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Objective: Third molar removal is a frequent surgical procedure. Common complications associated with third molar surgery are well-recognized and frequently explained to patients during the process of informed consent. The general dental practitioner, as well as the oral and maxillofacial surgeon, must be familiar with all possible complications. This systematic review serves as a reminder of the unusual complications of this routine procedure. Method and Materials: Studies were located using systematic searches in Medline and the Cochrane Library electronic databases, as well as hand searching of key texts, references, and reviews relevant to the field. Key words included third molar, wisdom tooth, complications, unusual, and rare. References from the relevant articles were also double-checked. The review was limited to English- and German-language articles published within the last 18 years. Results: Frequently detected, well-known complications are permanent nerve damage and immediate or late mandibular fractures. Twenty-four other complications were identified in 22 articles. Among these complications were inflammatory processes, abscess formation, and displacement of teeth and instruments. Single case reports describe asphyxial death after postextraction hematoma, life-threatening hemorrhage, brain abscess, epidural abscess, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. Conclusion: To achieve good patient care, it is necessary to realize the variety of possible complications. Rare complications must be recognized early so that adequate therapy can be immediately ensured. (Quintessence Int 2009;40:565-572). [ABSTRACT FROM AUTHOR]

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Dental treatment can lead to disputes between patients and dentists, which are then brought before the civil courts as medical malpractice cases. The court regularly commissions a dental expert to answer questions of evidence in court. In the majority of cases, the expert is able to answer these questions based on his professional expertise and practical experience. In order to make the assessment comprehensible and credible for the judge and the parties, it can be helpful and reasonable to cite relevant literature references from dental textbooks and specialist journals. In individual cases, it may be necessary to carry out a systematic literature search on specific topics. Based on the situation in Germany, this narrative review makes recommendations of how to perform a literature search and make citations specifically for expert opinions that are generally applicable independent of national jurisdiction., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

This case report of a 45-year-old patient at initial presentation shows an illustration of the limitations of periodontal maintenance therapy and subsequent implant prosthetic therapy. In close consultation with the patient, treatment strategies were adopted to maximize the preservation of prognostically questionable teeth. Eight years later, the patient had a highly atrophied maxilla that could be successfully restored with implants. This was achieved with 2 zygoma implants and 2 anterior conventional implants, which were immediately loaded according to the All-on-4 concept and immediately provided with a definitive prosthetic restoration. The case report demonstrates to the general practitioner that using zygoma implants in such constellations may offer a solution to achieve a fixed, rapid, and financially acceptable prosthetic rehabilitation.

Double teeth, like fusions and geminations, are rare disorders of tooth development. In this short case presentation, we describe the unique appearance of a fully erupted mandibular wisdom tooth in a 72-year-old patient whose tooth exhibited gemination. This was possible because tooth 46 had to be removed from the patient at the age of 20 and the missing molar was not replaced. This geminated tooth of 48 had been in function for almost 50 years and finally had to be removed due to a periodontal inflammation. To the best of our knowledge, this is the first case presented of this dental anomaly for a fully erupted lower wisdom tooth., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Background: The digital panoramic radiograph (orthopantomogram, OPG) is the standard radiographic technique for basic diagnostics in dental practice. A correctly taken image provides a good overview of teeth and jaw, whereas radiopaque foreign materials, e. g. metal, can obscure relevant findings., Methods: A literature review on unexpected metallic foreign bodies in OPG was performed to determine the spectrum of metallic foreign bodies that may cause radiopaque areas on panoramic radiographs in routine clinical use., Results and Conclusion: A total of 37 different unexpected metallic foreign bodies were found. They can be categorized as jewelry, clothing, personal protective equipment, medical devices, iatrogenic foreign bodies, and rare incidental findings. Radiopaque foreign materials in the OPG are often relatively easy to recognize as artifacts because of their location, and they are avoidable in most cases. If unclear, a three-dimensional radiograph was helpful for determining the location. Radiopaque areas caused by foreign bodies can lead to misinterpretation or partial or complete non-evaluability and should therefore be avoided., Key Points: · The OPG is the standard radiograph for dentists, oral surgeons, and oral and maxillofacial surgeons.. · Foreign bodies made of metal can lead to non-evaluability of panoramic radiographs. Based on a review of the literature and exemplary radiographs, this article provides an overview of rare but typical metallic foreign bodies in OPG, thus addressing the problem of the subfield of radiography by making radiologists more familiar with these images.. · The spectrum of unexpected metallic foreign bodies includes unremoved earrings with the typical ghost images on the contralateral side, piercings, hearing aids, acupuncture needles, rare iatrogenic foreign bodies, incidental findings in infants in the nose and external auditory canal, vascular clips after surgical interventions, and ritual subcutaneous foreign materials.., Citation Format: · Brauer HU, Bartols A, Hellmann D et al. Unexpected metallic foreign bodies on panoramic scans - a narrative review. Fortschr Röntgenstr 2023; 195: 809 - 818., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht.

Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Legal expert opinions are a crucial instrument of professional self-control in medicine. To give impulses for further development, focus groups were initiated to reflect upon the perspective of legal dental experts., Methods: 5 focus group discussions on the topic "Professionalization of legal dental experts" were conducted. A total of 32 experienced legal dental experts participated in the discussions. The results were evaluated by qualitative content analysis., Results: A catalogue of 68 ideas was generated for improvement and divided into 15 categories. Among these were periodic quality circles, interprofessional exchange, supervision of novices and periodic feedback for legal dental experts and dentists., Conclusion: Self-reflection can be included as an instrument for quality improvement of legal dental expert opinions., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Several prospective clinical trials have indicated an association between maternal periodontal status and adverse pregnancy outcome, e.g., low birth weight, pre-term birth and pre-eclampsia. However, the translation of these findings into clinical care and decision making is still a matter of debate. Gynecologists and obstetricians are usually not very familiar with periodontal diseases and do not always consider this pathology in routine preconception counselling. This article outlines the clinical pictures of the most common periodontal diseases and thus helps the gynecologists to identify patients with periodontal diseases., (© Georg Thieme Verlag KG Stuttgart · New York.)

In this short communication, the very rare glandular odontogenic cyst (GOC) is presented as an independent entity. The GOC is a jawbone cyst of the maxilla and mandible. The typical radiological and histopathological characteristics of the GOC are described. Furthermore, differential diagnoses, current treatment options and the recurrence rates of this of entity are discussed.

According to the 2005 WHO classification of head neck tumors the parakeratinized form of the odontogenic keratocyst (primordial cyst) is listed as benign odontogenic tumor and is classified as keratocystic odontogenic tumor (KCOT). In this short communication the surgical regimen as well as KCOT as an entity are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar with less frequent complications. This review gathers unusual complications of this surgical procedure and presents unique complications from single case reports., Method and Materials: Studies were located using systematic searches in Medline and the Cochrane Library electronic databases. Key words included the terms "implant", "dental", "oral", "complication", "unusual", and "rare". References from the relevant articles were also double-checked. The review was limited to English and German language articles, published within the last 15 years., Results: 17 different unusual complications were identified. The majority of studies report five different complications: permanent nerve injury, damage to teeth adjacent to the implant, excessive bleeding resulting in hematoma of the floor of the mouth, mandibular fracture, and displacement of implants into the maxillary sinus. Benign paroxysmal positional vertigo and a plunging ranula were reported sporadically. Another 10 complications were only described once in our literature search., Conclusion: Unusual complications are challenging. It is important for the dental practitioner to be aware of all the possible complications and to recognize them early so that adequate therapy can immediately be ensured.

Background: The keratocystic odontogenic tumour (KCOT), formerly known as the odontogenic keratocyst, is a benign intra-osseous odontogenic tumour. The KCOT is characterised by a potential for locally destructive behaviour and a relatively high recurrence rate. Most KCOT are incidentally discovered as well-defined unilocular or multilocular radiolucencies on routine panoramic radiographs., Case Report: A 15-year-old boy was referred to dental care with a non-syndromic KCOT in the right angle of the mandible. Using cone-beam computed tomography (CBCT) as a diagnostic instrument for precise assessment of the KCOT, the exact location of the lesion was determined., Treatment: The cystic formation was enucleated without peripheral ostectomy., Follow-Up: At post-operative follow-up after 3 and 6 months, the boy reported no pain and there was no residual swelling or fracture. Imaging was planned after 1 year to decide whether further surgical treatment is indicated., Conclusion: The CBCT is considered beneficial in cases of cystic formations to determine the localisation and borders of the lesion in all three dimensions.

Background: A well-established doctor-patient relationship is essential for dental care. Once ­there is a legal dispute between the dentist and the patient this doctor-patient relationship has failed. Here we show for the first time how dentists experience these lawsuits. We characterise the dentist's perspectives and investigate their influence on the doctor-patient relationship., Methods: The experience of dentists who were involved in a legal dispute due to a failed dental treatment is pictured in a pilot study on the basis of narrative and problem-oriented interviews. The narrative part of the interview was analysed with the technique of narration analysis. The problem-oriented part of the interview was evaluated content-analytically. From these data a model describing the failure of a doctor-patient relationship was developed., Results: Communicated burdens and stress were: expenditure of time, duration of the proceedings, financial burdens, limited support and the feeling of being treated unfairly. Consequences taken from the legal dispute were a more detailed documentation and an improvement in patient information. The conflict in the doctor-patient relationship is transformed to a different platform when the legal profession is involved. This contradictory constellation leads to a break in the doctor-patient relationship. Advice for other affected colleagues is: remain calm, aim at an out of court settlement, seek advice from other colleagues and request legal advice, be proactive, avoid court litigation and in the end draw conclusions from the dispute. There is a need for a higher quality of legal dental experts. A contact platform provided by the dental profession is required for interactive collegial communication., Conclusion: Lawsuits in cases of a conflict between the doctor and the patient are very stressful and need an active coping management but also are a chance for the development of the individual dentist and the profession., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Dental litigation has a key role for the autonomy of the dental profession. We conducted a study among legal dental expert witnesses in order to reflect the present situation and reveal the potential for professional development., Methods: A questionnaire was distributed among 161 participants of the Karlsruhe training for legal dental experts between 2004 and 2009. They were asked to describe and to reflect on the present situation of dental litigation in Germany., Results: 83 questionnaires were returned (51.6%). The main reason to become a legal dental expert was to "support the profession". 68 participants (85.0%) think that civil action resulting from dental treatment will become more frequent. The quality of dental expert opinions is considered to be in need of improvement. Strategies to optimise dental expert opinions and to deal with the potential growing number of claims are developed., Conclusion: Basic and advanced training for dental expert witnesses assures the quality of dental expert opinions and also provides a chance for the further development of the dental profession., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Supernumerary teeth are an infrequent developmental alteration that can appear in any area of the dental arches and which are often associated with several syndromes such as cleidocranial dysplasia or Gardner syndrome. Multiple supernumerary teeth in individuals with no other associated diseases or syndromes are very uncommon., Case Report: A 14-year-old male patient presented with 13 unerupted supernumerary teeth distributed in all four quadrants., Treatment: After taking a cone beam computed tomograph (CBCT), surgical extraction was performed under general anaesthesia in two steps in order to minimize the risk of airway-constriction by haematoma., Follow-Up: Follow-up examination was uneventful. Further orthodontic treatment is planned which will secure the orthodontic alignment and correct occlusion., Conclusion: Cone beam computed tomography is crucial for exact localization, for treatment planning, and for the surgical approach in cases of multiple supernumerary teeth.