viable orientation Whether the delayed eruption is due to over-retained primary molars such as ankylosis and incomplete root resorption. The amount of space available for the succedaneous tooth to erupt The presence of overlying soft tissue or bone. Space management and proper management of primary molars will frequently facilitate uneventful eruption of premolars. Orthodontic guidance of eruption is rarely indicated if problems can be detected early and managed properly. Four case reports elucidate the recommended treatment methods for these commonly occurring unerupted premolars.

Ankylosis↗

Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study.

A survey was carried out to record both initial and longterm effects on the lingual and inferior alveolar nerves following third molar removal. Eight hundred and twenty five patients were included from eight West of Scotland Oral Surgery Units, and had 1339 third molars removed. Changes in sensation were recorded by direct questioning at 6 to 24 h and 7 to 10 days, and by postal questionnaire at 12-18 months. The incidence of lingual nerve damage was found to be 15% of operated sides at 6 to 24 hours, 10.7% at 7 to 10 days, and 0.6% after 1 year. The incidence of inferior alveolar nerve damage was 5.5% of operated sides at 6 to 24 h, 3.9% at 7 to 10 days, and 0.9% after 1 year. These results are proposed as an indication of the likely incidence of nerve damage complicating third molar removal in the general circumstances of current United Kingdom practice and are presented as a basis for discussion of patient information and current prudent practice. Since one in four patients suffered at least temporary sensory deficit, we believe the case for effective warning of all patients undergoing impacted third molar removal is overwhelming.

Adolescent↗

An ectopically impacted premolar with a radiolucent defect.

This is a case report of an ectopically impacted, mandibular left second premolar. Radiographically the tooth was observed to have a large radiolucency in the crown. The surgical, orthodontic and restorative management of the case is presented with a brief literature review. The histological report substantiated the previous literature by confirming that the defect was not carious.

Adolescent↗

The mandibular third molar position as a predictive criteria for risk for pericoronitis: a retrospective study.

During the 6-month period from mid February 1988 to mid August 1988, 148 patients presented with 154 diagnosed cases of mandibular third molar pericoronitis. All patients were members of the recruit population stationed at the Recruit Training Command, Great Lakes, Illinois. Selected clinical parameters relating to the orientation and eruption status of these third molars were collected and analyzed. The goal was to obtain a predictive clinical profile of the impacted mandibular third molar (MTM) at greatest risk for pericoronitis in the young naval and Marine Corps personnel. The majority of pericoronitis cases, 120 of 148 or 81.0%, involved vertically oriented MTMs; of this total, 79.1% were erupted to the approximate height of the occlusal plane of the arch. The remaining 20.9% were at or below the height of contour of the adjacent tooth. Mesioangular impacted MTMs accounted for only 11.2% of pericoronitis cases. The remaining cases comprised distoangular and horizontally impacted MTMs (3.4% and 3.8%, respectively). Involvement by impinging maxillary dentition was observed in 39.7% of the vertically oriented MTMs, 56.2% of the mesioangular oriented MTMs, 40.0% of the distoangular MTMs, and 14.0% of the horizontally impacted MTMs. The mean value for occlusal coverage by a soft tissue operculum observed for all MTMs in this study was 49%. In the population studied, risk for pericoronitis appears to increase with greater vertical orientation and height of eruption. The absence of impinging maxillary dentition did not eliminate the risk of mandibular third molar pericoronitis. These data have implications for targeting treatment needs of naval and Marine Corps personnel who may be without dental support for extended periods of time.

Adult↗

"Fatigue on rest" and associated symptoms (headache, vertigo, blurred vision, nausea, tension and irritability) due to locally asymptomatic, unerupted, impacted teeth.

"Fatigue on Rest", headache, vertigo and the feeling of loss of balance, blurred vision, nausea, tension and irritability, were found to be prevalent amongst patients who had locally asymptomatic, unerupted impacted teeth. A comparative pressure sign was developed, which, when positive, confirmed the relationship between the impacted teeth and the medical symptoms. Removal of the impactions resulted in the alleviation of the symptoms. Stress and psychogenic factors are considered as trigger mechanisms, rather than as basic causes of the symptoms.

Adult↗

A rare case of hereditary multiple impacted normal and supernumerary teeth.

An eight-year-old girl residing in Bangalore presented with a complaint of retained primary maxillary and mandibular incisors. Radiographic examination of the case revealed multiple impacted permanent succedaneous teeth with deficient resorption of primary teeth and multiple impacted supernumerary teeth. Family history revealed that the mother also exhibited multiple impacted supernumerary teeth. Based on the clinical presentation, radiographic examination and histopathological studies, this paper discusses the differential diagnosis and management of such a case.

Child↗

Orthodontics. Part 10: Impacted teeth.

This section deals with the important issue of impacted teeth. Impacted canines in Class I uncrowded cases can be improved by removal of the deciduous canines. There is some evidence that this is true for both buccal and palatal impactions. Treatment of impacted canines is lengthy and potentially hazardous. Interceptive measures are effective and preferred to active treatment. Supernumerary teeth may also cause impaction of permanent incisors, their early diagnosis and appropriate treatment is essential to optimise final outcomes. If there are any doubts about impacted teeth it is better to refer too early than too late, this latter option may unnecessarily extend the length of treatment as well as the treatment required.

Bicuspid↗