1 ORIGINAL PAPERS Dent. Med. Probl. 2014, 51, 1, ISSN X Copyright by Wroclaw Medical University and Polish Dental Society Yan Vares A, B, D, E, Solomiya Kyyak A F Management of Asymptomatic and Mandibular Impacted Third Molars that do not Present any Considerable Pathological Changes Leczenie bezobjawowych i niewykazujących zmian patologicznych zatrzymanych trzecich zębów trzonowych żuchwy Department of Oral and Maxillofacial Surgery, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine A concept, B data collection, C statistics, D data interpretation, E writing/editing the text, F compiling the bibliography Abstract Background. Tooth impaction is one of the most common pathologies in our everyday practice. Over the recent years there has been a debate over the advisability of removing symptom-free wisdom teeth or leaving them in place. One of the main reasons for removal of a symptom-free wisdom tooth is high incidence of later complications, low incidence of their eruption, especially after the age of 25, and 2 times greater risk of complications after the age of 24. Objectives. The aim of our investigation was to systematize a scheme of objective preoperative clinical and roentgenological assessment of mandibular impacted symptom-free wisdom teeth to create a rationale for their prophylactic removal. Material and Methods. 84 clinical cases of patients with impaction of asymptomatic and without any considerable pathological changes mandibular third molars, who have been treated in the Department of Surgical Dentistry and Maxillofacial Surgery of Lviv Danylo Halytsky National Medical University during Results. For the justified removal of a symptom-free mandibular impacted third molar, we processed known clinical, roentgenological parameters, which characterize asymptomatic and without any considerable pathologic changes mandibular impacted third molars and do not belong to the list of indications and contraindications to atypical removal. There were no considerable intra- or postoperative complications in the first subgroup (41 cases of patients years old); minor complications in the second subgroup (10 cases of year old patients). In the case of 68 year-old patient surgery, all complications were related to considerable bone atrophy of the operated area. 5 of 7 clinical cases from control group #1 needed surgical intervention because of the appearance of indications during the next 5 years of follow-up. Mandible third molars from control group #2 during the last five years still have had no pathological changes that may warrant their removal. Conclusions. Considering the abovementioned, all the chosen criteria facilitate the formation of indications for a proper treatment tactic regarding asymptomatic impacted lower third molars without any considerable pathological changes. The low-to-no percentage of intra- and postoperative complications does not give any reason to leave a wisdom tooth with minor clinical manifestations or an asymptomatic wisdom tooth with bad prognosis in place, since early surgical procedures generate less number of complications, having shorter operative time and postoperative period (Dent. Med. Probl. 2014, 51, 1, 35 42). Key words: asymptomatic third molar, impaction, atypical removal. Streszczenie Wprowadzenie. Zatrzymanie zębów jest jedną z częstszych patologii w codziennej praktyce. W ostatnich latach toczy się debata nad kwestią konieczności usuwania bezobjawowych zębów mądrości lub ich pozostawienia. Jednym z głównych powodów usuwania bezobjawowych zatrzymanych zębów mądrości jest duże prawdopodobieństwo późniejszych powikłań, małe prawdopodobieństwo ich wyrżnięcia się, zwłaszcza po 25 roku życia i dwukrotnie większe ryzyko powikłań po 24 latach.
2 36 Y. Vares, S. Kyyak Cel pracy. Pokazanie całego zakresu objawów klinicznych i radiologicznych zatrzymanych trzecich zębów trzonowych w żuchwie w celu uzasadnienia konieczności ich profilaktycznego usuwania. Materiał i metody. Materiał stanowiło 84 wyselekcjonowanych pacjentów z bezobjawowo zatrzymanymi trzecimi zębami trzonowymi żuchwy. Byli oni leczeni na Oddziale Stomatologii Chirurgicznej i Chirurgii Szczękowo- -Twarzowej w Lwowskim Uniwersytecie Medycznym im. Daniela Halickiego w latach Wyniki. W celu uzasadnienia usunięcia bezobjawowych zatrzymanych trzecich zębów trzonowych żuchwy badano znane parametry kliniczne i radiologiczne charakteryzujące zatrzymane trzecie zęby trzonowe w żuchwie, nie wykazujace wskazań i przeciwwskazań do atypowego usunięcia. Nie było żadnych znaczących powikłań śród- i pooperacyjnych w pierwszej podgrupie (41 przypadków klinicznych u pacjentów w wieku lat); nieznaczne komplikacje w drugiej podgrupie (10 przypadków klinicznych u pacjentów w wieku lat). U 68-letniego pacjenta wszystkie powikłania były związane ze znaczną atrofią kości żuchwy w obszarze operacyjnym. 5 z 7 przypadków klinicznych w grupie kontrolnej wymagało interwencji chirurgicznej z powodu pojawienia się wskazań w ciągu najbliższych 5 lat obserwacji. Trzecie zęby trzonowe żuchwy z grupy kontrolnej w ciągu pięciu lat nie wykazywały patologicznych zmian, które nakazywałyby ich usunięcie. Wnioski. Zaproponowane kryteria dają wskazania do odpowiedniego leczenia bezobjawowych i niewykazujących zmian patologicznych zatrzymanych trzecich zębów trzonowych w żuchwie. Niski odsetek powikłań śród- i pooperacyjnych nie daje żadnego powodu do pozostawienia zęba mądrości z łagodną chorobą objawową lub bezobjawowego zęba mądrości ze złym rokowaniem miejscowym, ponieważ wczesne interwencje chirurgiczne wywołują mniejszą liczbę powikłań, przy czym okres operacyjny i pooperacyjny jest krótszy (Dent. Med. Probl. 2014, 51, 1, 35 42). Słowa kluczowe: bezobjawowy ząb trzonowy, zatrzymanie, atypowe usunięcia. Tooth impaction is one of the most common pathologies in our everyday practice. Furthermore, it presents the greatest surgical challenge and provokes the biggest controversy when indications for removal are considered. During the recent years there has been a debate over the advisability of removing symptom-free wisdom teeth or leaving them in place [1 3]. One of the main reasons for removing a symptom-free wisdom tooth is the high incidence of their late complications, low incidence of their eruption, especially after the age of 25, and 2 times greater risk of complications after the age of 24 [4 7]. According to M. Miloro et al., an impacted tooth can cause mild to severe complications if it remains unerupted. Not every impacted tooth causes problems of clinical value but each one has a potential for it . For example, partial retention of a wisdom tooth is very common but lack of competence and sometimes carelessness of surgeons may lead to severe complications . Opponents of prophylactic removal of wisdom teeth consider that most of third molars, impacted or not, remain without changes, but the risk of iatrogenic complications because of surgical manipulations is higher than the risk to leave asymptomatic tooth that does not [resent considerable pathological changes [9, 10]. The decision to remove impacted teeth should be based on the thorough evaluation of potential benefits and risks. In the case when pathology exists, the decision to remove is not complicated and vice versa; such situations exist when the removal of an asymptomatic impacted tooth is contraindicated, while surgical complications may exceed the possible benefits . The aim of our investigation was to systematize a scheme of objective preoperative clinical and roentgenological assessment of mandibular impacted symptom-free wisdom teeth to create a rationale for their prophylactic removal. Material and Methods Material and methods of the investigation were 84 clinical cases of patients with impaction of asymptomatic and mandibular third molars that did not present any considerable pathological changes; these patients have been treated in the Department of Surgical Dentistry and Maxillofacial Surgery of Lviv Danylo Halytsky National Medical University during clinical cases of impacted mandibular third molars that were removed according to the results of the proposed tables compose the main group with 3 subgroups (first subgroup 41 cases of patients years old, second subgroup 10 cases of year old patients, and third subgroup 1 case of 68 year old patient). Control group # 1 consists of 7 clinical cases of patients that according to the proposed tables needed their mandibular third molars removed but refused to remove them. Control group # 2 consists of 25 clinical cases of patients that according to the proposed tables at the time of diagnostic did not need their mandibular third molars removed. Results In order to justify the removal of a symptomfree mandibular impacted third molar, a specialist
3 Management of Mandibular Impacted Third Molars 37 needs to compare all possible pathological changes and complications in the area of the tooth in question in case of different treatment tactics. We processed the known clinical, roentgenological parameters, which characterize asymptomatic mandibular impacted third molars that do not present any considerable pathologic changes and do not belong to the list of indications and contraindications to atypical removal, but in complex estimation can play a considerable role while planning a tactic concerning the aforementioned teeth. Processed characteristics were classified into a table, which also includes the age and other parameters. The table is classified according to a treatment tactic of an impacted mandibular third molar (Table 1). Table 1. General appearance of the table classified according to a treatment tactic of an impacted mandibular third molar Tabela 1. Ogólny wygląd tabeli klasyfikacji według taktyki leczenia zatrzymanego trzeciego zęba trzonowego żuchwy No Criteria + +/ Result 1 Operator s experience experienced inexperienced 2 Age years < 25 years 3 Weight normosthenic asthenic hypersthenic 4 Sex female male 5 Frequency of acute respiratory more than 3 times per year 1 time per year diseases 6 Patient readiness for systematic not ready ready observation 7 Bad habits smoker ( non-smoker 8 Severity of gag reflex no to not severe severe 9 Oral hygiene state bad (in case of 10 Presence of erupted opposite upper third molar 11 Presence (in anamnesis) of perecoronaritis 12 Presence of plaque distally on a third molar 13 Results of periodontal probe distally to a third molar 14 Degree of third molar follicle enlargement 15 Root morphology, risk of crown retention 16 Proximity to the mandibular canal present depth up to 5 mm (if a third molar is a cause) up to 2.5 mm moderate to good (in case of present (till the age of 45) bad (in case of full retention)good absent absent absent periodontal pocket is absent no enlargement present (after the age of 45), absent in contact up to 3 mm more than 3 mm 17 Angulation distal (till vertical (from 25/if place for eruption is available/till 18 Depth according to the occlusal line 19 Position in relation to anterior edge of mandibular ramus 20 Probability of resorption or caries occurrence (evaluation of contact with second molar) 21 Presence of a bone and a risk of its loss distally along the second molar. high (partial retention till 45 years and if ortopedic indications) no place (till middle, deep (till little place (till the rest of cases all angulations enough place and high (till moderate (till low and after 45 years absent (till 45 tears), mm in case of mesial and horizontal angulation (till absent for more than 1/3 of root length (till absent (after 45)
4 38 Y. Vares, S. Kyyak Each item may have positive or negative valuation (conduct surgery or not, respectively) in accordance to a clinical case, which has been noted in an appropriate column. In the scheme of general criteria we included: operator s experience, age, weight, sex of a patient, frequency of acute respiratory diseases, readiness of a patient to systematic observation, bad habits, and severity of gag reflex. The scheme of clinical criteria contains: an oral hygiene state, presence of an erupted opposite upper third molar, presence (in anamnesis) of perecoronaritis, presence of plaque distally on a third molar, results of periodontal probe distally to a third molar. In roentgenological characteristics we included: a degree of third molar follicle enlargement, root morphology, proximity to the mandibular canal, angulation, as well as such important characteristic as depth according to the occlusal line, position in relation to the anterior edge of mandibular ramus, evaluation of contact with the second molar, presence of bone and risk of its loss distally along the second molar. The third molar removal was conducted using the surgical bur technique. In accordance with the severity of impaction, a proper incision and tooth sectioning were made following the strict conventional scheme and with a minimization of the distal bone removal and the operative time. Clinical Case no. 1 Patient K., 28 years old, entered our department after a trauma of the maxillofacial area. A panoramic radiography was made (Fig. 1). An asymptomatic impacted mandibular third molar that did not present any considerable changes was revealed. The data was entered into the table (Table 2) and the result was negative, thus, the operative treatment was not conducted. Clinical Case no. 2 Patient, 30 years old, entered our department. An asymptomatic impacted mandibular third molar presenting no considerable pathological changes was occasionally revealed during a routine sur- Fig. 1. Panoramic radiography. Clinical case no. 1. Asymptomatic and without any considerable changes impacted mandibular third molar is revealed Rys. 1. Panoramiczne zdjęcie rengenowskie. Przypadek kliniczny nr 1. Bezobjawowy zatrzymany trzeci ząb trzonowy żuchwy Fig. 2. Asymptomatic and without any considerable pathological changes impacted mandibular third molar was occasionally revealed while routine radiographic examination. Clinical case no. 2 Rys. 2. Bezobjawowy zatrzymany trzeci ząb trzonowy żuchwy sporadycznie ujawnił się podczas rutynowego badania radiologicznego. Przypadek kliniczny nr 2
5 Management of Mandibular Impacted Third Molars 39 Table 2. Data entered into the table from clinical case No. 1 (result was negative, thus, the operative treatment was not conducted) Tabela 2. Dane wprowadzone do tabeli przypadku klinicznego nr 1 (wynik końcowy był ujemny, więc leczenie operacyjne nie było prowadzone) No Criteria + +/ Result 1 Operator s experience experienced inexperienced + 2 Age years < 25 years + 3 Weight normosthenic asthenic hypersthenic + 4 Sex female male 5 Frequency of acute respiratory more than 3 times per 1 time per year diseases year 6 Patient readiness for systematic not ready ready + observation 7 Bad habits smoker ( non-smoker 8 Severity of gag reflex no to not severe severe 9 Oral hygiene state bad (in case of 10 Presence of erupted opposite upper third molar 11 Presence (in anamnesis) of perecoronaritis 12 Presence of plaque distally on a third molar 13 Results of periodontal probe distally to a third molar. 14 Degree of third molar follicle enlargement 15 Root morphology, risk of crown retention 16 Proximity to the mandibular canal moderate to good (in case of bad (in case of full retention) good absent + present absent depth up to 5 mm (if a third molar is a cause) absent periodontal pocket is absent up to 2.5 mm no enlargement +/ present (till the age of 45) present (after the age of 45), absent in contact up to 3 mm more than 3 mm + 17 Angulation distal (till vertical (from 25/if place for eruption is available/till 18 Depth according to the occlusal line 19 Position in relation to anterior edge of mandibular ramus 20 Probability of resorption or caries occurrence (evaluation of contact with the second molar) 21 Presence of a bone and a risk of its loss distally along the second molar high (partial retention till 45 years and if orthopedic indications) no place (till middle, deep (till little place (till +/ the rest of cases + all angulations enough place and high (till moderate (till low and after 45 years absent (till 45 tears), mm in case of mesial and horizontal angulation (till absent for more than 1/3 of root length (till +/ + absent (after 45) Do not remove gical radiographic examination (Fig. 2). The patient and impaction information were entered into our table. The final result was positive (Table 3), thus, the operative treatment was conducted following the strict conventional surgical protocol of atypical removal and considering the strategy of minimal surgical trauma. There were no considerable intra- or post- -operative complications in the first subgroup (41 cases of patients years old); minor com-
6 40 Y. Vares, S. Kyyak Table 3. Data entered into the table from clinical case no. 2 (final result was positive, thus the operative treatment was conducted) Tabela 3. Dane wprowadzone do tabeli przypadku klinicznego nr 2 (wynik końcowy był pozytywny, więc leczenie operacyjne zostało przeprowadzone) No Criteria + +/ Result 1 Operator s experience experienced inexperienced + 2 Age years < 25 years + 3 Weight normosthenic asthenic hypersthenic + 4 Sex female male + 5 Frequency of acute respiratory more than 3 times per 1 time per year diseases year 6 Patient readiness for systematic not ready ready + observation 7 Bad habits smoker ( non-smoker 8 Severity of gag reflex no to not severe severe 9 Oral hygiene state bad (in case of 10 Presence of erupted opposite upper third molar 11 Presence (in anamnesis) of perecoronaritis 12 Presence of plaque distally on a third molar 13 Results of periodontal probe distally to a third molar. 14 Degree of third molar follicle enlargement 15 Root morphology, risk of crown retention 16 Proximity to the mandibular canal moderate to good (in case of bad (in case of full retention)good absent + present absent + depth up to 5 mm (if a third molar is a cause) absent periodontal pocket is absent up to 2.5 mm no enlargement +/ present (till the age of 45) present (after the age of 45), absent in contact up to 3 mm more than 3 mm 17 Angulation distal (till vertical (from 25/if place for eruption is present/till 18 Depth according to the occlusal line 19 Position in relation to anterior edge of mandibular ramus 20 Probability of resorption or caries occurrence (evaluation of contact with the second molar) 21 Presence of a bone and a risk of its loss distally along the second molar. high (partial retention till 45 years and if orthopedic indications) no place (till middle, deep (till little place (till +/ the rest of cases all angulations enough place and high (till moderate (till low and after 45 years absent (till 45 tears), mm in case of mesial and horizontal angulation (till absent for more than 1/3 of root length (till + +/ + absent (after 45) + Remove + plications in the second subgroup (10 cases of year-old patients) like fracture of the root tip of third molar, more severe trismus in postoperative period and generally longer intraoperative time and postoperative period than in subgroup # 1. In the case of a 68-year-old patient, surgery was complicated because of considerable bone atrophy of the operated area.
7 Management of Mandibular Impacted Third Molars 41 Patients from control group # 1 were subjected to annual long-term follow-ups. Five of 7 clinical cases from control group needed surgical intervention because of the appearance of indications during the next 5 years of follow-ups. Patients from control group # 2 were also subjected to annual long-term follow-ups and still for the last 5 years there were no pathological changes in those teeth that may warrant their removal. Discussion On the basis of our own observations and analysis of specialized literature, we revealed that 17 32% of the population has third molars, and 73.5% of them are mandibular ones. Almost one third of impacted third molars are those with perspective of eruption. Symptomatic impacted mandibular third molars make 20%, 8 10% of which are with pericoronitis, and the rest (80%) are asymptomatic, respectively. Postoperative complications occur in 30 40% of cases where pain is not considered, but trism and swelling make approximately 9 and 11% respectively. More risk of pathological changes is caused by partial retention, while the postoperative period in this case runs with minor complications. Taking into consideration our research, we can agree with some studies [4 7] that the risk of complications resulting from the removal of a third molar grows approximately twice after the age of 24. Hence, the best time for their removal is the age of . We consider that if impacted mandibular third molar has more characteristics from the positive valuation column from the table it belongs to risk group. That means the surgeon in the future should expect the development of any pathology that will warrant the removal of aforementioned impacted mandibular tooth. Moreover, if these patients do not undergo at least an annual follow-up, the pathology may develop in an uncontrolled manner and a number of impacted mandibular third molar pathologic changes may be clinically silent. Undesired progression of pathological changes, if not mentioned, increases with time; other risk factors like age etc. can lead to more complicated procedures of removal. Hence, surgeons should consider all factors, since the tooth that has mostly positive valuation in our table will, in most cases, develop a pathology finally requiring the removal of the tooth. Considering the above-mentioned, all the chosen criteria facilitate the formation of indications for a proper treatment tactic regarding asymptomatic impacted mandibular third molars that do not present any considerable pathological changes. Knowledge of clinical, roentgenological assessment of a mandibular wisdom tooth and further step-by-step surgical technique of its removal provide a great possibility of successful intra- and post-operative management of patients with vertical, mesioangular, horizontal and distoangular impaction without any severe complications. The low-to-no percentage of intra- and post-operative complications does not give any reason to leave a wisdom tooth with minor clinical manifestations or an asymptomatic wisdom tooth with bad prognosis in place, since early surgical procedures generate less number of complications, having shorter operative time and postoperative period. References  Alling C.C., Alling R.D.: Indications for management of impacted teeth. In: Impacted teeth. Eds.: Alling C.C., Helfrick J.F., Alling R.D., W.S. Saunders, Philadelphia 1993,  Chaparro-Avendano A.V., Perez-Garcia S., Valmaseda-Castellon E., Berini-Aytes L., Gay-Escoda C.: Morbidity of third molar extraction in patients between 12 and 18 years of age. Oral Med., Oral Pathol., Oral Cir. Bucal. 2005, 10,  Lopes V., Mumenya R., Feinmann C., Harris M.: Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br. J. Oral Maxillofacial Surg. 1995, 33,  Bataineh A.B.: Sensory nerve impairment following mandibular third molar surgery. J. Oral Maxillofacial Surg. 2001, 59,  Benediktsdottir I.S., Wenzel A., Petersen J.K., Hintze H.: Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg., Oral Med., Oral Pathol., Oral Radiol., Endod. 2004, 97,  Chiapasco M., De Cicco L., Marrone G.: Side effects and complications associated with third molar surgery. Oral Surg., Oral Med., Oral Pathol. 1993, 76,  Lysell L., Rohlin M.: A study of indications used for removal of the mandibular third molar. Int. J. Oral Maxillofacial Surg. 1988, 17,  Miloro M., Ghali G.E., Peter E.L., Peter D.W.: Peterson s Principles Of Oral And Maxillofacial Surgery. 2 nd ed. London: BC Decker Inc. Hamilton, 2004, 1502 p.  Laine M., Ventä I., Hyrkäs T.: Chronic inflammation around painless partially erupted third molars. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2003, 95, 3,
8 42 Y. Vares, S. Kyyak  Praveen G., Rajesh P., Neelakandan R.S., Nandagopal C.M.: Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique. Ind. J. Dent. Res , 1,  Chiapasco M., Crescentini M., Rmanoni G.: Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications. J. Oral Maxillofac. Surg. 1995, 53, Address for correspondence: Kyyak Solomiya Kotlyarevskogo 28/3 Lviv Ukraine Tel.: Received: Revised: Accepted: Praca wpłynęła do Redakcji: r. Po recenzji: r. Zaakceptowano do druku: r.
Residency Competency and Proficiency Statements 1. REQUEST AND RESPOND TO REQUESTS FOR CONSULTATIONS Identify needs and make referrals to appropriate health care providers for the treatment of physiologic,
CLINICAL AVOIDING INJURY TO THE INFERIOR ALVEOLAR NERVE BY ROUTINE USE OF INTRAOPERATIVE RADIOGRAPHS DURING IMPLANT PLACEMENT Jeffrey Burstein, DDS, MD; Chris Mastin, DMD; Bach Le, DDS, MD Injury to the
Molar Uprighting Dr. Margherita Santoro Division of Orthodontics School of Dental and Oral surgery Molars The wide occlusal surface is designed for food grinding. The surface needs to be aligned with the
Communication Task - Scenario 1 Your patient is 30 years old, and has presented today complaining of pain from the lower right posterior side. The tooth had been cold sensitive for several weeks, but the
Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers Dubravka KnezoviÊ-ZlatariÊ Asja»elebiÊ Biserka LaziÊ Department of Prosthodontics School of Dental Medicine University
Lee et al. Maxillofacial Plastic and Reconstructive Surgery (2015) 37:30 DOI 10.1186/s40902-015-0030-4 RESEARCH Open Access Assessment of the proximity between the mandibular third molar and inferior alveolar
PAGE 1 of 5 References Related ACA Standards 4 th Edition Standards for Adult Correctional Institutions 4-4369, 4-4375 PURPOSE To provide guidelines for determining appropriate levels of care and types
LATERAL BONE EXPANSION FOR IMMEDIATE PLACEMENT OF ENDOSSEOUS DENTAL IMPLANTS Department of Oral Maxillofacial Surgery, Chisinau Abstract: The study included 10 using the split control expansion technique
Dental Covered services and limitations module Dental Covered Services and Limitations Module Covered Dental Services for Patients Under the Age of 21...2 Examinations...2 Radiographs and Diagnostic Imaging...2
TREATMENT REFUSAL FORMS These forms are intended to be used when a patient refuses the treatment. These forms help confirm that the patient is informed and aware of the risks involved with not proceeding
IMPLANTS The Immediate Placement of Dental Implants Into Extraction Sites With Periapical Lesions: A Retrospective Chart Review Christopher Lincoln Bell,* David Diehl, Brian Michael Bell, and Robert E.
8 Periapical radiography Periapical radiography describes intraoral techniques designed to show individual teeth and the tissues around the apices. Each film usually shows two to four teeth and provides
Replacement of the upper left central incisor with a Straumann Bone Level Implant and a Straumann Customized Ceramic Abutment by Dr. Ronald Jung and Master Dental Technician Xavier Zahno Initial situation
1 Complications Associated with Tooth Extraction Mark M. Smith, VMD, DACVS, DAVDC Center for Veterinary Dentistry and Oral Surgery 9041 Gaither Road Gaithersburg, MD 20877 Introduction Tooth extraction
CHAPTER 10 RESTS AND DEFINITIONS A REST is any rigid part of an RPD framework which contacts a properly prepared surface of a tooth. A REST PREPARATION or REST SEAT is any portion of a tooth or restoration
Teeth and Dental Implants: When to save, and when to extract. One of the most difficult decisions a restorative dentist has to make is when to refer a patient for extraction and placement of dental implants.
Bitewing Radiography B.E. DIXON B.D.S., M.Sc., D.P.D.S. Main Indications Detection of Dental Caries Monitoring progression of caries Assessment of existing restorations Assessment of Periodontal status
411 PDS Periodontal surgery report for crown lengthening of tooth number -Course director : Dr. Nahid Ashri - instructor: Dr.Fatin Awaratani - - Student Name: Hanadi Alyami Computer Number: K S U - D E
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Purpose Use this guide to explain Federal Employee dental benefits to your patients if they
Journal section: Oral Surgery Publication Types: Case Report doi:10.4317/jced.3.e360 Prosthetic rehabilitation with dental implants after treatment of a keratocystic odontogenic tumor. case report Amila
E. Richard Hughes, D.D.S. Docket No. FDA-2012-N-0677 Blade Form Endosseous Dental Implants E. Richard Hughes, D.D.S. 46440 Benedict Dr.,# 201 Sterling, Va. 20164 USA 703-444-1152 firstname.lastname@example.org Diplomate,
Case Number: CM13-0026016 Date Assigned: 11/22/2013 Date of Injury: 08/11/2005 Decision Date: 02/03/2014 UR Denial Date: 08/30/2013 Priority: Standard Application Received: 09/18/2013 HOW THE IMR FINAL
University of Washington School of Dentistry CLINICAL GOALS OF PATIENT CARE AND CLINIC MANAGEMENT Philosophical Basis of the Patient Care System The overall mission of the patient care system in the School
8.00 9.00 Registration and coffee/bread 9.00 9.45 1. Status of Dental Traumatology worldwide. Is prevention realistic? Lars Andersson Presently almost all countries have published data on the dental trauma
1. Introduction The EFP has previously published its recommendations concerning undergraduate and specialist education in periodontology. The aim of this document is to give guidance to those authorities
PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN 01101 100% Class A Initial examination of a new patient 01102 100% Class A Initial examination of a new patient 01103 100% Class A Initial
Oral Maxillofacial Surg Clin N Am 19 (2007) 23 43 General Technique of Third Molar Removal Sam E. Farish, DMD a,b, *, Gary F. Bouloux, MD, BDS, MDSc, FRACDS, FRACDS(OMS) b a Division of Oral and Maxillofacial
Dental Services For enquiries and appointments, please contact us HKSH Healthcare Medical Centre Dental Centre Level 22, One Pacific Place 88 Queensway, Hong Kong (852) 2855 6666 (852) 2892 7589 email@example.com
RESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS Evaluation and treatment of dental emergencies Recognize, anticipate and manage emergency problems related to the oral cavity. Differentiate between those
INTERNATIONAL MEDICAL COLLEGE Joint Degree Master Program: Implantology and Dental Surgery (M.Sc.) Basic modules: List of individual modules Basic Module 1 Basic principles of general and dental medicine
C HAPTER 4 O RAL AND M AXILLOFACIAL S URGERY I. TREATMENT PLANNING GUIDELINES As part of informed consent, the clinician should carefully explain the risks and benefits of oral and maxillofacial surgery
Case Report(s): Uncomplicated Crown Fractures Tooth fractures can be classified as follows: Uncomplicated crown fracture = fracture limited to the crown of the tooth with dentin exposure but no pulp exposure.
THE ADVERSE EFFECTS OF ORTHODONTIC TREATMENT By The Adverse Effects of Orthodontic Treatment William F. Holt and Judith B. Rose From Riolo, M. and Avery, J. Eds., Essentials for Orthodontic Practice, EFOP
Exhibit A Benefits Covered for OH Paramount Advantage Medicaid Children Diagnostic services include the oral examinations, and selected radiographs, needed to assess the oral health, diagnose oral pathology,
SYSTEMATIC APPROACH TO ORTHODONTIC DIAGNOSIS DENT 656 ORTHODONTIC CLASSIFICATION / DIAGNOSIS Goal of diagnosis: An orderly reduction of the data base to a useful list of the patient s problems Useful??
Advice for General Dental Practitioners, PCTs and LHBs Guidelines for Referrals for Orthodontic Treatment This document has been produced by the British Orthodontic Society Guidelines for Referrals for
Dental Policy WMI Mutual Insurance Company PO Box 572450 Salt Lake City, UT 84157 (801) 263-8000 & (800) 748-5340 Fax: (801) 263-1247 DENTAL POLICY A. Schedule of Benefits: Annual Maximum Dental Benefit
Journal of Data Science 6(2008), 591-599 Life Table Analysis for Evaluating Curative-effect of One-stage Non-submerged Dental Implant in Taiwan Miin-Jye Wen 1, Chuen-Chyi Tseng 2 and Cheng K. Lee 3 1 National
Retrospective study on the survival rate of IBS implant Date : 30. 05. 2013 Written by : Dr. Je Won Wang, Director of research Approved by : Prof. Min Seung Ki - Contents - 1. Purpose Of Study 2. Materials
Diagnostic services include the oral examinations and selected radiographs needed to assess the oral health, diagnose oral pathology and develop an adequate treatment plan for the Participant s oral health.
Original Article Braz J Oral Sci. July September 2012 - Volume 11, Number 3 Topographic relationship of impacted third molars and mandibular canal: correlation of panoramic radiograph signs and CBCT images
Dental and www.eip.sc.gov Employee Insurance Program 91 Table of Contents Introduction...93 Your Dental Benefits at a Glance...94 Claim Examples (using Class III procedure claims)...95 How to File a Dental
Dental Provider Specific Policy Revision Table Revision Date Sections Revised Description 7/1/02 All Complete manual revision to reflect changes related to the MMIS and HIPAA compliance. 8/19/04 184.108.40.206,
11. The Effect of Abutment Tooth Connection with Extracoronal Attachment using the Three Dimensional Finite Element Method - Part 2. The Construction of Finite Element Model from CT Data - Ando A., Nakamura
Bonitas Dental Benefit Table 2015 Dental benefits are paid at the Bonitas Dental tariff (BDT). Hospitalisation and certain specialised dentistry and treatment must be pre-authorised*. Procedures and treatment
PREPARATION OF MOUTH FOR REMOVABLE PARTIAL DENTURES Dr. Mazen kanout Mouth preparation includes procedures in four categories: 1. Oral Surgical Preparation. 2. Conditioning of Abused and Irritated Tissue.
Dentistry Dental Services The Department of Dentistry s multi-disciplinary team cares for your oral health and wellness, and provides you with personalised service that is integrated, comprehensive, teambased
SCD Case Study Treatment Considerations for Implant Rehabilitation Multiple surgical and restorative factors play a role in the treatment planning of implant restorations for the edentulous patient (Ali
DENTAL IMPLANTS J Oral Maxillofac Surg 68:2267-2271, 2010 Augmentation in Proximity to the Incisive Foramen to Allow Placement of Endosseous Implants: A Case Series Gerry M. Raghoebar, DDS, MD, PhD,* Laurens
What Parents Should Know about the Safety of Dental Radiology. There are many different types of x-ray images (pictures) that can be taken of children in the dental office to assist in diagnosis. These
WHITE PAPER ON THIRD MOLAR DATA A Task Force was convened by the American Association of Oral and Maxillofacial Surgeons in March 2007 to review the current literature with regard to selected aspects relating
DENTAL IMPLANT THERAPY PATIENT WELCOME PACK Dr. Syed Abdullah BDS, MSc (Dental Implants) What are dental implants? In the early 1950s, a Swedish Scientist, Per-Ingvar Branemark observed that titanium metal
Humana Health Plans of Florida Important: Dental discount membership in Florida is determined by viewing the member s ID card and verifying that the Humana Logo and Medicare name is listed with an effective
1. day Friday March 7 th, 2014 New horizons in prevention and treatment of tooth impaction and tooth retention. 8.00 9.00 registration and coffee/bread 9.00 9.30 1 Classification of tooth eruption in disturbances
Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal R.A.E. BRYAN*, B.O.I. COLE**, R.R. WELBURY* ABSTRACT. Aim This was to assess the
Improving Esthetics with Sequential Treatment Planning and Implant-Retained Dentures by Timothy F. Kosinski, DDS, MAGD While oral function is the primary concern for most patients, the importance of esthetics
Course Number: 108.2 Flapless Implant Surgery for Replacement of Posterior Teeth Authored by J. Steven Cloyd, DDS Upon successful completion of this CE activity 1 CE credit hour may be awarded A Peer-Reviewed
Page 1 of 6 Creating colored diagnostic wax-ups By Lee Culp, CDT To fulfill the role of partner in the successful dentist-technician restorative team, the technician needs to have a complete understanding
DENTAL COUNCIL Statutory Examination The Dentists Act 1985 requires that in order to practice dentistry in the Republic of Ireland a dentist must be registered with the Dental Council of Ireland. Registration
Chapter 6 Aesthetical improvement Use of one-piece type implants 1. Improving esthetics with one-piece implant Director of Kinebuchi Dental Clinic Takao Kinebuchi Aesthetics of two-piece two-stage type
Tough Choice for Young First Permanent molars: To Do Pulp Treatment or to Extract? Jung-Wei Chen, DDS, MS, PhD Professor and Program Director Advanced Education Program in Pediatric Dentistry Loma Linda
Periodontal Disease Department of Orthodontics and Restorative Dentistry Information for Patients i University Hospitals of Leicester NHS Trust What is Periodontal Disease (Gum Disease)? Periodontal disease
The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania Effective August 1, 2015 Introduction The Penn Dental Plan of the University of Pennsylvania ( Penn Dental
Survival Analysis of Dental Implants Andrew Kai-Ming Kwan 1,4, Dr. Fu Lee Wang 2, and Dr. Tak-Kun Chow 3 1 Census and Statistics Department, Hong Kong, China 2 Caritas Institute of Higher Education, Hong
Table 2.1 Tooth movement following alveolar decortication injury is represented by 10 evidence-based, refereed, professional journal articles through to May 2013. All investigations include measurements
Position Classification Standard for Dental Officer Series, GS-0680 Table of Contents SERIES DEFINITION... 2 BACKGROUND... 2 TITLES... 3 GRADE-LEVEL EVALUATION CRITERIA... 3 NOTES ON THE USE OF THE STANDARDS...
Anatomic Anomalies Steven R. Singer, DDS 212.305.5674 firstname.lastname@example.org Anomalies! Anomalies are variations in the:! Size! Morphology! Number! Eruption of the teeth Anomalies Anomalies There are two categories:!
CLINICAL ARTICLES J Oral Maxillofac Surg 61:535-544, 2003 Recovery After Third Molar Surgery: Clinical and Health-Related Quality of Life Outcomes Raymond P. White, Jr, DDS, PhD,* Daniel A. Shugars, DDS,
Educational Requirements & Professional GUIDELINES Approved by Council May 2013 This is replacing the document last published in August 2002. Educational Requirements & Professional The Guidelines of the
1 The Single Tooth Implant The Ultimate Aesthetic Challenge by Daniel G. Pompa, D.D.S. 2 Before starting any Maxillary Anterior Single Implant, or any case in the esthetic zone: TAKE A PHOTO OF YOUR PATIENT
Unless otherwise noted, the content of this course material is licensed under a Creative Commons Attribution - Non-Commercial - Share Alike 3.0 License. Copyright 2008, Dr. Jeff Shotwell. The following
Global Journal of Medical research: J Dentistry and Otolaryngology Volume 14 Issue 1 Version 1.0 Year 2014 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Inc.
LINGUAL ACTIVE RETAINERS TO ACHIEVE TEETH LEVELLING IN ORTHODONTICS: CASE SERIES ANNA MARINIELLO 1, FABIO COZZOLINO 2 ABSTRACT In the present paper, a clinical procedure to achieve teeth levelling by means
Immediate Molar Implant Placement: A Private Practice Clinical Investigation Gargiulo et al Alphonse Gargiulo, DDS, MS 1 Thomas Manos, DDS, MS 2 Mark Kolozenski, DDS, MS 3 Alex Tzanos, DDS, MSD 3 Michael
Health Spring Meeting May 2008 Session # 42: Dental Insurance What's New, What's Important Floyd Ray Martin, FSA, MAAA Thomas A. McInteer, FSA, MAAA Jonathan P. Polon, FSA Dental Insurance Fraud Detection