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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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The objective of this article is to establish a large sample-based prediction model for maxillary canine impaction based on linear and angular measurements on panoramic radiographs and to validate this model., Materials and Methods: All patients with at least two panoramic radiographs taken between the ages of 7 and 14 years with an interval of minimum 1 year and maximum 3 years (T1 and T2) were selected from the Department of Oral Health Sciences, University Hospital Leuven database. Linear and angular measurements were performed at T1. From 2361 records, 572 patients with unilateral or bilateral canine impaction were selected at T1. Of those, 306 patients were still untreated at T2 and were used as study sample. To construct the prediction model, logistic regression analysis was used., Results: The parameters analyzed through backward selection procedure were canine to midline angle, canine to first premolar angle, canine cusp to midline distance, canine cusp to maxillary plane distance, sector, quadratic trends for continuous predictors, and all pairwise interactions. The final model was applied to calculate the likelihood of impaction and yielded an area under the curve equal to 0.783 (95% CI [0.742-0.823]). The cut-off point was fixed on 0.342 with a sensitivity of 0.800 and a specificity of 0.598. The cross-validated area under the curve was equal to 0.750 (95% CI [0.700, 0.799])., Conclusion: The prediction model based on the above mentioned parameters measured on panoramic radiographs is a valuable tool to decide between early intervention and regular follow-up of impacted canines., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Introduction: This study aimed to identify significant factors affecting the spontaneous angular changes of impacted mandibular third molars as a result of second molar protraction. Temporary skeletal anchorage devices in the missing mandibular first molar (ML-6) or missing deciduous mandibular second molar (ML-E) with missing succedaneous premolar spaces provided traction., Methods: Forty-one mandibular third molars of 34 patients (10 male and 24 female; mean age 18.3 ± 3.7 years) that erupted after second molar protraction were included in this study. They were classified into upright (U) and tilted (T) groups. Linear and angular measurements were performed at the time of treatment initiation (T1) and of ML-6 or ML-E space closure (T2). Regression analyses were used to identify significant factors related to third molar uprighting., Results: Nolla stage (odds ratio [OR] 4.1), sex (OR 0.003 for male), third molar angulation at T1 (OR 1.1), missing tooth space (OR 0.006), rate of third molar eruption (OR 23.3), and rate of second molar protraction (OR 0.2) significantly affected third molar uprighting. Age, third molar angulation at T1, rate of third molar eruption, and rate of second molar protraction were significant factors for predicting third molar angulation at T2., Conclusions: Available space for third molar eruption before and after second molar protraction is not associated with uprighting of erupting third molars. Older patients whose third molars are in greater Nolla stage, are in a more upright position at T1, and have a greater eruption rate have a greater chance for third molar uprighting. Alternatively, an increase in second molar protraction rate results in mesial tipping of the third molars., (Copyright © 2019 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Impacted third molars (ITM) are the most commonly-impacted teeth. There is a risk for ITM to cause a number of pathological conditions, and external root resorption (ERR) of adjacent teeth is one of the most prevalent. Retaining or prophylactic extraction of ITM is a polemic topic. External root resorption of adjacent teeth is one of possible indications for prophylactic removal of ITM. The aim of this study was to assess the relationship between external root resorption (ERR) on the distal aspect of second molars' roots and positional parameters of ITM. Methods : Cone beam computed tomography scans of 109 patients (41 males, 68 females; mean age 26.4 ± 7.9 years) with 254 ITM (131 in the maxilla and 123 in the mandible) were retrospectively analyzed. Positional parameters of ITM (mesio-distal position, angulation, impaction depth, and available eruption space) were evaluated. The presence, location, and depth of ERR of adjacent second molars were assessed. Results: Analysis showed a relationship between ITM impaction depth, mesial inclination angle, and the presence of ERR. Mesial inclination angle of more than 13.6° increased the odds of ERR occurrence by 5.439 (95% CI, 2.97-9.98). ITM presence at the level of ½ of roots of the adjacent second molar or more apically increased the odds of ERR occurrence by 2.218 (95% CI, 1.215-4.048). No significant correlation was detected between the occurrence of ERR and patient age, gender, or the available eruption space in the mandible. Depth of ERR did not depend on its location. Conclusions: Incidence of ERR in second molars is significantly associated with mesial inclination and a deep position of ITM.

Background: Even though periodontal health was suggested to be not related to the traction technique, some other variables might influence the esthetic outcome of palatally displaced canines (PDC) when aligned, such as the initial position and impaction rate of the canine before treatment. The purpose of the present study was therefore to evaluate the existing correlations between periodontal health outcome of PDC after their exposure and alignment and their initial position identified according to the different rates of impaction severity., Materials and Methods: The final sample enrolled 293 PDC which satisfied inclusion and exclusion criteria. All the canines were exposed using CT by the same oral surgeon and orthodontic traction was applied using the easy cuspid device followed by fixed appliance treatment. Image analysis and periodontal status evaluation were performed for all PDCs., Results: α-Angle and d-distance showed no significant differences in the periodontal outcome of PDCs after treatment. The only tested variable showing significant differences was S, since canines with CEJ visible at the end of the treatment presented sectors with a mean score of 1.67, which was significantly different (P < 0.05) when compared to the S-sector for the canines that showed PD < 2 mm at the end of the treatment., Conclusions: Radiographic variables as α-Angle and d-distance seem to not influence the periodontal outcome of the treated impacted canine regardless of the amount of gravity. On the contrary, S-sector might play a significant role when higher rates of gravity are present suggesting the possibility in few cases for periodontal damage at the end of treatment.

Introduction: The aim of this study was to compare the root resorption (RR) of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage., Methods: This retrospective longitudinal study included 60 cone-beam computed tomography scans of patients with maxillary impacted canines: 30 scans taken before and 30 taken after orthodontic traction with nickel-titanium coil springs. Two groups were formed according to the impaction condition: 15 with unilateral maxillary impacted canines and 15 with bilateral maxillary impacted canines. Three trained orthodontists made the measurements. Demographic variables, occlusal characteristics, skeletal class, and measurements related to canine impaction were collected from the clinical history, dental models, and radiographs of each patient. RR (mm and mm 2 ) for each maxillary incisor was measured in 3 dimensions. Independent t or Mann-Whitney U tests were used, depending on data normality. Multiple linear regression analyses were used to evaluate the influence of all variables (predictors) on RR (α = 0.05)., Results: RR did not show significant differences between groups in any section (P > 0.05). No subject had RR greater than 2 mm or 5 mm 2 . The specific influence of some predictor variables varied depending on the type of maxillary incisor., Conclusions: RR of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage was similar and is not a risk to the integrity of the maxillary incisor root., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to assess the eruption of impacted teeth in cleft lip and/or palate (CLP) after alveolar bone graft., Materials and Methods: Research was carried out through a cross-sectional study at the Craniofacial Rehabilitation Center of the University General Hospital of the University of Cuiabá, Mato Grosso, Brazil. Variables related to cleft, cleft side, gender, age, laterality of cleft, impacted teeth, and orthodontic traction were analyzed., Results: Forty-two patients treated at the institution from 2004 to 2011 had their charts retrospectively reviewed. They were 54.7% male and 45.2% female. The group aged 9 to 11 years was most affected, representing 59.5% of cases. A unilateral cleft was the most prevalent craniofacial anomaly (85.7%). A total of 57 impacted teeth were observed. Maxillary canines were the most commonly impacted teeth (97.6%) and the most frequently identified in patients with a transforamen incisor cleft (TIC) (76.3%). Orthodontic traction was required for both impacted maxillary canines and impacted lateral incisors (64.3 and 35.7% respectively). The orthodontic traction was required only in patients with a TIC (p = 0.0101)., Conclusion: The canine teeth were the most commonly impacted teeth, found mainly in patients with a TIC. After placement of the alveolar bone graft in patients with a preforamen incisor cleft (PIC), all impacted teeth erupted spontaneously., Clinical Significance: An impacted tooth can have negative consequences on a patient's quality of life. Thus, a survey evaluating the incidence and prognosis of impacted teeth after an alveolar bone graft for CLP was important.

Objective: Canine impaction is a dental anomaly involving intraosseous displacement of the unerupted tooth. This situation is of significant importance causing orthodontic, surgical and interceptive problems. Trauma in the incisor area is a possible cause of the displacement of the tooth bud of the permanent canine resulting in the deviated eruption path. The aim of this article is to present two clinical cases with diagnosis of maxillary canine displacement and impaction in the incisor region after a traumatic injury during childhood, discussing treatment possibilities and outcomes achieved after orthodontic treatment., Materials and Methods: In this article ectopic maxillary canines migration in the central incisor area after a traumatic injury to the anterior upper teeth are described. The path of eruption of the canine can cause severe central incisor root resorption. Treatment strategy established for the case reports described involves orthodontic space opening, extraction of the central incisor, uncovering the impacted canine and orthodontic traction of the tooth in place of central incisor. Modification of crown morphology and color were essential to obtain an aesthetic and function outcome., Results: The patients finished treatment with normal and stable occlusion, an adequate width of attached gingiva and good aesthetic results., Conclusion: Authors suggest that might have been a possible connection between the trauma of primary dentition causing the displacement of the tooth bud of permanent canine and the deviated path of eruption. For the growing patients with a combination of dental trauma and ectopic eruption, maxillary canine to replace a central incisor was a viable option, offering excellent aesthetic results without recourse to prosthetic replacement.

Purpose: The current data suggest that the presence of lower third molars predisposes the patient to a greater risk of mandibular angle fracture. Thus, the present review sought to determine whether an association exists between the presence of a lower third molar and the occurrence of a mandibular angle fracture in adults and to assess the influence of third molar position according to the Pell and Gregory classification., Materials and Methods: The present study was a systematic review and meta-analysis of analytical observational studies. The present review included all reports of the relationship between mandibular angle fractures and lower third molars. No restriction regarding year, language, or publication status was used. The review protocol was registered at the PROSPERO database (registration no. CRD42016047057). Electronic searches unrestricted for publication period and language were performed in the PubMed, Scopus, SciELO, and Latin American and Caribbean Health Sciences databases. Google Scholar and OpenGrey databases were used to search the "gray literature," avoiding selection and publication biases. The entire search was performed by 2 eligibility reviewers. Association and proportion meta-analyses were planned for the studies with sufficient data. The primary predictor variable was the relationship between the presence of a lower third molar and the development of mandibular angle fractures. The secondary outcome variables were the vertical and horizontal positions of the lower third molar, according to the Pell and Gregory classification and their relationship to the susceptibility to developing a mandibular angle fracture., Results: The search strategies resulted in 411 studies, from which 16 were selected for qualitative and quantitative review. The association meta-analysis included all the selected studies and showed that patients with lower third molars are 3.16 times more likely to develop mandibular angle fractures. The proportion meta-analysis included 5 studies and showed that the overall rate of mandibular angle fractures was 51.58% and that positions III and C are more likely to result in fracture, with a rate of 59.84 and 63.67%, respectively., Conclusions: The results of the present study have shown that the presence of impacted third molars increases by 3.16 times the risk of mandibular angle fractures in adults, with the greatest risk present when third molars are classified as IIIC according to Pell and Gregory. The available evidence is not sufficiently robust to determine whether third molar presence or the level of impaction is the main causative factor for the occurrence of mandibular angle fractures., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Food impaction after impacted mandibular third molar extraction is a serious problem that should not be ignored. Incomplete suturing of the distal incision in the conventional method is the main cause of food impaction and delayed wound healing. The present study introduces a novel suture and drainage technology that requires hermetic suturing of the distal incision and rubber drainage for buccal drainage. 76 patients with horizontally/mesially impacted third molars (bilateral) were enrolled in this prospective study. An impacted tooth on one side of each patient was extracted by occlusal drainage using the conventional method, whereas the other side tooth was extracted by buccal drainage using the novel method. The differences in wound healing, facial swelling, bleeding and dry socket between the two sides of each patient were compared postoperatively, and the trends for patient selection of the surgical method were also compared. The results indicated that buccal drainage had obvious advantages in wound healing and reduced the risk of postoperative bleeding, and most patients preferred this technique; there were no significant differences in postoperative facial swelling or pain. Thus, buccal drainage can solve the problem of long-term food impaction induced by traditional incision postoperatively and is worthy of clinical promotion.

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I 2 =87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I 2 =91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I 2 =0%) and class I (OR 1.37, 95% CI 1.05-1.77, I 2 =32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I 2 =56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I 2 =0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars on angle fractures. An electronic search was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and VHL databases, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 35 studies were included in the systematic review and 28 in the meta-analysis. Twenty studies presented a score of ≤6 stars in the Newcastle-Ottawa scale assessment, indicating a risk of bias in the analysis. The presence of a mandibular third molar increases the chance of an angle fracture (case-control and cross-sectional studies: odds ratio (OR) 3.83, 95% confidence interval (CI) 3.02-4.85, I 2 =83.1%; case-control studies: OR 3.27, 95% CI 2.57-4.16, I 2 =81.3%). The third molar positions most favourable to angle fracture according to the Pell and Gregory classification are class B (OR 1.44, 95% CI 1.06-1.96, I 2 =87.2%) and class II (OR 1.67, 95% CI 1.36-2.04, I 2 =72.4%). Class A (OR 0.60, 95% CI 0.45-0.81, I 2 =87.1%) and class I (OR 0.51, 95% CI 0.37-0.71, I 2 =89.4%) act as protective factors for angle fracture. The results suggest that the presence of the third molar increases the chance of angle fracture by 3.27 times and that the most favourable positions of the third molar for angle fracture are classes B and II, whilst classes A and I act as protective factors., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A 22-year-old woman came with a unilateral missing mandibular first molar and buccal crossbite. The open space was closed by protraction of the mandibular left second molar and uprighting and protraction of the horizontally impacted third molar using temporary skeletal anchorage devices, and her buccal crossbite was corrected with modified palatal and lingual appliances. The total active treatment time was 36 months. Posttreatment records after 9 months showed excellent results with a stable occlusion., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the relationship between dental follicle width and maxillary impacted canines' descriptive and resorptive features with three-dimensional (3D) cone-beam computed tomography (CBCT)., Methods: The study comprised 102 patients with cone-beam computed tomography 3D images and a total of 140 impacted canines. The association between maxillary impacted canine dental follicle width and the variables of gender, impaction side (right and left), localization of impacted canine (buccal, central, and palatal), and resorption of the adjacent laterals was compared. Measurements were analyzed with Student's t -test, Kruskal-Wallis test, and Mann-Whitney U statistical test., Results: According to gender, no statistically significant differences were found in the follicle size of the maxillary impacted canine between males and females ( p > 0.05). Widths of the follicles were determined for the right and left impaction sides, and no statistically significant relation was found ( p > 0.05). There were statistically significant differences between root resorption degrees of lateral incisors and maxillary impacted canine follicle width ( p < 0.05). Statistically significant higher follicle width values were present in degree 2 (mild) resorption than in degree 1 (no) and degree 3 (moderate) resorption samples ( p < 0.05)., Conclusions: No significant correlation was found between follicle width and the variables of gender, impaction side, and localization of maxillary impacted canines. Our study could not confirm that increased dental follicle width of the maxillary impacted canines exhibited more resorption risk for the adjacent lateral incisors.

Introduction: The aim of this study was to evaluate the effect of malocclusion severity on oral health-related quality of life and food intake ability in adult patients, controlling for sex, age, and the type of dental clinic visited., Methods: The sample consisted of 472 Korean patients (156 male, 316 female) with a mean age of 21.1 (SD, 8.6) years in a dental hospital and a private clinic. The correlations between the Korean version of the Oral Health Impact Profile-14 (OHIP-14K), subjective food intake ability (FIA) for 5 key foods, and Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) were investigated., Results: The mean IOTN-DHC and OHIP-14K scores were significantly higher for the dental hospital patients than for the private clinic patients (IOTN-DHC, P <0.001; OHIP-14K, P <0.05). Malocclusion severity was significantly higher in male than in female subjects (P <0.001). Older patients perceived their oral health-related quality of life more negatively than did the teens (P <0.001). As the severity of the malocclusion increased, oral health-related quality of life and masticatory function worsened (OHIP-14K, P <0.001; FIA, P <0.05)., Conclusions: As the severity of the malocclusion and the age of the patients increased, oral health-related quality of life and masticatory function relatively deteriorated. This finding provides evidence that severe malocclusions are associated with lower quality of life and less masticatory efficiency in older patients., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

The aim of the present study was to investigate the influences of the presence and position of a lower third molar (M3) on the fragility of mandibular angle and condyle, using finite element analysis. From computed tomographic scans of a human mandible with normally erupted M3, two additional virtual models were generated: a mandibular model with partially impacted M3 and a model without M3. Two cases of impact were considered: a frontal and a lateral blow. The results are based on the chromatic analysis of the distributed von Mises and principal stresses, and calculation of their failure indices. In the frontal blow, the angle region showed the highest stress in the case with partially impacted M3, and the condylar region in the case without M3. Compressive stresses were dominant but caused no failure. Tensile stresses were recorded in the retromolar areas, but caused failure only in the case with partially impacted M3. In the lateral blow, the stress concentrated at the point of impact, in the ipsilateral and contralateral angle and condylar regions. The highest stresses were recorded in the case with partially impacted M3. Tensile stresses caused the failure on the ipsilateral side, whereas compressive stresses on the contralateral side., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess the null hypothesis that there is no difference in the rate of dental development and the occurrence of selected developmental anomalies related to shape, number, structure, and position of teeth between subjects with impacted mandibular canines and those with normally erupted canines., Materials and Methods: Pretreatment records of 42 subjects diagnosed with mandibular canines impaction (impaction group: IG) were compared with those of 84 subjects serving as a control reference sample (control group: CG). Independent t-tests were used to compare mean dental ages between the groups. Intergroup differences in distribution of subjects based on the rate of dental development and occurrence of selected dental anomalies were assessed using χ(2) tests. Odds of late, normal, and early developers and various categories of developmental anomalies between the IG and the CG were evaluated in terms of odds ratios., Results: Mean dental age for the IG was lower than that for the CG in general. Specifically, this was true for girls (P < .05). Differences in the distribution of the subjects based on the rate of dental development and occurrence of positional anomalies also reached statistical significance (P < .05). The IG showed a higher frequency of late developers and positional anomalies compared with controls (odds ratios 3.00 and 2.82, respectively; P < .05)., Conclusions: The null hypothesis was rejected. We identified close association of female subjects in the IG with retarded dental development compared with the female orthodontic patients. Increased frequency of positional developmental anomalies was also remarkable in the IG.

Background: There is no consensus regarding the prophylactic removal of mandibular third molars (TM) in fracture lines to facilitate healing. Recent evidence suggests that poor healing is attributed to the limited use of antimicrobials, delayed care and semi-rigid fixation as a treatment method, favoring retention of TM., Study Design: A retrospective cohort study of all patients presenting with mandibular angle fractures at the Hippokration General Hospital of Athens (2006-2011) was designed to examine the association between the presence versus absence of TMs in the line of mandibular fractures and the fracture healing process. Development of complications during the healing process was the outcome of interest. Additional factors considered were patient age, sex, and fracture etiology., Materials and Methods: Data were extracted from a retrospective chart review, including information from clinical and radiological examinations. The analytical sample included 112 patients with 121 angle fractures. Bivariate methods including Fisher's exact and chi-square tests were used to test the association between TM presence in the fracture line and healing complications., Conclusion: This study found no association between the presence of mandibular TM in the fracture line and postoperative complications and the healing process when combined with light intermaxillary fixation for 15 days., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the clinical manifestation of and treatment modalities for this severe phenotype of infraocclusion and to examine relationships between deep submersion and the occurrence of other dental anomalies., Materials and Methods: The experimental sample consisted of 25 orthodontic patients with at least one deciduous molar in infraocclusion greater than 5 mm. Dental records were used to assess severity of infraocclusion, treatment modality, and presence of other dental anomalies (tooth agenesis, small maxillary lateral incisors, palatally displaced canines, and distal angulation of mandibular second premolars)., Results: The sample included 14 females and 11 males, age 7 to 14 years (mean age 10.1 years). The mean infraocclusion depth was 9 mm, with a range of 5-18 mm. The crowns of the adjacent teeth were severely tilted toward the infraoccluded tooth, space was lost in the dental arch, and the successor premolars were impacted in all cases. Treatment consisted of space regaining, surgical extraction of the deciduous molar, and space maintenance. The impacted premolar erupted spontaneously in 95% of the cases. There was a significant increase in prevalence of dental anomalies in the deep-submersion sample compared with that of reference values (P < .001)., Conclusions: The treatment modality used in this sample resulted in spontaneous eruption of the impacted premolar in most cases. Markers for early diagnosis of deep submersion include other dental anomalies, severe tilt of adjacent teeth, and local space loss. The increased prevalence of other dental anomalies supports a shared genetic etiology.

Background: Goal of the research was to study occurrence frequency of impacted teeth, to develop rational methods of diagnostics and treatment of denotalveolar and facial anomalies caused by impacted teeth., Patients and Methods: From 1989 for 2013 period of time 7172 patients with dentoalveolar anomalies, referred to our clinic for the orthodontic help were surveyed., Results: At 899 (12.53 +/- 0.39%) patients it is revealed 1405 impacted teeth, from them on the maxilla--623, on mandible--752 teeth. The most widespread impacted teeth on the maxilla were canines, on the mandible--the second premolars and the third molars. Treatment of impacted teeth by stimulation of their eruption by low-frequency ultrasound with a frequency of fluctuations of 26.5 kHz, intensity of 1 W/cm, with an amplitude of 40-60 microns and wave of 0.012 m long, daily or within 1 days, with period of 3-10 seconds with the course of treatment averaging 1-5 procedures, until a tooth eruption is carried out., Conclusion: The way of stimulation developed by us for late erupted impacted permanent teeth on the basis of application physiologic for an organism low-frequency ultrasound promotes increase of efficiency and reduction of treatment terms of dentoalveolar and facial anomalies. The received positive results allow to recommend this method for adoption in orthodontic practice.

Objective: To compare the root development and the growth rate of the mandibular third molar (M3 inf) in individuals where the M3 inf erupted vs individuals exhibiting M3 inf impaction., Materials and Methods: Serial standardized intraoral radiographs (Eggen technique) were taken annually of the mandibular third molar region from 132 subjects (71 male and 61 female) from 15 to 20 years of age. Based on the films, 264 lower third molars were classified into an eruption and an impaction group. Root development was recorded according to a quantitative method described by Haavikko (1970), and the eruption status was analyzed using logistic regression., Results: In total, 155 (59%) of the M3 inf erupted, and 109 (41%) were impacted at age 20. In 44 (33%) patients both M3 inf were impacted, in 21 (16%) patients one tooth was erupted and the contralateral tooth impacted, and in 67 (51%) patients both M3 inf were erupted. The more mature a tooth was at age 15, the higher was the probability of eruption (odds ratio: 3.89, P < .001). The growth rate of the root development stage was statistically significantly associated with the probability of eruption (odds ratio: 10.50, P  =  .041)., Conclusions: Delayed mandibular third molar root development is associated with impaction. Radiographs taken at age 15 may predict the risk of impaction and thereby guide decision making for the orthodontist or the oral and maxillofacial surgeon.

Delayed tooth eruption can affect the accuracy of orthodontic diagnosis and treatment planning and could delay overall treatment. A girl, aged 7 years 4 months, who had unilateral delayed eruption of several teeth was successfully treated. The evaluation of delayed tooth eruption should be considered by the orthodontist because the role of these teeth can affect the overall treatment of malocclusion. In patients with delayed tooth eruption, careful and accurate diagnosis and treatment planning will allow the orthodontist to start treatment at the proper stage and might reduce the overall orthodontic treatment time., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

One of the main criteria used in dental age diagnostics in living adolescents and young adults is assessment of the mineralisation stage of the third molars. In the case of Europid populations, it has been established that impaction status has an influence on the rate of mineralisation of the third molars. In view of this, a study was undertaken to determine whether the chronological process of wisdom tooth mineralisation is dependent upon impaction status in black Africans too. Orthopantomograms (553) of 437 male and 116 female black South Africans with verified birth dates in the age group between 10 and 26 years were studied. Mineralisation stage and impaction status were determined for all third molars. Statistical measures were calculated for the mandibular wisdom teeth at stages F, G and H and for the maxillary wisdom teeth at stage H in the male gender for both impacted and non-impacted third molars. It was ascertained that the minimum age in persons with impacted third molars, depending on the wisdom tooth observed, was 0.19-2.57 years higher than in those with non-impacted wisdom teeth. Test persons with impacted mandibular wisdom teeth at stage F or G were on average between 0.32 and 1.88 years older than those with non-impacted mandibular wisdom teeth. The 50 % probability values of impacted wisdom teeth at stage H were 1.85-3.31 years higher than those in non-impacted wisdom teeth. The conclusion was drawn that in male black Africans, impacted mandibular wisdom teeth mineralise more slowly than non-impacted lower third molars. The presence of impacted mandibular wisdom teeth in mineralisation stage H in male black Africans does not, however, furnish proof of completion of the 18(th) year of life beyond reasonable doubt.

Aim: The purpose of the present study was to establish the relationship between the eruption of permanent maxillary canines and cervical vertebral maturation stages (CVMs) to assess an alternative method for determining time of canine eruption in the late mixed dentition., Materials and Methods: One hundred and twenty subjects with erupting permanent maxillary canines were observed both intraorally and radiographically with orthopantamograms. Lateral cephalograms were recorded to divide subjects according to CVM stage into prepeak (CS1 and CS2), peak (CS3 and CS4) and postpeak (CS5 and CS6) groups of puberty., Statistical Analysis: The differences between the prevalence rates of canine eruption in different groups of puberty were estimated using 'z test'., Results: Prepeak group comprised of forty six subjects, peak group sixty eight subjects and postpeak group six subjects. The differences in prevalence rates between peak and prepeak and between peak and postpeak groups were noticed highly significant (p<0.001), while prevalence rates between peak and postpeak was found less significant ( p0 <0.01)., Conclusion: Eruption of the permanent maxillary canine can occur at any CVM stage till end of the puberty or after puberty (CS1-CS6). Thus, an absence of maxillary canine during or after postpeak stage of puberty (CS5 or CS6) suggests delayed eruption and canine impaction.

A new formulation of a micronized acetylsalicylic acid swallowable tablet with an effervescent component (FR-aspirin) was evaluated in two independent studies using the dental impaction pain model. These clinical studies were performed to confirm the results of preclinical dissolution studies and human pharmacokinetic studies, which indicated an improved onset of analgesia without compromising duration of effect or safety. Study 1 evaluated a 650-mg dose of aspirin and Study 2 evaluated a 1,000-mg dose of aspirin. Both studies were double-blinded, parallel group and compared to regular aspirin (R-aspirin) and placebo. Speed of onset was measured by the double stopwatch method for time to both first perceptible relief and meaningful relief. In both studies, the FR-aspirin was significantly faster (p<0.038-0.001) than both R-aspirin and placebo for both onset measures. There were no significant differences between FR-aspirin and R-aspirin for peak or total effects and both treatments were significantly better than placebo. For first perceptible relief, FR-aspirin onset was 19.8 and 16.3 min for 650 mg and 1,000 mg, respectively, compared to 23.7 and 20.0 for R-aspirin. For meaningful relief, FR-aspirin onset was 48.9 and 49.4 min for 650 mg and 1,000 mg, respectively, compared to 119.2 and 99.2 for R-aspirin. These efficacy studies clearly demonstrate that the onset of analgesic efficacy is dramatically improved by adding an effervescent component and micronized active ingredient to the swallowable tablet aspirin formulation. The enhanced onset did not adversely impact either the peak effect or duration of effect or tolerability compared to regular aspirin.

Objectives: To propose a treatment protocol for the management of impacted second molars., Materials and Methods: Patients were randomly divided into two equal groups (20 patients in each). The patients in the first group underwent a surgical removal of the mucosa covering retained teeth; the second group was the control group and patients were not treated but only observed. The total number of retained teeth considered were 66 (34 in the first group and 32 in the control group). A Chi squared test has been performed to compare the prevalence of eruption in the two groups. We compared the frequency of eruption for the treatment compared to the control group by calculating the risk ratio (RR) and 95% confidence interval (95% CI)., Results: Eruption occurred in 32 teeth after surgical removal of the mucosa while in the control group only 3 teeth erupted in the considered period. The difference between the two groups showed statistically significant. Among the non erupted teeth, 20 were positioned with a mesial inclination and 12 were positioned vertically., Conclusions: The results show that the removal of the mucosa covering teeth allows in several cases second molars to erupt. It's a conservative method which doesn't exclude the possibility of a successive different therapy. Therefore it must be considered among the treatment options during treatment planning., (Copyright © 2011 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.)

Tooth eruption is a localized event that requires a dental follicle (DF) to regulate the resorption of alveolar bone to form an eruption pathway. During the intra-osseous phase of eruption, the tooth moves through this pathway. The mechanism or motive force that propels the tooth through this pathway is controversial but many studies have shown that alveolar bone growth at the base of the crypt occurs during eruption. To determine if this bone growth (osteogenesis) was causal, experiments were designed in which the expression of an osteogenic gene in the DF, bone morphogenetic protein-6 (Bmp6), was inhibited by injection of the first mandibular molar of the rat with a small interfering RNA (siRNA) targeted against Bmp6. The injection was followed by electroporation to promote uptake of the siRNA. In 45 first molars injected, eruption was either delayed or completely inhibited (seven molars). In the impacted molars, an eruption pathway formed but bone growth at the base of the crypt was greatly reduced compared with the erupted first-molar controls. These studies show that alveolar bone growth at the base of the crypt is required for tooth eruption and that Bmp6 may be essential for promoting this growth., (© 2011 Eur J Oral Sci.)

Purpose: Numerous previous studies already have proven that mandibles with a third molar are significantly more susceptible to angle fracture by external force. Similarly, other data suggest that the absence of a third molar increases the risk of condylar fracture, while concurrently decreasing the risk of angular fracture. We attempt to characterize the effect of a third molar on the incidence of mandibular angle and condylar fractures., Methods: This retrospective study reviews data from 385 patients, all of whom were seen in our clinics between February 2006 and November 2009. All data were collected from clinical examination notes and panoramic radiographs, with third-molar state evaluated by the Pell and Gregory classification system., Results: Our results mirror those of previous studies. The incidence of mandibular angle fracture was significantly greater on sides with a third molar, whereas the condylar fracture rate significantly increased in mandibles lacking a third molar or without a fully erupted third molar. The rate of symphysis and mandibular angle fracture was also high in cases of multiple comorbid fractures., Conclusions: Both the presence and the state of the lower third molar affect the risk of future mandibular angle and condylar fracture.

Bone formation below the crown of mandibular horizontal incompletely impacted third molar is frequently seen in the middle-aged and elderly. The phenomenon shows lamina dura loss without radiolucency and we hypothesized the participation of mature enamel without any influence on the environmental oral status. In order to investigate the characteristics of the phenomenon based on the presence/absence of the lamina dura and radiolucency below the crown, we studied the relationship between 58 men and 43 women with a lamina dura without radiolucency, 12 men and 8 women without a lamina dura with radiolucency, 34 men and 16 women without a lamina dura without radiolucency, and the status of teeth in the ipsilateral mandible. Subjects without a lamina dura without radiolucency were significantly older than those with a lamina dura without radiolucency in both men (P < 0.0001) and women (P <0.01), indicating different chronological causes. Men without lamina dura with radiolucency showed significantly more tooth loss than those with a lamina dura without radiolucency (P < 0.00001) and those without a lamina dura without radiolucency (P < 0.0001), indicating the influence of poor oral health. Thus, the phenomenon without a lamina dura without radiolucency may show the clinical importance of bone formation in the elderly.

The modern version of the Dental Impaction Pain Model (DIPM) was developed in the mid-1970s. Since that time, several hundred studies have been conducted by numerous investigators. Today it is arguably the most utilized of all the acute pain models. Its popularity is due to the success rate of the studies, fast subject entry, and cost effectiveness. The surgical procedure is extremely standardized, and the surgery requires either minimal or no use of CNS depressant anesthetics. The methodology is similar to that utilized in other acute pain models; however, the DIPM is much more versatile than most other models. The model can be easily adapted to perform multiple-dose studies, pharmacokinetics/pharmacodynamics (PK/PD) correlations, preemptive interventions, and sleep-pain studies. A few investigators have even developed microdialysis techniques, wherein they insert probes into extraction sockets to collect exudates for measuring biochemical mediators of pain or drug levels at the site of injury. In many instances, an accomplished site can complete a study of several hundred subjects in approximately 3 months. There are studies in the literature that have incorporated up to six treatment arms in one study and clearly separated the drugs from each other. The exquisite assay sensitivity is due to the homogeneity of the study population, the predictable level and appropriate intensity of the postsurgical pain, and the minimizing of variability by using only one or two study centers. The DIPM has been employed to evaluate NSAIDs (both nonselective and selective Cox inhibitors), opioids and combination analgesics, as well as some investigational drugs with unique mechanisms of action. The model is particularly useful for proof-of-concept studies that require dose-ranging and profiling the time-effect curve for efficacy including onset, peak effect, and duration of analgesic activity.

Objective: A tooth with a dentigerous cyst (DC) does not always erupt by marsupialization. The eruption duration and conditions of DC-associated premolars were examined to predict such eruption following marsupialization., Study Design: The eruption and conditions including depth, root formation, inclination, and eruption space were examined retrospectively in 21 DC-associated mandibular premolars using dental and panoramic radiograms., Results: Fifteen of 21 premolars erupted half within 3 months and all 15 erupted completely within 10 months after marsupialization, without orthodontic traction. The age of the patients, tooth depth, and inclination were significantly different between the erupted and non-erupted groups, whereas there was no significant difference in the root formation or the eruption space between the 2 groups., Conclusions: The successful eruption of a DC-associated premolar can be predicted within 3 months after marsupialization. Furthermore, the eruption may be affected by the patient's age, tooth depth, and tooth inclination.

Background: Small upper lateral incisors in patients with palatally impacted canines may contribute to inter-arch tooth size discrepancies., Aim: To compare the Bolton ratios in female patients with and without unilateral palatally impacted canines., Methods: The pretreatment dental casts of 30 female patients with unilateral palatally impacted canines (Impaction group) and 30 female patients without palatally impacted canines (Control group) were used. The latter were matched for age and incisor malocclusion with the Impaction group. The anterior and overall Bolton ratios were calculated for each group., Results: Although the total width of the upper anterior teeth in the impaction group was significantly smaller than the total width of the upper anterior teeth in the Control group (p = 0.029), there was no significant difference between the mesio-distal widths of the lower anterior teeth in the two groups. Furthermore, there were no significant group differences in either the mean anterior Bolton ratio (p = 0.156) or the overall Bolton ratio (p = 0.652)., Conclusion: Females patients with palatally impacted canines may not have more inter-arch tooth size discrepancies than female patients without palatally impacted canines.

Purpose: The aim of the study was to assess changes in the angular position and eruption status of third molars in students of an Asian Indian population during a 4-year follow-up period., Patients and Methods: The series consisted of 43 students (11 males, 32 females). Standardized panoramic radiographs were taken at baseline (mean age, 19.1 +/- 0.7 years) and at the end of study (mean age 23.1 +/- 0.7 years). Angulation and degree of impaction of third molars were determined by their sagittal relationship to the adjacent second molar and eruption to the occlusal plane. Root formation was also assessed., Results: During the 4-year follow-up period, 11 of 72 of the mandibular teeth (15%) and 17 of 74 of the maxillary teeth (23%) changed their sagittal inclination. Thirty-one of 118 impacted teeth (26%; level B + C) achieved level A eruption more so in the mandible, ie, 15 of 52 (29%), than in the maxilla, ie, 16 of 66 (24%). In the mandible, 9 of 24 impacted vertical teeth (37.5%), 3 of 6 distoangular teeth (50%), and 3 of 22 mesioangular impacted teeth (13.6%) erupted to the occlusal plane. In the maxilla, 9 of 36 impacted vertical teeth (25%) and 7 of 27 distoangular teeth (26%) erupted to the occlusal plane during the follow-up. The number of teeth with complete root formation increased in mandible from 61% to 93% and in maxilla from 62% to 94.5%., Conclusions: Unpredictable changes in the position and angulation of teeth continued to occur even after the age of 19 years, more so in vertical and distoangular teeth than in mesioangular teeth.

Purpose: The purpose of this study was to investigate the eruption of mandibular premolar teeth associated with dentigerous cysts., Patients and Methods: A total of 60 cyst-associated teeth in the mandibular premolars were examined retrospectively by using normalized panoramic radiographs. The subjects were divided into 2 groups: the erupted group, in which the teeth had erupted spontaneously after marsupialization, and the nonerupted group. Patient age, as well as impacted premolar angulation to the adjacent teeth axes, the cusp depth, space/tooth size, eruption period and cyst size, as measured on initial images, were used as parameters., Results: Using a logistic model of our data, we found that patient age less than 10 years, cusp depth less than 5.1 mm, angulations less than 25 degrees, and space/tooth size greater than 1.0 enhanced the success of eruption., Conclusion: Our findings present predictors of successful eruption of impacted mandibular premolars associated with dentigerous cysts after marsupialization.

Dental emergencies can significantly affect the mission of the deployed unit. As many as 22% of all emergency department visits at a deployed Expeditionary Medical Support facility can be attributed to dental problems and many of these problems are caused by impacted third molar teeth. Currently, there is no reliable method of predicting when asymptomatic, partially erupted third molar teeth will become painful. Therefore, it is imperative that Air Force dental providers carefully consider the consequences of giving patients a clean bill of health when asymptomatic, partially erupted third molar teeth are present in the oral cavity. Recommendations for future study are presented.

The ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor that occurs predominantly in children and is generally associated with unerupted teeth. The choice of treatment for this entity is conservative surgery with enucleation and its prognosis is excellent. However, preserving the associated impacted teeth may make complete removal of the lesion difficult and may explain some cases of recurrence. A case of AFO in a 6-year-old girl treated with enucleation and preservation of an impacted lower left first permanent molar is reported. After two years of follow-up, there were no signs of recurrence and complete spontaneous eruption of the preserved tooth was observed. The present report indicates that the degree of involvement of the impacted tooth by AFO is a fundamental aspect to be considered during radiological analysis and surgical assessment. We concluded that preservation of the impacted permanent teeth associated with this tumor should always be considered and carried out with caution, since they are clearly not included in the surgical cavity.

Objective: Pain associated with third molar (wisdom) teeth is a common cause of morbidity for soldiers in the United Kingdom and on operational deployments. This study compared the incidence of third molar symptoms between soldiers serving in Iraq and soldiers stationed in barracks in Northern Ireland and assessed if pre-deployment screening could be improved., Method: Data was collected in a prospective cohort study over five consecutive months. Dental officers recorded each time an Army soldier presented with third molar related symptoms., Results: 1% of soldiers in Iraq had third molar related symptoms in this time compared to 1.4% of those stationed in Northern Ireland. The range of pathologies and teeth affected were similar between locations. In both locations approximately 40% of teeth that caused problems had been symptomatic before and 13 -16% had untreated decay., Conclusions: This study suggests that soldiers experience a lower incidence of symptoms related to third molars when in Iraq compared to Northern Ireland (P < 0.033) possibly due to pre-deployment treatment. If ideal pre-deployment screening of third molars was carried out and National Institute of Clinical Excellence guidelines applied 38% of the Operation Telic group of patient's problems could have been prevented.

Introduction: The purpose of this study was to determine whether a clinically significant association exists between maxillary skeletal width and palatal canine impaction, also known as palatally displaced canine (PDC)., Methods: Seventy-nine patients with PDC were matched for age, sex, and malocclusion to 79 controls. Maxillary and mandibular skeletal widths and nasal cavity widths were measured on posteroanterior cephalograms; maxillary and mandibular intermolar widths were measured on dental casts; and maxillary interalveolar arch widths at 3 levels (canine, premolar, and first molar) were measured on occlusograms., Results: Only maxillary alveolar arch width at the canine level was significantly different between the 2 groups. However, further analysis showed that the presence of erupted deciduous or permanent canines, rather than their absence in the canine area (whether due to extraction, exfoliation, impaction, or not yet having erupted), was strongly associated with maxillary intercanine alveolar arch width., Conclusions: The additional finding in this study that the eruptive status of canines significantly affects maxillary alveolar arch width in this area suggests that maxillary intercanine alveolar arch width as measured in this or other studies is not a good predictor of PDC.

Aims: Delayed eruption of teeth may be caused by the presence of one or more supernumerary teeth. The purpose of this study was to evaluate findings, predisposing factors and differentiate different techniques used that affect the outcome following removal of supernumerary teeth. A comprehensive literature review was also undertaken., Methods: A longitudinal retrospective study was carried out at the Royal Liverpool Children's Hospital. A total of 120 patients were identified from the general anesthesia records that had supernumeraries extracted. Only 43 cases had delayed eruption of teeth caused by supernumeraries. The pre and post extraction record data collected were the gender, radiographic assessment, position of the supernumerary, age at time of referral and extraction of the supernumerary, age at time of eruption of the impacted tooth and the orthodontic and surgical management., Results: The mean age of referral was 9.1 years with a male to female ratio of 4.4:1. There was a greater predilection for supernumeraries to be on the left side and be positioned palatally. Tuberculate type supernumeraries were the most frequent followed by the conical type. Spontaneous eruption of the impacted tooth occurred in 49% of cases. Eruption of the impacted tooth within eighteen months following removal of the supernumerary was observed in 91% of cases. The chronological age and space availability were the two factors that were critical in determining if eruption was spontaneous following removal of the supernumerary., Conclusions: The findings of this study reiterates the fact that given early referral, sufficient space and time, the majority of teeth prevented from erupting by a supernumerary tooth would erupt spontaneously following removal of the supernumerary alone. Randomized multi-centre prospective studies are suggested.

Objectives: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice., Methods: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals., Results: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients., Conclusions: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Intraosseous migration of impacted teeth across the midline to the opposite side of the jaw is a rare dental anomaly of unknown etiology. Transmigration of an impacted mandibular canine through the symphysis to the contralateral side of the arch has been documented. Transmigration of an impacted maxillary canine across the midpalatal suture to the opposite side of the maxilla has not been previously observed and is reported here for the first time.

Purpose: Most mandibular fractures occur because of blunt trauma. In some cases, the mandible can be weakened by the presence of an unerupted or impacted tooth. The fate of this tooth in the fracture line and its effects on bone healing remain an important outcome event., Materials and Methods: In this study, we analyzed the records of 117 patients with a total of 121 fractures having an unerupted tooth remaining in the fracture line who were treated and followed by the Dental Faculty of Ankara University between 1986 and 1996. All were open fractures, and none of the patients had a history of an acute inflammatory episode related to the unerupted tooth before the injury. Intermaxillary fixation was used in all cases., Results: Three of the patients subsequently required open reduction with internal fixation. The unerupted tooth was not extracted in any patient. The fixation was maintained for an average of 45 days and followed up for 3 months. No complications were encountered., Conclusion: According to these results, we suggest that asymptomatic impacted teeth in the fracture line of uncomplicated mandible fractures do not cause delayed healing when treated with closed reduction.