Pericoronitis is the most common odontogenic problem associated with the wisdom tooth in young men and women. Patients may present with problems associated with infection, swelling and pain. However, other associated pathology such as caries, periodontal disease and referred pain from the temporomandibular joint must be investigated when treating pain from the wisdom tooth. The authors wish to present a case in which the pain from a wisdom tooth was due to a fractured dens evaginatus. The importance of this dental anomaly should not be overlooked.
The paradental cyst is an odontogenic cyst occurring near to the cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket. A distinct form of the paradental cyst occurs not infrequently on the buccal aspects of erupted mandibular third molar, where there is an associated history of pericoronitis. A search of the literature revealed that these cysts had all been reported in relation to partially, newly or fully erupted molars. This report presents one case in which the cyst was noticed to be associated with an unerupted third molar. The histological appearance of the cyst and the gross relationship to the cemento-enamel junction is similar to those typical of paradental cysts reported in the literature. However, the radiographic and clinical appearance of the tooth being unerupted do not tally with paradental cyst and yet exclude the diagnosis of dentigerous cyst. The diagnosis of dental follicular tissue was excluded based on the histopathological presentation. The authors suggested that this case may represent an early form of paradental cyst which in the past may have been dismissed as dental follicular residues and thus, the prevalence of paradental cyst may have been under reported in the literature.
The aim of this study was to identify the position of impacted mandibular third molars based on the classifications of Pell & Gregory and Winter, the indications for extraction, and the relation of post-operative complications and position. Records of patients who attended Hospital Universiti Sains Malaysia between January and December 2007 for surgical removal of mandibular third molars were reviewed. The angulation type, width and depth of impaction were determined by reviewing the orthopantomograms. The indications of extraction and occurrence of any post- operative complications were recorded. A total of 238 impacted teeth were surgically extracted from 194 patients (97 males, 97 females). The reasons for extraction include recurrent pericoronitis (43.1%) followed by prophylactic purposes (33.5%). Mesioangular impactions accounted for 52.3% and Class IIA position of impaction accounted for 45.7% of extractions. The most common post-operative complication was persistent pain and swelling (14.7%) followed by trismus (4.1%) and dry socket (3.0%). There was no significant relationship between the angulation, width and depth of impaction and the occurrence of complication. Mesioangular type and Class IIA position of impaction were the most common impaction. Although the association was not significant, high frequency of post-operative complications was observed in mesioangular, horizontal, IIA and IIC positions.