Factors Associated With Successful Surgical Exposure of Impacted Maxillary Canines.

PURPOSE: Impacted maxillary canines occur in up to 3% of the population and their eruption is of great importance in establishing, maintaining the shape, aesthetics, and function of the dental arch. Hence, surgical exposure of canines for the purpose of aligning them is a common surgical procedure. This study identifies the frequency and the statistically significant factors associated with successful surgical exposure of impacted maxillary canines and the relative risk factors for repeat surgery. METHODS: This is a retrospective cohort study of 182 patients who underwent surgical exposure of impacted maxillary canines and orthodontic alignment, over a 5-year period between 2014 and 2018. The variables recorded and analyzed included demographics (age and gender), type of surgery (closed or open exposure), grade of surgeon, and radiographic features on orthopantomogram (canine overlap of adjacent tooth root, vertical canine crown height, canine angulation to midline, position of canine root apex). Outcome data recorded were successful surgical exposure and orthodontic alignment and the need for repeat operation or surgical removal due to ankylosis. The data were analyzed to identify the statistically significant correlates of successful surgical exposure and the relative risk factors associated with repeat surgery. RESULTS: A total of 182 patients and 232 bone-impacted maxillary surgical canine exposures were analyzed, as 50 patients had bilateral impaction. Mean age was 15 years (range = 10-38 years), with 122 (67%) female to 60 (33%) male ratio. Total of 222/232 (96%) impacted maxillary canine teeth were successfully surgically exposed and 10/232 (4%) required re-exposure surgery. Correlates of successful surgical exposures were open exposure technique (P < .002) and reduced distance of vertical canine crown height from alveolar bone margin (P < .033). Relative risk factors for repeat surgery were increased age, male, closed surgical exposure, grade of surgeon, central impaction, increased overlap of adjacent root, increased vertical height, increased angulation to midline, canine apex position above second premolar and procedure done under local anesthetics. CONCLUSIONS: This is the largest impacted maxillary canine study to date which has identified the factors that result in successful surgical exposure, hence allow selection of the patients most suitable for this treatment. Secondly, patients with relative risk factors for repeat surgical intervention may be consented appropriately, triaged for a closer orthodontic follow-up and prioritized for surgery to reduce overall treatment time.

Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis.

The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9-2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1-16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.

Prospective study of the long-term outcomes and complications after total temporomandibular joint replacement: analysis at 10 years.

This prospective analysis was performed to assess the long-term benefits of the TMJ Concepts joint replacement system in the UK. All patients who had replacement temporomandibular joints (TMJ) with at least 10 years of follow-up were included. The most common primary diagnoses were trauma, multiple previous operations, psoriatic arthritis, rheumatoid arthritis, degenerative disease, and ankylosis. A total of 43 patients (62 joints) were followed up for 10 years (mean age 45, range 22-70 years); 39 were female and four were male. The mean number of previous TMJ procedures was 2.5 (range 0-10). Over the 10 years of follow-up, there were significant improvements in pain score (10-point scale; decreased from 7.4 to 1.7), maximum mouth opening (increased from 21.0 mm to 34.7 mm), and dietary score (10-point scale; increased from 4.1 to 9.5). Joints in two patients failed, one secondary to a local dental infection and one due to reankylosis. None failed due to wear of the prosthesis, whether the prosthesis was standard cobalt-chrome or all-titanium. Total TMJ replacement gives good long-term improvements, both lessening pain and improving function, and is an effective form of management for irreparably damaged joints.

Decoronation followed by dental implants placement: fundamentals, applications and explanations

ABSTRACT Dental arches areas with teeth presenting dentoalveolar ankylosis and replacement root resorption can be considered as presenting normal bone, in full physiological remodeling process; and osseointegrated implants can be successfully placed. Bone remodeling will promote osseointegration, regardless of presenting ankylosis and/or replacement root resorption. After 1 to 10 years, all dental tissues will have been replaced by bone. The site, angulation and ideal positioning in the space to place the implant should be dictated exclusively by the clinical convenience, associated with previous planning. One of the advantages of decoronation followed by dental implants placement in ankylosed teeth with replacement resorption is the maintenance of bone volume in the region, both vertical and horizontal. If possible, the buccal part of the root, even if thin, should be preserved in the preparation of the cavity for the implant, as this will maintain gingival tissues looking fully normal for long periods. In the selection of cases for decoronation, the absence of microbial contamination in the region - represented by chronic periapical lesions, presence of fistula, old unconsolidated root fractures and active advanced periodontal disease - is important. Such situations are contraindications to decoronation. However, the occurrence of dentoalveolar ankylosis and replacement resorption without contamination should neither change the planning for implant installation, nor the criteria for choosing the type and brand of dental implant to be used. Failure to decoronate and use dental implants has never been reported.

RESUMO Áreas dos maxilares com dentes em anquilose alveolodentária e reabsorção dentária por substituição podem ser consideradas como portadoras de osso normal, em pleno processo fisiológico contínuo de remodelação; e os implantes osseointegráveis podem ser aplicados com sucesso. A remodelação óssea promoverá sua osseointegração, independentemente de haver raízes em anquilose e/ou em reabsorção por substituição. Após 1 a 10 anos, todos os tecidos dentários terão sido substituídos por osso. O local, a angulação e o posicionamento ideal no espaço para se colocar o implante devem ser ditados pela conveniência clínica associada, exclusivamente, ao planejamento prévio. Uma das vantagens da decoronação com colocação imediata de implantes em dentes anquilosados e com reabsorção por substituição é a manutenção do volume ósseo na região, tanto vertical quanto horizontalmente. Se possível, deve-se preservar, na preparação da cavidade para o implante, a parte vestibular da raiz, mesmo que fina; isso deixará os tecidos gengivais com aspecto de plena normalidade por longos períodos. O importante na seleção de casos para a decoronação é a ausência de contaminação microbiana na região, representada por lesões periapicais crônicas, presença de fístula, fraturas radiculares antigas não consolidadas e doença periodontal avançada ativa. Essas situações são contraindicações para a decoronação. A ocorrência de anquilose alveolodentária e reabsorção por substituição sem contaminação não deve mudar o planejamento para instalação de implantes, nem mesmo os critérios de escolha do tipo e marca de implante dentário a ser utilizado. Nunca foi relatado fracasso na decoronação e uso de implantes dentários.

Ankylosis of Permanent First Molar: Diagnosis by Cone Beam Computed Tomography / Anquilosis del Primer Molar Permanente: Diagnóstico por Tomografía Computarizada con Haz Cónico

ABSTRACT: Ankylosis is an anomaly of tooth eruption characterized by the fusion of cementum and alveolar bone, and may affect from small regions to the entire root surface. Clinical assessment combined with imaging exams can aid diagnosis. Radiographic testing enables assessing only proximal regions of possibly affected roots. Whereas cone beam computed tomography (CBCT) allows a three-dimensional assessment of axial, coronal, and sagittal planes of all dental extension, eliminating thus overlapping images and helping to confirm the correct diagnosis. The present study contains a case report of a male patient with ankylosis in tooth 16 diagnosed by CBCT, aiming at providing information for dentists about this anomaly, its characteristics and situations in which CBCT should be indicated.

RESUMEN: La anquilosis es una anomalía de la erupción del diente caracterizada por la fusión de cemento y hueso alveolar, y puede afectar desde pequeñas regiones hasta toda la superficie de la raíz. La evaluación clínica combinada con los exámenes de imagen puede ayudar a diagnosticar esta anomalía. Las pruebas radiográficas permiten evaluar sólo las regiones proximales de las raíces posiblemente afectadas. La tomografía computarizada de haz de cono (CBCT) permite una evaluación tridimensional de los planos axial, coronal y sagital de toda la extensión dental, eliminando así las imágenes superpuestas y ayudando a confirmar el diagnóstico correcto. En el presente estudio se presenta un reporte de caso de un paciente con anquilosis en el diente 16 diagnosticado por CBCT, con el objetivo de proporcionar información para los dentistas sobre esta anomalía, sus características y situaciones en las que debe indicarse la CBCT.

Anquilose alveolodentária e subsequente reabsorção por substituição: a colocação de implantes osseointegráveis no mesmo local pode ser feita? / Alveolodental ankylosis and subsequent replacement resorption:can osseointegrated implants be placed in the same location?

os dentes com anquilose alveolodentária naturalmente evoluirão para reabsorção por substituição e, desde que sem contaminação microbiana, devem ser considerados no contexto ósseo como mais uma das estruturas a serem remodeladas continuadamente. A remodelação constante representa uma das características mais marcantes da biologia óssea, haja vista que serve para manter estável o nível sanguíneo de cálcio e outros minerais essenciais à vida. Outra consequência da anquilose alveolodentária é a gradativa infraoclusão do dente envolvido. As áreas ósseas com raízes ou fragmentos radiculares em reabsorção por substituição, desde que livres de contaminação microbiana, podem ser incluídas nas áreas onde se farão alvéolos cirúrgicos para receber implantes osseointegráveis que não atrapalharão o processo de reparo ósseo peri-implantar mais conhecido como osseointegração. Quando contaminada por bactérias e seus produtos, a estrutura radicular deve ser eliminada para depois se avaliar o local para se indicar futuras correções de volume e forma.

Teeth with alveolodental ankylosis naturally evolve to replacement resorption. Provided that they remain free of microbial contamination, these teeth should be considered in the bone context as one more structure that should undergo continuous remodeling. Continuous remodeling is one of the most remarkable characteristics of bone biology, given that it is responsible for keeping blood calcium, as well as other minerals essential to life, levels stable. Another consequence of alveolodental ankylosis is the gradual infraocclusion of the affected tooth. Provided that free of microbial contamination, the areas of bone with root or root fragments under going replacement resorption can remain in the sites where surgical sockets are prepared to receive osseointegrated implants which shall not hinder the process of peri-implant bone repair also known as osseointegration. In the event of being contaminated by bacteria and their byproducts, the root structure should be eliminated. The remaining site should be further assessed to indicate potential corrections of volume and shape.

Algorithm for the differential diagnosis of posterior open bites: two illustrative cases.

PURPOSE: Posterior open bites can result from several causes: trauma, degenerative changes, tongue thrust habits, single-tooth ankylosis, multiple-tooth ankylosis, and/or condylar hyperplasia. Occasionally, posterior open bites are secondary to a combination of condylar hyperplasia and dental ankylosis, which can be difficult to diagnose and treat because of the large array of causative problems. MATERIALS AND METHODS: This article presents 2 unusual cases of posterior open bite secondary to multiple etiologies in adolescent male patients. A useful method of algorithmic diagnosis, treatment, and protocol is presented that was used for these cases. RESULTS: The 2 cases were successfully diagnosed and treated using the formulated algorithm for posterior open bites. CONCLUSIONS: The algorithms presented facilitate the differential diagnosis of posterior open bites with ambiguous etiology.

Analysis of failure in the treatment of impacted maxillary canines.

INTRODUCTION: In this study, we aimed to evaluate the reasons for failure of orthodontic treatment for impacted maxillary canines and to recommend measures to overcome them. METHODS: Twenty-eight patients (ages, 17.4 +/- 4.3 years) with 37 maxillary impacted canines were referred after a failed attempt to resolve the impaction. Reasons for failure were analyzed, and corrective measures undertaken. The success rate of the revised treatments and the durations of both treatments were recorded. RESULTS: The mean duration of the failed treatments was 26.2 +/- 17.2 months. The failed treatments were mostly based on plane radiographs, intra-arch dental anchorage, and elastic traction directly to the labial archwire. The major reasons for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several patients, there was more than 1 possible reason for failure. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 +/- 7.2 months. Repeat surgery was needed for 62.9% of the canines in which corrective treatment was started, mostly to redirect the ligature wires. The corrective measures included the use of 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced by dental and skeletal means. CONCLUSIONS: Inaccurate 3-dimensional diagnosis of location and orientation of impacted teeth and failure to appreciate anchorage demands were the major reasons for failure in the treatment of impacted canines.

Bifid condylar process: cases report / Proceso condilar bífido: reporte de casos

The bifid condylar process is a rare anomaly. Most of the known cases are radiographic findings, mainly in ortopantomography and nuclear magnetic resonance. The condition is usually asymptomatic, while in some cases are associated with ankylosis of the temporomandibular joint. It is reported that the presence of bifid condylar process is not determined by age and gender, but the findings are among the ages of 3 to 67 years, with the average age of 35 years. The present report presents two cases of patients with abnormalities of condylar process detectable through radiographic examination.

El cóndilo bífido es una anomalía poco común. La mayoría de los casos que se conocen son hallazgos radiográficos, principalmente en ortopantomografía y resonancia nuclear magnética. La condición es usualmente asintomática, mientras que en algunos casos se asocia con anquilosis de la articulación temporomandibular. Se reporta que la presencia de proceso condilar bífido no es determinada por edad ni género, sin embargo los hallazgos figuran entre las edades de 3 a 67 años, teniendo como promedio de edad los 35 años. En el presente reporte se presentan dos casos de pacientes con anomalía de forma del proceso condilar detectables a través de examen radiográfico.

Severe lateral open bite caused by multiple ankylosed teeth: a case report.

Multiple ankylosed teeth in a dental arch is rare and occasionally causes severe open bite. This article describes a case of severe lateral open bite caused by multiple ankylosed teeth. The patient was a 31-year-old female and her chief complaint was inadequate masticatory function on the right side. All the maxillary right teeth exhibited infraocclusion. The maxillary right first molar showed partial impaction and the maxillary and mandibular right second molars were completely impacted, although on the left side these teeth had fully erupted. CT images revealed unclear periodontal space between the alveolar bone and roots of the maxillary teeth from the incisor to the first molar on the right. To improve the masticatory function, a removable prosthetic appliance was applied to the maxillary arch. Prosthetic rehabilitation may be an effective alternative to surgical procedures such as distraction osteogenesis of the alveolar bone and subluxation of the ankylosed teeth.

Restaurações adesivas indiretas opção clínica para molares decíduos em infra-oclusão / Indirect adhesives restorations clinical option for infraoccluded primary molars

A infra-oclusão de molares decíduos é uma situação clínica que pode ser encontrada em dentes com anquilose dento-alveolar, e pode causar prejuízos ao desenvolvimento da oclusão. Este artigo apresenta uma revisão de literatura sobre etiologia, diagnóstico e seqüelas da anquilose e conseqüente infra-oclusão de molares decíduos, e um relato de caso clínico utilizando restaurações adesivas indiretas como uma possibilidade de manejo desta situação, proporcionando funcionalidade e buscando evitar a instalação de desarmonias oclusais. No relato são apresentadas as etapas clínicas e laboratoriais envolvidas na confecção das restaurações.

Interceptive management of eruption disturbances: case report.

The aim of the present report is to describe a case of a patient with eruption disturbances of an ankylosed lower primary second molar, delayed development of a maxillary permanent canine associated with an odontoma and a class III dental malocclusion. In such a case the objectives of treatment are: to prevent impaction of the lower second premolar and tipping of the lower first molar; to establish correct anterior overbite and overjet and to control the development of the permanent upper canine.

Root resorption--diagnosis, classification and treatment choices based on stimulation factors.

Etiology of different types of root resorption requires two phases: mechanical or chemical injury to the protective tissues and stimulation by infection or pressure. Injury can be similar in various types of root resorption. The selection of proper treatment is related to the stimulation factors. Intrapulpal infection is the stimulation factor in internal root resorption and external periradicular inflammatory root resorption. Adequate root canal treatment controls intrapulpal bacteria and arrests the resorption process. In cervical root resorption, infection originates from the periodontal sulcus and stimulates the pathological process. As adequate infection control in the sulcus is unlikely, removal of granulation tissue from the resorption lacuna and sealing are necessary for repair. Removal of the stimulation factor, i.e. pressure, is the treatment of choice in root resorption related to pressure during orthodontic treatment, or an impacted tooth or tumor. In ankylotic root resorption, there is no known stimulation factor; thus, no predictable treatment can be suggested. Therefore, various types of root resorptions can be classified according to the stimulation factors: pulpal infection resorption, periodontal infection resorption, orthodontic pressure resorption, impacted tooth or tumor pressure resorption, and ankylotic resorption.

Unilateral primary or secondary retention of permanent teeth, and dental malformations.

The purpose of the present investigation was to describe the dentition in subjects with local primary or secondary unilateral retention of two or more permanent teeth, and to elucidate the aetiology by comparing the regions of retention with the innervation pattern of the jaws. The material comprised radiographic dental orthopantomograms (OTP) from 12 patients with an age range of 6-18 years (six females and six males). The locations of retention and the dental morphology in the affected regions were analysed. Comparison with contralateral teeth was undertaken and the innervation pattern of the affected field was considered. Varying degrees of dental root malformation were found to be associated with primary and secondary retention. More pronounced root malformations were observed in subjects with several affected teeth. A connection between unilateral retained permanent teeth and temporary or permanent disruption of the nerve supply to the affected region is suggested.