• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.167-170
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• 1994

The surgical removal of the wisdom teeth is obligate when forceps extraction fails or when the wisdom teeth are impacted. The surgical removal of impacted maxillary third molars is a commonly performed procedure usually associated with few complications & little morbidity. The most frequent complications are tooth root fracture, maxillary tuberosity fracture, tooth displacement into the maxillary sinus & oroantral fistula formation. A rarely reported complication is the displacement of a tooth into the infratemporal fossa. The method of prevention of this complication is by the placement of either a finger or periosteal elevator posterior to the tooth during extraction. To remove the displaced upper third molar is very difficult & has many complications, e.g., persistent bleeding & nerve damage. When the wisdom teeth is displaced, it is initially necessary to gain access to bone by developing a mucoperiosteal path of delivery is developed by additional bone removal or, preferably planned sectioning of the tooth. There are many approaching techniques to remove the displaced upper third molar. This following report describes the surgical technique of displaced upper third molar in the pterygopalatine fassa by the midpalatal ＆transpharyngeal approach.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.575-582
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• 2021

Background: The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth. Methods: Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated. Results: In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics. Conclusion: Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.91-95
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• 2023

This study examined the effects of a vertical incision on postoperative edema after third molar extraction. The study design was that of a comparative split-mouth approach. Evaluation was performed via magnetic resonance imaging (MRI). Two patients with homogeneous bilateral impacted mandibular third molars were enrolled. These patients underwent facial MRI within 24 hours after simultaneous extraction surgery. Modified triangular flap and enveloped flap incisions were made. Postoperative edema was evaluated by MRI and was assessed according to anatomical space. The two pairs of homogeneous extractions demonstrated that vertical incisions were associated qualitatively and quantitatively with extensive postoperative edema. The edema associated with these incisions spread toward the buccal space, beyond the buccinator muscle. In conclusion, a vertical incision with mandibular third molar extraction was related to edema in the buccal space and the fascial space, which contributed to clinical facial swelling.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.3
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• pp.121-128
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• 2015

Background: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Methods: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. Results: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Conclusions: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

• 대한치과마취과학회:학술대회논문집
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• 2004.06a
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• pp.44-44
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• 2004

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.1
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• pp.56-63
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• 2017

Delayed eruption of the first molar, without a generalized or localized cause, is usually associated with delayed development of the affected tooth. The aim of this study was to investigate the clinical features of the first permanent molar showing delayed development and eruption, and its association with developmental anomalies of other teeth. Panoramic radiographs of 40 healthy children showing delayed development and eruption of first permanent molars were analyzed. The clinical features of affected first molars and developmental anomalies of other teeth (except third molars) were evaluated. Delayed first molars were more frequent in the maxilla. The incidence of bilateral delayed development of first molars was greater than that of unilateral cases in female patients. In contrast, male patients showed unilateral delayed development of the first molar more frequently. A higher incidence of congenitally missing teeth was observed in patients with delayed first molar. In each case, delayed development or congenital absence was observed in the second molar adjacent to the delayed first molar. Overall, delayed first molar seems to be associated with congenital absence of additional teeth. Understanding the developmental mechanisms of this phenomenon requires further studies.

• Imaging Science in Dentistry
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• v.30 no.4
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• pp.259-263
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• 2000

Purpose: Upper cervical vertebrae are commonly imaged together with the jaw bones in panoramic radiography. There have been many studies investigating the possible role of mandible as an indicator of osteoporosis. But the result doesn't show unanimity. This study measured bone densities of mandible and second and third cervical vertebrae to find out any relationship between these two areas. These results may contribute in panorama being used as a screening method in detecting possible osteoporotic patient. Materials and Methods: Randomly selected 226 digitized panoramic images with cervical vertebrae shadows from 156 dental patients between 5 to 80 years of age were used. And the bone densities of second and third cervical vertebrae, apical areas of first and second mandibular molars and interdental areas were measured. The bone density measurements were restricted to the cancellous bone and the average and standard deviations and paired t-tests were done to each measurements. Results: All the measurements were statistically significantly related. The best relationship was found between the third cervical vertebrae and first and second mandibular apical areas. The average and standard deviations of the measured bone density ratios of these areas were 1.20±0.45 and 1.34±0.48 each. Conclusion: Patients whose panoramic bone density of the third cervical vertebrae are much below those of mandibular first or second molar apical areas may have osteoporosis.

• Restorative Dentistry and Endodontics
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• v.7 no.1
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• pp.59-63
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• 1981

Ninety four human mandibular third molars were chosen to study the anatomy of the root canal. The experimental teeth were injected with china ink, decalcified, cleared and used in study, in vitro, to determine the number of root, the number of root canals, canals per root, frequency and location of transverse anastomoses, frequency and location of lateral canals and frequency of the apical deltas. The results were as follows: 1. Most of the teeth showed two canals, but 17.0% of the teeth were found to have one canal, 17.0% of them three canals, 3.2% of them four canals and l.1% of them five canals. 2. In so far as observing one canal per root, 17.0% of the teeth were found to have one canal in single-rooted tooth, 48.9% of them in mesial root and 58.5% of them in distal root. 3. In roots with two or three canals, the separated apical foramen appeared in 55.6% in single-rooted tooth, 64.3% in mesial side and 80.0% in distal side, and the common apical foramen appeared in 44.4% in single-rooted tooth, 35.7% in mesial side and 20.0% in distal side. 4. Of the two root canals in one root, 19.1% of the canals were found to have transverse anastomoses and were usually located in the apical third of the root. 5. 63.8% of 94 teeth were found to have lateral canals, and ramifications were mainly located in the apical third of the root.

• Imaging Science in Dentistry
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• v.37 no.4
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• pp.197-203
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• 2007

Purpose: To provide diagnostic information by evaluation of the positional relationship between the mandibular third molar and the mandibular canal. Materials and Methods: Eighty-nine mandibular third molars were classified as mesioangular, horizontal, vertical, distoangular groups. The distances between the mandibular third molar and the mandibular canal were measured in cone-beam computed tomographs. The height and width ratios of distances from the mandibular third molar and the mandibular canal to the mandibular inferior border and to the lingual cortical plate were calculated. Results: The vertical and buccolingual distances between the mandibular third molar and the mandibular canal were 0.03 mm, 2.96 mm in the mesioangular, 0.37 mm, 3.38 mm in the horizontal, -1.50 mm, 1.38 mm in the vertical, -1.10 mm, 4.20 mm in the distoangular group. There were significant differences in vertical (P < 0.05), but not in buccolingual (P>0.05). The height and width ratios of distances on the mandibular third molar were 47.1 %, 36.1 % in the mesioangular, 47.4%, 34.4% in the horizontal, 37.0%, 46.7% in the vertical, 40.9%, 37.4% in the distoangular group. There were significant differences between the mesioangular and the vertical group, and the horizontal and the vertical group in height ratio (P < 0.05), and also between the mesioangular and the vertical group in width ratio (P < 0.05). The height and width ratios of distances on the mandibular canal showed no significant differences between groups (P > 0.05). Conclusion : The mesioangular group showed the nearest distance between the mandibular third molar and the mandibular canal vertically. The root apex of the mandibular third molar was positioned more buccally in the vertical group than in the mesioangular group.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.1
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• pp.41-45
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• 2004

In the normal growth and development of the mandible, the molar tooth buds distal to the first permanent molar have a mesial inclination. This inclination is usually self-correcting, but, unfortunately, this self-correction does not always occur. The first case is about, 14-year-old female patient with familial history of lower second molar impaction. Her lower second molars were both impacted, and she was treated with sectional wires and open-coil springs. The second case, 14-year-old male, we treated his impacted #47 with Halterman appliance. The third case, 11-year-old male, his both mandibular second molars were impacted during full-fixed orthodontic treatment. They were treated with brass wire, sectional wire and open-coil spring.