Julia Caillet’s research while affiliated with University Hospital Estaing of Clermont-Ferrand and other places

Objectives To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis.Materials and methodsA surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: “Ectopic teeth”, “Third molar”, “Mandibular”. One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles.ResultsFrom the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft.Conclusions The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle.Clinical relevanceThis study will help to orientate surgeons vis-à-vis ETMM treatment.

Ectopic maxillary third molars (EMTM) are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. There is currently no consensus on the treatment of this eruption and its management is heterogeneous and multidisciplinary. Two literature searches were performed with no time restrictions via Pubmed. In the first, we used the keywords "ectopic AND third molar" and in the second the keywords "dentigerous cyst AND ectopic third molar". For both articles, epidemiological, symptomatic, radiological and surgical data were recorded. Overall, 33 eligible articles were identified involving 39 cases of EMTM. 79% of patients were symptomatic. 87% of the teeth were associated with a dental cyst. In only 13% of cases was the location of the tooth in the sinus specified in the three planes of the space. Surgery was performed in 77% of patients by the Caldwell-Luc technique, by nasal endoscopy in 10% and by the Le Fort I approach in 3%. The indications for avulsion of EMTM are symptomatic patients or asymptomatic patients with an associated cyst. The intra-sinusal location of the tooth is not a factor in the choice of technique used, which depends rather on the individual skills of the surgeon. Although for a trained operator the Le Fort I osteotomy is an easy procedure, its interest in the treatment of EMTM is limited owing to the rare but potentially severe complications involved.

Objective: The objective of this systematic analysis was to perform a qualitative and quantitative synthesis of the literature concerning salivary and serum leptin variations in patients with chronic periodontitis (CP) compared with healthy subjects. Saliva leptin concentration analysis could be a relevant and non-invasive biological test for the evaluation of periodontal disease in both medical and clinical trials, beyond the clinical and radiographic elements. Material and Method: Querying the PubMed and Web of Science databases identified articles that met our inclusion criteria. Quantitative analysis of the literature data was performed with the Review Manager 5.3 software. Results: The qualitative analysis included 14 articles and showed a decrease of salivary leptin (5 studies out of 5) and an increase of serum leptin (11 of 12 studies) in patients with CP compared to unaffected subjects of CP. Quantitative analysis was performed on 4 trials. For salivary leptin, we confirmed a decrease in its level in patients with CP with a standardized mean difference (SMD) of −2.27, 95% CI [−2.68, −1.86]. The difference was highly significant but we detected a very important heterogeneity in this dataset ( I² = 94%). For serum leptin, we also confirmed an increase in its rate in patients with CP with an SMD of 2.18, 95% CI [1.75, 2.61]. The difference was highly significant but the heterogeneity measured in this dataset was also too high ( I² = 95%). Conclusion: The current level of evidence was insufficient to assert an increase in serum leptin and a decrease in salivary leptin in CP patients compared to healthy controls due to a great heterogeneity of the values measured in the studies.