OBJECTIVE: The aim of this retrospective study was to determine the prevalence and patterns of impacted third molars in a Trinidadian population.
METHODS: A total of 1500 orthopantomograms (OPG) taken at the School of Dentistry, University of the West Indies, from 2008 to 2019 in patients between 15 and 67 years old were evaluated. From the data collected, the prevalence of third molar impaction, the parameters of gender, angulation, level of impaction, and associated pathologies were evaluated. Other types of impacted teeth were also recorded.
RESULTS: Of the 1500 OPG viewed, 408 (27.2%) of the study sample presented with at least one impacted third molar. 161 (39.5%) were males and 247 (60.5%) were females, with a male-to-female ratio of 1:1.5. There was a greater incidence of mandibular third molars versus maxillary third molars, which had a frequency of 77.9% and 22.1%, respectively. The most common type of impaction (Winter\'s classification) was horizontal in the mandible and distoangular in the maxilla. The most common level of impaction in the mandible (Pell and Gregory classification) was level 1A. The total number of impacted teeth was 775, and of these, 75 (9.7%) showed other impacted teeth besides the third molars. Canines and second premolars were the most prevalent with 7.6% and 1.5%, respectively. Caries on the second molar (49.3%) and third molars (40%) were the most frequently associated pathologies identified.
CONCLUSIONS: The prevalence of impacted wisdom teeth in this study was 27%. These results raise awareness and provide insight among dental professionals in Trinidad as to the prevalence of impacted third molars, their patterns, as well as commonly associated pathologies, and the need for screening within the population.

OBJECTIVE: The study aimed to examine the authenticity of the often-mentioned statement that the third molar is the most frequently extracted tooth. This finding has not been shown previously in a large population-based sample.
METHODS: Data comprised a nationally representative sample of 6082 panoramic radiographs taken from adults in the cross-sectional Health 2000 Survey. From the radiographs, all missing teeth were recorded. Information on congenital agenesis of individual teeth was retrieved from two published meta-analyses. Primary outcome was the frequency of missing teeth by tooth type. Explanatory variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression.
RESULTS: Mean age of participants (46% men, 54% women) was 53 years (SD 14.6; range 30‒97 years). Missing teeth occurred more often in women than in men (P < 0.001). The third molar was most frequently missing and the canine least frequently. In the maxilla and mandible, the third molar was missing more often than each of the other tooth types up to the age of 80 years (P < 0.01).
CONCLUSIONS: When considering the rates of congenital agenesis of individual teeth, it is concluded that the third molar remained the most common tooth extracted up till the age of 80 years.
CONCLUSIONS: The third molar is the most common target for extraction, but also the most common tooth associated with malpractice claims, and therefore, calls for skills, adequate equipment, and other resources for a successful extraction.

BACKGROUND: The distal aspect of the second molar (d-M2) often exhibits infrabony defects due to the adjacent third molar. Although the defects can be treated by guided tissue regeneration (GTR) after removing the third molar, the optimal timing remains uncertain following third molar removal in clinical decision-making. This study aimed to compare delayed and immediate GTR treatments to assist in clinical decision-making.
METHODS: D-M2 infrabony defects with a minimum 1-year follow-up were collected and divided into three groups: Immediate GTR group, which underwent third molar extraction and received GTR simultaneously; Delayed GTR group, which underwent delayed GTR at least 3 months after third molar extraction; and Control group, which underwent only scaling and root planing during third molar extraction. The clinical and radiographic parameters related to the infrabony defect before GTR and post-surgery were evaluated using the Kruskal-Wallis test or one-way ANOVA, followed by post-hoc Dunn\'s test or the Bonferroni test for pairwise comparisons.
RESULTS: A total of 109 d-M2 infrabony defects were assessed. No significant differences were found between the two GTR groups, although both of them showed significant reductions in infrabony defect depth: the immediate GTR group (2.77 ± 1.97 mm vs. 0.68 ± 1.03 mm, p < 0.001) and the delayed GTR group (2.98 ± 1.08 mm vs. 0.68 ± 1.03 mm, p < 0.001) compared to the control group.
CONCLUSIONS: GTR can effectively improve d-M2 infrabony defects when the third molar is removed, whether simultaneously or delayed. Patients may experience less discomfort with immediate GTR treatment as it requires only one surgery.

OBJECTIVE: To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators.
METHODS: CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1-5 mm), tooth section fissure width (1-3 mm), elevator depth in fissure (2-6 mm), elevator position (buccal, lingual, central), elevator width (2-5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue.
RESULTS: Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width (~ 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M.
CONCLUSIONS: Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process.
CONCLUSIONS: These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study\'s predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

OBJECTIVE: The study aimed to investigate the potential beneficial role of hydrogen peroxide (H2O2) and hyaluronic acid (HA) combination formulation in socket healing after third molar surgery. Biomaterials, including mouthwash formulations, were hypothesized to contribute to improved socket healing and reduced post-operative complications.
METHODS: A triple-blinded parallel randomized controlled clinical trial was conducted at a single-center dental hospital in Milan, Italy. The trial included 114 patients who underwent extraction of impacted, partially erupted, and completely erupted third molars. Patients were randomly assigned to three parallel groups: Group 1 (H2O2 and HA), Group 2 (placebo), and Group 3 (0.2% chlorhexidine). The trial was registered at ClinicalTrial.gov (registration number NCT04438434). The main outcome measures included various parameters related to socket healing, such as pain, inflammation, swelling, plaque index, bleeding index, granulation tissue, suppuration, re-epithelialization, bleeding upon palpation, odor, and taste alteration. Patients were followed up for 7 days.
RESULTS: All 114 enrolled patients completed the study, with no dropouts or loss to follow-up. The mean age of patients in the three groups differed (H2O2 and HA: 30.9±14.9; placebo: 27.6±13.1; 0.2% chlorhexidine: 23.05±10.16). Significant reductions (p<0.001) in visual analog scale (VAS) pain levels and other outcome measures were observed in the H2O2 and HA group compared to the placebo group. These findings suggest a positive effect of the H2O2 and HA combination on socket healing after the third molar surgery.
CONCLUSIONS: The study concludes that the combination of hydrogen peroxide and hyaluronic acid can be considered a potential mouthwash with beneficial effects on socket healing following third molar surgery. However, additional clinical trials are recommended to validate its effectiveness further and provide additional evidence supporting its use in clinical settings.
BACKGROUND: gov: NCT04438434.

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

Removal of third molars in healthy patients is considered a procedure with a low risk of bleeding. However, exactly how low the incidence of postoperative bleeding is remains unclear due to the heterogeneity of available studies. To determine the exact postoperative risk of bleeding after the removal of third molars in healthy patients, a prospective observational multicentre study was conducted. A total of 1,035 patients with complete follow-up was included. Of these, 329 patients reported subsequent bleeding, but did not consult their attending physician. A total of 15 patients visited the hospital, 8 of whom required minimally invasive (re)treatment. No hospitalizations were necessary. There was a large difference between the incidence of postoperative bleeding reported by patients and postoperative bleeding requiring clinical examination and/or treatment. To reduce this difference in future, patients should be given detailed information about what degree of postoperative bleeding is considered normal after removal of a third molar.
Het verwijderen van derde molaren bij gezonde patiënten wordt beschouwd als een procedure met een laag bloedingsrisico. Maar hoe laag de incidentie van nabloedingen precies is, blijft onduidelijk door de heterogeniteit van de beschikbare onderzoeken. Om het precieze nabloedingsrisico na verwijdering van de derde molaar bij gezonde patiënten te bepalen werd een prospectief observationeel multicenteronderzoek uitgevoerd. In totaal werden 1.035 patiënten met een volledige follow-up geïncludeerd. Hiervan meldden 329 patiënten achteraf een nabloeding, maar raadpleegden hun behandelend arts niet. In totaal bezochten 15 patiënten het ziekenhuis, van wie 8 patiënten een minimaal invasieve (her)behandeling nodig hadden. Er waren geen ziekenhuisopnamen noodzakelijk. Er was een groot verschil tussen de incidentie van door patiënten gemelde nabloedingen en nabloedingen waarvoor klinisch onderzoek en/of behandeling noodzakelijk was. Om dit verschil in de toekomst te verkleinen moeten patiënten gedetailleerde informatie krijgen over welke mate van nabloeding als normaal wordt beschouwd na het verwijderen van een derde molaar.

OBJECTIVE: To assess the biocompatibility, bioactivity, and immunomodulatory properties of three new calcium silicate cement-based sealers: Ceraseal (CS), Totalfill BC Sealer (TFbc) and WellRoot ST (WR-ST) on human periodontal ligament stem cells (hPDLSCs).
METHODS: HPDLSCs were isolated from extracted third molars from healthy patients. Eluates (1:1, 1:2, and 1:4 ratio) and sample discs of CS, TFbc and WR-ST after setting were prepared. A series of assays were performed: cell characterization, cell metabolic activity (MTT assay) cell attachment and morphology (SEM assay), cell migration (wound-healing assay), cytoskeleton organization (phaloidin-based assay); IL-6 and IL-8 release (ELISA); differentiation marker expression (RT-qPCR assay), and cell mineralization (Alizarin Red S staining). HPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media were used as a comparison. Statistical significance was established at p < 0.05.
RESULTS: All the tested sealers exhibited similar results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group. CS and TFbc exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. CS and TFbc also showed a significantly higher calcified nodule formation than the negative and positive control groups. Both the marker expression and calcified nodule formation were significantly higher in CS-treated cells than TFbc treated cells. WR-ST exhibited similar results to the control group. CS and TFbc-treated cells exhibited a significant downregulation of IL-6 after 72 h of culture compared to the negative control group (p < 0.05).
CONCLUSIONS: All the tested sealers exhibited an adequate cytocompatibility. CS significantly enhances cell differentiation by upregulating the expression of key genes associated with bone and cementum formation. Additionally, CS was observed to facilitate the mineralization of the extracellular matrix effectively. In contrast, the effects of TFbc and WR-ST on these processes were less pronounced compared to CS. Furthermore, both CS and TFbc exhibited an anti-inflammatory potential, contributing to their potential therapeutic benefits in regenerative endodontics.
CONCLUSIONS: This is the first study to compare the biological properties and immunomodulatory potential of Ceraseal, Totalfill BC Sealer, and WellRoot ST. The results act as supporting evidence for their use in root canal treatment.

Introduction Impacted mandibular third molars can be asymptomatic or cause some pathologies, such as distal caries and odontogenic cysts and tumours. This study investigates the prevalence of distal caries of the mandibular second molar adjacent to the mesioangular or horizontally partially erupted mandibular third molar and its relationship regarding decayed, missing and filled teeth (DMFT) risk group, age, side (left-right) and sex.Methods The study included patients who had an appointment for mesioangular or horizontally positioned and partially erupted mandibular third molar surgery. Before the surgery, the DMFT score, age, sex and side were recorded. After extraction, the second molar was clinically examined for distal caries. The prevalence of distal caries and the correlation between the DMFT risk group, age, sex and side were determined.Results The study was conducted on 514 patients and involved 639 teeth. Men and patients in the moderate- or high-risk group are significantly prone to developing distal caries of the second molar. No statistically significant relationship exists regarding age group, side and position.Conclusion Sex and DMFT risk groups affect the prevalence of distal caries in second molars adjacent to the mesioangular or horizontally partially erupted third molars. The prophylactic extraction should be considered in men and patients in the moderate- or high-risk group.