Jéssica de Fátima Segantin

Lower third molars (L3M) are the last teeth to erupt in the oral cavity. Uneruption of these teeth still raises questions about its causes, in the literature (1) genetic factors, (2) dental lamina activity and, mainly, (3) insufficient growth and development of the bone bases are included. While the lack of space theory influenced by mandibular morphology and size of L3M was argued to be the main reason for L3M impaction, there is a limitation in the literature in examining such association using more accurate tomographic analysis obtained from CBCT. This work aimed to evaluate the relationship between mandibular morphology and the eruption of L3M. In this regard, 85 Cone Beam Computed Tomographies (CBCT), with 147 L3M, were selected from the archives of the Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, obtained using an Accuitomo® Morita device and using the Dolphin Imaging 11.9 software. L3M eruption was related to linear measurements of jaw length (Co-Gn), retromolar space dimension (D2R), mesiodistal width of the L3M crowns, mandibular first molars (L1M) and mandibular canines (LC) and the angle mandibular (Ar-Go-Me). Independent samples t-test, chi-square tests and logistic regression were performed adopting a significance level of 5%. The average mandible length of 116.446 mm + 6.415 mm, retromolar space of 11.634 mm + 2.385 mm, mesiodistal size of the L3M of 10.054 mm + 0.941 mm, sum of the mesiodistal widths of the L1M and LC of 15.564 mm + 1.218 mm and mandibular angle of 127.23° + 6.109. There was no statistically significant association between these factors and the eruption. With the results obtained in this study, we conclude that the length and angle of the mandible, teeth size and dimension of the retromolar space are not associated with the L3M eruption.

During dental appointments, patients often present anxiety and exacerbated fear, especially in surgical procedures. These reactions can promote systemic alterations, such as elevated blood pressure, fainting, and convulsions. The aim of this study was to evaluate the level of anxiety of patients during the lower third molar extraction procedure, seeking indicative parameters of possible complications and, at the same time, contributing to a safe and less uncomfortable procedure for the patient. Forty patients needing extraction of the lower third molar were selected. The study had an evaluator to monitor the systemic variables: blood pressure, oxygen saturation, respiratory and heart rate - while the same surgeon performed the surgical procedures, always using the same surgical technique for all patients. At the anamnesis and at the end of the surgery, the patients answered a visual analogue scale (VAS) questionnaire on anxiety. The results showed that for the four variables observed during the surgery, only the oxygen saturation did not present a statistically significant variation during the procedure. All the others showed changes, mainly during the use of the high-speed engine. We concluded that anxiety, fear and stress showed influences on systemic factors during the extraction procedure. It shows the importance of careful anamnesis and the knowledge of patient systemic diseases before starting any surgery to prevent risks or complications.

The maxillary sinuses are the largest of the paranasal sinuses. They consist of pneumatized bilateral cavities, lined by respiratory mucosa, identical to the nasal mucosa, consisting of pseudostratified epithelium, with hair cells and goblet cells, producing mucus. Radiographically, the maxillary sinus is seen as a radiolucent area, ovoid or rounded, with a well-defined contour, delimited by a continuous radiopaque line or with small interruptions and radiolucency similar to that of the orbit. When a change in the maxillary sinus is suspected, images of the sinus are usually found, the presence of septa, thickening of the mucosa, or polyps. Sinusitis is the main pathology of the maxillary sinus, being of multifactorial etiology, and may be due to anatomical, environmental factors or viral, bacterial, or fungal infections. The diagnosis of sinusitis is clinical, but it can be confirmed by imaging exams such as panoramic radiography or cone beam computed tomography (CBCT). Case Presentation: In this case of a 21-year-old patient treated by the FOB-USP Surgery team, due to the proximity of the third molar to the maxillary sinus, a cone-beam scan was performed in which bubbles were noted on the surface of the maxillary sinus content. The image is compatible with sinusitis however, the presence of bubbles is a very unusual image in this type of alteration of the maxillary sinus. Conclusions: CT images with fluid levels and bubbles on their surface, although uncommon in dental practice, are characteristic of acute sinusitis and the dentist must have this knowledge for the correct diagnosis of maxillary sinusitis.

It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption.