Impacted teeth are a frequent phenomenon encountered by every clinician. The artificial eruption of embedded teeth is the process of directing an impacted tooth into normal occlusion. This procedure is currently attracting attention, with the aim of finding the best technique to use according to each case. This article presents key information regarding impacted incisors, canines, and premolars. In addition, we describe the most common techniques to use for artificial eruption, the open and closed techniques. We review the literature concerning these techniques and outline how clinicians can manage every type of impacted tooth.
Bicuspid ; Incisor ; Surgery, Oral ; Tooth ; Tooth, Impacted

OBJECTIVES: This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars. METHODS: Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests. RESULTS: The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status ( CONCLUSIONS The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.
Humans ; Mandible/surgery* ; Molar, Third/surgery* ; Prospective Studies ; Tooth Extraction ; Tooth, Impacted/surgery*

OBJECTIVE: To evaluate the relevant indicators affecting difficulty in the extraction of impacted mandibular third molars and score difficulty of different operation and risk indicators, so as to build an intuitive and accurate scale to help operators make more accurate analysis and prediction of difficulty before the operation. METHODS: Based on literature and the clinical review, the difficulty indicators of tooth extraction were summarized. Firstly, 10 doctors from Peking University School and Hospital of Stomatology who had been engaged in alveolar surgery for a long time established an expert nominal group, and then rated whether the summarized indicators needed to be retained in the form of face-to-face questionnaires. A level 1 and 2 item frame for evaluating difficulty in the tooth extraction was formed after discussion; Then Delphi method was used to send a questionnaire to 30 experts by e-mail. After two rounds of scoring and modification, the scale of difficulty in the extraction of impacted mandibular third molars was formed. RESULTS: The recycling rate of two rounds of questionnaires was 100.0%, which showed that the experts were very enthusiastic about the study; The authority coefficients (Cr) of the two rounds of Delphi expert consultation were both 0.92, which showed that the results were representative and authoritative. After two rounds of grading and revision, the variable coefficient (CV) decreased and the Kendall's concordance coefficient (W) increased, which were statistically significant: In the first round, the CV was 0.24 and W was 0.56 (P < 0.001), and in the second, the CV was 0.19 and W was 0.72 (P < 0.001), which indicated that there was a good convergence among the expert opinions. Finally, a scale of difficulty in the tooth extraction containing 12 items at level A and 37 items at level B was formed, including operation difficulty indicators, risk difficulty indicators and common difficulty indicators. CONCLUSION Based on comprehensive literature retrieval, the study has put forward the concept that difficulty in the extraction of impacted mandibular third molars is composed of operation difficulty and risk difficulty. Using Delphi method, the long-term clinical experience and professional knowledge of experts are transformed into quantitative indicators as a scoring scale. The scale has certain representativeness and authority.
Delphi Technique ; Humans ; Mandible/surgery* ; Molar, Third/surgery* ; Tooth Extraction ; Tooth, Impacted/surgery*

Objective: To evaluate the effect of the application of a self-developed three-dimensional visualized model of impacted tooth for surgical extraction in undergraduate oral experimental teaching. Methods: Forty-one undergraduates majoring stomatology of Tongji University from 2018 [19 males and 22 females, aged (22.4±0.8) years] were enrolled and randomly divided into the conventional group and the experimental group. Students of the conventional group (21 students including 8 males and 13 females) received a teaching protocol for the surgical extraction of impacted tooth including theoretical lectures, watching operation videos, and operating on head-simulator teaching systems. Students of the experimental group (20 students including 11 males and 9 females) received an additional training of resistance assessment and surgical extraction using the three-dimensional visualized model of impacted tooth before operating on the head simulators. After class, a questionnaire survey was carried out among students, and the operation results on the head simulators were evaluated by the teacher. Results: The results of the questionnaire showed that the students in the experimental group were rated higher than those in the traditional group in terms of being able to imagine the relationship between impacted teeth and adjacent structures (U=114.00, P=0.006), avoiding damage to adjacent teeth (U=87.00, P<0.001) and inferior alveolar nerve during tooth extraction (U=111.50, P=0.006), and being more confident in clinical operations in the future (U=120.00, P=0.013). According to the evaluation results of tooth extraction on the head simulators, there was no significant difference in the operation time between the two groups (U=138.50, P=0.056). In the experimental group, 5% (1/20) caused adjacent tooth loosening and 15% (3/20) caused the excessive bone defect, which was less than those in the traditional group [38% (8/21) and 48% (10/21), respectively] (P=0.021; P=0.043). There was no significant difference in the incidence of grinding out the deep bone of impacted teeth between the two groups (P=0.232). Conclusions: The application of three-dimensional visualized model of impacted tooth for surgical extraction in undergraduate oral experimental teaching had achieved good results and was worth popularizing.
Female ; Humans ; Male ; Molar, Third/surgery* ; Operative Time ; Students ; Tooth Extraction/methods* ; Tooth, Impacted/surgery*

INTRODUCTION: Surgical extraction of third molar is one of the most frequently performed procedures in oral and maxillofacial surgery unit as the impacted wisdom teeth could cause various complications. Even though, however, extraction of the impacted wisdom teeth is an obligation for the reason of possible complication even for general practitioners, it has been avoided. Various factors concerning surgical extraction of impacted third molar are considered: general condition of patients, relationship with relative anatomies, aspects of impaction, surgeon's skill. MATERIALS AND METHODS: The consideration and crossing analysis of these factors with 2,463 patients who visit Dankook University dental hospital to extract those impacted third molar. RESULTS: 1. Gender doesn't affect. 2. Medical problems have more complications. 3. There are more complications in high difficulty index (DI) impacted teeth. 4. When inferior alveolar canal overlap mandibular third molar, complication rate is 26.92%. 5. The most common complication was swelling and pain. 6. There is no statistical difference between the incidence of complication and surgeon's experience. CONCLUSION: In regard to these results, it seems that clinical or radiological examination can predict potential complications of wisdom teeth, and it is helpful to bear in mind the fact.
General Practitioners ; Humans ; Incidence ; Molar, Third ; Retrospective Studies ; Surgery, Oral ; Tooth Extraction ; Tooth, Impacted ; Ursidae

OBJECTIVES: This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications. METHODS: Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0. RESULTS: Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), CONCLUSIONS Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.
Humans ; Mandible ; Molar, Third/surgery* ; Platelet-Rich Fibrin ; Tooth Extraction ; Tooth, Impacted

OBJECTIVES: This study aimed to establish a new treatment of the mandibular second molars with external root resorption caused by impacted teeth to preserve the affected teeth and their vital pulps. METHODS: For mandibular second molars clinically diagnosed as external root resorption caused by impacted teeth, debridement and removal of the root at the resorption site via micro-apical surgery and direct capping of the pulp with bioactive material on the surface of the root amputation via vital pulp therapy were performed immediately after the impacted teeth were extracted. RESULTS: The external root resorption of the affected tooth was ceased. It was asymptomatic with intact crown, normal pulp, periapical alveolar bone reconstruction, normal periodontal ligament, continuous bone sclerosis, and no periapical translucency in radiographic examination at the 1-year postoperative follow-up, thus showing good prognosis. CONCLUSIONS Simultaneous combination of micro-apical surgery and vital pulp therapy after extraction of impacted teeth could successfully preserve mandibular second molars with ERR caused by impacted teeth and their vital pulps.
Humans ; Tooth, Impacted/surgery* ; Molar ; Mandible ; Dental Pulp ; Root Canal Therapy ; Root Resorption/etiology* ; Tooth Extraction

OBJECTIVES: To summarize the open-eruption technique of impacted anterior maxillary teeth, this study reports a technically improved operation on surgical exposure based on dental follicles and evaluates post-treatment periodontal health considering the effect of dental follicles. METHODS: Patients who underwent open-eruption technique with unilateral labially impacted maxillary central incisors were selected. The impacted teeth were assigned to the experimental group, and the contralateral unimpacted maxillary central incisors were assigned to the control group. In the surgical exposure, the new technique makes use of dental follicles to manage the soft tissue, so as to preserve soft tissue for better aesthetic results and healthier periodontal tissue. Tooth length, root length, alveolar bone loss, and alveolar bone thickness were recorded after the therapy. RESULTS: A total of 17 patients with unilateral maxillary central incisor impaction were successfully treated. The tooth length and root length of the two groups showed a statistically significant difference between the impacted and homonym teeth, with a shorter length in the impacted tooth (P<0.05). More labial alveolar bone loss was found in the experimental group compared with that in the control group (P<0.05). The outcomes of the cementoenamel junction width, pa- latal alveolar bone loss, and alveolar bone thickness did not indicate statistical significance between the experimental and control groups (P>0.05). CONCLUSIONS In the surgical exposure, the new technique uses dental follicles to manage the soft tissue and preserve it for better aesthetic results and healthier periodontal tissues.
Humans ; Tooth, Impacted/surgery* ; Incisor ; Alveolar Bone Loss/diagnostic imaging* ; Tooth Root ; Dental Sac ; Maxilla/surgery* ; Esthetics, Dental

INTRODUCTION: Very high aggressiveness and recurrence are important clinical characteristics of ameloblastoma compared to the other benign tumors. Therefore, an accurate diagnosis and treatment plan is important. This study examined the association of the clinical findings and recurrence based on the radiological findings of ameloblastoma. In recurrent cases, these results are expected to help in the diagnosis and treatment of ameloblastoma to examine the relevance with the clinical characteristics and radiological features. MATERIALS AND METHODS: For a clinical (gender, age) and radiological (location, internal pattern, size, perforation, border pattern, impacted tooth, root resorption) evaluation , this study examined 156 cases of 147 patients diagnosed with ameloblastoma, who had been treated and in most cases regularly checked at the department of oral and maxillofacial surgery, Kyungpook National University Hospital, between January 1993 and December 2009. For a recurrent rate evaluation, a more than 3 years follow-up period is needed. Accordingly, 116 patients diagnosed with ameloblastoma between January 1994 and December 2007 were investigated. RESULTS: The recurrence rate in all cases was 6.1% but was 7.8% in cases with follow-up periods more than 3 years. The male-to-female ratio was 3:2, showing a slight male predilection. Ameloblastoma had a peak occurrence in the second decade of life followed by the fourth decade of life. The mandibular angle area is the most frequent site of ameloblastoma (50.8%) in the jaws. Six cases of unilocular (7.8%) and 3 cases of multilocular (7.7%) ameloblastomas recurred. Seven cases of smooth (10%) and 2 cases of irregular (4.3%) ameloblastomas recurred. No cases of ameloblastomas without perforation of the cortical bone (0%) and 9 cases with a perforation of cortical bone (11.1%) recurred. Four cases of the ameloblastomas with impacted teeth (11.4%) and 5 cases of ameloblastomas without impacted tooth (6.2%) recurred. Seven cases of ameloblastomas with root resorption (10.9%) and 2 cases of ameloblastomas without root resorption (3.8%) recurred. CONCLUSION: A multiple smooth margin, unilocular ameloblastoma with an impacted tooth, root resorption tends to recur more easily. Therefore, they need to be treated more carefully and require a a longer follow-up.
Ameloblastoma ; Follow-Up Studies ; Humans ; Jaw ; Male ; Recurrence ; Root Resorption ; Surgery, Oral ; Tooth, Impacted

INTRODUCTION: Third molar extraction is one of the most common procedures in oral and maxillofacial surgery. The impacted third molar causes many pathological conditions, such as pericoronitis, caries, periodontitis, resorption of adjacent teeth, and cyst or tumors associated with impacted teeth. Extraction is often considered the treatment of choice for impacted lower third molars. On the other hand, imprudent extraction of deeply impacted third molars can cause permanent complications, such as inferior alveolar nerve damage. Therefore, guidelines for the extraction of lower third molars should be set to prevent embarrassing complications. This study examined the indication and current trends of the extracted lower third molars in the dental hospital of a dental college. MATERIALS AND METHODS: 557 extracted third molars were evaluated at the department of oral and maxillofacial surgery of Yonsei University. The chief complaint, diagnosis, age and degree of impaction were analyzed to determine the tendency for the extraction of asymptomatic lower third molars. RESULTS: The percentage of asymptomatic third molars was 40.8%. In cases of full impacted tooth or full erupted tooth, the percentage of asymptomatic teeth was more than 50% (52.4% and 54.3, respectively). Among those partially impacted teeth, 73.1% of them showed symptoms, such as pain, tenderness and swelling. In terms of age, pericoronitis was evident at a younger age, and dental caries/periodontitis was the main cause of removal in those aged over 50. Twenty nine cases (1.6%) had teeth associated with pathological changes. CONCLUSION: The incidence of pathological changes to the lower third molar was relatively low. Surgical extraction is recommended in cases of partially impacted teeth. In Korea, the incidence of asymptomatic third molar extraction was relatively higher than in European countries. More careful attention would be desirable to consider the risks and benefits of lower third molar extraction.
Aged ; Decision Making ; Hand ; Humans ; Incidence ; Korea ; Mandibular Nerve ; Molar, Third ; Pericoronitis ; Periodontitis ; Risk Assessment ; Surgery, Oral ; Tooth ; Tooth, Impacted