Directrices para el diagnóstico y tratamiento de Molares Retenidos / Guidelines for diagnosis and treatment of impacted molars

Los terceros molares son piezas dentarias correspondientes a la dentición permanente y se encuentran por detrás de los segundos molares. Erupcionan entre los 18 y 27 años aproximadamente, tienen variedad de formas, anomalías y disposición diversa. Normalmente se encuentran total o parcialmente retenidos en el hueso maxilar. La retención es muy frecuente y afecta aproximadamente al 75% de la población. La causa principal es por la falta de espacio dentro de la boca. La patología derivada de la retención de un tercer molar puede generar diferentes alteraciones: abscesos, sinusitis, reabsorción de las raíces de los dientes adyacentes, caries del molar retenido y/o del segundo molar, úlceras en la mucosa contigua, podrían generar quistes, ameloblastomas y ulceraciones leucoqueratósicas que pueden degenerar en carcinomas, alteraciones nerviosas o vasomotoras: dolores faciales, trismus, y parálisis facial ipsilateral. Las extracciones profilácticas de terceros molares asintomáticos están justificadas cuando los terceros molares se encuentran bajo prótesis removible que puede estimular su erupción, molares semierupcionados que pueden generar pericoronitis, caries o problemas periodontales; pacientes que van a ser sometidos a radioterapia; cuando el diente incluido interfiera en una cirugía ortognática. Si el molar retenido presenta sintomatología por parte del paciente está aconsejada su extracción quirúrgica.

The third molars are dental pieces corresponding to the permanent dentition and are located behind the second molars. They erupt between the ages of 18 and 27 approximately, have a variety of shapes, anomalies, and diverse dispositions. They are normally fully or partially retained in the maxillary bone. Retention is very frequent and affects approximately 75% of the population. The main cause is due to the lack of space inside the mouth. The pathology derived from the retention of a third molar can generate different alterations: abscesses, sinusitis, resorption of the roots of adjacent teeth, caries of the retained molar and/or second molar, ulcers in the contiguous mucosa, could generate cysts, ameloblastomas and leukokeratotic ulcerations that can degenerate into carcinomas, nervous or vasomotor disorders: facial pain, trismus, and ipsilateral facial paralysis. Prophylactic extractions of asymptomatic third molars are justified when the third molars are under removable prosthesis that can stimulate their eruption, semi-erupted molars that can generate pericoronitis, caries or periodontal problems; patients who are going to undergo radiotherapy; when the included tooth interferes with orthognathic surgery. If the retained molar presents symptoms on the part of the patient, its surgical extraction is recommended.

Cleidocranial dysplasia and novel RUNX2 variants: dental, craniofacial, and osseous manifestations

Abstract Cleidocranial dysplasia (CCD) is a skeletal disorder affecting cranial sutures, teeth, and clavicles, and is associated with the RUNX2 mutations. Although numerous patients have been described, a direct genotype-phenotype correlation for RUNX2 has been difficult to establish. Further cases must be studied to understand the clinical and genetic spectra of CCD. Objectives To characterize detailed phenotypes and identify variants causing CCD in five unrelated patients and their family members. Methodology Clinical and radiographic examinations were performed. Genetic variants were identified by exome and Sanger sequencing, data were analyzed by bioinformatics tools. Results Three cases were sporadic and two were familial. Exome sequencing successfully detected the heterozygous pathogenic RUNX2 variants in all affected individuals. Three were novel, comprising a frameshift c.739delA (p.(Ser247Valfs*)) in exon 6 (Patient-1), a nonsense c.901C>T (p.(Gln301*)) in exon 7 (Patient-2 and affected mother), and a nonsense c.1081C>T (p.(Gln361*)) in exon 8 (Patient-3). Two previously reported variants were missense: the c.673C>T (p.(Arg225Trp)) (Patient-4) and c.674G>A (p.(Arg225Gln)) (Patient-5) in exon 5 within the Runt homology domain. Patient-1, Patient-2, and Patient-4 with permanent dentition had thirty, nineteen, and twenty unerupted teeth, respectively; whereas Patient-3 and Patient-5, with deciduous dentition, had normally developed teeth. All patients exhibited typical CCD features, but the following uncommon/unreported phenotypes were observed: left fourth ray brachymetatarsia (Patient-1), normal clavicles (Patient-2 and affected mother), phalangeal malformations (Patient-3), and normal primary dentition (Patient-3, Patient-5). Conclusions The study shows that exome sequencing is effective to detect mutation across ethnics. The two p.Arg225 variants confirm that the Runt homology domain is vital for RUNX2 function. Here, we report a new CCD feature, unilateral brachymetatarsia, and three novel truncating variants, expanding the phenotypic and genotypic spectra of RUNX2 , as well as show that the CCD patients can have normal deciduous teeth, but must be monitored for permanent teeth anomalies.

Dentigerous cyst in a young child: a case report.

Dentigerous cysts are one of the most common developmental types of odontogenic cysts occurring in the oral cavity and often manifest as incidental findings on dental radiographs and/or as asymptomatic swellings. These cysts develop from remnants of reduced enamel epithelium around the crown of an unerupted or impacted tooth, attached at the level of the cementoenamel junction. Most are considered developmental. However, in young clients they may be inflammatory in origin, the result of caries in the primary dentition. This short communication highlights a case of an asymptomatic dentigerous cyst identified in a 4-year-old child and subsequent enucleation under general anesthesia. A thorough clinical and radiographic assessment of the oral cavity in pediatric clients merits a review of dentigerous cysts by the dental hygienist.

Les kystes dentigères sont parmi les types développementaux de kystes odontogènes les plus courants qui apparaissent dans la cavité buccale et se manifestent souvent comme des découvertes imprévues sur les radiographies dentaires ou comme des enflures asymptomatiques. Ces kystes se développent à partir de restes d'épithélium d'émail réduit autour de la couronne d'une dent incluse ou enclavée, attachés au niveau de la jonction cémento-émail. La plupart des kystes sont considérés comme développementaux. Cependant, chez les jeunes clients, ils peuvent être d'origine inflammatoire, la conséquence de caries dans la dentition primaire. Cette brève communication souligne un cas de kyste dentigère asymptomatique décelé chez un enfant de 4 ans et une énucléation subséquente sous anesthésie générale. Une évaluation clinique et radiographique approfondie de la cavité buccale des clients pédiatriques justifie que l'hygiéniste dentaire se renseigne sur les kystes dentigères.

Prevalência das posições e grau de dificuldade cirúrgica de terceiros molares inferiores: um estudo radiográfico retrospectivo / Prevalence of positions and degree of surgical difficulty in lower third molars: a retrospective radiographic study

Objetivo: Os objetivos deste estudo foram avaliar a prevalência do posicionamento dos terceiros molares inferiores seguindo a classificação de Winter e Pell & Gregory, e determinar os níveis de dificuldade para a exodontia através do índice de Pederson. Materiais e Métodos: Estudo radiográfico, transversal e retrospectivo avaliou 100 radiografias panorâmicas provenientes dos prontuários odontológicos atendidos nos ambulatórios de Cirurgia bucal, de pacientes entre 15 e 61 anos de idade, no período de 2015 a 2017. As radiografias panorâmicas foram avaliadas por meio do software ImageJquanto aos posicionamentos dos terceiros molares inferiores pela classificação de Winter e Pell & Gregory, enquanto o nível de dificuldade foi avaliado pelo índice de Pederson. Os resultados obtidos foram submetidos à análise estatística descritiva. Resultados: A maior prevalência de terceiros molares inclusos foi observada em mulheres, com idade média de 26 anos. Quanto a posição dos dentes inclusos, a posições vertical (44,0%), nível A (74,7%) e classe III (69,9%) foram as mais prevalentes. Na escala de Pederson, a dificuldade cirúrgica "muito difícil" foi a mais encontrada. Discussão: nossos resultados sugerem estabelecer um melhor planejamento cirúrgico e prognóstico aos pacientes, minimizando a possibilidade de complicações durante e após as extrações de terceiros molares inferiores. Conclusão: Ambas classificações auxiliam o cirurgião-dentista a estabelecer um melhor planejamento e prognóstico aos pacientes. A aplicabilidade das radiografias panorâmicas, associados a avaliação clínica, justificam menores possibilidades de complicações pós-cirúrgicas em terceiro molar inferior.

Aim: The objectives of this study were to evaluate the prevalence of the mandibular third molars position in according to the Winter and Pell & Gregory classification, and to determine the levels of difficulty for exodontia through the Pederson index. Materials and Methods: Radiographic, cross-sectional and retrospective study evaluated 100 panoramic radiographs of patients between 15 and 61 years old, from dental records seen at the Oral Surgery department in the period from 2015 to 2017. The panoramic radiographs were evaluated using ImageJ software regarding the positioning of the lower third molars by the Winter and Pell & Gregory classification, while the level of difficulty was evaluated by the Pederson index. The results obtained were submitted to descriptive statistical analysis.Results: The highest prevalence of included third molars was observed in women, with an age average of 26 years. Regarding the position of the included teeth, the vertical position (44.0%), level A (74.7%), and class III (69.9%) were the most prevalent. In the Pederson scale, the "very difficult" surgical difficulty was the most found. Discussion: results suggest establishing better surgical planning and prognosis for patients, minimizing the possibility of complications during and after extractions of mandibular third molars.Conclusion: Both classifications help the dental surgeon to establish better planning and prognosis for patients. The applicability of panoramic radiographs, associated with clinical evaluation, justifies a fewer possibility of complications in the lower third molar post-extraction

Fratura de mandíbula associada à transmigração de canino / Mandibular fracture associated to canine transmigration

Introdução: Apesar de ser considerado um assunto controverso, o tratamento de fraturas mandibulares, que envolvem terceiros molares inclusos, já se afigura como uma temática amplamente debatida na literatura. Por outro lado, poucos estudos discutem o manejo das fraturas em região de dentes inclusos anteriores8 . Nesse sentido, o presente estudo visa relatar um caso de fratura associada a um canino transmigrado em parassínfise mandibular. Relato de caso: Paciente A.S.S., sexo masculino, 43 anos e 6 meses de idade, apresentou-se à emergência do Hospital Geral do Estado da Bahia, com histórico de acidente motociclístico cursando com trauma em face. O exame de imagem constatou fratura em parassínfise mandibular bilateral, associada ao deslocamento de canino previamente impactado. Optou-se pela remoção do dente envolvido, redução e fixação óssea com miniplacas e Barra de Erich. O acompanhamento pósoperatório revelou estabilidade da mandíbula e regressão dos sinais e sintomas pré-traumáticos. Considerações finais: Ao tratar fraturas mandibulares que envolvem dentes inclusos, deve-se ponderar acerca da remoção ou manutenção desse dente. Para tanto, o cirurgião deve avaliar o grau de comprometimento da unidade dentária bem como sua importância para redução e fixação ósseas... (AU)

Introduction: Despite being a controversial subject, the treatment of mandibular fractures involving the included third molars is already a widely debated topic in the literature. On the other hand, few studies discuss the management of fractures in the region of anterior included teeth8. In this sense, the present study aims to report a case of fracture associated with a transmigrated canine in the mandibular parasphysis. Case report: Patient A.S.S., male, 46 years and 6 months old, presented to the emergency of the State General Hospital of Bahia, with a history of motorcycle accidents, coursing facial trauma. The image examination revealed bilateral mandibular parashymphisis fracture, associated with the displacement of a previously impacted canine. It was decided for removal of the involved tooth, reduction and bone fixation with miniplates and Erich Bar. Postoperative follow-up revealed jaw stability and regression of post-traumatic signs and symptoms. Final considarations: When treating mandibular fractures involving included teeth, consideration should be given to the removal or maintenance of this tooth. Therefore, the surgeon should assess the degree of impairment of the dental unit as well as its importance for bone reduction and fixation... (AU)

Detection of the gubernacular canal and its attachment to the dental follicle may indicate an abnormal eruption status.

OBJECTIVES: To evaluate and compare the detection of gubernacular canals (GC) and their characteristics in normal and abnormal tooth eruption. MATERIALS AND METHODS: Patients with unerupted teeth were classified according to sex and age. Each tooth was classified according to dental group, eruption status, formation status, angulation, and GC detection. The opening of the GC in the alveolar crest and the attachment sites in relation to the dental follicle were assessed. Data were analyzed by the chi-square and Kruskal-Wallis tests, with a significance level of 5%. RESULTS: Cone-beam computed tomography scans of 159 patients were evaluated. The final sample (N = 598) consisted of 423 teeth with normal eruption, 140 impacted teeth, and 35 teeth with delayed eruption. The overall detection rate of GC was 90.6%. These rates were 94.1%, 87.1%, and 62.9% for normal eruption, impacted teeth, and delayed eruption, respectively. GC detection rates were higher in the early stages of tooth formation in normal tooth eruption and in impacted teeth. The rate of GC detection was even lower in delayed teeth when they were angulated. Unusual attachment sites of the GC to the dental follicle were associated with abnormal eruption status. CONCLUSIONS: The results of the present study suggest that GC characteristics may indicate an abnormal eruption status.

Da necessidade e oportunidade da exodontia: relato de caso de incisivo superior retido / The necessity and opportunity of the exodontia: case report of upper incisor retained

A evolução dos materiais e técnicas na Odontologia Contemporânea aperfeiçoou as possibilidades terapêuticas assim como os meios de diagnóstico por imagem. Utilizar meios complementares aos exames clínicos colabora para uma maior previsibilidade de tratamento, com menor morbidade para o paciente e maior segurança na localização anatômica de estruturas nobres. A segurança cirúrgica está centrada no binômio mínima invasão dos tecidos e confiança interventiva, com evidentes benefícios durante a anestesia/diérese, a hemostasia, bem como a síntese. Planejar adequadamente possibilita prever riscos e ponderar eventuais sequelas que possam surgir durante e após o ato operatório. Mesmo que a desejável correção ortodôntica e a imediata instalação de fixações não sejam possíveis, aguardar a oportunidade ideal de reabilitação e a necessidade de intervenções posteriores requerem uma curva de aprendizagem que denota paciência e meticulosidade. Variáveis como dentes retidos, lesões intraósseas, falta de espaço na arcada dentária, proximidade com vasos sanguíneos e nervos, entre outras; constituem empecilhos comumente encontrados na clínica diária. O objetivo deste trabalho foi ilustrar um caso clínico cuja remoção de um incisivo superior retido melhorou a condição oclusal do paciente, para que pudesse ser submetido, posteriormente, a uma correção ortodôntica para ganho de espaço e aposição de fixação osseointegrada em área estética.

The evolution of materials and techniques in Contemporary Dentistry has improved the therapeutic possibilities as well as diagnostic imaging means. Using complementary means to the clinical exams contributes to a greater predictability of treatment, with lower morbidity for the patient and greater safety in the anatomical location of noble structures. Surgical safety is centered on the binomial minimal invasion tissues and interventional confidence, with obvious benefits during anesthesia/dieresis, hemostasis; as well as the synthesis. Adequate planning makes it possible to predict risks and to consider possible sequelae that may arise during and after surgery. Even if the desired orthodontic orrection and the immediate implant placement are not possible, waiting for the ideal rehabilitation opportunity and the need for subsequent interventions requires a learning curve that denotes patience and meticulousness. Variables such as: retained teeth, intraosseous lesions, lack of space in the dental arch, proximity to blood vessels and nerves, among others, are commonly encountered in the daily clinic. The aim of this study was to illustrate a clinical case whose removal of an unerupted superior incisor improved the patient's occlusal condition. For this reason, it could be submitted to an orthodontic correction to gain space and osseointegrated implant placement in aesthetic area

Avaliação das posições de terceiros molares retidos em radiografias panorâmicas: revisão da literatura / Evaluation of the positions of impacted third molars on panoramic x-rays: a literature review

A exodontia de terceiros molares inclusos é a prática mais comum dos cirurgiões bucomaxilofaciais. Portanto, para facilitar a comunicação entre profissionais e a elaboração de um planejamento satisfatório; foram criadas classificações distintas desses elementos dentários, como a de Winter e a de Pell e Gregory. O presente estudo propõe-se avaliar as posições de terceiros molares retidos em ortopantomografias por meio de uma revisão de literatura. Para isso realizou-se uma revisão de literatura incluindo o tema nas seguintes bases de dados: PubMed, CAPES, SCIELO, BBO, BIREME e LILACS. A posição vertical, conforme classificação de Winter, foi a de maior prevalência entre os terceiros molares superiores e inferiores; em relação à classificação de Pell e Gregory, as posições de maior prevalência foram a posição A e Classe I.

Exodontia of third molars included is a common practice of oral maxillofacial surgeons. Therefore, to facilitate communication between professionals and a drafting of a satisfactory planning were created for these dental elements, such as that of Winter and one of Pell and Gregory. The present study proposes to evaluate how the positions of third molars refer to orthopantomographies through a literature review. For this, a literature review was carried out including the theme in databases: PubMed, CAPES, SCIELO, BBO, BIREME and LILACS. The vertical position, as classified by Winter, had a higher prevalence among the upper and lower third molars; relative to the classification of Pell and Gregory, the positions of higher prevalence were A position and Class I.

Impacted canine in orbita: case report / Inclusão de canino em órbita: relato de caso

ABSTRACT The canines are important teeth as regards function, occlusion and esthetics. Disturbances with the eruption of permanent maxillary canines are common. Ectopic eruption of a tooth germ can occur at any time after eruption. It has also been observed that upper canines are affected with eruption disorders more than the third molars. The diagnosis of retained teeth is performed through clinical and radiographic examination, or through the investigation of various complaints, such as pain or orthodontic problems. The dental surgeon should be familiar with the anatomical and functional changes of the impaction, ectopic teeth and the possible repercussions for the patient, because recommendations on the decisions to be taken in cases of canine impaction, are determined through a careful study of each case. The purpose of this paper is to report a rare case of a buried canine in the proximity of the orbital border.

RESUMO Caninos são elementos dentários importantes no que se refere a função, oclusão, estética. Distúrbios na erupção de caninos superiores permanentes são comuns. A erupção ectópica de um germe dentário pode ocorrer a qualquer momento, desde a sua erupção. Verifica-se ainda, que caninos superiores são mais acometidos com distúrbios de erupção que os terceiros molares. Diagnósticos de elementos dentários retidos são realizados por meio de exames clínicos e radiográficos, ou através de investigações de queixas diversas, como dor ou ortodônticas. O Cirurgião-Dentista deve estar familiarizado com as alterações funcionais e anatômicas referentes as impactações, ectopias dentárias e suas possíveis repercussões ao paciente, pois recomendações sobre as decisões a serem seguidas nos casos de impactações de caninos são determinadas através de minucioso estudo de cada caso. O objetivo do presente artigo é relatar um raro caso de canino incluso com proximidade da órbita.

No erupción de segundos molares mandibulares permanentes en radiografía panorámica / Unerupted mandibular permanent second molars in radiographic analysis

RESUMEN: La no erupción de segundos molares es relativamente baja, pero ha ido en aumento en los últimos años. Se relaciona con un tratamiento multidisciplinario largo, costoso y complejo, por lo cual es de suma importancia enfocarse en el diagnóstico precoz y tratamiento temprano. El objetivo de este estudio es poder hacer una comparación de medidas radiográficas entre un grupo de pacientes con segundo molar mandibular permanente no erupcionado o sin posibilidades de erupcionar y un grupo control. Método: Se realizó una revisión manual consecutiva de las 16.835 fichas sobre las cuales se aplicaron criterios de inclusión y exclusión. Los datos se obtuvieron de radiografías panorámicas de las cuales se obtuvieron medidas lineales y angulares que fueron comparados entre dos grupos de estudio. Se desarrolló un modelo predictivo mediante análisis discriminante. Resultados: El 1,5% de los pacientes tuvieron segundos molares no erupcionados. Los promedios de las variables relevantes fueron: Ángulo del segundo molar 33,7°; distancia desde distal del primer molar al borde anterior de la rama mandibular 15mm; invasión distal del primer molar por el segundo molar 2,1mm; inclinación mesial de segundo molar con respecto al plano oclusal 128° y al plano mandibular 63°. El puntaje crítico discriminante fue de 36,7. Conclusión: La presencia de segundos molares incluidos es baja. Se encontró diferencias estadísticamente significativas entre casos y controles en todas las variables. El modelo predictivo puede identificar molares sin probabilidad de erupción natural. Es necesario contar con nuevos estudios con muestras poblacionales para establecer cuáles serían los valores de normalidad para poder diagnosticar en forma precoz esta condición.

ABSTRACT: No eruption of seconds is relatively low, has been increasing in recent years. It relates to long, costly and complex multidisciplinary treatment, so it is important to focus on early diagnosis and early treatment. The aim of this study is to make a comparison of radiographic measurements among a group of patients with mandibular second permanent molar eruption and no possibility of a control group. Method: A consecutive manual review of 16,835 sheets on which inclusion and exclusion criteria were applied. The data were obtained from panoramic radiographs of which linear and angular measurements were compared between two study groups were obtained. A predictive model was developed using discriminant analysis. Results: 1.5% of patients had unerupted second molars. The averages of the relevant variables were: Angle of the second molar 33.7 °; distance from distal of the first molar to the anterior border of the ramus 15 mm; invasion distal of the first molar the second molar 2.1mm; second molar mesial inclination relative to the occlusal plane 128 ° and 63 ° mandibular plane. The critical discriminant score was 36.7. Conclusion: Statistically significant differences between cases and controls was found in all variables. The predictive model can identify likely molars with or without natural eruption. It is necessary to have further studies with population samples to establish what would be the normal values to diagnose this condition at an early stage.

Surgical approach to malformation of maxillary central incisor following trauma to its predecessor. Two case reports.

In the case reports, two different approaches have been described to treat the developmental disturbances in the maxillary central incisors due to trauma to its predecessor. The treatment plan was chosen according to the type and severity of the malformations, the exact location and the morphology of the involved teeth. In the first case, the disimpaction of the maxillary right central incisor was achieved with the combined of surgical and orthodontic therapy, that was planned in two consecutive stages. In the second case the severe root angulation and the failure of the previous orthodontic traction made impossible the repositioning of the upper right central incisor, which was surgical removed.

Avaliação da localização de caninos superiores não irrompidos em radiografias panorâmicas digitais / Radiographic localization of unerupted maxillary canine

O presente estudo teve como objetivos avaliar a prevalência de caninos superiores não irrompidos, suas posições intraósseas e se há relação com a idade e o gênero. Foram avaliadas 100 radiografias panorâmicas digitais, no período compreendido entre os anos de 2009 a 2010. Para a coleta de dados foi utilizada uma ficha específica onde se registrou a idade, gênero e posicionamento dos elementos. Para análise da angulação e distância da cúspide do canino à crista do rebordo alveolar foi utilizado o programa Meazure®. Os resultados apontaram para uma prevalência de 61,1% para o gênero feminino, faixa etária entre 21 a 25 anos (44, 4%), unilateralidade (83, 3%) e posição mesioangular (77, 7%). Com respeito aos valores médios para as medidas de angulação dos caninos em relação a linha média e da distância da cúspide à crista do rebordo alveolar os resultados revelaram que as mulheres apresentam tanto angulação média (44,20) quanto distância média (9,30) superiores às medidas dos homens. Por fim, avaliando tais medições em relação à posição do canino, percebe-se que os dentes mesioangulares unilaterais têm angulação média menor (36,80) e distância média maior (10,56) que as dos dentes identificados nas posições vertical e horizontal. A média geral da angulação dos pacientes que apresentaram caninos não irrompidos unilaterais foi de 42,67° e com distância de 9,02mm. Desta forma, conclui-se que caninos não irrompidos são prevalentes em indivíduos jovens do gênero feminino, apresentando-se predominância unilateral e em posição mesioangular

The present study aimed to evaluate the prevalence of unerupted maxillary canines, the intraosseous position and the prevalence of unerupted canines related to age and gender. 100 digital panoramic radiographs were evaluated at the period between the years 2009-2010. A specific record were developed for collection data related to age, gender and placement of the elements. For analysis of the angle and canine distance of the cusp to the crest of the alveolar ridge Meazure® was used. The results showed a prevalence of females (61,1%), aged between 21-25 years (44,4%), unilateral (83,3%) and mesioangular position (77,7%). In respect to the average for measures of canine angulation in relation to the midline and the distance of the leaflet to the crest of the alveolar ridge values, the results revealed that women present both mean angulation (44.20) and average distance (9.30) superior to measures of men. Evaluating such measurements relative to the position of the canine, can be noted that the mesioangular teeth have unilateral lower mean angle (36.80) and greater average distance (10.56) that the teeth in vertical and horizontal position. The mean angulation of patients with unilateral unerupted canines was 42.67° and distance of 9.02 mm. Thus, it is concluded that unerupted canines are prevalent in young females, presenting predominantly unilateral and mesioangular position

Inverted mesiodens: case report / Mesiodens invertido: relato de caso

ABSTRACT Mesiodens is the term used for describing the supernumerary tooth that occurs in the maxilla, between the central incisors, in the midline region. These may erupt in the oral cavity or keep themselves impacted. Their presence causes cleaning inadequate, impossibility or difficult of the eruption of the regular teeth and having the aesthetic compromised. This paper aims at showing that early identification of supernumerary teeth, planning and correct approach, allow the preservation of the teeth and adjacent structures. This article presents the clinical case of a seven-year-old child, male, who sought for treatment complaining that teeth 11 didn't appear in the buccal cavity. Clinical and radiographic exams were done and they demonstrated the presence of the supernumerary tooth. The plan of treatment aimed at the correct localization, extraction of this supernumerary tooth and continuous follow up of the case.

RESUMO Mesiodens é o termo utilizado para denominar o dente supranumerário que ocorre na maxila, entre os incisivos centrais, na região de linha média. Esses podem irromper na cavidade oral ou ficarem impactados. A sua presença acarreta higienização inadequada, dificuldade ou impossibilidade de erupção dos dentes regulares e comprometimento da estética. O presente trabalho objetiva mostrar que a identificação precoce de dentes supranumerários, o planejamento e abordagem corretas, permitem a preservação dos dentes e estruturas adjacentes. Este artigo apresenta o caso clínico de criança de 7 anos de idade, gênero masculino, cujos pais procuraram por tratamento com queixa de não esfoliação do dente 51. Foram realizados exames clínicos e radiográficos e estes demonstraram a presença de dente supranumerário invertido. O plano de tratamento teve por objetivo a correta localização, exodontia do mesiodens que não irromperia por ser invertido; e contínuo acompanhamento do caso.

Prediction of Mesiodistal Width of Unerupted Lateral Incisors, Canines and Premolars in Orthodontic Patients in Early Mixed Dentition Period.

OBJECTIVES: Proper diagnosis and prevention of malocclusion are superior to treatment. Discrepancy between arch length and tooth size in mixed dentition period is a condition requiring timely diagnosis. Estimating the mesiodistal width of unerupted teeth according to the size of erupted ones can lead to earlier diagnosis of malocclusion. On the other hand, the best timing for serial extractions is before the eruption of lateral incisors. The aim of this study was to present prediction formulas for mesiodistal width of unerupted lateral incisors, canines and premolars in an Iranian population based on the width of erupted permanent mandibular central incisors and maxillary first molars. MATERIALS AND METHODS: A total of 120 dental models (60 males, 60 females) of orthodontic patients between 11-25 years were evaluated in Yazd city. The measurements were made by a digital caliper on the widest mesiodistal width of teeth at the interproximal contacts. Data were analyzed to calculate the prediction equation. RESULTS: The prediction equation in the upper jaw was y=0.57x+10.82 for males, y=0.7x+6.37 for females and y=0.64x+8.46 for both sexes. The equation for the lower jaw was y=0.76x+2.86 for males, y=0.74x+3.53 for females and y=0.77x+2.7 for both sexes. CONCLUSIONS: The prediction equations suggested in this study can predict the mesiodistal width of unerupted lateral incisors, canines and premolars in an Iranian population in early mixed dentition period without taking radiographs.

Pericoronal radiolucency associated with incomplete crown.

The author experienced 8 cases of pericoronal radiolucency involving an incomplete tooth crown that had not developed to form the cemento-enamel junction, and the underdeveloped crown sometimes appeared to be floating within the radiolucency radiographically. The first impression was that these cystic lesions had odontogenic keratocysts, but half of them turned out to be dentigerous cysts histopathologically. There has been no report concerning odontogenic cysts involving an incompletely developed crown. The purpose of this paper is to report that dentigerous cysts may develop before the completion of the cemento-enamel junction of a developing crown.

Avaliação quanto à posição e prevalência de dentes impactados nas radiografias panorâmicas da Clínica Odontológica da Faculdade Ingá-PR / Evaluation of the position and prevalence of impacted teeth in the panoramic radiographs of the Dental Clinic of the Ingá Faculty

Objetivo - Analisar a prevalência dos tipos mais frequentes dos dentes impactados quanto à sua posição no complexo maxilo-mandibular, por meio da visualização dos filmes radiográficos com lupa e negatoscópio e em imagens digitalizadas por meio da máquina fotográfica digital nas radiografias panorâmicas. Métodos - Foram analisadas 341 radiografias panorâmicas, de pacientes abrangendo uma faixa etária de 14 a 49 anos, dos arquivos da Clínica Odontológica da Faculdade Ingá, Maringá-PR. As radiografias foram visualizadas com lupa e negatoscópio e digitalizadas por meio de máquina fotográfica digital amadora (Sony Cybershoot DSC-W320) montada em tripé para avaliar a correlação dos dados observados em filmes radiográficos comparadas com as imagens fotográficas. Resultados - Destas foram encontradas 63,2% mulheres e 36,7% homens, apresentando-se diferença de forma estatística significante aplicando o teste qui-quadrado em nível de significância de 5%, os dentes que mais apresentaram retenção foram o terceiro molar superior direito (26,6%), logo em seguida o terceiro molar superior esquerdo (26,1%), o terceiro molar inferior direito (21,4%) e por fim terceiro molar inferior esquerdo (17,1%). Aplicando-se o coeficiente de correlação de Pearson foi igual a 0,9997, indicando forte correlação entre os filmes radiográficos e as imagens radiográficas digitalizadas. Conclusão - Os terceiros molares foram os dentes com maior prevalência. A maior prevalência foi para o sexo feminino. Com relação aos dentes retidos as imagens fotográficas não apresentaram diferenças comparadas com os filmes radiográficos.

Objective - To investigate the prevalence of the most frequent impacted teeth and their position in the maxillo-mandibular complex and compare the results of visualization of the radiographic films using magnifying glass and light box and scanned images by digital camera. Methods - A total of 341 panoramic radiographs obtained from the patient records seen at the Dental Clinic of the Ingá Faculty were analyzed. The radiographs were evaluated using a magnifying glass and light box and then scanned using amateur digital camera (Sony Cybershoot DSC-W320) attacked on a tripod. Then the observed data found in panoramic radiographic were compared to the scanned images. Results - Of the total patients (aged 14 to 49 years), 63.2% were female and 36.7% were male. The most prevalent impacted teeth was the third molar right (26.6%), followed by the upper left third molar (26.1%), the lower right third molar (21.4%) and the lower left third molar(17.1%), A correlation was observed between panoramic radiographs and scanned radiographs images (r = 0,9997). Conclusion - The third molar teeth were the higher prevalent impacted teeth. The prevalence was higher for females. There were no differences between the evaluation of panoramic radiographs and their respective scanned images.

Isolated bilateral macrodontia of mandibular second premolars: A case report.

Isolated bilateral macrodontia of mandibular second premolars is an extremely rare dental anomaly with only 5 cases reported to date. This case report presents clinical and radiographic findings of isolated bilateral macrodontia in a 12-year-old child. The patient was referred to the clinic with local crowding of mandibular posterior teeth. Radiographic findings revealed the presence of impacted macrodont mandibular second premolars and their distinct morphological appearance, characterized by large, multitubercular, molariform crowns, and tapering, single roots. Following surgical removal of the impacted premolars, orthodontic therapy was initiated to correct the malocclusion. Along with the features and treatment of this rare anomaly, this case report also illustrates the benefits, in terms of treatment planning and surgical technique, of supplementing conventional radiography with cone-beam computed tomography to localize the macrodont premolars and accurately establish their relationship with the neighboring roots and anatomic structures.

Condutas terapêuticas para caninos inclusos / Therapeutic behavior for impacted canines

Normalmente, os últimos dentes a erupcionar são os que permanecem inclusos ou semi-inclusos, como é o caso dos caninos. O estudo teve como objetivo relatar algumas opções de tratamento a fim da manutenção estética e funcional da área atuada diante de um canino incluso, discutindo as suas indicações, contra-indicações, vantagens e desvantagens. Este trabalho também busca enfatizar a acessibilidade que o paciente teria caso a sua opção ideal fosse uma das formas de tratamento abordadas. Para a identificação dos estudos incluídos ou considerados nesta revisão, foi realizada uma estratégia de busca detalhada para os bancos de dados pesquisados: Pubmed, Bireme, Scielo, Cochrane e Dentistry Oral Science até o ano de 2011. Foram utilizados como descritores: dente não-erupcionado, canino e terapêutica. Os critérios de inclusão foram: artigos clínicos e de revisão que abordavam o tema. Foi constatado mediante esta revisão que a falta do conhecimento técnico-científico por parte do cirurgião-dentista e a impossibilidade financeira da maioria da população são alguns dos empecilhos para o estabelecimento do correto planejamento para o canino incluso.

Normally, the last teeth to erupt are the ones which remain impacted or semi-impacted, and that is the case of the canines. This study aimed to report a few options of treatment, aiming at esthetic and functional maintenance of the affected area before a impacted canine, discussing its indications, contraindications, advantages and disadvantages. This study also aims to emphasize the accessibility the patient would have in case his/her option were one of the approached ways of treatment. In order to identify the studies included or analyzed in this review, a detailed search strategy was performed for the database used: Pubmed, Bireme, Scielo, Cochrane, and Dentistry Oral Science up to 2011. We used non-erupted teeth, canine, and therapeutics as descriptors. The criteria of inclusion were clinical and review articles that approached the theme. Through this review, it was found that the surgeon dentist?s lack of technical and scientific knowledge and the financial impossibility of most population are some hindrances for the establishment of the right planning for the impacted canine.

Supernumerary teeth vary depending on gender

The presence of supernumerary teeth (ST) is a dental developmental anomaly of patterning and morphogenesis. Its variability of morphology, location and developmental timing can shed light on its etiology. In this work we report ST patterns. Orthopantomograms of 1,166 pediatric subjects were examined and the morphology, location and timing of the formation of ST were determined. The frequency of supernumerary teeth in the studied population was 2.3 percent (n = 27). Twenty-five subjects presented one ST. Maxilla midline was the most commonly affected region (nine cases). We noted high incidence of conical morphology in the midline region. Only teeth with tuberculate morphology presented delayed formation. ST in the midline region occurred more often in males whereas ST in the incisor region were more common in females. In conclusion, ST patterns vary depending on gender.

Incidência das Posições Anatômicas e Agenesia dos Terceiros Molares em Estudantes de São Luís, Maranhão / Incidence of the Anatomic Positions and Agenesis of Third Molars in Students from São Luís, MA, Brazil

Objeti vo: Investi gar os aspectos clínicos e radiográfi cos dosterceiros molares com relação à incidência das posiçõesanatômicas e agenesia em estudantes de uma escola públicade São Luís, Maranhão.Método: Trata-se de um estudo transversal descriti vo dascaracterísti cas clínicas e radiográfi cas dos terceiros molaresnuma população de estudantes de 18 a 21 anos de ambos osgêneros. Avaliou-se 155 pacientes por meio de exame clínicoe radiográfi co (radiografi a panorâmica dos maxilares) noperíodo de maio a novembro de 2006. Dos 155 estudantes,obti vemos 531 dentes presentes e 89 ausentes. Dos presentes,somente 462 foram avaliados segundo as posições de Wintere Pell e Gregory, visto que apresentavam rizogênese completa.Registraram-se ainda a ausência congênita destes dentes. Todosos dados foram registrados em fi chas apropriadas, tabuladosno EPI-INFO 2000 e submeti dos ao teste Qui-Quadrado paraverifi car a existência de associações entre as variáveis deestudo, com nível de signifi cância de 5%.Resultados: Os resultados mostraram diferenças signifi cantespara as posições mesial (p=0.0001), distal (p=0.0278) e horizontal(p=0.0179) em relação aos diferentes terceiros molares. Já paraa posição verti cal não houve diferenças. (p=0.1354), entretantofoi mais freqüente na amostra. Com relação à classifi cação dePell e Gregory não foram observadas diferenças signifi cantes(p>0.05). A agenesia foi consideravelmente freqüente nestapopulação com 14,4%.Conclusão: As posições mais freqüentes segundo Winter forama verti cal seguida pela mesial, distal e horizontal; e segundo Pelle Gregory foram Classe I, II e III e Posições A, B e C . A agenesiaesteve freqüente na amostra...

Objecti ve: To investi gate the clinical and radiographic aspectsof third molars with respect to the incidence of the anatomicpositi ons and agenesis in students from a public school of SãoLuís, MA, BrazilMethod: This was a descripti ve cross-secti onal study ofthe clinical and radiographic characteristi cs of third molarsin a populati on of students of both genders aged 18 to 21years. A total of 155 pati ents were examined clinically andradiographically (panoramic radiograph of the jaws) betweenMay and November 2006. The 155 students had 531 teethpresent and 89 absent. From the teeth that were present, only462 had complete root formati on and were evaluated accordingto the Winter and Pell & Gregory positi ons. Congenital absenceof teeth was also noted. The data were recorded in appropriatecharts, tabulated in the EPI-INFO 2000 soft ware and analyzedusing the Chi-square test to verify the existence of associati onsbetween the study variables, with level of signifi cance set at5%.Results: The results showed signifi cant diff erences for themesial (p=0.0001), distal (p=0.0278) and horizontal (p=0.0179)positi ons for the diff erent third molars. No signifi cant diff erenceswere found for the verti cal positi on (p=0.1354), but it was themost frequent positi on in the sample. Regarding the Pell &Gregory classifi cati on, no signifi cant diff erences were observed(p>0.05). Agenesis was considerably frequent in this populati on(14.4%).Conclusion: According to Winter, the most frequent positi onswere verti cal followed by mesial, distal and horizontal, whileaccording to Pell & Gregory were Class I, II and III and Positi onsA, B and C. Agenesis was a frequent occurrence in the sample...