Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires.

Skeletal and dental discrepancies cause asymmetric malocclusions in orthodontic patients. It is difficult to achieve adequate functional occlusion and guidance in patients with congenital absence of a mandibular incisor due to the tooth-size discrepancy. Here, we describe the orthodontic treatment of a 22-year-old woman with an asymmetric Angle Class II malocclusion, mandibular deviation to the left, and 3 mandibular incisors. The anterior teeth and maxillary canines were crowded. We used an improved superelastic nickel-titanium alloy wire (Tomy International, Tokyo, Japan) to compensate for the asymmetric mandibular arch and an asymmetrically bent archwire to move the maxillary molars distally. A skeletal anchorage system provided traction for intermaxillary elastics, and extractions were not needed. We alleviated the crowding and created an ideal occlusion with proper overjet, overbite, and anterior guidance with Class I canine and molar relationships. This method of treatment with an asymmetrically bent nickel-titanium alloy wire provided proper Class I occlusion and anterior guidance despite the mandibular deviation to the left and 3 mandibular incisors, without the need for extractions.

[Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications]. / Überzählige Zähne im Ober- und Unterkiefer – eine interdisziplinäre Herausforderung.

Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases.

Supernumerarios / Supernumerary teeth

En este artículo se describen los supernumerarios, las diversas teorías sobre su etiología, su frecuencia y lasalteraciones que pueden producir. Además, se dan pautas para su tratamiento. Los supernumerarios son anomalías del desarrollo que se encuentran con poca frecuencia, del 0,30 por ciento al 3,80 por ciento de la población, pero en pacientes con labio ypaladar fisurado pueden llegar al 28 por ciento. Se los puede definir como dientes adicionales a la serie dental normal. Se los encuentra raramente en ladentición primaria, en esta la distribución por sexo es similar; mientras que en la dentición permanente el sexo masculino prevalece en una proporción de 2 a 1. El mesiodens es el que se encuentra con mayor frecuencia. Constituye, según Shafer y Cols, más del50 por ciento de todos los supernumerarios...

Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up.

This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.

Radiographic assessment of maxillary incisor position after rapid maxillary expansion in children with clinical signs of eruption disorder.

BACKGROUND AND OBJECTIVE: In this study we assessed the influence of rapid maxillary expansion (RME) on the intraosseous vertical position and inclination of the impacted incisors diagnosed at an early developmental stage on panoramic radiographs and subsequently treated by surgical removal of the obstacle. MATERIALS AND METHODS: Following surgical removal of the obstacles to incisor eruption (T1), a group of 34 subjects (mean age 8 years 11 months ± 11 months) underwent RME, while a group of 28 subjects (mean age 9 years 1 month ± 1 year) was monitored after surgery without further treatment. At T2 (on average 10 months after T1), the prevalence rate of subjects with erupted incisors was recorded. The measurements were taken on the panoramic radiographs at T1 and T2 to assess the vertical position and angulation of delayed unerupted incisors. RESULTS: At T2, impacted incisors erupted in 82.4% of the patients in the RME group versus 39.3% of those in the monitored group (χ(2) =8.45, p<0.001). All the patients treated with RME showed an improvement in the vertical and angular position of the unerupted teeth. Logistic regression revealed RME therapy as the only significant predictive variable (p<0.001) for successful eruption of the delayed incisors at T2. CONCLUSION: RME in early mixed dentition appears to be an effective procedure to increase the prevalence rate of impacted maxillary incisor eruption.

Tuberculate supernumerary teeth: report of a case showing typical and atypical features and the management.

Tuberculate supernumerary teeth are found in the maxillary anterior region. They usually result in oral problems such as malocclusion, food impaction, poor aesthetics and cyst formation. There is paucity of literature on this anomaly in our environment. This paper describes a case of tuberculate supernumerary teeth with typical and atypical features of supernumerary teeth in this region. Treatment is carried out with a combination of surgical and orthodontic methods. Early diagnosis and treatment of this anomaly is suggested to avoid more serious consequences and to prevent severe orthodontic complications.

Dos dientes supernumerarios en la línea media: presentación de caso / Two supernumerary teeth in the middle line: a case presentation

Un mesiodens es un diente supernumerario localizado en la región de los incisivos centrales superiores. Es el diente supernumerario más común. Representa el 50-80 por ciento del total de ellos, producen con elevada frecuencia diastema medio y retienen los incisivos permanentes que erupcionan espontáneamente después de la extracción de los mismos, si tienen espacio suficiente en la arcada y conservan la fuerza eruptiva.Objetivo: demostrar que los mesiodens en línea media no siempre se presentan asociados con diastema o retención dentaria.Caso clínico: paciente femenina de diez años de edad, que acudió a consulta por urgencia estomatológica por traumatismo a nivel de dientes antero superiores. El informe radiográfico con vista oclusal en la zona del trauma, evidenció la presencia de dos dientes supernumerarios en la línea media, de forma invertida, con sus ápices hacia incisal y coronas en posición apical con ausencia clínica de diastema. Se procedió de inmediato la reducción y ferulización del sector anterosuperior. Se dieron las indicaciones pertinentes y se indicó laserterapia. El tratamiento multidisciplinario fue de vital importancia en esta paciente, se involucraron las especialidades de Estomatología General Integral, Ortodoncia, Cirugía y Neurología pediátrica.Conclusión: se comprobó clínicamente la ausencia de diastema central maxilar y la presencia de los dientes incisivos permanentes brotados, lo que constituyó un caso no común dentro de la especialidad estomatológica

A mesiodens is a supernumerary tooth located in the upper central incisors region. It is the most common supernumerary tooth. It represents 50-80 percent of all supernumerary teeth; occur with high frequency medium diastema and retain the permanent incisors which erupt spontaneously after extraction, if they have sufficient space in the arch and preserved the eruptive force.Objective: to demonstrate that mesiodens in middle line not always are associated with diastema or tooth retention.Clinical Case: a ten years old, female patient, who was treated in the emergency unit by trauma in the anterosuperior teeth. The x-ray report with occlusal view in the area of trauma showed the presence of two inverted supernumerary teeth in the midline region, with their apices to incisal edges and crowns in apical position with clinical absence of diastema. Reduction and splinting of anterosuperior area was proceeded immediately. The patient was instructed as requested and laser therapy was suggested. A multidisciplinary treatment was crucial in this case, involved specialists in Comprehensive General Dentistry, Orthodontics, Surgery, and Pediatric Neurology

Non-syndromic occurrence of true generalized microdontia with mandibular mesiodens - a rare case.

Abnormalities in size of teeth and number of teeth are occasionally recorded in clinical cases. True generalized microdontia is rare case in which all the teeth are smaller than normal. Mesiodens is commonly located in maxilary central incisor region and uncommon in the mandible. In the present case a 12 year-old boy was healthy; normal in appearance and the medical history was noncontributory. The patient was examined and found to have permanent teeth that were smaller than those of the average adult teeth. The true generalized microdontia was accompanied by mandibular mesiodens. This is a unique case report of non-syndromic association of mandibular hyperdontia with true generalized microdontia.

Cinco dientes supernumerarios retenidos: presentación de un caso / Five supernumerary teeth retained: a case presentation

Los dientes supernumerarios se refieren a una condición caracterizada por la presencia de un número de dientes superior al normal en los maxilares. El diagnóstico y tratamiento de estas piezas se hace necesario para evitar complicaciones posteriores que pudieran alterar el arco dental. Se presenta el caso de un paciente masculino de 18 años que acude a consulta de cirugía máxilo facial por presentar Síndrome Doloroso Facial, sin causa aparente, al que se le diagnostican 5 dientes supernumerarios retenidos. Se realiza exéresis de los mismos. La evolución es satisfactoria

Supernumerary teeth refer to a condition characterized by the presence of a number of teeth higher than normal in maxillaries. The diagnosis and treatment of these parts is necessary to avoid further complications that could change dental arch. An 18 years male patient case is presented who came to Maxillofacial consultation for presenting Facial Pain Syndrome, without apparent cause, which was diagnosed five supernumerary teeth retained. The exerethis of these are carried out

Evaluation of facial asymmetry using soft-tissue thickness for forensic purposes / Evaluación de la asimetría facial mediante el grosor de tejidos blandos para propósitos forenses

Facial reconstruction for forensic sculpture aims to reproduce the face of an individual for identification. This technique is based on the knowledge of the facial soft-tissue thickness, which differs in terms of sexual dimorphism. However, in terms of asymmetry, the real significance of the soft-tissue thickness on both sides of the face is not considered to make an approximation of the morphofacial characteristics of an individual. This study analyzed the facial tissue thickness of 32 adult Spanish corpses of both sexes in six bilateral cephalometric landmarks through the needle puncture technique, comparing the measurements of right and left sides. No significant differences were found when comparing the soft-tissue thickness on the right and left sides in the total sample (p <0.05), or when comparing the values in men and women (p<0.05). The facial morphology is created by internal and external forces exerted on the soft tissue and influenced by their evolutionary development in vivo, where asymmetry parameters have a genetic and muscular determination, which in normal individuals do not represent a significant difference in the process of reconstruction of forensic sculpture, and can reliably standardize the entire information of facial thickness to the right or left side of the face.

La reconstrucción facial por escultura forense tiene por finalidad reproducir el rostro de un individuo para su identificación. Esta técnica se sustenta en el conocimiento del grosor del tejido blando facial; el cual presenta diferencias en términos de dimorfismo sexual. Sin embargo, en términos de asimetría, no se ha considerado la real significancia del espesor de tejido blando a ambos lados del rostro al realizar una aproximación de las características morfofaciales de un individuo. En este estudio se analizaron los grosores tisulares faciales de 32 cadáveres españoles adultos de ambos sexos en 6 puntos cefalométricos paramedianos bilateralmente mediante el método de punción por agujas, comparando las mediciones del lado derecho e izquierdo. No se encontraron diferencias significativas al comparar el espesor del tejido facial en el lado derecho e izquierdo en el total de la muestra (p<0,05), así como al comparar los valores en hombres y mujeres (p<0,05). La morfología facial es creada in vivo por fuerzas internas y externas ejercidas sobre el tejido blando e influenciada por su desarrollo evolutivo, donde parámetros de asimetría tienen una determinación genética y muscular, que en individuos normales no representan una diferencia significativa para el proceso de reconstrucción por escultura forense, pudiendo homologar de manera confiable la totalidad de la información del grosor facial del lado derecho o izquierdo del rostro.

Plano inclinado: una solución rápida y económica / Inclined plane: an economic and fast solution

Debido a la creciente demanda de tratamientos de ortopedia que se han generado en los últimos años en el Servicio de Odontología del Hospital Interzonal Especializado Materno Infantil Don Victorio Tetamanti, se hizo nedesario que los residentes intervinieran tomando de la lista de espera niños con palatoversión anterior. Ellos fueron tratados mediante planos inclinados, aparatos confeccionados por los profesionales con el fin de evaluar efectividad y reducir la demanda en forma rápida y económica.

Tratamiento en sala de operaciones de dientes supernumerarios, inclusiones dentarias y quiste dentígero asociado / Operating room treatment of supernumerary teeth, dental inclusions and associated dentigerous cyst

Los dientes supernumerarios y las inclusiones de dientes permanentes son muy frecuentes en la infancia. Algunos dientes incluidos pueden estar asociados a la presencia de quistes dentígeros. Reportamos el caso de un paciente de sexo masculino de once años de edad con presencia de tres dientes supernumerarios en el maxilar superior, inclusión dentaria de pieza 11 e inclusión dentaria de pieza 13 con quiste dentígero asociado. El motivo de consulta fue precisamente la falta de las piezas 11 y 13 en boca. Al examen clínico intraoral presentaba: gingivitis generalizada asociada a placa bacteriana, caries dental, ausencia clínica de piezas 11 y 13, aumento de volumen en palatino a nivel de piezas 11 y 12. Al examen radiográfico se observó que las piezas ausentes en boca se encontraban incluidas y los tres dientes supernumerarios fueron hallazgos radiográficos. El tratamiento quirúrgico se realizó bajo anestesia general. El diagnóstico temprano y tratamiento multidisciplinario fueron de vital importancia.

Supernumerary and impacted permanent teeth are common in children. Some impacted teeth may be associated to dentigerous cysts. We report a case of an eleven years old male patient with presence of three supernumerary teeth in the maxilla; tooth 1.1 impacted, and 1.3 impacted associated to dentigerous cyst. The chief complaint was precisely the lack of 11 and 13 in mouth. Intraoral examination showed: generalized gingivitis associated to dental plaque, dental caries, clinical absence of 11 and 13, and increased volume on the palatal area at 12 and 11. The radiographic examination revealed that 11 and 13 were impacted, and the three supernumerary teeth were a radiographic findings. Surgical treatment was performed under general anesthesia. Early diagnosis and multidisciplinary treatment were vital.

Pré-molares supranumérários tardios: intercorrência remota no período pós-traumático ortodôntico / Late-developing supernumerary premolars: remote intercurrence in the post-orthodontic treatment period

O presente artigo discorre sobre o surgimento de pré-molares supranumerários tardios e revisa a literatura pertinente. Dois relatos de casos clínicos ilustram o texto. No intuito de evitar consequências imprevisíveis, o tratamento indicado consiste na extração dos elementos supranunerários.

Multi-lobed mesiodens with a palatal talon cusp: a rare case report

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch and the talon cusp is a rare dental developmental anomaly seen on the lingual surface of anterior teeth. This paper presents a rare clinical case of development of talon cusp in a mesiodens with multiple lobes, which interfered with both occlusion and appearance of an 11-year-old patient. During clinical interview, the patient reported difficulty on mastication. Clinical and radiographic examination revealed that a supernumerary tooth with completely formed root was causing an occlusal interference. The supernumerary tooth was diagnosed as multi-lobed mesiodens associated with a palatal talon cusp. The treatment plan consisted in the extraction of the supernumerary tooth followed by orthodontic treatment for diastema closure and tooth alignment.

Mesiodens é um dente supranumerário mais comumente visto no arco maxilar na linha média, e a cúspide em garra (talon cusp) é uma anomalia dental de desenvolvimento rara que ocorre na face lingual de dentes anteriores. Este artigo apresenta um caso clínico raro de desenvolvimento de uma cúspide em garra em um mesiodens multilobulado que causava interferência tanto na oclusão quanto na aparência de um paciente de 11 anos de idade. Durante a entrevista clínica, o paciente relatou dificuldade na mastigação. Exame clínico e radiográfico revelou que um dente supranumerário com raiz completamente formada estava causando interferência oclusal. O dente supranumerário foi diagnosticado como sendo um mesiodens multilobulado associado a uma cúspide em garra palatina. O plano tratamento consistiu na extração do dente supranumerário seguida de tratamento ortodôntico para fechamento de diastema e alinhamento dos dentes.

Dientes supernumerarios: presentación de dos casos / Supernumerary teeth: a two-case report

Los dientes supernumerarios se refieren a una condición caracterizada por la presencia de un número de dientes superior al normal en el arco dental. Motivados por el tema y la asistencia de estos casos a las consultas de Estomatología se realiza este trabajo para actualizar y concretar conocimientos sobre los dientes supernumerarios. En este trabajo se discuten dos casos en menores de 15 años, del sexo masculino, en los cuales el plan de tratamiento sugerido fue la exodoncia después de ser interconsultados por el Ortodoncista del Área de Salud.

The supernumerary teeth refer to a condition characterized by the presence of a number of teeth higher to the normal one in the dental arc. Motivated by this subject and the presence of these cases to the Stomatology office was carried out this work to update and to synthesize knowledge on the supernumerary teeth. In this work two cases are discussed about minors under 15 years old, of male sex, to whom an exodoncy was done after the interconsultation with the orthodontist of the healthcare area occurred.

Aspectos singulares no tratamento ortodôntico do mesiodens / Uncommon aspects in the mesiodens orthodontic treatment

Os dentes supranumerários são aqueles que excedem o número normal nas dentaduras decídua e permanente, e resultam, provavelmente, da proliferação contínua da lâmina dentária. Essa anomalia de número tem predileção pelo gênero masculino, na proporção de 2:1. Na dentadura permanente, o supranumerário mais frequente ocorre entre os incisivos centrais superiores, sendo denominado mesiodens. O diagnóstico é confirmado por meio de exame radiográfico e o tratamento ideal é a extração, quando possível, em fase precoce, para a prevenção de alterações na oclusão dentária estética do sorriso. O presente trabalho apresenta o tratamento ortodôntico de um paciente com mesiodens e má oclusão de Classe II, por meio da extração dos pré-molares superiores, do mesiodens e aplicação de biomecânica diferenciada. Resultado final satisfatório foi obtido e mantido na fase de contenção.

Dientes supernumerarios en la dentición mixta diagnóstico y tratamiento / Supernumerary teeth in the mixed dentition diagnosis and treatment

El objetivo de este artículo es relatar casos clínicos de dientes supernumerarios que se presentan en la clínica odontopediátrica y las alternativas de solución de acuerdo al caso, que puede ser con una simple extracción ó con un tratamiento quirúrgico.

The objetive of this case presentation is to describe clinical cases of supernumerary teeth can be found dentistry clinic and the alternative for solution, that can be a simple extraction or a surgical treatment.

Treatment of dental anomalies in children with complete unilateral cleft lip and palate at SickKids hospital, Toronto.

OBJECTIVE: To quantify dental anomalies in permanent dentition associated with complete unilateral cleft lip and palate and to survey treatment modalities used to address these problems. METHOD: Retrospective study of 116 children with complete unilateral cleft lip and palate treated at SickKids since birth. Presence and morphology of lateral incisors and second premolars were determined. Orthodontic, surgical, and/or prosthetic procedures were analyzed. RESULTS: The cleft-side lateral incisor was absent in 93.1% of finished cases. The lateral incisor mesial to the cleft was present in 4.3%, absent due to agenesis in 75.9%, and extracted in 19.8% of cases. The lateral distal to the cleft was present in 2.6%, absent due to agenesis in 33.6%, and extracted in 63.8% of cases. Of 105 lateral incisors, only one had normal morphology. Noncleft-side lateral incisors were absent in 16% of finished cases. Absence was due to agenesis in 12.1% of cases and extraction in 4.3%. When the lateral incisor was missing, closure of the dental space occurred by orthodontic tooth movement after alveolar bone grafting (45%); surgical closure with simultaneous alveolar bone grafting (35%); prosthetic closure (17%); and 3% were failures. Agenesis of premolars occurred in 12.1% of cleft-side and 10.3% of noncleft-side maxillary second premolars. CONCLUSIONS: The cleft-side lateral incisor is rarely present at the conclusion of orthodontic and surgical treatment of complete unilateral cleft lip and palate. Often absent due to agenesis, when present it is typically abnormal in size and bone support and is commonly extracted in favor of canine substitution.

Impacted maxillary central incisor, canine, and second molar with 2 supernumerary teeth and an odontoma.

This report describes the orthodontic treatment of a 14-year-old boy who had 3 impacted maxillary teeth (right canine, left central incisor, and left second molar), 2 supernumerary teeth, and an odontoma. The treatment protocol involved surgical intervention followed by sequential traction of the 3 impacted teeth. The patient's smile dramatically improved after orthodontic treatment. Good posterior occlusion was achieved. However, long-term monitoring of the stability and periodontal health is critical.