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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.

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

Background Impacted third molars, particularly in the mandible, are commonly associated with complications such as pericoronitis, root resorption, and notably, distal caries in adjacent second molars. Despite this association, previous studies in Saudi Arabia have predominantly relied on two-dimensional imaging, which may underestimate diagnostic features. This study aimed to assess the prevalence and patterns of impacted third molars and their association with distal caries incidence in second molars using cone beam computed tomography (CBCT). Methods A retrospective cross-sectional study was conducted from a leading dental center in Ha’il, Saudi Arabia, analysing 315 CBCT scans obtained between 2019 and 2024. The angulation, depth, and position of impacted third molars were classified using Winter’s classification and the Pell and Gregory system. The presence of caries on adjacent second molars was recorded. Statistical analysis included Chi-square and Fisher’s exact tests, with significance set at p  ≤ 0.05. Results Mesioangular impaction was most common in the mandibular arch, particularly among younger individuals (18–25 years). Class B and C impactions were prevalent in the lower molars, with deeper impactions more frequently observed in females and older individuals. Distal caries on mandibular second molars were significantly associated with mesioangular and horizontal impactions, particularly in the quadrant 4 CBCT imaging demonstrated a notable prevalence of distal caries, which appears higher than the rates reported in previous two-dimensional studies; however, direct intra-study comparison was not performed. Conclusions Impacted mandibular third molars, especially those with mesioangular angulation and in deeper positions, pose a significant risk to adjacent second molars. While these findings highlight a potential role for early intervention, including prophylactic removal in selected high-risk cases, longitudinal and interventional studies are necessary to establish definitive clinical guidelines.

The aim of the study is to investigate the effectiveness of the modified Akinosi technique [MAT] in endodontic management of mandibular molars with symptomatic irreversible pulpitis, and to compare it with the standard inferior alveolar nerve block for effective pulpal anesthesia. A total of 80 clinically healthy patients of both genders, between 16 and 65 years, diagnosed with symptomatic irreversible pulpitis in mandibular first and second molars were included in the study. The subjects were divided into two groups. Group A received nerve block and pulpal anesthesia through Inferior Alveolar Nerve Block technique, while Group B received nerve block through MAT with 2% lignocaine containing 1:200,000 adrenaline. All endodontic treatments were performed in a single visit. We evaluated the presence of pain during various phases of endodontic treatment with Visual Analog Scale. The pain level was registered at the end of the following phases of the endodontic treatment: 1. During access cavity preparation; 2. While determining working length for all the root canals; 3. During cleaning and shaping of root canals. In Group B, 80% of patients reported no pain, as compared to 51% in Group A. MAT is an effective method for achieving pulpal anesthesia in endodontic treatment of symptomatic irreversible pulpitis.

Pell and Gregory, and Winter’s classifications are frequently implemented to classify the mandibular third molars and are crucial for safe tooth extraction. This study aimed to evaluate the classification accuracy of convolutional neural network (CNN) deep learning models using cropped panoramic radiographs based on these classifications. We compared the diagnostic accuracy of single-task and multi-task learning after labeling 1330 images of mandibular third molars from digital radiographs taken at the Department of Oral and Maxillofacial Surgery at a general hospital (2014–2021). The mandibular third molar classifications were analyzed using a VGG 16 model of a CNN. We statistically evaluated performance metrics [accuracy, precision, recall, F1 score, and area under the curve (AUC)] for each prediction. We found that single-task learning was superior to multi-task learning (all p < 0.05) for all metrics, with large effect sizes and low p-values. Recall and F1 scores for position classification showed medium effect sizes in single and multi-task learning. To our knowledge, this is the first deep learning study to examine single-task and multi-task learning for the classification of mandibular third molars. Our results demonstrated the efficacy of implementing Pell and Gregory, and Winter’s classifications for specific respective tasks.

Objectives This study aimed to evaluate the clinical and radiographic success of endodontic treatment in primary molars, in addition to the evaluation of the working time (WT) and cost-effectiveness Ratio (CER), and Incremental Cost-Effectiveness Ratio (ICER) of the Fanta AF Baby and Zuanba file systems, compared to manual K-files. Materials and methods One hundred and sixty-two-second primary molars were randomly assigned into three groups, according to the type of the instrumentation file system. A pulpectomy procedure was performed, and the average WT was recorded for each group. Clinical assessments were made at 3-, 6-, and 12-month follow-ups, while radiographic assessments were performed at 6- and 12-month follow-ups. The direct medical cost for one molar in each group was calculated, and the (CER) was determined for each group. ICER was calculated for each group, based on the average WT and radiographic success at the 12-month mark as clinical effectiveness parameters. Results The average WT in the manual K-file group was 14.65 (± 1.85) minutes, while the Fanta AF baby file system and Zuanba file system group had an average WT of 10.52 (± 1.13) minutes, and 9.46 (± 1.12) minutes, respectively. By the end of the follow-up period, all groups exhibited the same clinical success rate of 96.7%, with no statistically significant difference ( p  > 0.05). For the radiographic success, the K-file group displayed a higher frequency of failures (11.1%), followed by the Fanta AF baby file system group (7.4%). The Zuanba file system group had the fewest failures, reporting only two cases (3.7%). Regarding ICER, the Fanta AF Baby files system was found to incur an additional cost of 50.63 EGP for reducing one minute of working time, and 52 EGP for achieving one extra successfully treated second primary molar compared to the K-files system. While the Zuanba file system costs an additional 10.98 EGP for reducing one minute of WT, and an extra 28.5 EGP for getting an extra second primary molar successfully treated compared to the K-files. Conclusion Both assessed rotary file systems showed shorter average WT, higher radiographic success, and CER compared to the manual k file. Clinical relevance This study aids the pediatric dentist in the choice of the most effective, both clinically and economically, rotary filling system for endodontic treatment of primary molars. Trial registration The clinical trial was registered at clinical trial.gov identifier NCT04279041, on 2020-02-18.

Objective This study aimed to evaluate the prevalence and patterns of impacted mandibular third molars (MTMs) and their association with distal caries in adjacent mandibular second molars (MSMs). Methods A total of 2000 randomly selected orthopantomograms (OPGs) were analyzed. MTM impaction patterns were classified using Winter’s and Pell-Gregory systems, and distal caries on MSMs were assessed. Statistical analyses included chi-square tests and multivariate logistic regression to evaluate associations between impaction characteristics and caries prevalence. Results Of the 1594 eligible OPGs, 37% exhibited MTM impactions. Among the 828 impacted MTMs identified, 19.56% were associated with carious lesions on the distal surface of adjacent MSMs. Statistical analysis revealed that mesioangular impactions significantly increased the likelihood of distal caries in MSMs. In contrast, Pell-Gregory Classes II-C and III-C were associated with reduced odds of caries. Age emerged as a strong predictor, whereas gender and other Winter’s classification categories did not significantly influence caries occurrence. Conclusion Impacted MTMs are associated with an increased risk of caries on the distal surface of MSMs. Impaction patterns and patient age influenced the prevalence of caries. Prophylactic removal of impacted MTMs in high-risk cases may help reduce the risk of caries development in MSMs.