5 research outputs found
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 /// ΠΠ»ΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° Ρ ΠΈΡΡΡΠ³ΠΈΡΠ½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΡΠ΅ΡΠΈΠ½ΠΈΡΠ°Π½ΠΈ Π΄ΠΎΠ»Π½ΠΈ ΡΡΠ΅ΡΠΈ ΠΌΠΎΠ»Π°ΡΠΈ
[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 β 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 β 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] ΠΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡΡ ΡΡΡΠ΄ Π΅ Π½Π°ΡΠΎΡΠ΅Π½ ΠΊΡΠΌ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π½Π° Π°Π»ΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΠΈΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° Π²ΠΈΡΠΎΠΊΠΎ ΡΠΈΡΠΊΠΎΠ²ΠΈ ΡΠ΅ΡΠΈΠ½ΠΈΡΠ°Π½ΠΈ Π΄ΠΎΠ»Π½ΠΈ ΡΡΠ΅ΡΠΈ ΠΌΠΎΠ»Π°ΡΠΈ. Π¦Π΅Π»ΡΠ° Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΡΡΠ° Π΅ Π΄Π° ΡΠ΅ ΡΠ°Π·Π³Π»Π΅Π΄Π°Ρ Π°Π»ΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΠΈΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΡΠ΅ΡΠΈΠ½ΠΈΡΠ°Π½ΠΈ Π΄ΠΎΠ»Π½ΠΈ ΡΡΠ΅ΡΠΈ ΠΌΠΎΠ»Π°ΡΠΈ, ΠΊΠ°ΡΠΎ ΡΠ΅ ΠΎΡΠ΅Π½ΠΈ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡΠ° ΠΎΡ ΡΡΡ
Π½ΠΎΡΠΎ ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠ΅Π· ΠΎΠ±ΡΠ°Π·Π½ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π½Π° ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ β Π΄Π²ΡΠΈΠ·ΠΌΠ΅ΡΠ½Π° ΡΡΠ°Π½Π΄Π°ΡΡΠ½Π° ΠΎΡΡΠΎΠΏΠ°Π½ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ ΠΈ Π‘ΠΠ‘Π’. ΠΠ°ΠΏΡΠ°Π²ΠΈΡ
ΠΌΠ΅ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Π½Π° Π΄Π²ΡΠΈΠ·ΠΌΠ΅ΡΠ½ΠΈ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΈ ΠΎΡΡΠΎΠΏΠ°Π½ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ ΠΈ Π‘ΠΠ‘Π’-ΠΈΠ·ΠΎΠ±ΡΠ°ΠΆΠ΅Π½ΠΈΡ, Π·Π° Π΄Π° ΡΡΡΠ°Π½ΠΎΠ²ΠΈΠΌ ΠΏΡΠ΅ΡΠΈΠ·Π½ΠΎΡΡΡΠ° Π½Π° Π΄Π²Π°ΡΠ° ΠΌΠ΅ΡΠΎΠ΄Π° Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° Π²ΠΈΡΠΎΠΊΠΎΡΠΈΡΠΊΠΎΠ²ΠΈ ΡΠ΅ΡΠΈΠ½ΠΈΡΠ°Π½ΠΈ Π΄ΠΎΠ»Π½ΠΈ ΡΡΠ΅ΡΠΈ ΠΌΠΎΠ»Π°ΡΠΈ. Π Π΄Π²Π΅ Π³ΡΡΠΏΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΏΡΠΎΠ²Π΅Π΄ΠΎΡ
ΠΌΠ΅ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΎ ΠΊΠΎΡΠΎΠ½Π΅ΠΊΡΠΎΠΌΠΈΡ ΠΈ ΠΎΡΡΠΎΠ΄ΠΎΠ½ΡΡΠΊΠ° Π΅ΠΊΡΡΡΡΠ·ΠΈΡ Ρ ΠΏΠΎΡΠ»Π΅Π΄Π²Π°ΡΠ° Π΅ΠΊΡΡΡΠ°ΠΊΡΠΈΡ Π½Π° Π²ΠΈΡΠΎΠΊΠΎΡΠΈΡΠΊΠΎΠ²ΠΈ ΠΌΡΠ΄ΡΠ΅ΡΠΈ, Π·Π° Π΄Π° ΠΏΡΠΎΡΠ»Π΅Π΄ΠΈΠΌ ΡΡΠΏΠ΅Π²Π°Π΅ΠΌΠΎΡΡΡΠ° Π½Π° ΠΌΠ΅ΡΠΎΠ΄ΠΈΡΠ΅ ΠΈ Π½Π°Π΄Π΅ΠΆΠ΄Π½ΠΎΡΡΡΠ° ΠΈΠΌ ΠΏΡΠΈ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½ΠΎΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΡΠ°ΠΊΡΠ² ΡΠΈΠΏ Π·ΡΠ±ΠΈ. ΠΡΠ· ΠΎΡΠ½ΠΎΠ²Π° Π½Π° Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ½ΠΈΡΠ΅ Π΄Π°Π½Π½ΠΈ ΠΈ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΎΡ Π½Π°ΡΠΈΡΠ΅ ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ, ΡΡΠ·Π΄Π°Π΄ΠΎΡ
ΠΌΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ ΠΈ Π°Π»Π³ΠΎΡΠΈΡΡΠΌ, ΠΏΠΎ ΠΊΠΎΠΈΡΠΎ Ρ
ΠΈΡΡΡΠ³ΡΡ Π΄Π° ΡΠ΅ Π²ΠΎΠ΄ΠΈ ΠΈ ΠΏΡΠΈΠ΄ΡΡΠΆΠ° ΠΏΡΠΈ ΠΈΠ·Π±ΠΎΡ Π½Π° Π΅Π΄ΠΈΠ½ ΠΎΡ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»Π½ΠΎ ΡΠΈΡΠΊΠΎΠ²ΠΈΡΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ½ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° ΠΎΡΡΡΡΠ°Π½ΡΠ²Π°Π½Π΅ Π½Π° ΡΠ΅ΡΠΈΠ½ΠΈΡΠ°Π½ΠΈΡΠ΅ Π΄ΠΎΠ»Π½ΠΈ ΡΡΠ΅ΡΠΈ ΠΌΠΎΠ»Π°ΡΠΈ
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:Β 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:Β 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:Β 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:Β 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