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Objectives To evaluate the clinical efficacy of an autonomous robotic system in reducing bone resection volume and operative time for impacted teeth extraction in children, compared to conventional surgical techniques. Methods A single-blinded randomized controlled trial enrolled 10 pediatric patients impacted teeth. Each participant received robotic surgery (test group) and conventional surgery (control group) on contralateral quadrants. Primary outcomes were bone resection volume ratio (measured via pre-/post-op CBCT segmentation) and operative time. Secondary outcomes included nerve injury incidence and healing outcomes. Differences were analyzed via paired t-tests and generalized estimating equations. Results In this RCT of 10 children with impacted teeth, robotic surgery reduced total operative time by 35% (30.7 ± 6.3 vs. 39.3 ± 4.2 min, p  < 0.05) and bone resection time by 65% (8.6 ± 3.3 vs. 24.2 ± 4.8 min, p  < 0.001), while eliminating nerve injuries (0 vs. 1 case). Volumetric analysis confirmed 42% less bone resection (56.8 ± 9.2% vs. 98.4 ± 13.2%, p  < 0.001) through automated segmentation and Boolean subtraction. Conclusion This first RCT on autonomous robotic surgery for pediatric impacted teeth confirms its minimal invasiveness, and operative efficiency. The system significantly reduces bone loss while ensuring anatomical safety in complex pediatric cases. Clinical significance As the pioneering autonomous robotic platform validated through RCT for pediatric oral surgery, this technology offers a clinically viable solution to minimize surgical trauma and operative risks in children, addressing critical challenges in dentoalveolar procedures. Registry Chinese Clinical Trial Registry, TRN: ChiCTR2400092822, Registration date: 25 November 2024.

Objective This preliminary study aims to compare the clinical, radiological, and histological outcomes of third molar socket repairs after dental extraction with and without the use of particulate dentin graft. Materials and methods Ten patients requiring bilateral surgical extraction of impacted lower third molars were selected. One side received a blood clot (control side) and the other an autologous particulate dentin graft (experimental side). Postoperative evaluations at 7 and 21 days assessed pain, edema, trismus, suture dehiscence, and wound edge coaptation. At 120 days, CBCT was used to evaluate bone density, and a biopsy was performed for histological analysis. Data were analyzed using IBM SPSS software with descriptive statistics and paired t-test at a 5% significance level. Results At 21 days, only one case of suture dehiscence occurred on the experimental side, compared to three on the control side. No differences in pain, edema, or trismus were observed between groups. Tomographic analysis showed no significant difference in the distance from the alveolar bone crest to the CEJ, but the experimental group had significantly higher bone density ( p  = 0.002). Histologically, the experimental side exhibited thicker, denser connective tissue with higher cellularity, collagen production, and multinucleated giant cells, while the control side showed typical connective tissue with fewer multinucleated cells. Conclusion Particulate dentin grafting showed benefits in bone density and clinical stability, with a more advanced histological healing stage. Clinical relevance Improve post-extraction socket healing, offering a promising alternative to traditional methods, particularly in terms of enhancing bone regeneration and clinical outcomes.

Numerical aberrations of permanent dentition and dystopic tooth eruption are part of the phenotype of the tumor predisposition syndrome neurofibromatosis type 1 (NF1). In these cases, surplus tooth germs usually develop in the alveolar processes of the jaw. This report attests to the dystopic development of a dysplastic supernumerary tooth in NF1 arising outside the jaw. The 8-year-old male patient developed a microdont outside the bone and above the occlusal plane of the retained maxillary right second molar. The supernumerary tooth was completely embedded in oral soft tissue. Hyperplastic oral soft tissue in the molar region and microdont were excised. Specimen of the mucosa surrounding the teeth was interspersed with diffuse and plexiform neurofibroma. The retained upper right first molar emerged spontaneously within a few months after surgery. The upper right second molar did not change position. Odontogenesis can take place within tumorous oral mucosa in NF1. Surgical removal of the tumorous mucous membrane facilitates tooth eruption in some cases.

Background Alveolar Bone loss occurs frequently during the first six months after tooth extraction. Various studies have proposed different methods to reduce as much as possible the atrophy of the alveolar ridge after tooth extraction. Filling the socket with biomaterials after extraction can reduce the resorption of the alveolar ridge. We compared the height of the alveolar process at the mesial and distal aspects of the extraction site and the resorption rate was calculated after the application of HA/β-TCP or synthetic co-polymer polyglycolic - polylactic acid PLGA mixed with blood to prevent socket resorption immediately and after tooth extraction. Methods The study was conducted on 24 extraction sockets of impacted mandibular third molars bilaterally, vertically, and completely covered, with a thin bony layer. HA/β-TCP was inserted into 12 of the dental sockets immediately after extraction, and the synthetic polymer PLGA was inserted into 12 of the dental sockets. All sockets were covered completely with a full-thickness envelope flap. Follow-up was performed for one year after extraction, using radiographs and stents for the vertical alveolar ridge measurements. Results The mean resorption rate in the HA/β-TCP and PLGA groups was ± 1.23 mm and ± 0.1 mm, respectively. A minimal alveolar bone height reduction of HA/β-TCP was observed after 9 months, the reduction showed a slight decrease to 0.93 mm, while this rate was 0.04 mm after 9 months in the PLGA group. Moreover, the bone height was maintained after three months, indicating a good HA/β-TCP graft performance in preserving alveolar bone (1.04 mm) while this rate was (0.04 mm) for PLGA. Conclusion The PLGA graft demonstrated adequate safety and efficacy in dental socket preservation following tooth extraction. However, HA/β-TCP causes greater resorption at augmented sites than PLGA, which clinicians should consider during treatment planning.

To explore and evaluate the application of a surgical guide in the extraction of impacted mesiodentes. Patients with impacted mesiodentes approachable from the labial side of the maxilla were randomly divided into three groups. The surgical guide for group I was made using cone beam computed tomography (CBCT) and dental cast, whereas the surgical guide for group II was only made using CBCT data. Group I and group II were first evaluated to determine whether guide use could accurately locate the cementoenamel junction (CEJ) of the mesiodentes, and the impacted mesiodentes were extracted with the help of the surgical guide. Group III underwent an operation without a guide. For all patients, the preoperative design time, tooth searching time, operation time, complications, and costs were measured. The guides for group I and group II could locate the CEJ of the mesiodentes accurately, with good application effect during the operation. Group I and group II required additional preoperative design time compared with group III. However, the tooth searching time and operation time in groups I and II were significantly reduced compared with those in group III. Group I and group II showed no intraoperative complications, and two cases in group III showed imprecision during localization. The overall cost for group III was higher than that of group I or group II. But group I and group II required extra visits and costs. Despite some limitations, the surgical guide assisted with mesiodentes extraction and can improve the quality of the operation quality as well as reducing its economic burden, difficulty, and duration. Through proper design, we can create a high-quality surgical guide using only CBCT data. The surgical guide can be used as an important assistive tool in alveolar surgery.

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

Background It has been outlined that LTM (Lower third molar) extracted from patients in which grinding, cleaning, sterilization & demineralization prove to be highly effective as graft material for filling the alveolar socket of the very same patient. These investigations aim to assess the efficiency of ADDM (Autogenous Demineralized Dentin Matrix) graft in third molar extraction sockets. Purpose To check the effectiveness of ADDM as graft material in extraction socket by evaluating pain, swelling, trismus, PD (Probing Depth) and bone density. Study design, setting, sample A prospective, randomized control trial was conducted at our institute. The patients were haphazardly, non-blindly alienated into two groups. Group A (45 patients) on the test side after LTM impaction surgery will receive ADDM graft material with bio-collagen membrane and Group B (45 patients) on the control side underwent LTM removal, with the alveolus left to heal conventionally by forming a blood clot. Results Swelling showed significant difference between CG (Control Group) and TG (Test Group), the intergroup comparison of change in the swelling scores at seventh post-operative day (from pre-op level) was significantly higher in the TG (117.35) as compared to the CGs (115.92) ( p  = 0.001). A statistically significant difference in probing depth was also noted between the two groups, CG 4.46 ± 1.252 & TG 2.52 ± 0.641 in the post-operative examination at three months. In our study radiographical evaluation revealed progressive increase in bone density in TG (135.81 ± 8.73) when compared to CG (121.59 ± 13.83) over a period of three months. Pain and trismus evaluation did not reveal any significant difference between TG & CG. Conclusion The clinical results of the ADDM graft procedure demonstrate satisfactory outcomes in extraction sockets. The findings of this study highlight the importance of preservation methods in maintaining the periodontal pocket depth distal to the second molar and the remaining alveolar ridge following extraction.

Background Preservation of a healthy periodontium is critical for the long-term success of restored teeth. In cases of extensive caries, tooth fracture, inadequate crown length, and increased esthetic demands, the restorative margins need to be placed apical to the gingival margin. Violation of the biological width due to dental trauma frequently appears in clinical practice. There are three treatment options for preserving biological width and the ferrule effect: crown lengthening, orthodontic extrusion, and surgical extrusion. This case report describes the surgical intervention and fixed prostheses for crown-root fractured maxillary incisors in a growing patient. Case presentation A fourteen-year-old boy was referred from Department of Oral and Maxillofacial Surgery and visited the Department of Pediatric Dentistry after emergency dental treatment. He got hit with a baseball bat and his upper right central and lateral incisors were fractured with pulp exposure. A vertical fracture line extended 2 mm below gingival margin was observed. Surgical extrusion and conventional root canal treatments were performed on both fractured teeth. Surgical crown lengthening was additionally done to preserve the biological width and to make sure of the ferrule effect. Then, these teeth were finally restored with porcelain fused metal crowns. Conclusions Surgical extrusion and crown lengthening may be considered the most effective treatments to save the teeth instead of coronectomy or extraction for severely fractured teeth. The case described here showed satisfactory esthetic and periodontal outcomes during two years of follow-up, and the patient was satisfied that he could retain his natural teeth.

Aim: Damage to the inferior alveolar nerve (IAN) while extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. The aim of this study was to compare the sequelae of coronectomy with odontectomy in impacted mandibular third molars. Patients and Methods: This study included thirty patients which were divided into two groups, Group-I (test group) including 15 patients undergoing coronectomy and Group-2 (control group) of 15 patients undergoing odontectomy. Investigations included digital orthopantomogram. The parameters for this study included pain, swelling, nerve paresthesia, trismus, postoperative infection, postoperative wound dehiscence, postoperative pocket depth, and migration. Results: In Group-1 (coronectomy group), the patients underwent follow-up for 6 months to evaluate migration of the retained mandibular third molar root which was in proximity with the IAN. There was a mean increase in migration when the distance from the inferior border of IAN until the apex of the retained mandibular third molar root was measured which was by 3.43 mm after 6 months of follow up. Conclusion: On statistical analysis, the result in this study showed no statistical difference in both the groups in all the parameters that were taken.

Background One of the most frequent dental operations is the surgical extraction of an impacted third molar. The study aimed to evaluate the impact of the intra-socket application of 0.8% Hyaluronic Acid (HA) gel on hard & soft tissue healing after surgical removal of the impacted 3rd molar. Objective Materials and methods This randomized controlled clinical study included thirty patients aged from 21–36 years who were scheduled for surgical removal of impacted mandibular third molar. 0.8% hyaluronic acid gel (HA group) was applied immediately after surgery in the intra-socket of 15 patients, and nothing (No HA group) was applied to the socket of the other 15 patients. Soft tissue healing was assessed after extraction on the third, seventh, and fourteenth day. Bone healing was assessed 2 months post-extraction by measuring bone density and socket length from cone beam computerized tomography. Results The soft tissue healing index was significantly better (very good or excellent) in the HA group compared with no HA group after fourteen days postoperative ( p  < .001). Also, the percentage increase of bone density in the HA group was statistically significantly higher after two months than in the no HA group (( p  < .001). Conclusion Hyaluronic acid 0.8% gel application improves soft tissue healing and bone density healing following surgical extraction of the mandibular third molar. It could be considered a valuable material for improving bone healing and soft tissue. Trial registration The trial is retrospectively registered at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202407576478340 on 30/07/2024.