Clinical impact of ectopic teeth in the maxillary sinus.

OBJECTIVE: To evaluate the clinical features, aetiologic factors, challenging properties (such as radio opacity in Water's view in a patient with no sinusitis), signs and symptoms of the ectopic teeth in the maxillary sinus. STUDY DESIGN: Clinical symptoms and radiographic findings of 14 patients with ectopic teeth in the maxillary sinus were evaluated. Computed tomography (CT) and conventional radiographic images of maxillary sinus and clinical findings were compared with each other with regard to the final diagnosis. RESULTS: Water's view is inadequate to diagnose ectopic tooth in the maxillary sinus in some cases. Panoramic radiographs may be preferred before CT to evaluate the ectopic tooth in the maxillary sinus as structure of a tooth can be clearly detected on panoramic radiographs. Crowding was the most common aetiologic factor among the 14 cases. CONCLUSION AND SIGNIFICANCE: The patients with ectopic tooth in the maxillary sinus should be evaluated thoroughly by complete otorhinolaryngologic, intraoral examinations and proper diagnostic imaging procedures in order to avoid misdiagnosis of maxillary sinusitis. As the opacity of the maxillary sinus in Water's view due to ectopic tooth can be misinterpreted as maxillary sinusitis, patients who have sinusitis-like complaints and opacity of maxillary sinus in Water's view who are resistant to medical treatment should be evaluated with respect to the presence of ectopic tooth.

Evaluation of dental age and associated developmental anomalies in subjects with impacted mandibular canines.

OBJECTIVES: To assess the null hypothesis that there is no difference in the rate of dental development and the occurrence of selected developmental anomalies related to shape, number, structure, and position of teeth between subjects with impacted mandibular canines and those with normally erupted canines. MATERIALS AND METHODS: Pretreatment records of 42 subjects diagnosed with mandibular canines impaction (impaction group: IG) were compared with those of 84 subjects serving as a control reference sample (control group: CG). Independent t-tests were used to compare mean dental ages between the groups. Intergroup differences in distribution of subjects based on the rate of dental development and occurrence of selected dental anomalies were assessed using χ(2) tests. Odds of late, normal, and early developers and various categories of developmental anomalies between the IG and the CG were evaluated in terms of odds ratios. RESULTS: Mean dental age for the IG was lower than that for the CG in general. Specifically, this was true for girls (P < .05). Differences in the distribution of the subjects based on the rate of dental development and occurrence of positional anomalies also reached statistical significance (P < .05). The IG showed a higher frequency of late developers and positional anomalies compared with controls (odds ratios 3.00 and 2.82, respectively; P < .05). CONCLUSIONS: The null hypothesis was rejected. We identified close association of female subjects in the IG with retarded dental development compared with the female orthodontic patients. Increased frequency of positional developmental anomalies was also remarkable in the IG.

Intrabony migration of impacted teeth.

Intrabony migration of impacted teeth is a rare dental anomaly, which occurs only in the permanent dentition of the lower jaw. The teeth involved in this phenomenon are the mandibular lateral incisor, canine, and second premolar. Migration of the lateral incisor is usually in a distal direction, resulting in transposition with the canine. Migration of the canine is most frequently in a mesial direction, resulting in transmigration across the mandibular symphysis to the opposite side of the dental arch. The second premolar most often migrates distally, sometimes past the gonial angle and as far as the coronoid process. Surgical and orthodontic treatment options are presented for the three intrabony migrating teeth.

In defense of the guidance theory of palatal canine displacement.

From the foregoing debate it will be quite clear that Peck et al. have provided ample evidence that may be used to fuel the arguments of both sides: 1. Their material does not contradict the possibility that environmental factors may give rise to palatal displacement of canines generated by genetic anomaly of the adjacent teeth. 2. The buccally displaced canine finds itself similarly environmentally compromised by the different factor of crowding which leads to its characteristic buccally ectopic guidance pattern. 3. (a) Canines that are transposed with the premolar, (b) others that have erupted ectopically, high in the buccal sulcus and in the absence of crowding, and (c) certain palatal canines whose root apex is located markedly distant from their designated site, may all be labeled as genetically controlled with a fair degree of confidence. 4. In between these clearly defined entities there exists a "gray area" in which it is probable that the etiology of the individual displaced teeth may be linked to a combination of circumstances that obey premise number 1 and premise number 2, to varying degrees. The guidance theory cannot provide the complete answer to the etiology of the palatally displaced canine. Were this so, we would find PDC every time there was an anomalous or missing lateral incisor. Equally, it may not yet be discounted out of hand and certainly not on the basis of the evidence provided in the article in question.

Does the canine dental follicle cause resorption of permanent incisor roots? A computed tomographic study of erupting maxillary canines.

We performed computed tomography (CT) on 107 children and adolescents aged 9-15 years with 176 unerupted maxillary canines (152 erupting ectopically and 24 erupting normally) to determine whether there is an association between widened dental follicles of the maxillary canines and resorption of the adjacent incisors during eruption. Contiguous axial (transverse) CT scans were obtained through the maxilla in the region of the canines. The width and shape of the dental follicles were recorded, as were any contacts between the follicles and the crowns of the maxillary canines and neighboring incisors. Fifty-eight lateral incisors (38%) and 14 central incisors (9%) had some type of root resorption. The position of the maxillary canine in relation to the root of the lateral incisor varied greatly, as did the width and shape of the canine dental follicle. Follicle width ranged from 0.5 mm to 7.0 mm. The mean +/- SD width of dental follicles was, on average, larger for the ectopically positioned canines (2.9 +/- 0.8 mm) than for the normally erupting canines (2.5 +/- 0.8 mm) (P < or = .01). We found that during eruption, the follicle of the erupting maxillary canine frequently resorbed the periodontal contours of adjacent permanent teeth but not the hard tissues of the roots. We concluded that the dental follicle did not cause root resorption of permanent teeth. Resorption of neighboring permanent teeth during maxillary canine eruption was most probably an effect of the physical contacts between the erupting canine and the adjacent tooth, active pressure during eruption, and cellular activities in the tissues at the contact points, all of which are part of the eruptive mechanism. The findings also confirm an association between root resorption of deciduous canines and the dental follicles of erupting permanent canines.

Ectopic mandibular third molar in the ramus region: report of a case and literature review.

OBJECTIVES: Ectopic mandibular third molar is a rare condition, and information is limited about its causes and characteristics. This article reports a case of ectopic mandibular third molar and reviews the literature on the clinical signs and symptoms and management of this condition. STUDY DESIGN: We report a case of an impacted mandibular third molar dislocated high on the right side of the mandibular ramus. Thirteen cases of ectopic mandibular third molars reported in the English-language literature over the past 25 years, identified from Pubmed and Medline databases are also reviewed. RESULTS: Among the 13 case reports identified, 10 occurred in women. Pain and swelling on the ispilateral side of the mandible or the preauricular region were the most common symptoms. Seven cases involved an ectopic mandibular third molar in the condylar or subcondylar region. Eight of the 11 cases included the description of a radiolucent image around the ectopic molar on the radiograph and described diagnosis of a dentigerous cyst. Seven of the ectopic third molars were extracted through intraoral access, and 3 were extracted through extraoral access. CONCLUSIONS: The etiology of ectopic mandibular third molars has not yet been completely clarified. Annual follow-up visits with panoramic radiographs are required for patients with symptom-free highly aberrant wisdom teeth. Treatment should be carefully planned according to the position of the ectopic tooth and the potential for trauma caused by the surgery.

[Post-treatment evaluation of the periodontal situation of unerupted and ectopic teeth after orthodontic movement]. / Zur parodontalen Wertigkeit kieferorthopädisch mobilisierter Zähne.

The post-treatment evaluation of 83 patients demonstrated that orthodontic mobilization of unerupted or ectopic teeth is successful both, under periodontal and functional aspects. The results did not show any dependence on the age of the patients. Thus, the indication for orthodontic mobilization may be interpreted more broadly.

Tooth eruption and migration theories: can they account for the presence of a 13,000-year-old mesiodens in the vault of the palate?

A case of a mesiodens in the vault of the palate of a skull estimated to be approximately 13,000 years old is presented. The currently cited theories of tooth eruption were considered, and it was concluded that only the newly formulated BVT (blood vessel thrust) theory of tooth eruption can account for the migration of this mesiodens into that position.

Transmigration of impacted mandibular cuspids.

Transmigration of impacted mandibular cuspid is a rare finding. A cuspid is classified as "transmigrated" when more than half of its length has passed the mid-line. 13 cases of transmigration of impacted mandibular cuspids are presented, 3 of which occurred in pairs, raising the total number of teeth to 16. Radiographs showed positions ranging from a vertical impaction, to a cuspid having crossed the mid-line completely, reaching the first molar area of the opposite side.

The ectopic maxillary canine: a review.

This article reviews the aetiology and management of the ectopic maxillary canine. Much controversy surrounds the causes of canine palatal ectopia. The recent evidence surrounding the genetic and guidance theories are examined. The management options are detailed and the indications for each treatment modality based on the available scientific evidence are presented. Finally, the untoward sequelae of canine ectopia are discussed.

Dental age in maxillary canine ectopia.

An etiologic connection between palatally ectopic canines and small and missing teeth is well established in the literature. Additionally, it has been observed that patients with palatally ectopic canines have a delayed dental development. The present study was designed to examine the validity of this latter observation. We radiographically assessed the subjects' dental ages using criteria of tooth calcification, rather than tooth eruption pattern. A similar determination was made in relation to subjects in whom buccally ectopic canines were present. The experimental group consisted of panoramic radiographs of 55 consecutively treated patients with palatally displaced maxillary canines and of 47 consecutively treated patients with buccally displaced canines. They were compared with a control group of 57 consecutively treated patients with normally placed canines. Approximately half the subjects with palatal displacement exhibited a late-developing dentition, whereas the timing of dentition in the remaining subjects appeared to be normal. Buccal displacement was not associated with a retarded dental development, and the ranges of the dental age values were similar to those seen in the control group. The results support the idea that there are different etiologies for the occurrence of buccal versus palatal ectopia in maxillary canines. They also suggest that dentitions with a palatal canine appear to be of 2 distinct varieties, with different dental characteristics and, perhaps, different etiologies.

A review of clinical features in 13 cases of impacted primary teeth.

AIM: The aim of this study was to review clinical findings in 14 impacted primary teeth in 13 cases treated at a Paediatric Dental Clinic over a period of 18 years. METHOD: The retrospective study used clinical records, radiographs and oral photographs. Data included age, gender, presenting complaints, location, radiographic findings, aetiological factors, treatment and prognosis of impacted primary teeth and their permanent successors. RESULTS: The patients included five males and eight females aged from one year two months to seven years five months. One case had impacted bilateral, mandibular primary central incisors and the remaining 12 cases each had one impacted tooth. The maxillary second primary molar was the tooth most frequently involved. Permanent successor tooth germs were identified in 12 teeth but not in two. Five cases were impacted because of odontomas, in the case with bilaterally affected mandibular primary central incisors these were malpositioned and were erupting ectopically. In seven cases, aetiology was unknown. Four impacted primary teeth were extracted because eruption was unlikely. In four cases, odontomas were surgically removed and the teeth kept under observation. The remaining six were surgically exposed. Traction was applied in two of the six. Eight of the teeth erupted. In two teeth in which traction was used, one was subsequently extracted, and one erupted. In the cases of seven, permanent successors erupted. These were hypoplastic teeth and were delayed in development and eruption. CONCLUSIONS: Impacted primary teeth may be associated with defects in development and eruption of their permanent successors, long-term observation is therefore necessary until the permanent successors erupt.

Tooth size in dentitions with buccal canine ectopia.

Much interest has been expressed in recent years regarding various features common to dentitions with palatally displaced canines (PDC), particularly in relation to delayed dental development and reduced tooth size. The aims of the present study were to determine whether dentitions with buccally displaced canines (BDC) have features in common, which may be specific for the condition, when compared with PDC dentitions and those with normally erupting canines. Mesiodistal and buccolingual tooth dimensions were determined for 41 subjects with BDC (21 females and 20 males) aged between 11 and 15 years, who formed the experimental sample. The PDC sample was made up of 58 individuals (37 females and 21 males) and the control group comprised 40 age-matched and consecutively treated subjects (20 males and 20 females), exhibiting normally erupted and undisplaced maxillary canines. The results revealed marked sexual dimorphism. Larger-than-average teeth were present in BDC females, whereas the teeth in BDC males were normally sized. Unilaterally affected females had smaller teeth than bilaterally affected females. Tooth size in BDC was consistently larger than in PDC subjects, although the reason was different between the sexes. In females the PDC teeth were normally sized versus large BDC teeth, whereas in the males, the PDC teeth were small and the BDC teeth normal. It is concluded that combining male and female subjects into an overall BDC group obscures important differences that exist between the two sexes.

Alteraciones en la erupción de caninos permanentes / Canine permanent eruption alterations

En este trabajo son descritas alteraciones en la erupción de los caninos permanentes, su etiología, diagnóstico temprano y posibilidades terapéuticas. El canino recoge todos los problemas de espacio que puedan existir en la arcada y es frecuente la erupción en una zona alta. La inclusión de los caninos tiene una etiología compleja, favorecida por factores evolutivos, anatómicos y mecánicos. La impactación mandibular es menos frecuente y su incidencia se describe como veinte veces menos que la impactación del canino maxilar. La erupción ectópica de los caninos maxilares puede estar asociada a la reabsorción de las raíces de los incisivos adyacentes. A la edad de 8 a 10 años empieza a palparse la prominencia del canino en el fondo del vestíbulo. Los métodos radiográficos más utilizados son las radiografías panorámica, oclusal y periapical, con técnicas de tubo vertical y otras angulaciones. En la actualidad, es de gran ayuda la tomografía computarizada. El término tratamiento temprano implica una terapéutica en estadios precoces de desarrollo, cuando la patología puede ser interceptada o detenida y los tratamientos más utilizados son exodoncia de caninos temporales y extracción seriada. En conclusión, las alteraciones en la erupción de caninos permanentes requiere conocimiento de los parámetros de normalidad, cronología y secuencia, junto a la aplicación de pruebas complementarias, para poder efectuar una evaluación temprana y pertinente y evitar las complicaciones derivadas de un diente impactado.

This study describes the alterations in the eruption of the permanent canines, etiology, early diagnosis and therapeutic possibilities. The canine one gathers all the problems of space that can exist in the arches and is frequent the eruption in a high zone. The inclusion of the canine has a complex etiology, favored by evolutionary, anatomical and mechanical factors. The mandibular impaction is less frequent and its incidence is described less like twenty times than the impaction of the maxilar canine one. The ectopic eruption of maxillary canines can be associated to the reabsorbing by the roots of the adjacent incisors. From 8 to 10 years begins to be noticed the prominence of the canine in the bottom of vestibule The most used radiographies methods are the panoramic x-ray, oclusals and periapicals with techniques of vertical tube and other angles. At the present time it is helpful the computed tomography. The term "early treatment" implies a therapeutic action in early stages of development, when the pathology can be intercepted or stopped, and the most used are exodontias of temporary canines and serial extraction. In conclusion, the canine alterations of the eruption of permanent involve knowledge of the normality parameters, chronology and sequence, along with the development of complementary tests, to carry out an early and pertinent evaluation and to avoid the complications derived from an impacted tooth.

Eruption disturbances of permanent molars: a review.

Eruption disturbances of permanent molars may become clinically and radiographically manifest as impaction, primary retention or secondary retention. This may result in clinical problems such as malocclusion and loss of neighboring teeth due to caries and periodontal disease. Which of these disorders will develop, depends primarily on the eruptive stage. Factors that may interfere with the eruptive stages (i.e. follicular growth, pre-emergent eruptive spurt, postemergent eruptive spurt, juvenile occlusal equilibrium, circumpubertal occlusal eruptive spurt, adult occlusal equilibrium) and the clinical consequences of that interference are reviewed. Treatment recommendations are given.

Maxillary tooth transpositions: characteristic features and accompanying dental anomalies.

Transposition is a dental anomaly manifested by a positional interchange of 2 permanent teeth. The maxillary permanent canine usually transposes with the first premolar and occasionally with the lateral incisor. The records of 65 orthodontically treated individuals with maxillary tooth transpositions (40 females and 25 males) with an age range of 9 to 25 years (mean age, 13.4 years) were studied to determine the distribution of transposition and to evaluate the accompanying dental anomalies. Thirty-six individuals (55%) had a transposition of the maxillary canines and first premolars, 27 (42%) of the canines and lateral incisors, and 2 (3%) of the central and lateral incisors. Females had 60% more transpositions than did males. Substantially more transpositions were unilateral (88%), with a moderate left side dominance (58%). All dental anomalies associated with transposition--including missing lateral incisors and second premolars, undersized lateral incisors, retained deciduous canines, impaction of permanent canines and central incisors, and severely rotated adjacent teeth--were observed on the side of the transposition. This dominance of the affected side suggested that unknown local factors may play a major role in these dental anomalies.

Spontaneous improvement in position of canines from apparently hopeless positions.

Two cases are presented, each with both unerupted maxillary canines so badly positioned that eruption seemed unlikely. However, over a period of approximately three years, three out of the four initially displaced canines did erupt; the improvements in position being unrelated to whether or not the associated primary canine was extracted. Three out of four primary canines were removed. These cases highlight the difficulties in predicting canine eruption for individual patients.