Coronectomy may be a way of managing impacted third molars

Item does not contain fulltextData sourcesTPubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and the grey literature database SIGLE.Study selectionRandomised controlled trials (RCTs) and non-randomised controlled trials (CCTs) that compared coronectomy with total removal for third molar extractions with high risk of nerve injury were included.Data extraction and synthesisData were extracted independently and in duplicate by two reviewers. Risk of bias was assessed according to the Cochrane Reviewers' Handbook. Meta-analysis and sensitivity analysis were performed.ResultsFour studies (two RCTs and two CCTs) involving 699 patients and 940 third molars were included. Pooled risk ratios for coronectomy compared with total removal are shown in table 1.Coronectomy was changed to total removal during surgery due to root loosening or mobilisation in 2.3% to 38.3% of cases. In 0% to 4.9% of cases reoperation was required in the coronectomy group due to persistent pain, root exposure or persistent apical infections. Root migration was only reported in three studies and ranged from 13.2% to 85.9%.ConclusionsWe suggest that coronectomy can protect inferior alveolar nerves in the extraction of third molars with high risk of nerve injury as compared with total removal, and that the risk ratios of post-operative infections were similar between the two surgical modalities

Big dreams, did they come true? Opportunities and obstacles in the school trajectories of unaccompanied refugee minors

Big dreams, did they come true? Opportunities and obstacles in the school trajectories of unaccompanied refugee minors While many unaccompanied minors deal with their precarious situation by focusing on school success, there is a lack of knowledge about the diversity of factors that hinder and stimulate their life trajectories, including their school career. This article focuses on the long term school trajectories of unaccompanied minors who were highly motivated to have a successful school career when they arrived in the Netherlands. We show that in spite of their eagerness and qualities, institutional factors in education and discursive exclusion are obstacles in their school career. Nonetheless, these ambitious young people are largely able to overcome these obstacles by mobilizing different kinds of social support. However, some of them are confronted with a legal obstacle when they turn eighteen and did not obtain a residence ­permit. This makes them unable to continue their school career for several years. Therefore, the school careers of these highly motivated young people vary greatly: some people were still able to make their dreams partly come true, others got marginalized

Surgical removal versus retention for the management of asymptomatic impacted wisdom teeth

Contains fulltext : 109646.pdf (publisher's version ) (Open Access)BACKGROUND: The prophylactic removal of asymptomatic impacted wisdom teeth is defined as the (surgical) removal of wisdom teeth in the absence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. OBJECTIVES: To evaluate the effects of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention (conservative management) of these wisdom teeth. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. SELECTION CRITERIA: All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. MAIN RESULTS: No RCTs were identified that compared the removal of asymptomatic wisdom teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of impacted mandibular wisdom teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of wisdom teeth had an effect on lower incisor crowding over 5 years. AUTHORS' CONCLUSIONS: Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured.Watchful monitoring of asymptomatic third molar teeth may be a more prudent strategy

Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth

Contains fulltext : 220553.pdf (Publisher’s version ) (Open Access)BACKGROUND: Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. OBJECTIVES: To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . SELECTION CRITERIA: We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS: Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. MAIN RESULTS: This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensiona

Accuracy of assessing the mandibular canal on cone-beam computed tomography: a validation study

Item does not contain fulltextPURPOSE: To establish the accuracy of cone-beam computed tomographic (CBCT) views in determining the position and diameter of the mandibular canal. MATERIALS AND METHODS: Two freshly frozen cadaver heads, 1 dentate and 1 edentate, were used to acquire CBCT scans. Measurements on cross-sectional CBCT images were compared with measurements on digitized histologic sections of the same regions in the mandibles. The Student t test was used for statistical analysis. RESULTS: Comparing CBCT with histologic measurements showed that the position of the mandibular canal differed up to 0.47 mm (standard deviation, 0.29 mm). Mandibular canal diameters were up to 22.8% smaller in the CBCT planes. For the dentate jaw, these differences were statistically significant. CONCLUSION: To be safe, when assessing the mandibular canal position on CBCT views, a 0.76-mm deviation should be taken into account. Because the diameter of the mandibular canal is displayed smaller, an enlargement by 0.74 mm is recommended

Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography.

Contains fulltext : 79509.pdf (publisher's version ) (Closed access)This study investigated the diagnostic accuracy of cone beam computed tomography (CBCT) compared to panoramic radiography in determining the anatomical position of the impacted third molar in relation with the mandibular canal. The study sample comprised 53 third molars from 40 patients with an increased risk of inferior alveolar nerve (IAN) injury. The panoramic and CBCT features (predictive variables) were correlated with IAN exposure and injury (outcome variables). Sensitivity and specificity of modalities in predicting IAN exposure were compared. The IAN was exposed in 23 cases during third molar removal and injury occurred in 5 patients. No significant difference in sensitivity and specificity was found between both modalities in predicting IAN exposure. To date, lingual position of the mandibular canal was significantly associated with IAN injury. CBCT was not more accurate at predicting IAN exposure during third molar removal, however, did elucidate the 3D relationship of the third molar root to the mandibular canal; the coronal sections allowed a bucco-lingual appreciation of the mandibular canal to identify cases in which a lingually placed IAN is at risk during surgery. This observation dictates the surgical approach how to remove the third molar, so the IAN will not be subjected to pressure

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

Contains fulltext : 169785.pdf (Publisher’s version ) (Open Access)OBJECTIVES: The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. MATERIAL AND METHODS: A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject(R) Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher's exact test. RESULTS: A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject(R) group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. CONCLUSION: Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. CLINICAL RELEVANCE: Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal