thao final-thesis
TRANSCRIPT
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ROOT EXTERNAL MORPHOLOGY OF IMPACTED MANDIBULAR THIRD MOLARS:
A CROSS-SECTIONAL STUDY IN HAI PHONG MEDICAL UNIVERSITY HOSPITAL
Student: Pham Minh Thao
Instructor: Prof. Pham Van Lieu, PhD
Dr. PhamThanh Hai, DDS
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OUTLINE
1. Background
2. Material and method
3. Research results - Discussion
4. Conclusion
5. Recommendations
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• The latest teeth erupt between the ages of 18 and 25 • They often cause many problems therefore need to be extracted• There’re a lot of complications before, during and after 3rd molar
extraction one of the reasons was the variant of roots causing confused diagnosis.
BACKGROUND
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How was the variants of the roots of mandibular third
molars?
Could their variations be predicted by Panoramic X- ray to
help the tooth removing, or not?
BACKGROUND
Reseach question
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BACKGROUND
The variants of wisdom teeth
NormalVariants
48
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BACKGROUND
The roots of mandibular wisdom tooth are often similar to the root of the 2nd molar.
Conformity panorama
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BACKGROUND
2-D image ( Panorama X-ray)
3-D image ( CT X-ray)
Nonco
nfor
mity
pan
oram
a
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Le Duc Lanh (2009): Panoramic X- ray reflected the 2D space, CT scanner showed the others anatomical structures
BACKGROUND
Number of root
Research 1 2 ≥ 3
Jun-Beom Park(2013)37,9% 56,5% 1,9%
Heinz-Theo Lübbers(2013) 86,7% 13,3 %
Maryam Kuzekanani (year)11.5% 73%
5,5%
Reviews of the recent related studies
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1. Characterize the root external morphology of
impacted mandibular 3rd molar.
2. Compare the concordance of root morphology
between anatomical and panorama analysis.
OBJECTIVES
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Materials :
- Mandibular impacted wisdom teeth was extracted, intact roots.
- Panoramic radiograph (before extracting)
n = 57 wisdom teeth
Design of the study: cross sectional study
MATERIAL AND METHOD
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Sampling method:
- Convenient sample, all patients satisfying study criteria were enrolled in the study.
Selection criteria:
- The patients have impacted wisdom teeth, were extracted in Hai Phong Medical University Hospital, the roots were intact, or could be rearranged intactly.
MATERIAL AND METHOD
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Exclusion criteria:
- The lower wisdom teeth were extracted, had
not Panorama X- ray before extracting.
Time of the study:
- From December, 2014 to April, 2015.
Statistic: Used SPSS software for statisting
and data processing.
MATERIAL AND METHOD
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STEPS OF RESEARCH
Step 1: Interview the patient before extracting
Step 2: Collect Panoramic X- ray (before
extracting)
Step 3: Extract wisdom tooth
Step 4: Collect the wisdom tooth after extracting
Step 5: Observe
MATERIAL AND METHOD
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The variables Identified index Data collection
1. General variable Age (calendar year) Interviewed
Gender (Male/Female)
Name of tooth (International
regulations)2. Similar to the roots of 2nd molar 2 separate roots, the roots
curved distally
Observed
3.Variations by quantity 1 root (single root) Observed
More than 3 roots
4. Variations by morphology Equal length roots Observed
Fused roots
Apical fused roots
Straight roots
Mesio-angular roots
5. Compare with Panoramic X- ray Conformity Observed
Nonconformity
Research sheet
MATERIAL AND METHOD
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AgeTotal 11-20 21-30 31-40 41-50 51-60
57 5 31 16 4 1
100% 8.8 54.4 28.1 7.0 1.8
Consistent with the formation and evolution of wisdom tooth
Table 1: Ratio distribution of patients by age
RESULTS
1. Status distribution of patients by age
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Figure 1: Rate of variants in mandibular wisdom teeth
14%
86%
Similar to the root shape of 2nd mo-larVariants
RESULTS
The variant had a high ratio, consistent with the reviews of Hoang Tu Hung and the other scientists
2. The appreance of the variant lower wisdom teeth
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Figure 2: Rate of variations by quantity1 root 2 roots 3 roots 4 roots
0%
20%
40%
60%
80%
100%
12.30%
77.20%
8.80%1.80%
RESULTS
3. Variations by quantity
The tendency of result is similar to the results of M. Kuzekanani (73% two roots) , J. Park (56.5% two roots), Sarasswati F.K (67% two roots) with highest rate is 77.2% in 2 roots group
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Equa
l len
gth
r...
Fuse
d ro
ots
Apica
l fus
ed r.
..
Stra
ight
root
s
Mes
ioan
gular r
...
Norm
al ro
ots
Other
s0%
25%
50%
75%
100%
10.50%
31.60%
3.50%10.50%15.80%
19.30%8.80 %
Fused roots had the highest proportion of 31.6%, similar to the reviews of Hoang Tu Hung
RESULTS
4. Variations by morphology
Figure 3: Proportion of variations by morphology
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Variations by quantity
Variations by morphology
Combination0%
20%
40%
60%
80%
100%
22.80%
80.70%
23.00%
Figure 4: Combination of variations by quantity and by morphology
RESULTS
5. Combination of the variations by quantity and morphology
The combination were 23 %. when the variations by quantity appeared, the one by morphology appeared too. This result was consistent with Hoang Tu Hung
P<0.05
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Figure 5: Concordance of Panoramic X-ray
77%
23%
ConformityNoncon-formity
RESULTS
6. Investigation of the concordance of Panoramic X-ray
Sarasswati F.K: the ratio of true positives of Panoramic X-ray in supporting diagnosis was notable high (66.6 %- 83.3 %),
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1. Most of roots of morphology of impacted lower 3rd
molar was variant (86%). The ratio of the normal
wisdom teeth was very low (14%).
2. Most of the studied real roots were consistent with
their images on Panorama (77%).
CONCLUSIONS
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1. Before extracting the impacted mandibular
wisdom tooth, it is necessary to take Panoramic
X- ray, because most of their roots was variant.
2. Need to take the CT scanner, or CT conebeam
in doubting cases, that can not be determined
on Panorama.
RECOMMENDATIONS
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SOME GRAPHICS RESEARCH
Variations by quantity of third molars root
1 root 2roots 3 roots
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Variations by morphology
SOME GRAPHICS RESEARCH
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Thank you very much for your
attention