In May 2023, the Chinese Stomatological Association promulgated the group standard of "Clinical Practice Specifications for Permanent Tooth Extraction". These specifications were formulated after repeated discussions and revisions guided by relevant literature and the opinions of well-known experts in the field across the country. However, the content of the group standard is not elaborated and is limited to its writing form and requirements. As a consequence, medical workers might not easily understand and comprehend its content and knowledge points, which also limits its dissemination and wide use in primary medical units. This study aims to sort out and interpret the content of the 2023 edition of the "Clinical Practice Specification for Permanent Tooth Extraction" to help medical staff understand and apply it in clinical practice.
Tooth Extraction/standards* ; Humans ; China ; Dentition, Permanent ; Practice Guidelines as Topic

OBJECTIVES: To compare the clinical effects of concentrated growth factor (CGF) membrane and Bio-Gide ^® collagen membrane, combined with Bio-Oss ^® sticky bone respectively in alveolar ridge preservation (ARP) of maxillary anterior teeth. METHODS: Thirty patients who needed alveolar ridge preservation after maxillary anterior tooth extraction were selected and randomly assigned to the Bio-Gide group and the CGF group. In both groups, the extraction sockets were tightly filled with the Bio-Oss^® sticky bone. In the Bio-Gide group used Bio-Gide^® collagen membrane to cover the upper edge of the Bio-Oss^® sticky bone and closed the wound. The CGF group, the CGF membrane was covered on the upper edge of the Bio-Oss^® sticky bone and the wound was closed. The soft tissue wound healing status at 10 days after ARP, the changes in alveolar ridge height and width immediately after ARP and at 6 months after ARP, and the doctor-patient satisfaction at 6 months after ARP were compared and evaluated between the two groups. RESULTS: At 6 months after ARP, there was no statistically significant difference in the changes of alveolar bone width and height between the two groups (P>0.05). However, the CGF group showed better performance in soft tissue healing after ARP and doctor-patient satisfaction, and the differences were statistically significant (P<0.05). CONCLUSIONS Compared with the Bio-Gide^® collagen membrane, the combined application of CGF membrane and Bio-Oss^® sticky bone can lead to better soft tissue healing after ARP of maxillary anterior teeth and higher doctor-patient satisfaction, showing obvious advantages in ARP of maxillary anterior teeth.
Humans ; Maxilla/surgery* ; Tooth Extraction ; Alveolar Process/surgery* ; Membranes, Artificial ; Alveolar Ridge Augmentation/methods* ; Intercellular Signaling Peptides and Proteins/therapeutic use* ; Minerals/therapeutic use* ; Collagen ; Wound Healing ; Tooth Socket/surgery* ; Bone Substitutes/therapeutic use* ; Male ; Female ; Middle Aged ; Alveolar Bone Loss/prevention & control* ; Adult

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.
Humans ; Tooth Extraction/adverse effects* ; Mandible/surgery* ; Tooth Root ; Mandibular Nerve/anatomy & histology* ; Postoperative Complications/prevention & control* ; Intraoperative Complications ; Mandibular Nerve Injuries/etiology*

Dental trauma is a common oral condition in children. For single-type trauma to young permanent teeth, timely treatment often results in a high survival rate for both the teeth and the pulp. However, in cases of complex dental trauma or when supernumerary teeth are impacted near the apex of the injured tooth, the prognosis is less predictable. This article reports a case of root fracture in an immature maxillary permanent central incisor combined with impacted supernumerary tooth in the apical region. After supernumerary tooth extraction and pulp revascularization therapy, the case demonstrated a good treatment outcome over a nearly 10-year follow-up period.
Child ; Humans ; Incisor/injuries* ; Maxilla ; Tooth Extraction ; Tooth Fractures/complications* ; Tooth Root/injuries* ; Tooth, Impacted/surgery* ; Tooth, Supernumerary/surgery*

INTRODUCTION: Antimicrobial resistance (AMR) poses a critical global health threat, with millions of deaths attributed to it annually. Antibiotic stewardship to combat AMR is the responsibility of all healthcare professionals. Despite evidence suggesting that it is unnecessary, dentists routinely prescribe prophylactic antibiotics following third molar (3M) surgeries. METHOD: This mixed-methods study examined the behavioural barriers influencing antibiotic prescribing practices within the Division of Oral and Maxillofacial Surgery at the National University Centre for Oral Health Singapore. This study used the capability, opportunity and motivation for behavioural change or COM-B framework to implement interventions targeting the behavioural barriers. RESULTS: Pre- and post-intervention data over 6 months showed a significant reduction in antibiotic prescriptions from 84.45% to 20.89%, following the implementation of COM-B strategies (P<0.001). Qualitative feedback from focus group discussions highlighted a positive shift in clinicians' attitudes towards antibiotic reduction, acknowledging the minimal infection risk associated with non-prescribing practices. Notably, complication rates remained stable throughout the study period, indicating no adverse effects from reduced antibiotic usage. CONCLUSION These findings demonstrated that the COM-B model can be successfully applied to modify deeply ingrained prescription habits, and underscored the effectiveness of a structured behavioural change intervention in enhancing compliance with antibiotic stewardship guidelines. The study advocates continuation of initiatives to sustain this positive trend and mitigate AMR in clinical practice.
Humans ; Molar, Third/surgery* ; Anti-Bacterial Agents/therapeutic use* ; Singapore ; Antimicrobial Stewardship/methods* ; Practice Patterns, Dentists'/statistics & numerical data* ; Antibiotic Prophylaxis ; Female ; Attitude of Health Personnel ; Male ; Tooth Extraction ; Adult ; Focus Groups ; Practice Patterns, Physicians'

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

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*

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 risk factors of inferior alveolar nerve injury (IANI) after surgical removal of the mandibular third molars (M3) and present a new risk scoring system to predict the probability of IANI. Methods: Patients who underwent extraction of M3 in the Stomatology Hospital, Zhejiang University School of Medicine from April 2017 to December 2019 were involved. The investigators enrolled a sample composed of 949 mandibular third molars. Prediction model was used for univariate and multivariate analysis of gender, age, M3, inferior alveolar canal (IAC), and the contact between M3 and IAC, to assess the risk factors of IANI. Combined with the risk factors determined by the outcomes of prediction model, the risk scoring system was constructed. The diagnostic performance of each cut-off score was examined to conduct a risk stratification of IANI risk scores. The predictive ability and reliability of the model were evaluated. Results: In prediction model, twenty nine cases (4.4%, 29/664) experienced postoperative IANI. Number of root (P<0.01), depth of impaction (P<0.05), contact between M3 and IAC (P<0.01) and their contact position (P<0.05) were statistically significant as contributing risk factors of IANI. Specifically, the incidence of temporary IANI was higher in those who aged under 25 years (P<0.001), while female suffer more permanent injury (P<0.05). Based on the IANI risk scoring system, patients were stratified into low-risk, middle-risk and high-risk groups at cutoff scores of 3 and 4. The area under the receiver operator characteristic curve of the risk scoring system were 0.81 [95%CI (0.70-0.90), P=0.002] and 0.80 [95%CI (0.68-0.92), P=0.007] towards good discrimination. Conclusions: Age, gender, number of root, depth of impaction, and contact between M3 and IAC were risk factors of IANI. IANI risk scoring system might help in preoperative assessment, recognition of high-risk cases and decision-making to reduce IANI.
Aged ; Female ; Humans ; Mandible/surgery* ; Mandibular Nerve ; Molar, Third/surgery* ; Reproducibility of Results ; Risk Factors ; Tooth Extraction/adverse effects* ; Trigeminal Nerve Injuries/etiology*

ABSTRACT Alveolar ridge preservation is a surgical procedure aimed to preserve the alveolar bone after tooth extraction to eliminate or reduce the need for bone augmentation during implant placement. It includes the use of membrane that is either being used alone or in combination with a bone replacement graft. This case report describes the technique of alveolar ridge preservation after tooth extraction using a xenogenic bone graft combined with a resorbable collagen membrane, and the fabrication of an anterior fibre-reinforced composite (FRC) bridge in an 18-year-old male patient. This treatment allows him to have a good preservation of the volume and architecture of the alveolar ridge as well as soft tissues and temporarily replace a missing anterior tooth until a definitive restoration can be achieved.
Alveolar Ridge Augmentation ; Tooth Extraction ; Composite Resins ; Young Adult