National clinical guidelines for the management of unerupted maxillary incisors in children.

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

[Unerupted first deciduous molar located higher to the first premolar: a case report].

Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones. Of the primary teeth reported as unerupted, second deciduous molars are the teeth most frequently involved, followed by primary central incisors. At present almost no coverage is seen about the impaction of the first deciduous molar. In this case, a 4-year-old boy who presented with an impacted left maxillary first deciduous molar came to the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. This tooth, located higher to the left maxillary first premolar, was well near to the maxillary sinus. The family and medical histories were noncontributory and his physical findings were within normal limits. The mother was reported as having experienced no illness or other complications and taken no medications during pregnancy. His clinical extraoral examination was noncontributory. His clinical intra-oral examination revealed that the maxillary left first primary molar was not present. No enlargement of the area was apparent visually or on palpation. The remaining primary dentition was well aligned and in good condition. His oral hygiene was good, although there were incipient occlusal carious lesions in the mandibular second primary molars. There was no history or evidence of dental trauma. A diagnosis of a left maxillary first deciduous molar was made on the basis of the clinical and radiographic evidence. Numerous local etiologic factors have been described for impacted teeth. These include anomalous teeth, malposition, fusion with adjacent or supernumerary teeth, odontoma, dentigerous cysts, tumors, underdevelopment of the jaws, keratinized epithelial lining, hereditary conditions, and trauma. In this case, the reason for impaction was not clear. After the comprehensive clinical evaluation, treatment consisted of placement of a space maintainer, the periodic examination was indicated for the follow-up, so that early interventions, such as subsequent surgical intervention and orthodontic traction could be recommended timely to manage orofacial disfigurement and to avoid consequent problems with resultant proper functioning and good periodontal health.

Cleidocranial dysplasia syndrome (CCD) with an unusual finding in a young patient.

Cleidocranial dysplasia (CCD), an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals, presents with a wide range of variability. Dentists are often the first to encounter patients with CCD, some of whom do not show typical manifestations. Since it has similar features to other pathologies, CCD is misdiagnosed as other conditions. A 10-year-old boy suffering from CCD was misdiagnosed as having rickets and was referred for non-eruption of a few permanent teeth along with an unaesthetic facial appearance. Clinically and radiologically, a diagnosis of CCD was made. Currently, management of this patient's orofacial manifestations is underway.

Bilateral coronoid hypoplasia and complex odontoma: a rare concurrence of developmental pathology and odontogenic tumour of the mandible.

We present a rare case of concurrent bilateral coronoid hypoplasia and complex odontoma in the mandible, with replacement of missing posterior teeth in both sides of the lower jaw. A 20-year-old woman was diagnosed with bilateral occurrence of coronoid hypoplasia and unerupted complex odontoma after radiographic and histopathological examination. The patient was surgically treated with complete removal of the unerupted complex odontoma and prosthetic replacement of the missing teeth.

External manifestations of Gardner's syndrome as the presenting clinical entity.

Gardner's syndrome is an autosomal dominant disease characterised by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumours. Pathological features such as osteomas of the mandible, skull and facial skeleton are unaesthetic as well as incapacitating. We present the case of a 22-year-old man with pain and discharge from the left eye and a firm swelling in the left infraorbital region leading to proptosis of the left eye. A detailed examination of the patient led to the presence of a large osteoma in the left orbital region, multiple cystic lesion, corneal opacity and parapapillary atrophy in the left eye. Radiography revealed the presence of multiple unerupted supernumerary teeth and osteomas. Colonoscopic findings showed the presence of multiple polyps. Thus, external manifestations of the patient's facial region led to the establishment of the diagnosis of Gardner's syndrome. The importance of our case highlights the necessity of maintaining a high vigilance with regard to the occurrence of such an entity.

[Recognizing and preventing disturbances in eruption]. / Herkennen en voorkomen van eruptiestoornissen.

Disturbances in eruption and related problems are quite common in permanent dentition but rare in deciduous dentition. For the timely recognition of disturbances in eruption, knowledge of the normal development of dentition is essential. Disturbances in eruption comprise disturbances in which eruption does not occur at all, in which it is delayed or incomplete, or in which the normal direction of eruption is influenced. If identified early enough, many undesirable dental conditions can be avoided or their seriousness can be limited. A possible impacting of permanent cuspids, for example, can be avoided by extracting the deciduous cuspids at the right moment; in cases of a large overjet or the threat of a cover-bite, lip interference can be prevented.

Impaction of permanent upper canine causedby supernumerary tooth with talon cusp type III

Introduction: The talon cusp is defined as a developmental anomaly in which an accessory cusp-like structure projects in the area of the cingulum or cementoenamel junction in the anterior teeth attached to the lingual surface of the crown, ranging in size, shape, length and degree of union with the surface. Case report: This study aimed to report a case of a patient who came to Clinic for Preventive Dentistry of Federal University of Pernambuco, Recife-PE, Brazil, complaining of pain in the upper left region. The clinical exam observed the presence of a supernumerary tooth with talon cusp type III in the canine region which had a carious lesion in the developmental groove at the mesial surface and caused a prolonged retention of permanent tooth. Conclusion: With this we want to emphasize that the Dental Surgeon be aware of the changes caused by dental morphological variations, seeking to conduct a proper treatment plan, meeting the functional and aesthetic needs of the patient.

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.

Report of two Chinese patients suffering from CLCN7-related osteopetrosis and root dysplasia.

Osteopetrosis is a group of genetic bone disorders. There are three types of osteopetrosis: autosomal recessive osteopetrosis (ARO), autosomal dominant osteopetrosis type II (ADO II), and intermediate autosomal recessive osteopetrosis (IARO). The prevalence of ADO II is about 1:100,000, while no more than 20 cases of IARO have been reported worldwide. We present the first Chinese IARO patient with a novel homozygous variant in CLCN7 gene (p. Pro470Leu) and an ADO II patient with a heterozygous variant in CLCN7 gene (p. Arg286Trp). In addition to general osteosclerosis, the striking features of these two patients are unerupted teeth with root dysplasia. We speculate that ClC-7 in different tooth cells may contribute directly to the root development, the defect of ClC-7 may have a dose dependent effect on the phenotype of root dysplasia, and the tooth position may also affect the root phenotype with dysfunctional ClC-7.

Frecuencia de la posición de terceros molares incluidos en pacientes de las Cátedras de Ortodoncia I y II y Clínica integrada de la Facultad de Odontología de la Universidad Nacional de Asunción entre los años 2005-2010 / Frequency of the position of third molars in patients of the Department of Orthodontics I and II and Integrated Clinic, Faculty of Dentistry, National University of Asunción between the years 2005-2010

Los terceros molares incluídos corresponden a una de las patologías más frecuentes encontradas en cirugía oral y maxilofacial. Los terceros molares incluídos se categorizan de acuerdo a su posición y profundidad en relación al segundo molar, su proximidad con la rama ascendente de la mandíbula y su angulación hacia el molar adyacente. Su evaluación generalmente es radiográfica. Las investigaciones sobre el tema presentan resultados variables debido a las diferencias significativas regionales y raciales. Con el objetivo de determinar la frecuencia de la posición de los terceros molares incluidos, según la clasificación de Winter y la de Pell – Gregory, en pacientes que acudieron a la Facultad de Odontología de la UNA en las Cátedras de Ortodoncia I y II y Clínica Integrada entre los años 2005-2010, se planteó la realización de un estudio observacional descriptivo de corte transversal con componente analítico, temporalmente retrospectivo. Para el efecto fueron analizadas radiografías panorámicas de pacientes que acudieron a la institución en el período de tiempo fijado que evidenciaron imágenes de terceros molares incluidos. Se observó que el 54% de los molares incluidos estaban situados en la arcada inferior. Según la clasificación de Winter la mayor proporción de los molares superiores (35,7%) presentó la posición vertical y los inferiores la mesioangular (63%). Según la clasificación de Pell-Gregory las clases más frecuentes fueron la II (49%) para los superiores y la III (56%) para los inferiores. El tipo más frecuente tanto para los superiores como los inferiores fue el C, con 96% y 50% respectivamente. Se resalta la importancia de tomar medidas para un correcto diagnóstico del caso clínico, el planeamiento cuidadoso del acto quirúrgico y la prevención de las complicaciones intra y posoperatorias .

Canine transmigration: comprehensive literature review and report of 4 new Australian cases.

Canine transmigration is a rare dental anomaly unique to the mandibular arch, involving intraosseous migration of the unerupted tooth across the midline. Currently, there is a lack of consensus on the definition of transmigration. This report suggests a unified definition of transmigration, that being when a canine has crossed the midline by more than half its length. Numerous publications reporting mandibular canine transmigration therefore cannot be considered as being truly transmigrated. Here we undertake a comprehensive review of the literature, and report 4 new cases of transmigrated mandibular canines, 2 of which present with unique features. One case shows a vertically positioned transmigrated canine, whereas the other shows a horizontally transmigrated canine underlying an impacted canine. Furthermore, this cohort is the first to be reported in an Australian population.

Hypocalcified type of amelogenesis imperfecta in a large family: clinical, radiographic, and histological findings, associated dento-facial anomalies, and resulting treatment load.

OBJECTIVE: The purpose of this study was to report on the clinical, radiographic, and histological dental findings and the resulting treatment load in a five-generation family with amelogenesis imperfecta (AI). MATERIAL AND METHODS: Thirteen affected and 15 unaffected individuals were examined clinically and radiographically. In addition, four exfoliated deciduous teeth were examined by scanning electron microscopy and microradiography. RESULTS: The mode of inheritance of AI was autosomal-dominant. At eruption, most of the tooth enamel was yellow, lacking translucency, and prone to gradual loss in subjects with AI. Post-eruptive breakdown of enamel was extensive in accordance with the histological observations of hypomineralized and porous enamel. Extensive enamel loss and discoloration were observed in older affected individuals. The treatment need had been extensive: 76.2% of the total number of teeth present in affected individuals had been treated with partial or full coverage compared to 1.7% of the teeth in unaffected relatives. Unaffected individuals had more endodontically treated teeth than AI-affected relatives. Adjunctive findings, e.g. tooth agenesis, tooth impaction, pulp stones, enlarged follicular space, and taurodontism, were rare in both groups. CONCLUSIONS: Affected family members had the hypocalcified type of AI, which is characterized by severe hypomineralization, extensive post-eruptive loss, and discoloration of the enamel. Adjunctive findings were rare. Individuals with the hypocalcified type of AI have an extensive restorative treatment load compared to unaffected relatives.

A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona.

UNLABELLED: Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related. OBJECTIVES: We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered. MATERIALS AND METHODS: A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, position-axis, radiological study, surgical treatment, related pathologies, and surgical complications. RESULTS: Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding). CONCLUSION: Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%.

A importância da tomografia computadorizada volumétrica no diagnóstico e planejamento ortodôntico de dentes inclusos / The importance of volumetric computed tomography in diagnosis and orthodontic planning of impacted teeth

Nos casos ortodônticos em que há a presença de dentes inclusos, os primeiros exames complementares solicitados geralmente são as radiografias panorâmicas e periapicais para avaliação da condição do dente incluso e da relação deste elemento com os dentes e estruturas adjacentes. Porém, estes exames são bidimensionais e muitas vezes fornecem informações limitadas a respeito da real posição do dente incluso e da condição em que este se encontra. Muitas vezes, estes podem apresentar dilacerações e reabsorções imperceptíveis nos exames tradicionais. A tomografia volumétrica computadorizada permite a visualização das estruturas anatômicas em três dimensões, fornecendo muito mais detalhes e informações que serão muito úteis para o ortodontista no diagnóstico e plano de tratamento, e também para o cirurgião, que poderá determinar a melhor abordagem cirúrgica, removendo menor quantidade de osso. Esse trabalho teve como objetivo,ilustrar com caso clínico, a importância da tomografia volumétrica computadorizada no diagnóstico e planejamento do tratamento ortodôntico de dentes inclusos, ressaltando como as condutas clínicas podem ser diferentes quando se avalia o mesmo paciente com exames bi ou tridimensionais.

In orthodontic cases in which there is the presence of impacted teeth, the first complementary exams required are usually panoramic and periapical radiographs to assess the condition of the impacted tooth and the relationship of this element with the adjacent teeth and structures. However, these exams are bidimensional and they normally supply limited information about the real position of the impacted tooth and its physical condition. These could frequently present dilacerations and resorptions that are imperceptible in traditional exams. The volumetric computed tomography allows the anatomic structures to be visualized in three dimensions, providing more details and information, which are very useful to the orthodontist in diagnosing and planning treatment, as well as to the surgeon, who may determine the best surgical approach, removing a smaller quantity of bone. The aim of this study was to use a clinical case to illustrate the importance of the volumetric computed tomography in diagnosing and planning orthodontic treatment of impacted teeth, emphasizing how the clinical procedures could differ when the same patient is assessed by means of bi or tridimensional exams.

Case report: segmental odontomaxillary dysplasia--a rare disorder.

BACKGROUND: Segmental odontomaxillary dysplasia (SOD) is a rare developmental disorder of the maxilla characterised by abnormal growth and maturation of bone, teeth and gingival of the affected segment. Due to the rarity of the disorder, the full range of clinical manifestations is unknown. Since there are concerns that cases may be subject to misdiagnosis, this report aims to increase awareness of the condition among paediatric dentists. CASE REPORT: A 7-year-old boy was initially referred regarding failure of eruption of maxillary primary molars. Characteristic clinical and radiographic findings led to the diagnosis of SOD. Interestingly, the patient presented with unilateral ectopic eyelashes, a finding previously unreported in association with this condition. TREATMENT: Reassurance was provided regarding the benign nature of the condition. While no active intervention was needed at the time of diagnosis, close monitoring is essential. Future management may require surgical, orthodontic and prosthetic input. FOLLOW-UP: A period of four years elapsed between initial presentation of the condition and its definitive diagnosis. No significant increase in the unilateral maxillary swelling was noted. The patient will continue to be monitored on a regular basis. CONCLUSION: SOD is a rare cause of facial asymmetry. Prompt diagnosis can reassure both patient and healthcare professionals. Reporting of cases is encouraged to help determine the full range of clinical manifestations and establish a management protocol.

Cleidocranial dysplasia: a case report.

Cleidocranial dysplasias is an autosomal dominant disorder that presents with skeletal dysplasia. The dental manifestations are mainly delayed exfoliation of primary teeth and delayed eruption of permanent teeth, with multiple impacted supernumeraries. This report addresses the complex nature of the treatment modalities. In our patient, surgical exposure of unerupted teeth was done with orthodontic traction. Post-surgical follow-up was uneventful.

Oral health status of 207 head and neck cancer patients before, during and after radiotherapy.

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis, candidiasis, and xerostomia were evaluated during RT. Patients continued to be followed after RT for evaluation of mucositis, candidiasis, xerostomia, radiation caries, and osteoradionecrosis. For statistical analysis, 95% confidence intervals (CI) were determined using sample size, population, and percentages. Before RT, 120 (57.9%) patients presented with alterations in the oral cavity namely, 85 (41.0%) with periodontal disease, 44 (21.2%) with residual roots, 25 (12.0%) with caries, 15 (7.2%) with candidiasis, and 12 (5.8%) had an unerupted tooth present. Xerostomia was a complaint of 19 patients (9.1%). Restorations were indicated for 33 patients (15.9%), whereas extraction was indicated for 104 (50.2%) patients. During RT, mucositis was found in 80 (61.7%) patients, candidiasis in 60 (45.8%), and xerostomia was a complaint of 82 patients (62.6%). After RT, mucositis persisted in 21 patients (19.2%), candidiasis was identified in 23 patients (21.1%), and xerostomia was reported by 58 patients (53.2%). Radiation caries developed in 12 patients (11.0%), whereas six patients (5.5%) developed osteoradionecrosis. The demographic profile herein presented will be useful as baseline data to provide additional epidemiological information and to determine future measures for prevention and treatment of RT-induced complications and sequelae.