• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.1
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• pp.9-17
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• 2020

Background: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery. Methods: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer. Results: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013). Conclusion: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.492-498
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• 2009

We sought to evaluate the relationship between the mandibular canal and impacted mandibular third molars by using dental cone beam computed tomograph(CBCT) for third molar surgery. A total of 111 patients(177 teeth) offered the images through CBCT and panoramic radiography for the extraction of the mandibular third molars. In CBCT, the accurate relationship between the third molar and the mandibular canal were evaluated. In panoramic radiographies, we evaluated the impacted level and superimposition sign of the mandibular third molar with the mandibular canal, and also, the radiopacity of the white line in the canal. Data were statistically analyzed and estimated by $X^2$-test. In CBCT finding, high prevalence of contact between the mandibular canal and roots occured in the deep impacted third molars, narrowing mandibular canals, bending mandibular canals and cases where the radiopacity of white line of canals were "absence" on panoramic images. It showed statistical significance (P<0.05). When evaluating the mandibular canal and the roots through the panoramic radiography for third molar extraction, it could be difficult to diagnosis accurately. Thus, it is required to have an accurate diagnostic approach through CBCT that could evaluated the location between mandibular canal and root.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.2
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• pp.339-344
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• 2008

When a delayed eruption of tooth is diagnosed, the causative factor should be detected before an establishment of treatment plan, if possible. Although a panoramic radiograph is enough to evaluate the position of tooth and the stage of tooth development, a 3-D Dental CT would be a powerful tool to reveal a spatial relationships between objects. The reported case showed a delayed eruption of lower left permanent canine and a mini-plate with screws adjacent to the impacted canine. Although the screws adjacent to the root of impacted tooth showed a close proximity, it was not presumed that these screws would interfere the eruption of the tooth. The impacted canine did not show any spontaneous eruption during observation. After the mini-plate and screws were removed, an orthodontic traction using elastic power chain was performed. The position of mini-plates and screws should be carefully designed to avoid damaging the tooth follicles or tooth roots in the jaw. Also the screws should be removed before an orthodontic traction to prevent damaging the root surface of impacted tooth.

• The korean journal of orthodontics
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• v.28 no.6 s.71
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• pp.991-999
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• 1998

Tooth impaction may lead to malocclusion, root resolution, cyst or aberrant changes in adjacent teeth. Clinical and radiographic examinations are used to locate the impaction, and appropriate treatment plans must be made to relocate the impacted tooth. When surgically exposing the impacted tooth, periodontal considerations to conserve maximum amount of soft and hard tissue are used. Oral hygiene instructions are emphasized to maintain sound periodontal health. Securing enough space for the impacted tooth and proper anchorage is important. Proper use of force and mechanics is crucial to prevent such complications as root resolution. Various patterns of orthodontic traction may be employed as situation permits. Most impaction cases can be managed with orthodontic traction to restore function and esthetics, provided that early detection and proper diagnosis and treatment planning are made.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.5
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• pp.225-232
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• 2014

Objectives: The purpose of this retrospective study is to find the differentiating characteristics of cystic and cystic-appearing lesions that involve the impacted mandibular third molar by analyzing panoramic radiographs and computed tomography images, and to aid the preoperative diagnosis. Materials and Methods: Eighty-one patients who had a mandibular cystic or cystic-appearing lesion that involved impacted mandibular third molar and underwent cyst enucleation were included in the study. The preoperative panoramic radiograph and computed tomography findings were analyzed in accordance to the histopathologic type. Results: Most of the cystic lesions containing the mandibular third molar were diagnosed as a dentigerous cyst (77.8%). The occurrence of mesio-distal displacement of the third molar was more frequent in the odontogenic keratocyst (71.4%) and in the ameloblastoma (85.7%) than in the dentigerous cyst (19.1%). Downward displacement was primarily observed in each group. Odontogenic keratocyst and ameloblastoma showed more aggressive growth pattern with higher rate of bony discontinuity and cortical bone expansion than in dentigerous cyst. Conclusion: When evaluating mandibular cystic lesions involving the impacted mandibular third molar, dentigerous cyst should first be suspected. However, when the third molar displacement and cortical bone absorption are observed, then odontogenic keratocyst or ameloblastoma should be considered.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.3
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• pp.157-162
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• 2003

Background : The surgical removal of impacted mandibular third molar can result in considerable pain, swelling, and dysfunction that patient are incapable of work for several days. Factors contributing to post operative swelling, trismus and pain are complex. There is no question but that the procedure of surgically removing an impacted mandibular third molar is inherently a traumatic one and that some sequelae related to the inflammation response are expected. Meticulous surgical technique will minimize the sequelae of inflammation but will not prevent them. In an effort to minimize these sequelae the use of steroid was instituted. Patients and Methods : Present study was to investigate the effect of one preoperative steroid injection in the masseter muscle to the patients(male 9, female 11) who needed prophylactic removal of bilateral, symmetrical, impacted wisdom teeth in the mandible on the complaint like swelling, trismus and pain. through Double-Blind test. Results : 1. After 24 hours investigation, preoperative steroid injection had significantly reduced swelling with 39% and trismus with 57.5%. 2. $7^{th}$ post operative day investigation, reduced swelling and trismus had shown, however, not significant. 3. There wasn't major difference from the group who took preve-ntive steroid in the visual analogue scale, the first analgesic intake time and the pain period. 4. There wasn't any adverse reaction of steroid for 20 patient From the above result, If the patients are not contraindication to steroid and pronounced post operative reaction can be expected the use of steroid to the surgical removal of impacted mandibular third molar is recommended.

• Journal of The Korean Dental Society of Anesthesiology
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• v.4 no.1 s.6
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• pp.13-16
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• 2004

Background: Articaine, a new amide-type local anesthetic, was recently commercially available in Korea. The purpose of this study was to compare the anesthetic efficacy between articaine HCl and lidocaine HCl for the surgical extraction of bilateral mandibular impacted third molars. Patients and Methods: Forty young and healthy patients with bilateral impacted third molars were selected with permission. Randomly, one side of impacted third molar was operated under local anesthesia using 4% articaine and the other side under 2% lidocaine after 1 or 2 week recovery time. Intraoperative pain was evaluated via 0-10 cm visual analog scale (VAS) by both the patient and operator immediately after the operation. After 1 day and 7 days, the complications of local anesthesia were checked. Results: The pain VAS scores in articaine group, evaluated by both the patient and operator, were lower than those in lidocaine group, but they were not statistically significant (P = 0.44 and 0.54, respectively). The incidence of complications of local anesthesia between articaine and lidocaine was similar. Conclusion: In this study, articaine showed at least equal efficacy compared to lidocaine. The further dose-controlled study with more pharmacokinetic parameters will be needed.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.4
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• pp.600-604
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• 2003

Tooth impaction is defined as a cessation of the eruption of a tooth at the level of the oral mucosa or alveolar bone. Maxillary canines are the most frequently impacted teeth next to the third molar. Maxillary canine impaction is associated with congenital missing of lateral incisors, peg lateralis and genetic factors such as ectopic positioning of a tooth germ. The clinicians have an important role in early detection of tooth impaction for prevention of esthetic and functional problems. There are specific methods to treat impacted tooth for different conditions. In this case, an 11-year-old girl with a horizontally impacted maxillary right canine in a palatal position was treated through orthodontic traction along with surgical button attachment procedure. On regaining of eruption space, canine traction was performed. At the completion of treatment, the canine was positioned fairly within the arch with proper keratinized gingiva and complications such as root resorption were not observed.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.598-604
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• 2004

Impaction of mandibular first molar is relatively rare and its overall frequency has been reported to be 0.01%. The etiology of impaction are lack of eruption space, physical obstacles such as supernumerary teeth, odontomas or odontogenic tumors, hereditary factors, functional disturbances of endocrine glands and traumas. Impaction of mandibular first molar can result in a short lower facial height, formation of a follicular cyst, pericoronal inflammation, resorption of the roots of neighboring teeth and malocclusion. The treatment options available for impacted teeth include surgical exposure, orthodontic forced eruption, surgical repositioning and surgical removal of unerupted molar. This report presents two cases of distally tilted and impacted mandibular first molars which were treated by surgical exposure. In these cases, we could observe spontaneous eruption of the impacted mandibular first molars after surgical exposure.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.69-76
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• 2015

Background: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. Methods: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. Results: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. Conclusions: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.