Necessity of CBCT - examination in assessment of the surgical approach for the extraction of impacted lower third molars

Aim: The aim of this research is to demonstrate the necessity of CBCT - examination for evaluation of the surgical approach of high risk impacted lower third molars. As `high risk` we defined lower third molars which have signs of proximity to the mandibular canal seen on standard panoramic radiography. Material and methods: All patients who had undergone a CT examination between september 2015 and october 2016 were reviewed. We included images from conical-beam computed tomograph made in the Department of radiologic diagnose, University medical and dental centre of the Medical university of Varna. The device used is Planmeca ProMax 3D Max with software for images Planmeca Romexis. We chose 100 images randomly. From these images we selected 39 images with high-risk lower third molars. We examined different signs with which we defined the exact position to the mandibular canal of 60 wisdom teeth and we managed to asses the risk of damaging the IAN during a classical odontectomy of these teeth. In the research we included the panoramic radiographs of 20 patients from these 39 cases. Results: From the examination of the CBCT images we found: 28 lower third molars where the mandibular canal runs apical and have contact; 11 where the mandibular canal runs apical in contact with the tooth and it`s seen penetration of the apices of the tooth; 10 where the mandibular canal runs buccal with contact; 8 where the mandibular canal runs lingual with contact; 3 where the mandibular canal runs between the roots touching one/both of them. In three of the cases we found severe deviation of the root apices. From the examination of the panoramic radiographs we found: 5 cases with darkening of roots in the apical area; 8 with interruption of white line (lamina dura) of the mandibular canal; 1 with diversion of the mandibular canal with/without narrowing of the mandibular canal; 6 without any of these three signs. Conclusion: The development and rapid commercialization of new technologies like CBCT allows us to have precise images and exact diagnosis of the diseases in the oral and maxillofacial area. Our study confirmed the high diagnostic value of CBCT regarding to precise the position of the lower third molars to the mandibular canal and IAN. This gives the clinician the opportunity to determine which lower third molars are `high risk` teeth and to choose the best method for surgical treatment

Alternative Methods for Surgical Treatment of Impacted Lower Third Molars /// Алтернативни методи за хирургично лечение на ретинирани долни трети молари

[EN] The aim of this thesis is to consider alternative methods for surgical treatment of impacted lower third molars, assessing the need for their application through imaging methods – standard two-dimensional panoramic radiograph and cone-beam CT. A comparative study between the types of imaging methods used in diagnosis of impacted lower third molars – two-dimensional standard panoramic radiograph and cone-beam CT (CBCT) was performed. We performed coronectomy and orthodontic extrusion with subsequent extraction of high risk impacted third molars in two groups of patients respectively, in order to track the success of the methods and their reliability in the surgical treatment of impacted lower third molars. Our results showed that the application of orthodontic extrusion, regardless of the selected methodology and instrumentation is also encouraging and extremely valuable method in the treatment of high-risk wisdom teeth.[BG] Дисертационният труд е насочен към изследване на алтернативните методи за хирургично лечение на високо рискови ретинирани долни трети молари. Целта на дисертацията е да се разгледат алтернативните методи за хирургично лечение на ретинирани долни трети молари, като се оцени необходимостта от тяхното приложение чрез образни методи на изследване – двуизмерна стандартна ортопантомография и СВСТ. Направихме сравнителен анализ на двуизмерни стандартни ортопантомографии и СВСТ-изображения, за да установим прецизността на двата метода в диагностиката на високорискови ретинирани долни трети молари. В две групи пациенти проведохме съответно коронектомия и ортодонтска екструзия с последваща екстракция на високорискови мъдреци, за да проследим успеваемостта на методите и надеждността им при хирургичното лечение на такъв тип зъби. Въз основа на литературните данни и резултатите от нашите проучвания, създадохме критерии и алгоритъм, по които хирургът да се води и придържа при избор на един от минимално рисковите хирургични методи за отстраняване на ретинираните долни трети молари

Orthodontic extrusion with followed surgical extraction of high-risk lower third molar

lower third molar with sings that indicates high risk of postoperative complications. Materials and methods: We represent an orthodontic extrusion followed by surgical extraction of lower third molar. For precise diagnostics and approach to suitable method of treatment we used standard panoramic radiograph and CBCT. As a method of surgical treatment we chose assisted orthodontic extraction with individually manufactured ring with soldered bar, fixed to tooth 47. Results: In our clinical case we achieved traction of the impacted lower third molar to safe distance from the mandibular canal. On the second stage of the treatment we performed a classic odontectomy without affect or damaging the IAN. Conclusion: The classic odontectomy is surgical method with high risk of damaging the IAN when the impacted tooth is very close to the mandibular canal. The orthodontic extraction like an alternative surgical method of high-risk lower third molars is preventive method, by which there is minimal risk of damaging the nerve during the surgery. The orthodontic extrusion makes the following surgical extraction a safe and secure method for the patient

Dentigerous Cyst: a Case Report

Introduction: A cyst can be defined as a pathological cavity which contains fluid or semisolid material and is lined by an epithelium sac. Dentigerous cysts are odontogenic lesions, the second most common type after the radicular cysts. They are formed from residual remnants of the enamel epithelium and are histologically benign.The aim of the following report is to present a case of a dentigerous cyst with a rapid development and increasing size but asymptomatic course.Materials and Methods: A 30-year-old male was referred to the Department of Oral Surgery at the University Medico-Dental Centre because of a diagnosed cystic lesion with a significant size, encompassing the crown of the impacted mandibular third molar (tooth 48). It was found that the lesion was asymptomatic with the only complaint being dull, transitory pain in tooth 47 which was endodontically treated 2 years ago. An analysis of the panoramic radiograph was performed, a CBCT examination was done to determine the exact size, borders of the cystic lesion and its relationship to the mandibular canal and the second molar. After precise diagnostics the chosen method of treatment was radical extirpation of the cyst combined with odontectomy of the impacted molar and extraction of tooth 47.Results: On the panoramic radiograph and the CBCT image a unilocular radiolucency was present, with a well-circumscribed border and visible osteosclerotic margin, enclosing the crown of tooth 48 and the distal root of tooth 47 to the interradicular plate. No asymmetry, crepitation or exudation were present in the affected area. The operation was performed under general anaesthesia. No further complications occurred.Conclusion: Dentigerous cysts frequently show no clinical symptoms. This undoubtedly leads to difficulties in the diagnostics. Therefore, thorough examination shall be performed because early diagnosis reduces the risk of complications during the treatment