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Objectives This study aimed to assess whether awake bruxism and masticatory muscle activity could be related to external root resorption (ERR) in second molars adjacent to impacted mandibular third molars. Materials and methods Sixty patients, with requests for a cone-beam, computed tomography, were divided into two groups: ERR (patients with ERR in the second molar, n  = 30), and control group ( n  = 30). Awake bruxism was assessed through the Oral Behaviors Checklist (OBC) and an ecological momentary assessment (EMA). Surface electromyography (EMG) was used to assess the masseter and anterior temporal muscle function. Normality and homogeneity of variances were demonstrated. Descriptive analysis was performed, using the T-test and Chi-square test to compare the characteristics of the groups. A multiple regression model was performed. Results The ERR group presented more non-functional oral activities related to awake bruxism than the control group, according to OBC ( p  = 0.027) and EMA ( p  = 0.035). In addition, the ERR group had higher EMG activity than the control group in rest and isotonic protocols ( p  < 0.05). Conclusions Awake bruxism and greater masticatory muscle activity seem to be related to the presence of ERR in second molars adjacent to impacted mandibular third molars. Clinical relevance The results of the present study can reinforce the theory that triggering ERR in the second molars adjacent to impacted mandibular third molars may be related to mechanical forces coming from the masticatory function.

Purpose This study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures. Methods A prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p  < 0.05. Results In the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant ( p  = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury. Conclusion The precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery. Graphical Abstract

Objective This randomised clinical study aimed to assess the influence of low-dose cone-beam computed tomography (CBCT) on the visibility of the mandibular canal (MC) and its proximity to mandibular third molars (M3Ms) as assessed by general dental practitioners (GPs) and oral-maxillofacial surgeons (OMFSs), as well as its impact on their clinical decisions, when compared to standard-dose CBCT. Methods 154 impacted M3Ms from 90 patients were randomly assigned to three groups for two CBCT exposures using one standard-dose (333 mGy×cm 2 ) and one of the three investigated low-dose (78–131 mGy×cm 2 ) protocols. Blinded assessments of the MC visibility, M3M-MC proximity, surgical approach, crown/root sectioning, and referral decisions, were made by GPs and OMFSs on the images separately. Pairwise comparisons for MC visibility between paired scans were evaluated using Wilcoxon signed rank test, followed by a non-inferiority test with non-inferiority margin of 0.5 on a four-point scale. Differences in other variables between paired scans were evaluated using Wilcoxon signed-rank or McNemar tests. Results The majority (78.5–99.3%) of MCs were clearly identified on standard-dose CBCT by all observers. Pairwise comparisons showed significant differences between paired scans only in MC visibility but not in the M3M-MC proximity or treatment decisions. The mean differences in MC visibility between paired scans ranged 0-0.22 with the upper bounds of the 95% confidence intervals (0.09–0.36) falling within the non-inferiority region. Conclusions The investigated low-dose CBCT protocols could provide acceptable image quality for the evaluation of impacted M3Ms in most cases. When compared to standard-dose CBCT, these low-dose CBCT images did not significantly affect the assessments of the M3M-MC proximity, treatment strategies, and patient management decisions made by GPs and OMFSs. Clinical relevance The low-dose protocols might be clinically acceptable for M3M management while greatly reducing radiation exposure.

Background The periodontal status and distal bone level of the adjacent second molar can be negatively affected by the surgical extraction of an impacted lower third molar. Absorbable materials have some benefits, including enhancing primary wound coverage and promoting wound healing through isolation, clotting, wound stabilization and haemostasis. This study set out to compare primary and secondary healing and collagen-membrane-based primary healing after surgical removal of partially erupted impacted third molars (3Ms), evaluating the distal alveolar bone level (ABL) and periodontal status of the adjacent second molars (2Ms). Methods Patients who met the inclusion criteria were randomized into three groups: secondary healing ( n  = 28), primary healing ( n  = 27) and membrane-based primary healing ( n  = 29). Digital panoramic radiographs were obtained preoperatively (T1) and three months postoperatively (T2). The distances between the cemento-enamel junctions and the alveolar bone crests on the distal aspects of the adjacent 2Ms were measured using calibrated radiograph measurement software. The pocket depth and plaque index measurements were performed preoperatively and three months postoperatively. The periodontal plaque index (PPI) scores were registered on the distal aspects of the 2Ms, and the mean values were used. Results Three of the applied healing types positively affected periodontal pocket depth (PPD) and periodontal index values ( p  < 0.05). In terms of the ABL of the adjacent 2Ms, primary healing ( p  < 0.05) and membrane-based primary healing ( p  < 0.05) had superior results to secondary healing. Conclusion Membrane use is promising for the distal bone gain and periodontal status of the adjacent 2M. Trial registration This clinical study was registered by the Australian New Zealand Clinical Trials Registry, with the trial number ACTRN12618001551280.

BackgroundTo evaluate the predictive capacity of orthodontists and oral maxillofacial surgeons (OMFSs) in anticipating the process of impaction or eruption of lower third molars (L3Ms) through the examination of serial panoramic radiographs.MethodsSixty-eight lower third molars (L3Ms) were analyzed in 34 orthodontically treated patients without extraction. Twenty-seven OMFSs and 27 orthodontists were randomized in order to analyze the radiographs. Initially, the evaluators issued the prognosis for the L3Ms in XR1, a posterior for the XR1 + XR2. Concordance of the diagnosis was examined using Kappa statistics, and the differences between the groups of evaluators were examined using the chi-square test at p<0.05.ResultsWhen examining XR1 in cases where the teeth erupted spontaneously, the prognostic accuracy rate for OMFSs and orthodontists was similar, 63 and 65.7%, respectively (p=0.19). When evaluating XR1 + XR2, the accuracy among orthodontists (60%) was similar to that reported for XR1 (p=0.19), while OMFSs presented a reduction in the accuracy (55.3%, p<0.0001). When the L3Ms remained impacted, accuracy in XR1 was lower than in spontaneously erupting L3Ms, although similar between OMFSs (50.1%) and orthodontists (49.1%). Furthermore, for impacted L3Ms, when examining XR1 + XR2, the OMFSs presented a significant higher accuracy (71.8%, p <0.0001).ConclusionsOrthodontists and OMFSs seem unable to predict spontaneous eruption or impaction of the lower third molars from single or longitudinal x-rays. When adding a second longitudinal x-ray, orthodontists and more significantly OMFSs tend to indicate more extractions.

Objectives The primary objective of the study was to compare the postoperative complications following surgical removal of impacted third molars using panoramic radiography (PAN) images- and cone-beam computed tomography (CBCT)-based surgeries for “moderate-risk” cases of impacted third mandibular molars. The secondary objective was to compare the reliability of CBCT with that of PAN in preoperative radiographic determination of the position of the third molar, number of roots, and apical divergence. Materials and methods A randomized controlled multicenter trial was conducted to compare the surgical complications of PAN- and CBCT-based surgeries of impacted third molars. The sample consisted of impacted third molars from 256 patients with a close relation to the inferior alveolar nerve (IAN). Exclusion criteria were “no risk” and “high risk” of damage to the IAN based on the assessment of the panoramic radiograph. Patients were divided into two groups: the CBCT group ( n  = 126) and the PAN group ( n  = 130). The incidences of IAN sensory disturbance and other postoperative complications were recorded for each group at 7 days after surgery. Statistical analysis (kappa values) was used to compare the diagnoses of five trained dentomaxillofacial radiologists and to relate radiologic diagnoses to perioperative findings. Logistic regression was used to determine whether the imaging modality influenced occurrence of postoperative complications. Results Two extractions (1.5 %) in the CBCT group and five (3.8 %) in the PAN group resulted in IAN sensory disturbance ( p  = 0.45). Logistic regression models did not show that CBCT modality decreased postoperative complications following surgical removal of impacted third molars. Yet, CBCT revealed the number of roots and apical divergence of the roots more reliably than panoramic radiographs. Conclusions CBCT was not better than panoramic radiography in predicting postoperative complications for moderate-risk cases of impacted third mandibular molars. Nonetheless, a CBCT buccolingual view can accurately confirm the number of roots and root morphology of the third molar better than PAN. Clinical relevance For management of postoperative complications for moderate-risk cases of impacted mandibular third molars, careful preoperative radiographic planning followed by an atraumatic surgical approach seems to be valuable, irrespective of the 2D or 3D nature of the preoperative images.

Objectives The aim of this randomized observer-blinded split-mouth-study is to objectively assess the influence of a rubber drain on postoperative swelling using 3D face scans as measurement method and additionally evaluate pain, trismus and complications after the osteotomy of lower third molars. Material and methods Seventy-two patients with symmetrically impacted lower wisdom teeth were recruited. Before the operation, patients rated pain using the visual analogue scale, the interincisal distance was measured, and 3D face scans were taken with an optical scanner. Each patient underwent two procedures which were at least 30 days apart. On one side, a rubber drain was inserted randomly before closure, the contralateral control side was closed without drainage. On the third and tenth postoperative day, face scans to quantify the swelling, pain evaluation and trismus measurements were performed. Due to loss of follow-up, 32 patients were excluded which resulted in 40 out of 72 patients remaining in the study. Results There was no statistical difference in using a drain on swelling and trismus on the third and tenth day ( p  > 0.05). Pain was slightly worse on the third day on the treatment side, but the difference was not significant ( p  > 0.05). We observed no differences in the number of wound infections. Conclusions The insertion of a rubber drain does not have any influence on swelling, pain or trismus and has no impact on the number of wound infections. Clinical relevance The use of a rubber drain cannot be recommended as no reduction of postoperative discomfort was detected.

Background In current study we aimed to examine the effect of a low-level laser therapy on the pain, mouth opening and swelling of patients whose impacted 3rd molar tooth was extracted in addition measurement volumetrically to the edema with 3dMD face system. Methods It was surveyed 15 patients who had bilateral symmetric lower 3rd molars. Surgical sides of patients were randomly separated into two groups: the study group and the control group. It was applied extra oral low-level laser therapy (LLLT, 0.3 W, 40 s, 4 J/cm 2 ) to the study group ( n  = 15) after the surgical operation and on the 2nd day. Only routine postoperative recommendation (ice application) was made in the control ( n  = 15) group. The maximum mouth opening, pain level and facial swelling evaluated. 3dMD Face® (3dMD, Atlanta, GA) Photogrammetric System was used to evaluate volumetric changes of the swelling. Results There was no statistically significant difference in the edema and interincisal opening between the groups and the pain level in the laser group was significantly lower than in the control group on the 7 th postoperative day. Conclusions Although there were decreasing trismus, swelling, and pain level, with this LLLT, there was significant difference only in the 7th day pain level in the laser group compared with the control group.

Objectives The present longitudinal study aimed to compare changes in the lower third molar position and nerve involvement in orthodontically treated patients with and without premolar extractions. Materials and methods The sample consisted of pretreatment and posttreatment panoramic radiographs of 349 orthodontically treated patients subdivided into a non-extraction group ( n  = 263) and an extraction group ( n  = 86). Patients did not present dental agenesis in the lower jaw. The mandibular third molar position was assessed by classifying the teeth according to Pell and Gregory, Winter, and two new classifications. The relation between third molars and the mandibular canal was assessed based on Whaites’ classification. The development of third molars was evaluated based on Demirjian’s classification. Data were analyzed using frequency analysis, Mann–Whitney U test, Fisher’s exact test, and chi-square testing. Results There was a significant difference ( p  < 0.05) in eruption space between pretreatment and posttreatment panoramic radiographs for both groups. For pretreatment panoramic radiographs, chi-square tests revealed no significant differences between both groups. For posttreatment panoramic radiographs, significant differences appeared for extraction versus non-extraction patients for Pell and Gregory horizontal classification, Winter’s classification, and a potential relationship between third molars and the alveolar nerve ( p  < 0.05). Conclusions Orthodontic treatment without premolar extractions shows significantly more eruption problems of wisdom teeth than those with premolar extractions. Third molars in the non-extraction group were more frequently found in close relationship to the mandibular nerve compared to the extraction group. Clinical relevance Orthodontists should be aware of the effect of orthodontic treatment on the development of the lower third molars.

The availability of cone beam computed tomography (CBCT) and the numbers of CBCT scans rise constantly, increasing the radiation burden to the patient. A growing discussion is noticeable if a CBCT scan prior to the surgical removal of wisdom teeth may be indicated. We aimed to confirm non-inferiority with respect to damage of the inferior alveolar nerve in patients diagnosed by panoramic radiography compared to CBCT in a prospective randomized controlled multicentre trial. Sample size (number of required third molar removals) was calculated for the study and control groups as 183,474 comparing temporary and 649,036 comparing permanent neurosensory disturbances of the inferior alveolar nerve. Modifying parameter values resulted in sample sizes ranging from 39,584 to 245,724 respectively 140,024 to 869,250. To conduct a clinical study to prove a potential benefit from CBCT scans prior to surgical removal of lower wisdom teeth with respect to the most important parameter, i.e., nerval damage, is almost impossible due to the very large sample sizes required. This fact vice versa indicates that CBCT scans should only be performed in high risk wisdom tooth removals.