Tag Archives | Wisdom Teeth

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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Treating with Platelet Rich Fibrin After Wisdom Teeth Removal

An interesting article titled “Evaluation of Treatment Outcome After Impacted Mandibular Third Molar Surgery With the Use of Autologous Platelet-Rich Fibrin: A Randomized Controlled Clinical Study,” appears in the Journal of Oral and Maxilofacial Surgery written by Nilima Kumar and et al. (vol 73, pp. 1042-1049). The article sets out to explore the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing near the second molar, and progress of bone regeneration in upper wisdom teeth extraction sockets. Clinicians have identified a subpopulation of patients having wisdom teeth removed that are at ‘‘high risk’’ for periodontal defects after wisdom teeth removal (such as greater than 26 years old, pre-existing periodontal defects [attachment level, >3 mm; probing depth, >5 mm]; and horizontal or mesioangular impaction). The authors studied a patient sample that consisted of 31 patients with mesioangular or horizontal upper impacted wisdom teeth. Patients in the study were randomized by the closed-envelope method and divided into 2 groups. In one group, 16 patients had a impacted mandibular wisdom tooth surgically removed and PRF was placed into the extraction socket followed by flap approximation. The control group  had 15 patients treated with surgical removal of the impacted mandibular wisdom […]

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Filing Billing for Dentists to Help Patients

An interesting article titled “You want me to do what?” written by Douglas Auld appears in the March 2016 issue of JADA. The article discusses a patient who has an an abscess on a mandibular right third molar which requires extraction. The treatment was done in December and the patient had already used their full benefits from their dental insurance for the year. So the patient suggested to the dentist to bill for the extraction in January and also suggested to file it as a surgical extraction and apply the difference to his balance. The article asks if it is ethical for dentists to do any of this. The article states that a dentist has a duty to communicate truthfully with third parties. It says “A dentist who submits a claim form to a third party reporting incorrect treatment dates for the purpose of assisting a patient in obtaining benefits under a dental plan, which benefits would otherwise be disallowed, is engaged in making an unethical, false or misleading representation to such third party.” Therefore the dentist should file the claim with the correct date of service or wait until January to perform the treatment. The article says “A dentist who incorrectly describes on […]

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