Retrieving a Broken Dental Needle Using a Minimally Invasive Technique

An interesting article titled “Use of Intraoperative Navigation for Minimally Invasive Retrieval of a Broken Dental Needle” appears in the 2015 Journal of Oral and Maxillofacial Surgery and written by Kyle M. Stein (vol. 73, pp. 1911-1916). The article describes retrieving a broken dental needle using a Medtronic StealthStation S7 surgical navigation system. The use of disposable needles in dentistry has rendered the occurrence of needle breakage an extremely rare event. However, this complication continues to occur, and can be caused by improper technique, inappropriate armamentarium, and unexpected patient movement. I have described a few cases of this occuring on the wisdom teeth complications page at http://www.teethremoval.com/complications.html. In almost every case, needle breakage occurs when an inferior alveolar nerve block is administered with 30-gauge short needles. In the article a case of a 13 year old female had a broken dental needle located in the right pterygomandibular space. The female had received local anesthesia via an inferior alveolar nerve block using a 30- gauge short (25-mm) dental needle for routine restorative dentistry in the lower right quadrant. She suddenly moved during the procedure causing the breakage. Cone beam computed tomography (CBCT) images were obtained for evaluation. Given the localized trauma, minimal […]

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Do Mesial Angled Wisdom Teeth Cause Problems to Adjacent Second Molars

An interesting article titled “Mesial Inclination of Impacted Third Molars and Its Propensity to Stimulate External Root Resorption in Second Molars—A Cone-Beam Computed Tomographic Evaluation” written by Anne Caroline Costa Oenning and et al. appears in the 2015 Journal of Oral and Maxillofacial Surgery (vol. 73, pp. 379-386). The authors explore cone-beam computed tomography (CBCT) scans to look at the teeth in the mouth. They look at the  presence of external root resorption (ERR) in second molars adjacent to horizontally and mesioangular impacted mandibular wisdom teeth. Unlike cavities, ERR is usually asymptomatic and aseptic, unless the pulp cavity has been involved or the lesion has been secondarily infected. Literature attributes the occurrence of this resorption to pressure from an adjacent impacted tooth. This pressure can activate clastic cells responsible for triggering resorption. Studies of periapical and panoramic radiographs have looked at the presence of ERR in second molars adjacent to impacted wisdom teeth. Most of these studies have reported a low prevalence of ERR in second molars ranging from 0.3% to 7%. Even so  cone-beam computed tomographic images have been compared with with panoramic images and the detection of ERR on second molars was found to 4.3 times greater with […]

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Extraction of High Risk Impacted Upper Wisdom Teeth

An interesting article titled “Orthodontic Extraction of High-Risk Impacted Mandibular Third Molars in Close Proximity to the Mandibular Canal: A Systematic Review,” written by Mahmood Reza Kalantar Motamedi and et al. appears in the 2015 Journal of Oral and Maxilofacial Surgery (issue 73, pp. 1672-1685). The article describes extraction of lower wisdom teeth in close proximity to the mandibular canal which is high risk and called orthodontic extraction. The authors searched for case reports, case series, retrospective analyses, and clinical trials that reported orthodontic extraction of wisdom teeth with high risk of inferior alveolar nerve injury. The study population included patients scheduled for elective surgical removal of impacted mandibular wisdom teeth in close proximity to the mandibular canal as visualized by radiographic examination. Various databases were searched. The selected studies consisted of publications from August 1996 to March 2014 and the number of impacted mandibular wisdom teeth ranged from 1 to 64, with a total of 143 cases of mandibular impactions. Of these, 123 underwent orthodontic extraction and only 2 patients developed temporary paresthesia. A panoramic radiograph was the primary diagnostic predictor in all the included studies. If the wisdom teeth was deemed to be in close proximity to the mandibular canal, then a CBCT or CT scan was ordered for […]

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AAOMS Wisdom Teeth Removal Benchmark Study

An interesting article titled “American Association of Oral and Maxillofacial Surgeons’ Anesthesia and Third Molar Extraction Benchmark Study: Rationale, Methods, and Initial Findings” written by Thomas B. Dodson and Martin L. Gonzalez appears in the 2016 Journal of Oral and Maxilofacial Surgery (vol. 74, pp. 903-910). In 2007 the American Association of Oral and Maxillofacial Surgeons (AAOMS) Board requested a benchmarking study to assess practice patterns and outcomes of oral and maxiofacial surgeons (OMS). The study period was 12 months and began June 1, 2011 and ended May 31, 2012. The study was designed to enroll 300 OMSs randomly selected from a list of all active private practice AAOMS members. The first sample included OMSs who had enrolled as practice-based research collaborative (P-BRC) participants. The second sample included patients treated by the OMSs participating in the P-BRC. To be eligible for inclusion in the P-BRC, the OMSs were required 1) to be in private practice, full or part-time; 2) to be delivering anesthesia services in the office-based ambulatory setting; 3) to be current AAOMS members; 4) to have Internet access; and 5) to have agreed to participate. To develop a P-BRC composed of randomly selected OMSs, a list of active […]

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Using Fibrin Glue to Help Lingual Nerve Repair

An interesting article titled “Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report,” was written by Nicholas P. Theberge and Vincent B. Ziccardi and appears in the 2016 Journal of Oral and Maxilofacial Surgery (vol. 74, pp. 1899 e1-e4). The article describes a report of a case of a woman in her 20s who had an impacted wisdom tooth removed and developed left lingual nerve numbness and pain. She later had surgery with fibrin glue to help correct the lingual nerve injury. The article reports that most lingual nerve injuries after wisdom teeth removal occurs in 0.4% to 22% of cases. Such an injury can be detrimental to patients and lead to drooling, tongue biting, self-induced thermal injuries, and changes in speech, swallowing, and taste perception. Lingual nerve deficit has been reported to have the highest incidence in distally impacted lower wisdom teeth, followed by horizontal, mesial, and vertical impactions. When an injury to the lingual nerve occurs full recovery occurs in most patients (58%) within the first 6 months and in 72% patients after 2 years. The article later describes the specific surgery done on the woman. The nerve was freed with […]

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