A New Surgical Assistance Aid for Mesiodens Extraction Based on the Ideal Approach.

BACKGROUND: To date, the classification of mesiodens has been based on the location, crown orientation, and morphology; however, there is no assistance aid focusing on choosing surgical approach. PURPOSE: This study aimed to introduce and evaluate a new surgical assistance aid for mesiodens extraction based on surgical approach. STUDY DESIGN, SETTING, SAMPLE: For the retrospective trial part of this study, case data from mesiodens patients who had surgery at the Affiliated Stomatological Hospital was collected, and a new surgical assistance aid was developed. A prospective randomized controlled trial was conducted on mesiodens patients who were seen in our department (patients with one mesiodens were included). PREDICTOR VARIABLE: The predictor variable was surgical approach either with or without the surgical assistance aid. Subjects were randomized to one of the two study groups. For subjects assigned to the group using the surgical assistance guide, the approach was selected according to the aid detailed in this study. For subjects assigned to the group without the surgical assistant aid, 2 residents chose an approach based on their judgment and review of relevant imaging and physical examination. MAIN OUTCOME VARIABLES: The preoperative evaluation time, operative time, and complications associated with surgery were recorded separately for the two groups. COVARIATES: The age and sex were also recorded. ANALYSES: Variables were analyzed using the independent t-test and χ2 test. The level of statistical significance is P < .05. RESULTS: In the retrospective trial part, a new surgical assistance aid for mesiodens extraction was developed based on the ideal surgical approach. In the prospective randomized controlled trial, the experimental group (n = 50) was statistically significant in preoperative evaluation time (4.51 ± 0.34 mins vs 5.43 ± 0.34 mins) and operative time (31.87 ± 5.57 mins vs 36.32 ± 5.28 mins) compared to the control group (n = 50) (P < .001). There was no significant intergroup difference in complications associated with surgery (P > .05). CONCLUSION AND RELEVANCE: The new surgical assistance aid developed in this study guides surgeons to ease the selection of surgical approaches and shorten the operative time.

Management options and long-term follow-ups for permanent double incisors: six to eleven-year case reports.

BACKGROUND: Double teeth are dental anomalies that can lead to aesthetic and orthodontic problems. CASE PRESENTATION: This report discusses two cases involving the multidisciplinary management of permanent maxillary left lateral incisors fused with a supernumerary tooth in two girls aged 9 and 10. Following intraoral and radiographic examinations, one was diagnosed with fusion, and the other was diagnosed with concrescence. The crown of the fused incisor was separated using a burs and extracted intraorally. The concrescent incisor was separated along its length using a laser and intentionally replanted extraorally. After a 6-year follow-up, no pathological signs were observed in the fused incisor. However, after an 11-year follow-up, external resorption was observed in the concrescent incisor. CONCLUSIONS: Both incisors remained asymptomatic throughout the observation period. This case report highlights two different and effective methods employed to preserve the natural function, form, and aesthetics of double incisors.

Effect of maxillary anterior supernumerary tooth extraction on the underlying malocclusion.

INTRODUCTION: Orthodontic discrepancies are a common finding in patients with supernumerary teeth (ST). The presence of a ST can cause a number of orthodontic discrepancies, including delayed eruption or retention of adjacent teeth, crowding, spacing, and abnormal root formation. The aim of the present study was to assess the effect of extraction of an anterior supernumerary tooth on the underlying orthodontic discrepancies without additional treatment for a 6-month period. METHODS: This was a prospective, longitudinal, observational, study. It included 40 participants with orthodontic malocclusions due to maxillary anterior supernumeraries. We examined the changes in the crowding and excessive space in the anterior and posterior segments on cast models. RESULTS: In the group that presented with crowding, a statistically significant decrease of 0.95 ± 0.17 mm (P < 0.001) was found between T0 and T1. Of the participants, three exhibited full self-correction. The excessive space at T0 (3.06 mm) decreased by 1.78 ± 0.19 mm to T1 (1.28 mm) in the anterior segment. Seven participants showed full self-correction of the diastemas after the 6-month observation period. CONCLUSION: The results imply that orthodontic treatment can be postponed for at least 6 months after the extraction of the supernumerary tooth as potential self-correction can be expected. This natural alleviation of the malocclusions may make the orthodontic treatment simpler, shorten the treatment time and decrease overall appliance wear time.

Globe-shaped central incisors in a patient with otodental syndrome.

Hearing impairments and dental anomalies are found in many genetic syndromes. Otodental syndrome is a rare combination of hearing loss and the presence of a pathognomonic dental phenotype known as globodontia, in which the tooth exhibits an abnormal globe shape. There is no histologic evidence of structural anomalies in the enamel, dentin, or pulp. This report describes the case of a 12-year-old boy who had hearing loss and 2 supernumerary globe-shaped teeth in the sites of the permanent maxillary central incisors. The diagnosis of otodental syndrome was established based on the clinical, radiographic, and histologic features, but other conditions, including dens evaginatus, talon cusp, dens invaginatus, and compound odontoma, should be included in the differential diagnosis. Dental treatment consisted of the extraction of both anomalous teeth, allowing spontaneous eruption of the impacted permanent central incisors. Early diagnosis of otodental syndrome permits a multidisciplinary approach to prevent other pathologic conditions, reduce functional damage, and avoid social problems.

Minimally invasive surgical removal of bilateral impacted mandibular supernumerary teeth using 3D surgical guide template: a case report.

Impacted supernumerary teeth are defined as the presence of one or more teeth in a patient's upper and lower jaws in addition to the normal number of teeth in the dental arch. It has an incidence rate of approximately 1%-14% and more frequently occurs in males than females, may be single or multiple, unilateral or bilateral, erupted or impacted. In this article, we describe the case of a patient with two supernumerary teeth between the roots of the mandibular second premolar and the first molar, which influenced the effectiveness of the first orthodontic treatment. The special anatomical position of the complex supernumerary teeth made tooth extraction challenging. Given the higher risk status of surgery, we implemented a novel tooth extracting technique for this patient. Thus, in this study, we describe a case of minimally invasive extraction of bilateral mandibular impacted supernumerary teeth using a digital 3D positioning guide plate.

Computer-Assisted Preoperative Simulation and Augmented Reality for Extraction of Impacted Supernumerary Teeth: A Clinical Case Report of Two Cases.

Delayed eruption, malocclusion, poor oral hygiene, and formation of follicular cysts are some complications associated with an impacted supernumerary tooth (ST). Although surgical extraction is one of the methods to prevent these complications, it can also lead to fractured roots or has a risk of permanent injury to young teeth and gingiva. Recently, computer-assisted preoperative simulation has been helpful in planning the surgery for precise extraction of impacted ST guided with 3-dimensional images. Herein, we present 2 cases of extraction of severely impacted ST guided by preoperative computer-assisted simulation and intraoperative augmented reality. While being minimally invasive, the augmented reality-guided system can precisely highlight the tooth position. The therapeutic aspects of these procedures have also been discussed.

Interventions to facilitate the successful eruption of impacted maxillary incisor teeth due to the presence of a supernumerary: A systematic review and meta-analysis.

INTRODUCTION: A failure of maxillary incisor eruption is commonly attributed to the presence of a supernumerary tooth. This systematic review aimed to assess the percentage of impacted maxillary incisors that successfully erupt after surgical removal of supernumerary teeth with or without other interventions. METHODS: Systematic literature searches without restrictions were undertaken in 8 databases for studies reporting any intervention aimed at facilitating incisor eruption, including surgical removal of the supernumerary alone or in conjunction with additional interventions published up to September 2022. After duplicate study selection, data extraction, and risk of bias assessment according to the risk of bias in nonrandomized studies of interventions and Newcastle-Ottawa scale, random-effects meta-analyses of aggregate data were conducted. RESULTS: Fifteen studies (14 retrospective and 1 prospective) were included with 1058 participants (68.9% male; mean age, 9.1 years). The pooled eruption prevalence for removal of the supernumerary tooth with space creation or removal of the supernumerary tooth with orthodontic traction was significantly higher at 82.4% (95% confidence interval [CI], 65.5-93.2) and 96.9% (95% CI, 83.8-99.9) respectively, compared with removal of an associated supernumerary only (57.6%; 95% CI, 47.8-67.0). The odds of successful eruption of an impacted maxillary incisor after removal of a supernumerary were more favorable if the obstruction was removed in the deciduous dentition (odds ratio [OR], 0.42; 95% CI, 0.20-0.90; P = 0.02); if the supernumeraries were conical (OR, 2.91; 95% CI, 1.98-4.28; P <0.001); if the incisor was in the correct position (OR, 2.19; 95% CI, 1.14-4.20; P = 0.02), at the level of the gingival third (OR 0.07; 95% CI, <0.01-0.97; P = 0.04) and had incomplete root formation (OR, 9.02; 95% CI, 2.04-39.78; P = 0.004). Delaying removal of the supernumerary tooth 12 months after the expected eruption time of the maxillary incisor (OR, 0.33; 95% CI, 0.10-1.03; P = 0.05) and waiting >6 months for spontaneous eruption after removal of the obstacle (OR, 0.13; 95% CI, 0.03-0.50; P = 0.003) was associated with worse odds for eruption. CONCLUSIONS: Limited evidence indicated that the adjunctive use of orthodontic measures and removal of supernumerary teeth might be associated with greater odds of successfull impacted incisor eruption than removal of the supernumerary tooth alone. Certain characteristics related to supernumerary type and the position or developmental stage of the incisor may also influence successful eruption after removal of the supernumerary. However, these findings should be viewed with caution as our certainty is very low to low because of bias and heterogeneity. Further well-conducted and reported studies are required. The results of this systematic review have been used to inform and justify the iMAC Trial.

Determination of the range of intervention timing for supernumerary teeth using the Korean health insurance review and assessment service database.

This study aimed to identify the frequency of complications during the diagnosis, observation, and treatment of supernumerary teeth or odontomas and evaluate the relationship between complications and the timing of surgical intervention. This study was conducted based on data from the Korea Health Insurance Review and Assessment Service between January 2008 and December 2019. A 2-year washout period was applied, and a follow-up period of at least 2 years was also included. During the observation period, the age at diagnosis of supernumerary teeth and odontomas was analyzed using major diagnostic codes, and the treatment codes were used to determine the interval between diagnosis and surgical intervention. The incidence rates of supernumerary teeth (1.21%) and odontomas (0.36%) were comparable to that reported in previous studies. The frequency of supernumerary teeth was the highest in the anterior region, followed by the premolar and molar regions. The average ages at diagnosis according to the location of the supernumerary teeth were 7.25, 13.98, and 16.11 years in the anterior, premolar, and molar regions, respectively. The age at diagnosis correlated with the maturity period of the teeth at the corresponding location. For the supernumerary tooth group, surgical intervention was more likely to occur when malocclusion (p < 0.0001) or tooth eruption disturbances (p < 0.0001) were present or dentigerous cysts were absent (p = 0.006). For the odontoma group, malocclusion (p = 0.251) was not correlated with surgical intervention. When tooth eruption disturbances (p = 0.002) and dentigerous cysts (p < 0.0001) were present, surgical intervention was more likely to occur. Pediatric dentists should conduct timely clinical checks and periodic follow-ups to prevent complications and unnecessary orthodontic treatments in patients with supernumerary teeth or odontomas.

Technical Skills to Split Teeth During Extraction of Mesiodentes in High Site.

PURPOSE: Extraction of mesiodens in high site is complicated. Here we introduce some technical skills to simply the process and achieve high success rate meanwhile. METHODS: All patients should accept radiographic examination before surgery. According to the position of mesiodens based on cone-beam computed tomography, we choose the appropriate method and tool. RESULTS: A series of cases have proved that these skills are applicable and convenient. CONCLUSIONS: Dentists should analyze the inspection results seriously and select the optimal strategy to extract mesiodens in high site.

Technical Strategies for Custom-Made Surgical Guide in Removal of Impacted Supernumerary Mandibular Premolars.

ABSTRACT: The aim of this study is to evaluate the technique of surgical guide in the extraction of impacted supernumerary mandibular premolars. This case series included 5 patients. Impacted supernumerary mandibular premolars were removed through a lateral window approach using the surgical guides. The mental nerve and adjacent teeth were properly protected by our custom made surgical guides. All cases successfully underwent the operation. An average of 5.01 ± 1.10 min was required to locate the supernumerary mandibular premolar. There were no complications involving injury to the mental nerve injury or adjacent teeth in any case. The application of custom-made surgical guides in the extraction of impacted supernumerary mandibular premolars showed an acceptable clinical outcome in this case series.

Dental manifestations of a paediatric patient with Goldenhar syndrome.

Goldenhar syndrome (GS) is a rare congenital disorder. It arises from the first pharyngeal pouch, first branchial cleft, first and second branchial arches, and primordia of the temporal bone. It mainly involves abnormalities in the ear, mandibular, and maxillary arches, and is associated with variable clinical features such as skeletal, cardiac, and renal systems. The presence of extra teeth in the dental arch is called supernumerary teeth, and hypodontia refers to congenitally missing teeth. The occurrence of both these anomalies in the same patient is called concomitant hypohyperdontia. However, the GS itself is not very rare, though the presence of concomitant hypohyperdontia has not been reported. The purpose of the present case report is to describe the first case from Saudi Arabia with a characteristic combination of rare findings in a seven-year-old child with comprehensive oral rehabilitation.

Computer-designed surgical templates improve the extraction of impacted supernumerary teeth in the hard palate.

OBJECTIVES: The surgical procedure of bony impacted supernumerary teeth (SNT) in hard palate is commonly done with poor visualization and uncomfortable posture. This study aims to introduce our primary practice of presurgical evaluation and guiding exodontia of bony impacted supernumerary teeth (SNT) in the hard palate to reduce surgical trauma, duration and uncertainty. STUDY DESIGN: Twelve patients with impacted supernumerary teeth in hard palate were included. Intraoral scan and the three-dimensional (3D) reconstruction of the cone beam computed tomography (CBCT) file was superimposed, and virtual simulation of flap elevation and osteotomy was conducted on the rebuilt 3D model. A couple of surgical templates were designed with surgical planning software Mimics, fabricated by a 3D printer and were used to guide the extraction of the impacted SNT. RESULTS: The surgical templates fitted well to the teeth and operation site. All the impacted SNTs were accurately located and extracted without damaging the adjacent vital anatomical structures. All patients had an uneventful postoperative recovery without infection or sensory disturbance. CONCLUSIONS: The application of 3D printed surgical templates reduced trauma and increased the accuracy and predictability of surgical extraction of bony impacted SNT in hard palate. The results of this study increased the accuracy and predictability of surgical extraction of bony impacted SNT in hard palate, and reduced the surgeon's embarrassment and surgical trauma because of location difficulty.

Application of a surgical guide in the extraction of impacted mesiodentes: a randomized controlled trial.

OBJECTIVE: To explore and evaluate the application of a surgical guide in the extraction of impacted mesiodentes. MATERIALS AND METHODS: Patients with impacted mesiodentes approachable from the labial side of the maxilla were randomly divided into three groups. The surgical guide for group I was made using cone beam computed tomography (CBCT) and dental cast, whereas the surgical guide for group II was only made using CBCT data. Group I and group II were first evaluated to determine whether guide use could accurately locate the cementoenamel junction (CEJ) of the mesiodentes, and the impacted mesiodentes were extracted with the help of the surgical guide. Group III underwent an operation without a guide. For all patients, the preoperative design time, tooth searching time, operation time, complications, and costs were measured. RESULTS: The guides for group I and group II could locate the CEJ of the mesiodentes accurately, with good application effect during the operation. Group I and group II required additional preoperative design time compared with group III. However, the tooth searching time and operation time in groups I and II were significantly reduced compared with those in group III. Group I and group II showed no intraoperative complications, and two cases in group III showed imprecision during localization. The overall cost for group III was higher than that of group I or group II. But group I and group II required extra visits and costs. CONCLUSIONS: Despite some limitations, the surgical guide assisted with mesiodentes extraction and can improve the quality of the operation quality as well as reducing its economic burden, difficulty, and duration. Through proper design, we can create a high-quality surgical guide using only CBCT data. CLINICAL RELEVANCE: The surgical guide can be used as an important assistive tool in alveolar surgery.

Algorithm for Treatment of Supernumerary Nasal Tooth.

ABSTRACT: The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery.

Navigation in bone-impacted premaxillary supernumerary tooth removal: a preliminary clinical trial.

AIM: The present clinical trial aimed to preliminarily assess whether navigation could help to position impacted supernumerary teeth (STs) and reduce surgical trauma. MATERIALS AND METHODS: Subjects with an impacted supernumerary tooth (ST) in the premaxillary area were enrolled in the study and randomly distributed into a navigation group and a control group. In the navigation group, STs were positioned and extracted under real-time optic navigation. In the control group, STs were extracted depending on the surgeon's experience. Subjects were followed up for 12 to 24 weeks postsurgery. Operating time, futile bony trauma, and the positioning precision of the STs were the major outcomes assessed. Multivariate correlation analysis was performed. RESULTS: In 24 subjects, 32 STs were removed and no severe complications occurred in either group. The proportion of ST exposure at the planned access point was 100% in the navigation group and 68.75% in the control group (χ² = 5.926, P = 0.015). Futile length, futile width, and the distance between the point where the ST was initially exposed and the bony point planned for accessing it were related to both navigation/control grouping and bone thickness in the access side. For challenging STs with bone thickness of > 0.5 mm in the access side (N = 22), the futile length in the navigation group (0.0 [0.0, 4.0] mm) was significantly smaller than that in the control group (3.0 [0.0, 8.0] mm, P = 0.028). Similarly, the futile width in the navigation group (0.0 [0.0, 2.0] mm) was significantly smaller than that in the control group (2.0 [0.0, 4.0] mm, P = 0.018). CONCLUSIONS: Navigation helped to position impacted STs precisely and reduced surgical bony trauma to some extent, especially in challenging cases in which the bone in the access side was thicker than 0.5 mm.

Use of 3D printing in the planning of a patient with unerupted maxillary central incisors.

Impacted central incisors are a clinical dilemma faced by orthodontists, oral and maxillofacial surgeons, paediatric and restorative dentists. Successful management requires a robust diagnosis and treatment planning process. This case report highlights the use of 3D printing to aid the treatment planning of a patient with bilateral unerupted maxillary central incisors due to two supernumerary teeth acting as a physical obstruction. The preoperative cone beam computed tomography scan allowed for production of the printed model to the exact size and dimensions of the unerupted teeth and supernumeraries to facilitate the planning of the case and to aid in consenting the patient for treatment.

Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report.

Background: Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a prevalence of one per million births. The main causes of CCD are mutations in the core-binding factor alpha-1 (CBFA1) or runt-related transcription factor-2 (RUNX2), located at the 6p21 chromosomal region. RUNX2 plays important roles in osteoblast differentiation, chondrocyte proliferation and differentiation, and tooth formation. The disease is characterized by clavicular aplasia or hypoplasia, Wormian bones, delayed closure of cranial suture, brachycephalic head, maxillary deficiency, retention of primary teeth, inclusion of permanent teeth, and multiple supernumerary teeth. Materials and Methods: A 22-year-old girl suffering from cleidocranial dysplasia with short stature, narrow shoulders, craniofacial manifestations (short face, broad forehead, etc.) and dental anomalies (different lower dental elements under eruption, supernumerary and impacted multiple teeth, etc.) was examined at our service (Complex Operative Unit of Odontostomatology of Policlinico of Bari). RX Orthopantomography (OPG) and cone beam computed tomography (CBCT) were requested to better assess the position of the supernumerary teeth and their relationships with others and to evaluate the bone tissue. Results: Under eruption was probably caused by dental interferences with supernumerary teeth; hence, extractions of supernumerary upper canines and lower premolars were performed under general anaesthesia. Surgery outcome was excellent with good tissue healing and improvements in the therapeutic possibilities with future orthodontics. Conclusions: The objective of this article is to give an update about radiological, clinical, and molecular features of CCD and to alert the health team about the importance of establishing an early diagnosis and an appropriate treatment in these patients to prevent impacted teeth complications and to offer them a better quality of life.

Spontaneous eruption of impacted maxillary incisors after surgical extraction of supernumerary teeth: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the spontaneous eruption potential of impacted human permanent teeth localized in the anterior part of the maxilla, after the surgical extraction of obstacles in their eruption pathway, by means of a systematic review and meta-analysis. MATERIALS AND METHODS: A systematic literature search was carried out to locate studies reporting on the percentage of anterior permanent teeth erupting after surgical removal of the obstacle, without other interventions. Eruption potential of impacted teeth was calculated using a random-effects meta-analysis. Information about the sex proportion, follow-up duration, age and years during which the study was carried out was used for subgroup analyses. RESULTS: A total of twelve studies were included, with a total sample size of 960 cases and a follow-up period of up to 36 months. The results show that more than 65.5% of impacted teeth erupt spontaneously following surgical extraction of the obstacle, with an odds ratio of 4 (95% CI 1.9, 8.2) (p < 0.001) favouring spontaneous eruption. CONCLUSIONS: When faced with an impacted maxillary anterior tooth, surgical extraction of the obstacle can lead to spontaneous eruption of the impacted tooth in the majority of cases, with better success with a longer follow-up for up to 3 years. CLINICAL RELEVANCE: Based on the present meta-analysis, clinical recommendation would be to surgically remove the obstacle impeding the eruption of a maxillary anterior permanent tooth and wait for the eruption of the tooth for a period of 12-36 months, depending on the age of the patient.

Validation of a three-dimensional printed model for training of surgical extraction of supernumerary teeth.

INTRODUCTION: This study aimed to validate a three-dimensional (3D) printed model to provide training for supernumerary teeth (SNTs) extraction. MATERIALS AND METHODS: Each of the 30 participants, grouped as experienced and without experience, conducted two identically simulated surgeries on a 3D-printed replica of human mixed dentition with a SNT. The surgery time, area of bony window and volume of removed material were measured; subsequently, responses to a five-item questionnaire were recorded. The collected data were statistically analysed. RESULTS: The surgery time was 228.37 ± 141.53 seconds and 125.47 ± 53.03 seconds in the first and second surgery, respectively. The training significantly decreased the surgery time in the participants without experience (P = .000). However, there were no significant differences in the area of window opening (P = .271) and volume of removed material between the two surgeries (P = .075). The participants who perceived educational benefits accounted for more than 60% of the respondents for every question. Participants without experience in SNT extraction showed a tendency to rate a higher score than did those with experience. CONCLUSIONS: A 3D-printed model for surgical extraction of a SNT can improve surgical skill and, especially, shorten the learning curve in beginners.

Bilateral presentation of different supernumerary teeth in nonsyndromic patients: case reports.

Supernumerary teeth--teeth in excess of the normal dental complement--are usually asymptomatic, and their presence is detected incidentally on radiographs. Mesiodentes are the most common type of supernumerary teeth, followed by maxillary distomolars, maxillary lateral incisors, mandibular fourth molars, and maxillary premolars. Bilateral occurrence of supernumerary teeth is rare. When supernumerary teeth do occur bilaterally, they are most often associated with a syndrome such as Gardner syndrome or cleidocranial dysostosis. This article presents case reports of 4 nonsyndromic patients with different forms of bilateral supernumerary teeth: bilateral mesiodentes, bilateral paramolars, bilateral distomolars, and bilateral parapremolars. The supernumerary teeth were managed by extraction or clinical and radiographic monitoring.