Analysis of congenital deciduous teeth absence and its permanent teeth phenotype.

OBJECTIVES: This study aimed to investigate the clinical characteristics of congenital deciduous teeth absence and its permanent teeth performance type by using panoramic radiographs. METHODS: A total of 15 749 panora-mic radiographs of 3-6-year-old children with deciduous dentition were collected from January 2020 to December 2021. The incidence of congenital deciduous teeth absence was observed, and the abnormality of permanent teeth was recor-ded. SPSS 24.0 software was used for statistical analysis. RESULTS: The incidence of congenital deciduous teeth absence was 2.54% (400/15 749), which was found in 217 girls and 183 boys, and the difference between the genders was statistically significant (P=0.003). The absence of one and two deciduous teeth accounted for 99.75% (399/400) of the subjects. In addition, 92.63% (490/529) of mandibular deciduous lateral incisor was congenitally absent, 44.80% (237/529) of deciduous teeth was absent in the left jaw, and less than 55.20% (292/529) was absent in the right; the difference between them was statistically significant (P=0.017). The absence of 96.41% (510/529) deciduous teeth in the mandibular was significantly more than that of 3.59% (19/529) in the maxillary, and the difference between was statistically significant (P=0.000). Furthermore, 68.00% (272/400) and 32.00% (128/400) of deciduous teeth were absent in unilateral and bilateral, respectively, and the difference was statistically significant (P=0.000). Four types of congenital deciduous teeth absence with permanent teeth were observed as follows: 1) 73.91% (391/529) of permanent teeth was absent; 2) 20.60% (109/529) of permanent teeth was not absent; 3) the number of fused permanent teeth accounted for 4.91% (26/529); 4) the number of supernumerary teeth was 0.57% (3/529). CONCLUSIONS: Although the absence of congenital deciduous teeth is less common than that of permanent teeth, it affects deciduous and permanent teeth to some extent. Dentists should pay attention to trace and observe whether abnormalities are present in the permanent teeth and take timely measures to maintain children's oral health.

Macrodontia and double teeth: a review and case series.

Macrodontia is a dental anomaly pertaining to the increased size of a tooth or multiple teeth. Double teeth are dental abnormalities concerning tooth morphology and the term traditionally refers to geminated or fused teeth. These anomalies may manifest in both primary and permanent dentitions and usually become apparent in childhood. They may cause a variety of clinical sequelae, including orthodontic complications, such as crowding, ectopic eruption of adjacent teeth and periodontal concerns. Double teeth are also at a higher risk of developing caries. The aesthetic implications of these dental anomalies can affect the psychosocial development of a patient. This, together with the range of functional repercussions, can often need dental treatment to improve quality of life. The functional and aesthetic complexities that may arise in the affected patients can require endodontic, restorative, surgical and/or orthodontic input as part of the management strategy and execution. We present four clinical cases of paediatric patients where a range of management approaches were employed for both macrodontia and double teeth.

[Considerations of the classification and treatment for fused teeth].

Fused teeth were a phenomena of teeth anomalies in shape, which can affect the dental teeth both in primary and permanent dentition. Fused teeth do not only cause problems on crowding of dentition, abnormal occlusion and aesthetic, but also increase risks of dental caries, endodontics diseases, periapical diseases and periodontal diseases. Fusion of deciduous teeth may lead to abnormality of subsequent permanent teeth. Treatment of fused teeth may require multidisciplinary approach in endodontics, periodontics, oral and maxillofacial surgery, prosthodontics and orthodontics. The aim of the present article is to review the etiology, classification, clinical manifestations and treatment of fused teeth in order to provide dental clinicians with a reference of clinical management for fused teeth.

Dental pathologies in lamniform and carcharhiniform sharks with comments on the classification and homology of double tooth pathologies in vertebrates.

Double tooth pathologies are important indicators of trauma, disease, diet, and feeding biomechanics, and are widely documented in mammals. However, diagnosis of double tooth pathologies in extinct non-mammalian vertebrates is complicated by several compounding factors including: a lack of shared terminology reflecting shared etiology, inconsistencies in definitions and key features within and outside of mammals (e.g., gemination, fusion, twinning, concrescence); differences in tooth morphology, heterodonty, regeneration, and implantation between mammals and non-mammalian vertebrates; and the unmet need for diagnostic criteria that can be applied to isolated teeth, which are common in the fossil record. Here we report on double tooth pathologies in the lamniform and carcharhiniform Cenozoic sharks Otodus megalodon (NCSM 33639) and Carcharhinus leucas (NCSM 33640, 33641). All three teeth bear a singular bifid crown with mirrored halves and abnormal internal microstructure-a single, bifurcating pulp cavity in C. leucas and a more than tripling of vessels in O. megalodon (from two to seven main ascending canals). We identify these abnormalities as likely examples of gemination due to their symmetry, which rules out fusion of tooth buds in one tooth file in different developmental stages in polyphyodont taxa; however, we note that incomplete forms of mesiodistal tooth fusion can be morphologically indistinguishable from gemination, and thus fusion cannot be rejected. We further compile and recategorize, when possible, the diversity of tooth pathologies in sharks. The identification of double tooth pathologies in O. megalodon and C. leucas has paleobiological implications. Such pathologies in sharks are largely hypothesized to stem from trauma to developing tooth buds. Carcharhinus leucas is known to feed on prey documented to cause feeding-related oral traumas (e.g., rays, sawfish, spiny fish, and sea urchins). However, O. megalodon, is considered to have largely fed on marine mammals, and perhaps turtles and/or fish, raising the possibility that the dietary diversity of this species is, as of yet, underappreciated. The genetic underpinnings of tooth morphogenesis and regeneration is highly conserved throughout vertebrate evolution, suggesting a homologous framework can be established. However, more research is needed to link developmental, paleobiological, and/or paleoenvironmental factors to gemination/fusion in polyphyodont taxa. We argue that the definitions and diagnostic criteria for dental pathologies in vertebrates require standardization in order to advance macroevolutionary studies of feeding trauma in deep time.

Management of Fused Anterior Teeth: Review and Clinical Report.

The phenomenon of fusion is a type of tooth dysplasia, but few studies have systematically described the treatment of this kind of abnormality. This paper summarizes the treatment methods for fused teeth and classifies the management schemes according to whether the pulp is fused. Then, the treatment for a patient with bilateral anterior tooth fusion is reported. After orthodontic treatment, porcelain veneers were used to restore the normal shape and aesthetic appearance of the anterior teeth.

Double Gemination or Fusion of a Permanent Mandibular Second Molar: A Case Report.

Gemination and fusion are developmental conditions affecting the shape of teeth in both primary and permanent dentition. A 12-year-old girl presented for clinical assessment and the examination revealed an unusually shaped mandibular right second molar with irreversible pulpitis. Correlation of the intraoral and radiological appearance of this tooth suggested a diagnosis of either double gemination or fusion. The favourable position of the developing third molar supported early extraction of the abnormal second molar. The present report documents the clinical and radiological presentation of a mandibular second molar with an unusual developmental alteration in shape. Well-timed extraction therapy and good communication may reduce the need for unnecessary, complex treatment.

Fusión del tercer molar inferior con un cuarto molar: reporte de tres casos / Fusion of the lower third molar with a fourth molar: report of three cases

Los dientes supernumerarios y la fusión dental son anomalías del desarrollo dental cuyas causas aún no se han dilucidado con certeza. El cuarto molar inferior, también denominado distomolar, es uno de los dientes supernumerarios con menor frecuencia de aparición clínica y su fusión con el tercer molar es una condición todavía menos común. A continuación, se reportan los casos clínicos de tres pacientes masculinos que presentaron fusión del tercer molar inferior derecho con un distomolar tratados mediante odontectomía (AU)

Supernumerary teeth and dental fusion are abnormalities of dental development whose causes have not yet been elucidated with certainty. The lower fourth molar, also called distomolar, is one of the supernumerary teeth with the least frequency of clinical appearance and its fusion with the third molar is an even less common condition. Next, the clinical cases of three male patients who presented fusion of the right lower third molar with a distomolar treated by odontectomy are reported (AU)

Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3-5-year-old children in Ile-Ife, Nigeria.

BACKGROUND: To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3-5-year-old children resident in Ile-Ife, Nigeria. METHODS: This was a cross-sectional study. We analyzed data for 3-5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0-5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status. RESULTS: Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91-4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92-4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance. CONCLUSIONS: Enamel hypoplasia and hypomineralized second primary molars are developmental dental anomalies associated with ECC. developmental dental anomalies also increases the probability of having poor oral hygiene in the population studied.

Hypodontia of mandibular incisors: considerations on the orthodontic treatment

ABSTRACT Hypodontia is the most prevalent craniofacial malformation in mankind. It may present a wide variety of manifestations and, depending on the number and location of missing teeth, it may affect the esthetics, mastication, speech and occlusal balance. This paper discusses the therapeutic approaches to solve this condition, describing a case report with hypodontia of one mandibular lateral incisor, which treatment option included space closure at the region of hypodontia associated with composite resin restorations in the mandibular central incisors. The three-year follow-up after treatment revealed occlusal stability, adequate intercuspation in Class I relationship and excellent micro and macroesthetics.

Resumo A agenesia dentária é a malformação craniofacial mais prevalente em humanos. Pode apresentar uma grande variedade de manifestações e, dependendo do número e localização dos dentes ausentes, pode afetar a estética, a mastigação, a fala e o equilíbrio da oclusão. Neste artigo, serão discutidas as propostas terapêuticas para resolução dessa condição e será descrito um caso clínico com agenesia de um incisivo lateral inferior, cuja opção de tratamento foi o fechamento do espaço remanescente da agenesia, associado ao incremento de resina composta nos incisivos centrais inferiores. No acompanhamento por três anos após o tratamento, verificou-se estabilidade oclusal, adequada intercuspidação em Classe I e excelente micro e macroestética.

Targeted Endodontic Microsurgery: A Novel Approach to Anatomically Challenging Scenarios Using 3-dimensional-printed Guides and Trephine Burs-A Report of 3 Cases.

Endodontic microsurgery (EMS) techniques have increased success rates over traditional approaches. Despite surgical advances, anatomically challenging scenarios can preclude EMS in certain cases. The aim of this article was to introduce targeted EMS, which uses 3-dimensional-printed surgical guides (3DSGs) and trephine burs to achieve single-step osteotomy, root-end resection, and biopsy in complex cases. In each of 3 cases, a 3DSG with a trephine port was printed using computer-aided design/computer-aided manufacturing implant planning software. The osteotomy site, angulation, and depth of preparation were defined preoperatively to avoid sensitive anatomic structures. The 3DSG was inserted at the target site to achieve precise osteotomy and root-end resection during surgery. A hollow trephine rotated within the 3DSG port produced single-step osteotomy, root-end resection, and biopsy. Root-end preparation and fill were accomplished, and tissues were sutured in place. Targeted EMS potentiated successful surgical treatment in 3 anatomically challenging scenarios: (1) a palatal approach to the palatal root of a maxillary second molar, (2) a facial approach to a fused distofacial-palatal root of a maxillary first molar, and (3) a mandibular second premolar in close proximity to the mental foramen. Trephine burs guided by 3DSGs produce efficient targeted osteotomies with a predictable site, angulation, and depth of preparation. Apical surgery in challenging anatomic cases such as the palatal root of the maxillary second molar, fused molar roots, and root ends in approximation to the mental nerve are possible with targeted EMS.

A case of concrescent tooth-A developmental anomaly in a 19th century skull from Uganda.

Dental abnormalities in archeological material such us concrescence or odontoma are rare cases often found accidentally, mostly during routine X-ray analysis or during macroscopic examination of the mastication apparatus. In this study, we present a rare case of concrescence between an upper left third molar and a supernumerary fourth molar in a 19th century skull from Uganda. Simultaneously, it is a critical revision of earlier studies on the same object (which considered this abnormality as an odontoma), using dental X-ray imaging and histological analysis. Concrescence is a rare dental anomaly and this specimen is, to the best of our knowledge, the first such case reported in paleopathological studies of Eastern Africa. It may contribute to recognition and identification of etiopathogenetic factors in dental developmental defects in historical and contemporary populations of Africa.

Clinical and radiographic evaluation of double teeth in primary dentition and associated anomalies in the permanent successors.

OBJECTIVE: Understanding potential problems associated with primary double teeth (PDT) are important to provide prophylactic measures, thereby preventing or minimizing possible complications. The purposes of this study were to investigate the prevalence of PDT in a group of Turkish children and to compare the distribution of the different types of double primary teeth and their relationship to permanent successors. MATERIALS AND METHODS: A total of 17,268 children underwent a clinical examination to determine the presence of PDT. One hundred fifty-two PDT of 128 children were included in this study. All the 128 children with PDT underwent a clinical examination and had photographs taken at the time of the examination. The children underwent a further periapical or panoramic radiographic examination to determine the status of the underlying permanent successors. The PDT was classified according to Aguilo's classification. RESULTS: The prevalence of PDT was 0.74%, with no significant statistical difference between the sexes. PDT was most frequently observed between the mandibular lateral incisors and canines. Of the 152 PDT, 10.7% were Type I, 15.3% were Type II, 26.1% were Type III, and 47.9% were Type IV. Dental anomalies on the succedaneous permanent teeth were diagnosed in 69.4% of the children with affected primary dentition. Aplasia of the permanent lateral incisor was observed most frequently in association with Type I (52.7%) PDT. Caries involvement was observed most frequently in Type III (56.2%) PDT. CONCLUSION: The findings of this study have clinical relevance for the diagnosis of children with PDT. Early clinical and radiographic identification of PDT can help the clinician to evaluate the number and condition of permanent successors and draw up a proper treatment plan.

Caracterización de la Impactación de Segundos Molares Mandibulares Permanentes en una Población Sudamericana / Characterization of Permanent Mandibular Second Molars Impaction in a Southamerican Population

El objetivo de este estudio fue describir las características epidemiológicas de segundos molares mandibulares permanentes impactados unilateralmente en una muestra de la ciudad de Medellín, Colombia. Se trató de un estudio retrospectivo en el cual se evaluaron radiografías panorámicas de 6785 pacientes, de las cuales se analizaron un total de 28 radiografías en la muestra final. Fueron correlacionados el segundo molar mandibular impactado (grupo de estudio) y el contralateral no impactado (grupo control) con respecto a tres ángulos de referencia (intermolar, del plano oclusal e interplanar), el sexo y lado de impactación. Se encontró una prevalencia de 3,5 por cada 1000 radiografías evaluadas. El lado de mayor impactación fue el derecho; dos de los tres ángulos analizados (intermolar e interplanar) fueron los que arrojaron las diferencias más grandes entre el grupo de estudio y el grupo control. No se encontraron diferencias estadísticamente significativas según el sexo. Se concluyó que la prevalencia de segundos molares mandibulares permanentes impactados es baja, siendo mayor en el lado derecho, sin diferencias por sexo, y de preferencia el uso del ángulo interplanar como medida para la evaluación del riesgo de impactación (>7,9°).

The objective of this study was to describe the epidemiological characteristics of unilateral permanent mandibular second molars impacted, in a sample from Medellín, Colombia. It was a retrospective study in which we evaluated panoramic radiographs of 6785 patients, for a total of 28 radiographs analyzed in the final sample. The mandibular second molar impacted (study group) and the contralateral not impacted (control group) were correlated, with respect to three reference angles (intermolar, of the oclussal plane and interplanar), sex and impaction side. We found a prevalence of 3.5 for every 1000 radiographs evaluated. The most frequent side of impaction was the right side; two of the three angular measurements (intermolar and interplanar) had the biggest differences between the study and control group. We did not find significant statistical differences between males and females. It was concluded that the prevalence of impacted permanent mandibular second molars is low, there is a highest impaction in the right side, there are no differences between genders, and the use of the interplanar angle is preferable as a measurement to predict the impaction of permanent mandibular second molars (>7.9°).

Rehabilitación de dientes anteriores deciduos supernumerarios y fusionados. reporte de caso / Rehabilitation of deciduous anterior supernumerary and fused teeth. case report

Los dientes supernumerarios son definidos como cualquier diente adicional a la serie normal, son poco frecuentes en la dentición decidua; sin embargo, son considerados como una de las anomalías más significantes, más aún si se encuentran fusionados. La fusión dental es una anomalía que consiste en la unión de uno o más gérmenes dentarios adyacentes. Launión se da por medio del esmalte y la dentina dando como resultado un diente único. Se reporta el caso de una niña de 5años de edad que acude a la Clínica de Odontopediatría de la Universidad Científica del Sur con problemas de autoestimay bullying de sus pares a causa de su pobre condición y apariencia dental. Al examen clínico extra oral se observa que laniña muestra sonrisa de labio cerrado. Al examen clínico intra oral se observan múltiples caries y en la zona anterosuperior lesiones de caries activas con compromiso pulpar y zonas de lesiones detenidas de color obscuro y un diente supernumerario fusionado a pieza 51. Se realiza el tratamiento de pulpectomías en pieza 51 y supernumerario fusionado en unasesión y se procede a la rehabilitación estética mejorando la autoestima de la paciente después del tratamiento.

Supernumerary teeth are defined as any additional tooth to the normal series. They are rare in deciduous dentition; however, they are considered one of the most significant anomalies, even more if they are fused. Dental fusion is an anomalycaused by the union of one or more adjacent tooth germs. Joint occurs through the enamel and dentin resulting in asingle tooth. We report the case of a five years old girl who arrived to the Pediatric Dentistry Clinic of Universidad Cientí-fica del Sur with self-steem problems and bullying among friends because of her poor condition and dental appearance. Extra-oral clinical examination showed that the girl presented smile closed lip. By the other side, the intraoral clinical examination pointed out multiple cavities, inactive carious lesions at anterior upper teeth with evident pulpar lesion andareas of inactive lesions of dark color and a supernumerary tooth fused with 51 tooth. Pulpectomies in 51 tooth and supernumerary fused were done. Then, the aesthetic rehabilitation was completed improving the patient’s self-esteem.

Reabilitação do incisivo central decíduo fusionado ao supranumerário: relato de caso clínico / Primary maxillary right central incisor fused to supernumerary: case report

diagnosticadas precocemente. Este trabalho teve como finalidade relatar o caso clínico de uma paciente de três anos, gênero feminino, cuja queixa principal era a estética dos dentes anteriores superiores,devido ao tamanho desproporcional de um elemento dentário, que se apresentava também com coloração alterada. Ao exame clínico e radiográfico diagnosticou-se uma anomalia denominada fusão dentária, união de dois dentes adjacentes, na região anteros superior. O tratamento consistiu na secção dos dois dentes e exodontia do supranumerário, seguida do tratamento restaurador do incisivo central direito que apresentava lesão de cárie. Concluiu-se que, por meio de adequado diagnóstico e planejamento, o tratamento proposto foi efetivo na reabilitação da função e da estética,assim como na prevenção de complicações clínicas e ortodônticas que poderiam advir da anomalia dentária descrita, caso não tratada. A autoestima da criança foi restabelecida.

Dental anomalies can cause serious disorders in the development of teeth if not diagnose dearly. This study aimed to report a case of a three-year-old patient, female, who together with her responsible, whose main complaint was the aesthetics of the upper front teeth due to disproportionatesize and altered staining. During the clinical and radiographic examinations, ananomaly called teeth merger, which is the union of two adjacent teeth, was diagnosed in the upper anterior region. The treatment included the sectioning of the two teeth and extraction of the super numerary, followed by restorative treatment of the right central incisor that had caries lesions. It was concluded that, through proper diagnosis and planning, the proposed treatment was effective in the rehabilitation of function and aesthetics, as well as in the prevention of clinical and orthodontic complications that could result from the dental anomaly described, ifuntreated. The child’s self-esteem was re-established.

Prosthodontic Rehabilitation for a Patient with Ellis-Van Creveld Syndrome: A Case Report.

Patients suffering from Ellis-Van-Creveld syndrome are a challenge for dental management. Aesthetics are a major concern with limited manual dexterity, making choice of treatment critical. A 38 year old female diagnosed with Ellis-Van-Creveld syndrome presented with stained teeth and un-aesthetic smile and related that to her low self-esteem and depression. Intra-oral examination revealed mal-aligned megadont central incisors in the maxillary arch, fused mandibular canines with laterals and missing central incisors with space discrepancy and pronounced reverse over jet and overbite. Treatment involved non-surgical periodontal management, fabrication of veneers and dentine bonded crowns for maxillary anteriors and fixed-fixed resin retained bridge for mandibular arch.

Unusual finding of concrescence.

Concrescence is a rare dental anomaly whereby adjacent teeth are united by cementum. It has been reported to occur in around 0.8% of permanent dental extractions and a correct diagnosis prior to surgical intervention is important to ensure that patients can make an informed decision about their treatment and to reduce the potential for dentolegal action against the responsible clinician. An 83-year-old woman was referred to the Oral and Maxillofacial Surgery Department at the Wirral University Teaching Hospital, for extraction of her upper left first molar tooth. The operator noted that, when the upper left first molar was extracted, the upper left second molar tooth was also removed. Clinically, the roots of the adjacent teeth appeared fused and a diagnosis of concrescence was established. The patient was informed of the complication and provided with a 1-week review appointment, at which stage she was discharged.

Evaluation of the internal anatomy and instrumentation techniques with new mechanized instrumentation systems in second mandibular molars with fused roots / Avaliação da anatomia interna, instrumentação e técnicas de retratamento com novos sistemas mecanizados de instrumentação em segundos molares inferiores com raízes fusionadas

O objetivo deste estudo foi analisar por meio da microtomografia computadorizada os aspetos morfológicos e morfométricos da anatomia interna do sistema de canais radiculares com formato em C, e, avaliar a área de superfície, volume e áreas do canal não instrumentadas antes e após a instrumentação dos canais por meio de sistemas alternativos de instrumentação mecanizada, assim como, analisar o efeito de instrumentos manuais com movimento de 90º-oscilatório como instrumentação final. Cinquenta e dois segundos molares inferiores extraídos com canais em forma de C foram escaneados usando micro tomografia computadorizada. As secções transversais do canal radicular foram registradas de acordo com a classificação modificada de Melton. Os parâmetros morfométricos e a configuração tridimensional, foram avaliadas. Depois, 20 dentes com anatomias convergentes e configuração interna C1 foram divididos em dois grupos (n = 10) e instrumentados com Reciproc e SAF respectivamente. Em seguida, uma lima niti #30 do tipo K foi usado em movimento de 90º oscilatório como uma instrumentação final. Os espécimes foram escaneados usando Micro-CT após todos os procedimentos. Os parâmetros morfométricos foram analisados utilizando o programa CTAN. Além disso, a superfície do canal radicular não instrumentada foi calculada por terços. Os resultados indicaram uma distribuição uniforme dentro da amostra. Além disso, a análise da secção transversal revelou predominância das configurações de C4 e C3 a 1 mm a partir do ápice e as configurações C1 e C2 no terço cervical. De acordo com os parâmetros morfométricos, o tipo C1 e o canal distal do C2 apresentaram os menores valores de circularidade e valores mais elevados para a área, diâmetro maior e menor no terço apical. Todos os valores relativos a analise de instrumentação foram comparados entre os grupos utilizando o teste de Mann- Whitney e a comparação intra-grupos usando o teste de Wilcoxon. A instrumentação com Reciproc aumentou significativamente o volume do canal em comparação com SAF. Além disso, os volumes dos canais foram significativamente aumentados após a instrumentação de 90º-oscilatória (P <0,05). Depois de todos os protocolos de instrumentação, o aumento de área de superfície só revelou diferenças significativas na comparação intra-grupos (P <0,05). A instrumentação com Reciproc e SAF deixou 28% e 34%, de áreas não instrumentadas respectivamente, sem diferença estatística (P> 0,05). Já a instrumentação oscilatória final reduziu as superfícies do canal radicular não instrumentadas de 28% para 9% (Reciproc) e de 34% para 15% (SAF; P <0,05). Os molares inferiores com canais radiculares em forma de C apresentaram distribuições semelhantes de canais simétricos, assimétricos e convergentes. A configuração C1 e o aspecto distal da configuração C2 apresentaram os maiores valores de área de e diâmetros apicais. Além disso, o uso final da instrumentação com 90º oscilatório usando instrumentos manuais de NiTi diminuiu significativamente as paredes do canal não instrumentadas que permaneceram após a instrumentação com Reciproc e SAF. Finalmente, a combinação de dois sistemas ou técnicas de instrumentação provaram ser eficazes na obtenção de melhores resultados na instrumentação de segundos molares inferiores em forma de C.(AU)

The present study evaluated the morphometric aspects of the internal anatomy of the root canal and the effect of 90º-oscillatory instrumentation with hand files on volume, surface area and uninstrumented surface after shaping procedures with Self adjusting file and Reciproc in mandibular second molars with C-shaped canals. 52 extracted mandibular second molars with C-shaped canals were scanned with a micro-computed tomography scanner. The root canal cross-sections were recorded according to the modified Melton classification. Morphometric parameters and the tridimensional configuration, were evaluated. Afterwards, 20 teeth with merging type canals and C1 internal configuration were divided in two groups (n = 10) and instrumented with Reciproc and SAF instruments respectively. Then, a size 30 Niti hand K-file used in 90º-oscillatory was used as a final instrumentation. The specimens were scanned using Micro-CT after all procedures. Morphometric parameters were analyzed using CTAn software. Also, the uninstrumented root canal surface was calculated for each canal third. The results indicated an even distribution within the sample. Also, the cross-sectional configuration analysis revealed predominance of the C4 and C3 configurations at 1 mm from the apex and the C1 and C2 configurations in the cervical third. According to the morphometric parameters, the C1 and the distal aspect of the C2 exhibited the lowest roundness values and higher values for the area, major diameter and aspect ratio in the apical third. All values were compared between groups using the Mann­Whitney test and within groups using the Wilcoxon's signed-rank test. The significance level was set at 5%. Instrumentation with Reciproc significantly increased canal volume compared to SAF and the canal volumes were significantly increased after 90º-oscillatory instrumentation (P < 0.05). After all instrumentation protocols the surface area increase only revealed significant differences in the within groups comparison (P < 0.05). Reciproc and SAF instrumentation yielded a uninstrumented root canal surface of 28% and 34%, respectively, without differences (P > 0.05). Final oscillatory instrumentation reduced the uninstrumented root canal surface from 28% to 9% (Reciproc) and from 34% to 15% (SAF; P < 0.05). The apical and middle thirds exhibited higher uninstrumented root canal surfaces after the first instrumentation that was significantly reduced after oscillatory instrumentation (P < 0.05). Mandibular molars with C-shaped root canals exhibited similar distributions of symmetrical, asymmetrical and merging-type canals. The C1 configuration and the distal aspect of the C2 configuration exhibited the highest area values and large apical diameters. Furthermore, the final use of 90º-oscillatory instrumentation using NiTi hand files significantly decreased the uninstrumented canal walls that remained after Reciproc and SAF instrumentation. Finally, the combination of two instrumentation systems/techniques proved to be effective in achieving better instrumentation results in C-shaped mandibular second molars.(AU)

Quiste radicular asociado a diente geminado: tratamiento endodóntico-quirúrgico / Radicular cyst associated with a geminated tooth: endodontal-surgical treatment

El tratamiento endodóntico-quirúrgico en dientes con quistes inflamatorios radiculares es un desafío clínico debido a su complejidad, y más aún si están en piezas con anomalías de desarrollo dental, como lo es la geminación dentaria. A continuación se presenta un caso clínico en el que se logra la reparación de una lesión apical mediante una necropulpectomía de la pieza geminada y enucleación del quiste adyacente.

The surgical-endodontic treatment of teeth with an inflammatory radicular cyst is a clinical challenge due to its great complexity. Even more so, if they are in teeth with development anomalies such as gemination. The case below shows the repair of an apical lesion by a necro-pulpectomy of the geminated tooth and the enucleation of the adjacent cyst.

Occlusal characteristics and prevalence of associated dental anomalies in the primary dentition.

INTRODUCTION: Morphological variations in primary dentition are of great concern to a pediatric dentist as it may pose clinical problems like dental caries, delayed exfoliation and also anomalies in the permanent dentition, such as impaction of successors, supernumerary teeth, permanent double teeth or aplasia of teeth. The present study was conducted to investigate the presence of dental anomalies in the primary dentition of 1000 schoolchildren in the 3-5 year-old age group in Faridabad. MATERIALS AND METHODS: One-thousand schoolchildren were examined using Type III examination (WHO, 1997) for primary molar relationship, occlusal characteristics, primate spaces, physiological spaces and other anomalies of teeth, including number and morphology. RESULTS AND CONCLUSIONS: The prevalence of physiological spaces in maxillary and mandibular arches was 50.9% and 46.7%, respectively, whereas primate spaces were found in 61.7% of the children in the maxillary arch and 27.9% in the mandibular arch. The prevalence of unilateral anterior and posterior cross-bite was 0.1% and 0.8%, respectively, in the present study. The prevalence of hypodontia in the primary dentition was found to be 0.4% and the prevalence of fusion and gemination in the present study was 0.5%. Double teeth (fusion and gemination) and hypodontia were the most common dental anomalies found in the primary dentition in the present study.