Bucco alveolar bone thickness of mandibular impacted third molars with different inclinations: a CBCT study.

PURPOSE: To compare the buccal alveolar bone thickness of mesioangulated mandibular impacted third molars (MITM) with buccal versus lingual inclination using cone-beam computed tomography (CBCT). METHODS: This retrospective cross-sectional study evaluated 69 individuals (39 women and 30 men) who presented a total of 101 mesioangulated MITM according to the Winter classification and in B position according to the Pell and Gregory classification. The average age was 22.99 ± 3.94 years. The superior, medial and inferior alveolar thickness regarding buccal (n = 44) or lingual (n = 57) mandibular third molar inclination were measured. T test or Mann-Whitney U test and finally, a multiple linear regression were applied (p < 0.05). RESULTS: The buccal alveolar bone thickness of mesioangulated mandibular impacted third molars was significantly greater in the group with lingual inclination compared to the group with buccal inclination, in the superior region (6.21 ± 3.27 vs. 4.85 ± 3.06; p = 0.036). The lingual inclination significantly influenced the buccal alveolar bone thickness in the middle region (p = 0.011). CONCLUSIONS: The mesioangulated MITM in B position with lingual inclination have a greater thickness of the superior and medial buccal alveolar bone than the MITM with buccal inclination. These results should be considered during MITM diagnosis and surgical planning.

First and second permanent molars with failed or delayed eruption: Clinical and statistical analyses.

INTRODUCTION: The aim of this work was to analyze data of patients with failed or delayed eruption of first and second permanent molars, to assess the effectiveness of the treatment methods used. METHODS: Epidemiologic and clinical data of 125 patients (mean age 14.08 ± 4.04 years) with 197 affected molars (30 first and 167 second molars) were retrospectively analyzed. The treatment outcome was known in 161 molars after patient drop-out (20 patients with 36 molars). The cases were categorized into 8 groups according to the choice of treatment: orthodontic uprighting, surgical-orthodontic uprighting, surgical uprighting, surgical repositioning, surgical exposure, first or second molar extraction, third molar extraction, or removal of pathologic conditions. RESULTS: The overall treatment outcome was positive in 141 molars (87.6%). It was positive in all cases treated with orthodontic uprighting (7 molars), surgical exposure (10 molars), surgical uprighting (38 molars), and surgical repositioning (8 molars), but it was significantly lower for surgical-orthodontic uprighting (34/48 molars, 70.8%). The positive outcome was significantly lower for inclusion (52/68 molars, 76.5%) than for early-diagnosed condition (11/11 molars, 100%) and retention (78/82 molars, 95.1%), and for total bone crown coverage (21/28 molars, 75.0%) than for osteomucosal or mucosal crown coverage (120/133 molars, 90.2%). CONCLUSIONS: This study demonstrates that an early diagnosis results in a better outcome regardless of the treatment used, with the number of cases with a positive outcome being higher in younger patients.

Characteristics of Supernumerary Teeth in Nonsyndromic Population in an Urban Dental School Setting.

PURPOSE: The purpose of this study was to analyze the clinical records of all patients evaluated for supernumerary teeth at the University of Illinois-Chicago Department of Oral and Maxillofacial Surgery postgraduate clinic from January 1, 2010 to October 31, 2015 to determine the demographics of impacted supernumerary teeth among different ethnicities in the city of Chicago. MATERIALS AND METHODS: A retrospective case series was completed on patients eligible for inclusion in the study who had a diagnosis of at least 1 full bony impacted supernumerary tooth (D7240). Other variables evaluated included date of surgical intervention, age at time of treatment, gender, ethnicity, location and number of supernumerary teeth present, and family history of supernumerary teeth. RESULTS: There were 459 male and 308 female patients (male-to-female ratio, 1.5:1). Patient ages ranged from 4 to 51 years (average, 13.1) at the time of surgery. Five hundred seventy-three patients (74.7%) were of Hispanic descent. Supernumerary teeth were found most frequently in the maxilla (69.9%), specifically in the central incisor region (526 teeth; 51.2%). Of the responding patient sample (258 patients), 53 patients (20.5%) reported a family history of supernumerary dentition. Of these 53 patients who reported a family history of supernumerary dentition, 37 (69.8%) were of Hispanic descent. Most of these Hispanic patients (83.8%) originated from Mexico. CONCLUSIONS: The incidence of supernumerary teeth is higher in male patients (male-to-female ratio, 1.5:1), and these teeth are most frequently found in the maxilla (69.9%), specifically the central incisor region (51.2%). A large percentage of patients (20.5%) also had first-degree relatives with a supernumerary dentition, and this fact might warrant further investigation into the possible genetics responsible for the formation of supernumerary teeth.

Multidisciplinary management of an impacted maxillary central incisor associated with supernumerary teeth: a case report.

Permanent maxillary central incisor impaction is a rare condition of multifactorial etiology that should be treated on diagnosis. This article describes multidisciplinary treatment of an 11-year-old patient presenting with a permanent maxillary right central incisor that was impacted due to the presence of 2 supernumerary teeth. The diagnosis was reached through clinical evaluation, radiography, and cone beam computed tomography. Treatment involved the surgical removal of the supernumerary teeth followed by traction of the impacted tooth through a combination of removable and fixed orthodontic appliances. Orthodontic treatment was completed after 18 months, resulting in adequate positioning of the right central incisor in the arch. Periodic follow-up visits were scheduled for prophylaxis and oral hygiene reinforcement. After 2 years, the teeth were adequately aligned, the gingiva was healthy, and the patient was esthetically satisfied. The multidisciplinary approach allowed functional and esthetic oral rehabilitation, thus helping the patient to avoid the psychological impact of a missing anterior tooth.

Delayed Eruption of Maxillary Central Incisors Associated with the Presence of Supernumerary Teeth: A Case Report with 18 Months Follow-up.

AIM: The aim of this study is to discuss a case of an 11-year-old pediatric patient, who was diagnosed with delayed eruption of the permanent maxillary central incisors because of palatally impacted supernumerary teeth. BACKGROUND: The delayed eruption of permanent teeth can be a result of blocking by supernumerary teeth and over-retained primary teeth. Early diagnosis can help in avoiding the complications. The management of such cases depends on the stage of teeth development, teeth position, and space availability. Treatment may combine both surgical and orthodontic interventions. CASE DESCRIPTION: The case was managed by surgically removing the primary retained teeth and supernumerary teeth in two visits then allowing the impacted permanent incisors to erupt without any intervention. CONCLUSION: After 18 months follow-up, the two permanent incisors erupted spontaneously with no orthodontic intervention. CLINICAL SIGNIFICANCE: dentists should be aware of the importance of early diagnosis of supernumerary teeth. The management of such cases should be designed by a multidisciplinary team decision.

Association Between Odontoma and Impacted Teeth.

Odontoma is considered to be the most common odontogenic tumor of the oral cavity. Most odontomas are asymptomatic and are discovered during routine radiographic investigations and can cause disturbances in the eruption of the teeth, most commonly delayed eruption or deflection. By a retrospective study design, demographic and clinical data regarding patients who presented odontomas from year 1995 to 2015 were obtained in order and the influence of active therapy on the dentition and on the treatment of impacted teeth was analyzed. Forty-five patients (mean age 14.2 years) with 29 complex and 16 compound odontomas were included in this retrospective study. Initial symptoms were delayed eruption of permanent teeth (n = 25), pain (n = 6), swellings (n = 4), and no symptoms (n = 10); 31 patients were discovered by incidence, all of them via panoramic radiographs. The mandible/maxilla ratio was about 2:1 (31/15). Thirty-two out of 45 odontomas were in close proximity of at least 1 tooth (n = 21 at incisive). A total of 12 teeth were extracted (complex: n = 8; compound: n = 4). Of the nonextracted teeth, 33 teeth were displaced and retained. Of those, 29 teeth were aligned through orthodontic-surgical approach and 4 teeth erupted spontaneously after surgery during the follow-up period. An early detection of odontoma is more likely an accidental radiological finding, hence the need for routine radiographic analysis should be emphasized. Early diagnosis of odontomas in primary dentition is crucial in order to prevent later complications, such as impaction or failure of eruption of teeth.

Clinicopathologic correlation: mixed-density lesion in the posterior mandible.

A middle-aged man presented for evaluation of a mixed-density lesion of the left posterior mandible. This clinicopathologic correlation presents the radiographic, clinical, and histopathologic findings; differential diagnosis; and treatment plan for this case. The lesion was deemed to be of bacteriologic origin, likely a polymicrobial infection containing actinomycetes. Clinical care and follow-up for the patient are discussed.

Twelve Impacted Supernumerary Teeth in a Nonsyndromic Patient: A Rare Case Report.

Teeth in excess number than the normal count are called supernumerary teeth. They can be either unilateral or bilateral and single or multiple, found at any place in the dental arch, but most commonly found in the anterior maxillary region. Supernumerary teeth are commonly associated with syndromes when present in more numbers, but can be idiopathic. The present study shows a case report of a 16-year-old female patient who reported with overretained deciduous teeth. A panoramic radiograph showed multiple impacted supernumerary teeth. Based on clinical features and radiographic examination, a diagnosis of idiopathic hyperdontia was given. In such types of patients, management must be planned by a multidisciplinary approach.

Failure of eruption of permanent molars: a diagnostic dilemma.

BACKGROUND: Limited studies have proposed protocols for the management of failure of eruption (FOE) of permanent molars with no clear consensus or guidelines. Accurate diagnosis is challenging but key for successful management. AIMS: Confirm key diagnostic criteria that will aid diagnostic differentiation between primary failure of eruption (PFE) and mechanical failure of eruption (MFE) of permanent molars and identify successful management strategies. DESIGN: Retrospective descriptive study. Patients diagnosed with FOE of permanent molars (excluding impaction) between January 2003 and December 2013 were identified. Patient details and clinical and radiological features of FOE were recorded. Two examiners analysed the data. A diagnosis of PFE or MFE was made based on a combination of current protocols. Management strategies for each were identified and reported as satisfactory/unsatisfactory. RESULTS: Thirty-one patients met the inclusion criteria. Fifteen were classified as PFE and 14 as MFE. One patient was too young to confirm diagnosis, and one patient had delayed eruption. A total of 26% of cases were misdiagnosed which led to unsuccessful orthodontic management. CONCLUSION: We propose a protocol based on the results of this study coupled with existing protocols in the form of a simple flow diagram to aid accurate diagnosis and management of this rare and challenging clinical problem.

Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population.

OBJECTIVES: The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population. MATERIAL AND METHODS: A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05). CONCLUSION: The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

Even a Tooth Slips Sometimes.

While impaction of a tooth or two in dentoalveolar region is common, ectopic presence of them in non-dentate area is less commonly reported. A 45-year-old female reported to the department with pain on right back teeth region since two days. On examination, grossly decayed 46, root stump 47, missing 48, with poor periodontal status were noted. Panoramic radiograph was advised for screening, which revealed an inverted impacted 48 at the right ramus just below subcondylar region. However, it was an incidental finding and the patient was asymptomatic, she was informed about the pros and the cons of her case and kept under close monitoring.

Relationship between the positions of impacted third molars and the presence of dentigerous cysts.

The objective of this study was to assess the association between the histopathological diagnoses of dentigerous cysts and pericoronal follicles and the positions of impacted third molars. The sample comprised 151 cases, diagnosed as dentigerous cysts and pericoronal follicles. Most patients were female (70.9%), white (90.1%), and age 20 years or older (63.6%). Ninety-eight cases (64.9%) were diagnosed as pericoronal follicles and 53 (35.1%) as dentigerous cysts. Teeth that developed dentigerous cysts were predominantly located in the mandible (84.9%), in a mesioangular position (49.1%), and in the 20- to 29-year age group (66.0%). The mandible seems to be the most frequent location of impacted teeth, probably because mandibular tooth eruption is more difficult, as well as dentigerous cysts, probably because the long duration of impaction increases the exposure to inflammatory stimuli and, thus, the potential for formation of dentigerous cysts. The findings also suggest that the incidence of dentigerous cysts tends to increase with age, especially for mandibular teeth in mesioangular positions.

Unusual cases of transmigrated mandibular canines.

Transmigration, an extremely rare anomaly that happens almost exclusively with mandibular canines, is defined as a pre-eruptive migration across the midline. It can lead to various restorative, surgical, orthodontic, and interceptive problems. This condition usually is not related to any painful symptoms and cannot be detected on clinical examination. This article presents 3 cases of transmigration. In 1 case, the right canine was involved, which is considered to be especially rare. This case series also highlights the importance of early diagnosis for the interceptive treatment of transmigration.

Kissing dentigerous cysts involving mandibular canines: report of unusual case with review of literature.

Dentigerous cysts are odontogenic developmental cysts, which mostly surround the crown of unerupted teeth, odontomas or supernumerary teeth. These cysts are mostly solitary in occurrence and their bilateral presentation is rare, especially in the absence of syndromes such as Maroteaux-Lamy, basal cell nevus or cleidocranial dysplasia. We present an unusual case of a 24-year-old female with nonsyndromic bilateral dentigerous cysts associated with unerupted mandibular canines that were diagnosed histopathologically as dentigerous cysts.

Amelogenesis Imperfecta with Coronal Resorption: Report of Three Cases.

Intracoronal resorption of the permanent dentition in cases of amelogenesis imperfecta (AI) is a rare finding which poses an added complication to the already complex management of this condition. This paper presents three cases of AI associated with delayed eruption of permanent teeth in which asymptomatic intracoronal resorption occurred. CPD/Clinical Relevance: This paper highlights the fact that teeth affected with amelogenesis imperfecta may undergo asymptomatic intracoronal resorption which is only identifiable radiographically.

[Application of Low Dose Spiral CT in Diagnosing Impacted Teeth in Children and Adolescents].

UNLABELLED: [ABSTRACT] OBJECTIVE: To determine the value of low dose spiral CT scanning in diagnosing impacted teeth of children and adolescents. METHODS: A total of 153 children and adolescents with confirmed impacted teeth in West China Second University Hospital, Sichuan University were enrolled in this study. They were divided into 5 groups according to the different spiral CT scan parameters (tube current time product, scanning thickness and collimation value): Group A (n=30, 330 mAs, 6 X 0. 75 mm and 3. 0 mm), Group B (n=30, 140 mAs, 6 X 0. 75 mm and 3. 0 mm), Group C (n=30, 80 mAs, 6 X 0. 75 mm and 3. 0 mm), Group D (n=31, 80 mAs, 6 X 1. 50 mm and 5. 0 mm), and Group E (n=32, 50 mAs, 6 X 1. 50 mm and 5. 0 mm). There were no significant differences in general clinical features (P>0. 05) among the participants of the five groups. The phantoms were used to measure spatial resolution and contrast resolution of the scan images. Dose length product (DLP) was recorded during CT scanning for calculating effective dose (ED) of exposure. The quality of images was evaluated using a list of quality scoring criteria. RESULTS: (1) Under 330, 140, 80, 80 and 50 mAs, the images had a spatial resolution of 1.0 mm, with contrast resolution of 2. 0, 3. 0, 4. 5, 4. 5 and 6. 0 mm, respectively. (2) Significant differences in ED values were found among the five groups (F=1 064. 119, P=0. 000) and between every two of those groups (P<0. 05). Group E had the lowest ED (0. 19 mSv), 86. 52%, 67. 24%, 45. 71%, and 38. 71% lower than that in Group A, B, C and D, respectively (P<0. 05). (3) All of the five groups obtained an image quality score above 3, and no statistical differences appeared among the 5 groupl (F=1. 978, P>0. 05). The diagnostic results of the spiral CT were consistent with those of orthodontic surgery. CONCLUSION: Low dose spiral CT scanning can meet the image quality requirements for diagnosing impacted teeth, minimizing radiation exposure effectively.

Complex and compound odontomas: Analysis of 69 cases and a rare case of erupted compound odontoma.

OBJECTIVE: The purpose of this study was to analyze clinic and radiologic features of the 69 odontoma cases and present a rare case of erupted compound odontoma in the oral cavity. MATERIAL AND METHODS: The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted teeth, missing teeth, radiological and histopathological features and treatment protocols. RESULTS: Of the 69 cases, 49 were compound odontoma and 20 were complex odontoma. There was a female predilection for both compound and complex odontomas. Compound odontoma occurred more often in the anterior region of the jaws; complex lesions occurred more often at the posterior mandible. The most common clinical manifestations were the retention of permanent teeth. CONCLUSION: Compound odontomas rarely erupt into the mouth. The presented case is the 13 th case of erupted compound odontoma reported in the literature. The treatment of choice is surgical removal of the odontoma. In the case of odontomas associated to impacted teeth, the teeth should be preserved in wait of spontaneous eruption, or alternatively fenestration followed by orthodontic traction is indicated. Regular follow-up period is crucial to evaluate the prognosis of these teeth.

Odontogenic cutaneous draining sinus.

The aim of the present article was to discuss an unusual case report of the odontogenic cutaneous sinus with emphasis on diagnosis and treatment. The causative factor in this case was diagnosed intraoperatively due to infected follicular space in absence of any sign and symptoms. Timely diagnosis of the case could have prevented significant morbidity due to mistreatment medically and surgically with eventual recurrence.

Timely relocation of subapically impacted maxillary canines and replacement of an ankylosed mandibular molar are the keys to eruption disturbances in a prepubertal patient.

Eruption disturbances such as impaction and ankylosis complicate orthodontic treatment because soft-tissue and hard-tissue considerations must be taken into account. Treatment is further complicated when such eruption disturbances occur in a growing patient. Extraction of impacted or ankylosed teeth can be an option that carries the weight of additional prostheses and bony defects, whereas exposure or luxation followed by orthodontic traction can preserve the patient's teeth and bony structure with improved esthetics. Therefore, an accurate diagnosis is needed in establishing an efficient and effective force system to achieve the desired tooth movements with few unwanted sequelae. This case report describes the process of differential diagnosis with the aid of 3-dimensional imaging in constructing a force-driven system, using the centers of resistance as reference points, to successfully bring a pair of impacted maxillary canines into alignment and protract a mandibular molar to achieve an acceptable occlusion in an adolescent girl.

Panoramic radiography in evaluating the relationship of mandibular canal and impacted third molars in comparison with cone-beam computed tomography.

This study evaluated the validity of panoramic radiography and cone beam computed tomography (CBCT) in the assessment of mandibular canal and impacted third molar. In this descriptive-analytical study, 58 mandibular third molars from 42 patients who showed a close relationship between impacted third molar and canal on panoramic radiographs were selected. They were then classified into seven radiographic markers in panoramic radiographs (superimposition, darkening of the root, interruption of the white lines, root narrowing, canal diversion, canal narrowing, and also closed distance in OPG <1mm). The groups of markers were further assessed with CBCT to see presence or absence of contact. The three most common markers seen in panoramic images are superimposition, interruption of white line and root darkening. In CBCT, superimposition marker always presented higher frequency of contact with canal compared to non-contact group. There are 31% of teeth presented with interruption of white lines and there are 29.3% of teeth presented with superimposition. About 55.6% and 35.3% of the impacted mandibular third molars which indicated interruption of white lines and superimposition also indicated contact in the CBCT respectively. Presence or absence of radiological sign in panoramic radiography was not properly predict a close relationship with third molar and it is suggested that in case of tooth-canal overlapping, the patient should be referred for CBCT assessment.