Lviv clinical bulletin 2016, 1(13): 17-21

https://doi.org/10.25040/lkv2016.01.017

Determining of Treatment Tactic and Planning of Atypical Removal of Asymptomatic and Without Any Pathological Changes Impacted Mandibular Third Molars

Y. Vares, S. Kyyak

Danylo Halytsky Lviv National Medical University

Introduction. Management of the asymptomatic and without any pathological changes impacted mandibular third molars should be based on a detailed assessment of all advantages and risks. It is very important to make a correct diagnosis based on the clinical and radiologic data and to prognose the eruption or pathological changes appearance.

While the number of asymptomatic and without any pathological changes impacted mandibular third molars is approximately 80.0 %, the question of prophylactic removal is actual.

Simultaneously, a considerable prevalence of mandibular third molar impaction in the clinical practice of dental surgeon causes careless attitude to the stage of atypical removal planning. This provokes unpredictable prolongation of operative time, postoperative period, intra- and postoperative complications, which arise in 30.0–40.0 % of the cases.

The aim of our study was to create an algorithm for determining of the treatment strategy for patients with asymptomatic and without any pathological changes impacted mandibular third molars and create scheme of their atypical removal in accordance to the clinical case.

Material and research methods. With the aim of correct management of asymptomatic and without any pathological changes impacted mandibular third molars a number of criterion were collected and classified. In order to perform a correct planning, prediction of atypical removal and analysis of potential postoperative complications we created a computer program ″Xray analyzer″.

Results of the investigation and their discussion. 21 criteria written in the table (table 1) give us a possibility to find out a proper treatment tactic, namely removal of lower third molar. For planning the operation we used the computer program ″Хray analyzer″ which helped us to shorten the time of operation and avoid the intra- and postoperative complications.

Conclusion. Created algorithm of clinical and radiologic examination of the patients helps in indicated clinical case to set indications for correct management of asymptomatic and without any pathological changes impacted mandibular third molar. Detailed diagnostic and operation planning with the help of computer program considerably simplify operation process and reduce the intra- and postoperative complications.

References

  1. Kostiuk TM. Clinical diagnostics of orthopedic treatment and prophylactic of occlusal interruption which occurred because of third molars eruption [dissertation]. Kyiv, 2011. 16 p. (Ukrainian).
  2. Vares YE, Kyyak SV, inventor, assignee. Method of third molar atypical removal assessment. Patent Ukraine N 89563. 2014 Apr 25. (Ukrainian).
  3. Akhmedkhanov YA. The role of third molars for physiological and pathological dentaolveolar formation [dissertation]. Moskow, 2005. 21 p. (Russian).
  4. Ruzyn H, Hryhorova A, Yel-Ptshy Y, Permynov A. Complications in case of retention of lower third molars in elderly patients. Experimental and clinical dentistry. Kharkov: KhHMU, 2005;9:121-122. (Ukrainian).
  5. Archer WH. Oral & Maxillofac. Surg. 5th Philadelphia: WB Saunders, 1975;(1). 522 p.
  6. Hupp JR, Ellis E, Tucker MR, editors. Contemporary Oral & Maxillofac. Surg. 5th St. Luise: MOSBY Elsevier, 2008. 250 p.
  7. Elgazzar RF, Abdelhady AI, Sadakah AA. Aspiration of an Impacted Lower Third Molar During its Surgical Removal Under Local Anaesthesia: A Case Report and Review of the Literature. Int J Oral Maxillofac Surg. 2007;36(4):362-364. https://doi.org/10.1016/j.ijom.2006.08.011
  8. Gbotolorum O, Arotiba G, Ladeinde A. Assessmment of factors associated with surgical difficulty in impacted third molar extraction. J Oral Maxillofac Surg. 2007;65(10):1977-1983. https://doi.org/10.1016/j.joms.2006.11.030
  9. Golovcencu L, Anistoroaei D. Considerations regarding a prediction method for third mandibular molar eruption. Rev Med Chir Soc Med Nat Iasi. 2007;111(4):1052-1055.
  10. Andersson L, Kahnberg KE, Pogrel M, editors. Oral and Maxillofacial Surgery. Chichester: Wiley-Blackwell, 2010. 1273 p.
  11. Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg. 2004;62(11):1363-1371. https://doi.org/10.1016/j.joms.2004.05.214
  12. Diniz-Freitas M, Lago-Mendez L, Gude-Sampedro F. Pederson scale fails to predict how difficult it will be to extract lower third molars. Br J Oral Maxillofac Surg. 2007;45(1):23-26. https://doi.org/10.1016/j.bjoms.2005.12.004
  13. Miloro M, Ghali GE, Peter EL, Peter DW, editors. Peterson’s Principles of Oral and Maxillofacial Surgery. 2nd ed. London: BC Decker Inc., Hamilton, 2004. 1502 p.