Multiple calcifying hyperplastic dental follicles: a major diagnostic consideration in multiple pericoronal lesions - report of two cases.

BACKGROUND: Pericoronal radiolucent lesions are a common radiographic finding, but it is rare that they occur in multiple forms. Multiple calcifying hyperplastic dental follicles (MCHDF) are entities with few cases described to date; nevertheless, they appear to have a very particular phenotypic pattern. CASES PRESENTATION: Case 1: A 10-year-old male was evaluated radiographically, revealing four impacted canines, each accompanied by unilocular pericoronal radiolucency. Case 2: A 16-year-old male was planning orthodontic treatment; following his radiological evaluation all third molars were found to be accompanied with pericoronal radiolucencies. Enucleation, and third molar removal along with the pericoronal tissue were the respective treatments. Microscopically, in both cases, the specimens shown odontogenic epithelium, and type I and II calcifications in the hyperplastic follicles, all these characteristics were consistent with MCHDF. CONCLUSION: Although MCHDF are a rare entity, they must be considered in the differential diagnosis of multiple pericoronal lesions. Under the light of the current evidence, the histological findings may be relatively heterogeneous, but their integration with both the clinical data, which are apparently particular, and with the radiographic characteristics, can lead to a definitive diagnosis.

A clinicoradiographic and pathological study of pericoronal follicles associated to mandibular third molars.

BACKGROUND: Third molar surgery is considered the most frequently performed procedure in oral surgery. Although there are some indications for the removal of this tooth, such as the possibility of cystic degeneration or a tumor of the adjacent pericoronal follicle, there is no consensus in the literature about their prophylactic removal. OBJECTIVES: The aims of this study were to investigate the pathological alterations related to mandibular third molar dental follicles and to perform a narrative literature review. METHODS: A prospective clinical, radiographic, and histopathologic study was conducted with pericoronal follicles of third molars. After histopathologic evaluation and establishment of diagnosis, 2 groups were defined: G1 (pericoronal tissues with pathological alterations based on histopathologic analysis) and G2 (pericoronal tissues without pathological alterations based on histopathologic analysis). In addition, a systematic review of the literature was performed. RESULTS: One hundred thirteen specimens were analyzed. G1 was the most prevalent (P = 0.0004). Lesions were found in patients between 20 and 25 years of age (P < 0.004). The most prevalent histological diagnosis was the paradental cyst (47.7%; P < 0.0001). The narrative literature review showed that the majority of cases were mainly dentigerous cysts (P < 0.05). CONCLUSIONS: The mandibular third molars in young adults showed a direct relationship with age and a statistical propensity for the development of these cystic alterations, notably paradental cysts.

Conventional wisdom and the surgical exposure of impacted teeth.

OBJECTIVES: To provide evidence against the notion that direct contact between the crown of an impacted tooth and alveolar bone is an impediment to orthodontically assisted eruption of teeth. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the Hebrew University-Hadassah School of Dental Medicine, in Jerusalem, Israel, and the private practices of the authors. MATERIALS AND METHODS: Patients reported were those affected by impacted teeth, including individuals who were normal healthy patients, with and without resorption of the adjacent incisor roots, as well as individuals suffering from Cleidocranial dysplasia and increased bone density, and individuals with autogenous and synthetic bone grafts. A closed eruption surgical technique was used in which only a small window was opened into the dental follicle of the impacted tooth, leaving a maximum amount of bone covering much of the crown surface. Orthodontic extrusion forces were then applied. RESULTS: For all teeth, enamel-to-bone contact did not prevent a rapid response to the extrusive forces. CONCLUSION: Radical removal of bone during the exposure of an impacted tooth is unnecessary and potentially may be harmful in terms of the periodontal prognosis of an otherwise successfully treated outcome.

Autotransplantation of an unerupted wisdom tooth germ without its follicle immediately after removal of an impacted mandibular second molar: a case report.

An impacted left mandibular second molar (tooth 37) was extracted, but most of its dental follicle remained in the socket. The crown and dental papilla of an unerupted, left mandibular third molar (tooth 38) were then placed into the socket of tooth 37. Successful interaction between the dental follicle of tooth 37 and the crown and dental papilla of tooth 38 led to the formation of a new tooth 37 at the recipient site. This suggests that the dental follicle may function non-specifically with the crown and dental papilla of other tooth germs.

Extirpation of the primary canine tooth follicles: a form of infant oral mutilation.

BACKGROUND: Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background. CASE DESCRIPTION: We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States. CLINICAL IMPLICATIONS: Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

Orthodontic therapy in patients with pericoronal hamartoma.

Pericoronal lesions are undesirable for dental eruption, and they are always associated with unerupted teeth. Pericoronal lesions are common and are usually treated by extraction of the permanent tooth. Pericoronal hamartoma is a special type of pericoronal lesion, and little information about it is available in the orthodontic literature. This report presents a patient with pericoronal hamartoma on the mandibular left permanent first molar who had orthodontic treatment. Because of the similarity of the radiographic radiolucency of pericoronal hamartoma and other lesions, a differential diagnosis must be made to avoid extraction of permanent teeth.

Tooth follicle extirpation and uvulectomy.

Migration is not only the movement of people, but also of their culture, customs and beliefs. As more people from developing countries in Africa migrate to industrialized countries, the more likely health professionals will find themselves providing care for people of whose customs and practices they have little knowledge. This review of the literature suggests that removal of deciduous canine follicles and uvulectomy are frequently practised in some African and neighbouring countries. Reasons given for deciduous canine extirpation include the prevention of vomiting, fever and diarrhoea. The indications for uvulectomy appear widespread, including treatment for persistent fever, coughing and growth retardation. The practices are usually performed by traditional healers. Risks for children who undergo these procedures are extensive, including septicaemia, potential for HIV transmission, numerous dental complications and death. With improved understanding between Western health teams and local, traditional people, an improved system may develop whereby the two systems can work together in providing improved health outcomes for the people.

Kissing molars: report of three cases and new prospective on aetiopathogenetic theories.

Kissing molars (KMs) is an extremely rare condition of impacted third molars, pointed in the opposite direction in a single follicular space; it consists exactly in a full impacted of permanent molars which occurs only in the lower jaw. Actually, about less than thirty cases have been reported in scientific literatures. The aetiology and pathogenesis of this pathological double dental inclusion remain unknown; above all events that lead two molars to appear, as KMs remain mysterious. The association to metabolic connective diseases such as mucopolysaccharidosis was emphasized. KMs considered as an isolated event, may be associated to an abnormal position of the tooth-bud from lower permanent molars, or fourth supernumerary tooth (distomolar). Recently, hyperplastic dental follicle (HDF), with a down regulation of matrix metal-proteinases and up regulation of several genes of collagens, has been mentioned in association with KMs. In this paper, after having analyzed three new cases of KMs that have been treated, we report a new hypothesis. This last is based on the failure in the dental follicle's ability to initiate or continue properly resorption of the overlying alveolar bone, by many exogenous factors which may act on eruptive phase that would lead to its rotation with its contents coming out a pathological situation of KMs. The therapy of choice is related to the surgical removal of KMs through a double odontectomy with transalveolar method. Other treatments can be, eventually, orthodontic therapy of the impacted teeth and a radiological follow-up without surgery.

The effect of removing the true dental follicle on premolar eruption in the dog.

Eruption is a highly localized process during which the bone resorption and formation that occur on opposite sides of the tooth are dependent upon the surrounding soft tissues, the true dental follicle externally and the enamel organ internally. To examine the ability of the enamel organ to cause eruption the external layer (dental follicle) was removed just prior to and up to 4 weeks before eruption in 13 mandibular premolars in dogs and eruption followed clinically, radiographically and histologically. None of the teeth without dental follicles erupted but three teeth from which the follicle was separated then replaced did erupt. These data indicate that the enamel organ without the dental follicle cannot support tooth eruption and provide indirect evidence for the central role of the dental follicle, alone or in combination with the enamel organ, in eruption.

Removal of mandibular tooth follicles before distraction osteogenesis.

Distraction osteogenesis is an innovative technique that has transformed the treatment of craniofacial malformations in young children. Bone generation obviates the need for graft material, which is in short supply in young patients, thus making possible surgical procedures on the craniofacial skeleton in young children. Sufficient mandibular volume is required for the osteotomy and placement of the device screws and/or pins. To have adequate bone stock and to facilitate distraction, the authors preoperatively examined all patients radiographically and selected those with tooth follicles that precluded successful osteotomy and pin placement for planned mandibular distraction. This report is of the first 13 children, aged 9 months to 6 years, who underwent predistraction enucleation. The osteotomy and device placement were performed successfully at least 4 months after enucleation. The described procedure has minimal morbidity and has resulted in successful subsequent distraction. The advantages, disadvantages, and cost-benefit issues are discussed.

Unerupted mandibular second primary molar with an unusual histopathological finding: a case report.

This is the case of a healthy 6-year old female with a clinically absent right mandibular second primary molar with no history of that tooth ever being present. Radiographic examination revealed a well-circumscribed pericoronal radiolucency surrounding the mandibular right primary second molar. The mandibular right second premolar was displaced mesially. Treatment consisted of enucleation of the lesion with removal of both the unerupted primary second molar and second premolar. The histopathology of the excised lesion revealed a hyperplastic dental follicle with a focal proliferation of odontogenic epithelium and duct-like structures, probably representing an incipient adenomatoid odontogenic tumor.

Enlarged follicles and temporomandibular joint abnormalities in mucolipidosis Type III.

Mucolipidosis Type III, or pseudo-Hurler polydystrophy, is a rare genetic abnormality, the result of a mutation to one of two genes that encode the hexameric protein N-acetylglucosaminyl-1-phosphotransferase (Glc-NAc-PT). The abnormality results in the accumulation of unprocessed macromolecules in cell and tissue compartments throughout the body. In this case report, we describe the clinical and radiographic findings of a 15-year-old male with this disorder. He presented with bilateral ectopically developing mandibular molar teeth with enlarged follicles and multiple joint involvement, including the temporomandibular joints. The patient underwent surgical removal of the molar teeth and curettage of the associated follicles. The subsequent histopathological examination of the tissues revealed hyperplastic follicles suggestive of dentigerous cysts. This report presents the plain film and cone beam CT examinations of the patient.

Hyperplastic dental follicle - review of literature and report of two cases in one family.

Hyperplastic dental follicle is an extremely rare lesion. The practitioner should be able to differentiate it from a dentigerous cyst. The present article will review related literature and report on two cases in one family. A 12-year-old white female and her 15-year-old brother were referred for exposure of unerupted canines. No systemic diseases or syndromes were present. Intra-oral examinations were unremarkable, except for the absence of all eight canines. Radiographic examinations revealed impacted canines with each unerupted tooth surrounded by a well-demarcated radiolucency, which passed beyond the cementoenamel junction. The teeth were surgically exposed and tissue specimens surrounding the unerupted teeth were analysed histologically. Histology revealed fibrous connective tissue with areas demonstrating some ground substance and multiple odontogenic epithelial rests. Some surfaces were partially lined by reduced enamel epithelium. A diagnosis of hyperplastic dental follicle was made. Sometimes, it is difficult to differentiate hyperplastic dental follicle from odontogenic fibroma, both simple and central forms. A correct diagnosis should be based on clinical, radiographic and histological findings.

Regional control by the dental follicle of alterations in alveolar bone metabolism during tooth eruption.

Tooth eruption is a localized, bilaterally symmetrical series of events which involves resorption and formation of alveolar bone on opposite sides of the tooth and requires the presence of the dental follicle. We examined the effect on eruption of selective surgical removal of parts of the follicle. Removal of either the basal or coronal halves of the follicle prevented eruption. Bone resorption and formation of an eruption pathway did not occur after removal of the coronal part of the follicle and bone formation did not occur after removal of the basal part of the follicle. Exposure and incisions of the follicle had no effect on eruption. We interpret these data to mean that the polarized resorption and formation of alveolar bone that occur around a tooth during eruption are regulated by the adjacent parts of the dental follicle.

The regenerative potential of the periodontal ligament.

The current decline in the incidence of dental caries indicates that patients will retain most of their dentition. Reconstruction or regeneration of the entire attachment apparatus, including the periodontal ligament, cementum, and bone, is an attainable therapeutic goal. Clinical treatments designed to reattach connective tissue to exposed root surfaces commonly result in the formation of a long junctional epithelial attachment. This attachment is probably not an effective barrier to bacterial toxins and may allow recurrent pocket formation. To enhance reattachment of connective tissue, root-conditioning agents have been used but their clinical efficacy is questionable. Restoration of destroyed alveolar supporting bone by means of allogenic and autogenous bone-grafting materials has been recommended, but these procedures do not restore the cementum and PDL. Attempts to promote regeneration of the entire attachment apparatus have included clinical studies that used mechanical means to promote repopulation of affected root surfaces by periodontal ligament fibroblasts and prevent contact of epithelial or gingival connective tissue cells. Results thus far have been encouraging, but the practicality of these techniques may be limited. However, these studies have demonstrated that if only PDL cells contact the root surface during healing, a normal PDL can re-form. Dental follicle tissue is capable of inducing the formation of cementum-like structures and is clearly the cell population responsible for cementum and PDL formation. Recent research has demonstrated that the dental papilla probably shares the same inductive capabilities as the dental follicle.(ABSTRACT TRUNCATED AT 250 WORDS)

La efectividad del tratamiento quirúrgico comparado con el tratamiento no quirúrgico de la enfermedad periodontal: II zona de las furcaciones: estudio de 24 meses / Effectiveness of surgical treatment versus non surgical treatment of periodontal disease: II zone of forcations: 24 months study

La respuesta al tratamiento y mantención periodontal en un período que se extendió hasta 24 meses fue estudiado en 17 pacientes portadores de la enfermedad periodontal. Se comparó los efectos de la instrumentación radicular sola, versus la instrumentación radicular mas la técnica quirúrgica de colgajo como un medio de mejorar el acceso, en furcaciones con compromiso de clase I y II según clasificación de Staffileno. Un total de 123 sitios fueron estudiados en relación al índice de placa, frecuencia de hemorragia gingival, profundidad de saco y nivel de inserción clínica. Los resultados sometidos al análisis de regresión lineal demostraron que con aquellos sitios con compromiso de furcación y con lesiones de profundidad 0-3 mm o 4 - 6 mm a los 24 meses al igual que en las caras planas, hubo un mejoramiento en todos los parámetros clínicos estudiados independiente de la modalidad de tratamiento inicial efectuada. Sin embargo, en aquellos sitios cuyas lesiones tenían profundidad inicial de 7 o mas mm., sólo en los casos tratados quirúrgicamente hubo una evolución favorable de la profundidad del saco hasta los 24 meses, ya que el resto de los parámetros clínicos y muy especialmente el nivel de inserción clínica, experimenta un progresivo deterioro independiente de la modalidad de tratamiento empleado. De los resultados de este estudio, se concluye que los compromisos de furcaciones clase I y II de Staffileno con lesiones periodontales profundas, no existe aún una modalidad de tratamiento habitual, que determine en el largo plazo, mejoramiento y mantención de la salud periodontal, hecho que podría estar determinado, por la verdadera regeneración de los tejidos periodontales