Pre-eruptive intramural resorption in unerupted teeth: a cone-beam computed tomography evaluation of prevalence and related factors.

OBJECTIVE: Pre-eruptive intramural resorption (PEIR) is defined as an abnormal, well-circumscribed radiolucency within the coronal dentin of the tooth, which is often overlooked in plain radiographs. This study aimed to investigate the prevalence of PEIR and its related factors using cone-beam computed tomography (CBCT). METHODS: CBCT images of 590 unerupted teeth were evaluated for the presence of PEIR, location of PEIR, number of lesions in the affected tooth, PEIR score, tooth angulation, tooth position, and pericoronal space. Binary logistic tests were used to analyze the association between the characteristics of PEIR and the patient's demographic data and related factors. RESULTS: The tooth prevalence of PEIR was 13.6% among unerupted teeth. However, it was noteworthy that 19.2% of the unerupted teeth with PEIR were planned to be kept. PEIR was significantly associated with transverse (p = 0.020), inverted-angulated (p = 0.035), and centrally-positioned teeth (p = 0.043). The severity of PEIR was more pronounced in teeth with distal (p = 0.019), lingual (p = 0.023), or inverted-angulated (p = 0.040) positions, and in the absence of pericoronal space (p = 0.036). CONCLUSION: PEIR should be suspected in transverse, inverted-angulated, centrally positioned unerupted teeth, particularly in molars, with no pericoronal space. Further monitoring through CBCT is recommended in such cases. CLINICAL RELEVANCE: The management of unerupted teeth does not always involve surgical removal. Instead, they could be utilized for artificial eruption or tooth transplantation. The present study emphasizes the significance of early detection of PEIR. Clinical recommendations for screening PEIR in unerupted teeth are also proposed, which can be applied to routine plain radiographs.

Pulp stones in unerupted teeth: a retrospective analysis using cone-beam computed tomography.

BACKGROUND: A pulp stone is a calcified mass that develops in the dental pulp of any tooth. Despite many studies examining the relationship between pulp stone formation and non-oral factors, the methods used in these studies have been unable to explain the exact role of these factors alone as distinct from probable effects within the oral cavity environment. Considering that totally unerupted (impacted or developing) teeth are unexposed to the oral cavity's environmental and functional conditions, they provide a more suitable material for studying the effects of these non-oral factors on pulp stone formation. This research study aimed to investigate pulp stones in unerupted teeth and the associated factors in a Saudi subpopulation. METHODS: The study included 644 cone-beam computed tomography images, with 496 (50.9%) maxillary and 479 (49.1%) mandibular teeth. Of the investigated patients, 293 (45.5%) were men, and 351 (54.5%) were women. The age range was 15-76 years. A chi-square test was used to investigate the associations between pulp stones and age, gender, and history of systemic disease and chronic medication use. RESULTS: Pulp stones in unerupted teeth were present in 24.2% of the examined dental jaws and 18.6% of the examined teeth. There was no statistically significant relationship between pulp stones and gender (p > 0.05). A significantly greater percentage of pulp stones were found with increasing age (p = 0.000). Additionally, a significantly increased number of pulp stones was observed in patients with systemic diseases and chronic medications (p < 0.05). CONCLUSIONS: The results support the idea that pulp stones can be present in any type of unerupted tooth. This study provides additional evidence of the increased incidence of pulp stones with age, systemic disease, and chronic medications.

Pre-eruptive intracoronal radiolucencies in permanent dentition of children in Tamil Nadu-A cross-sectional study.

BACKGROUND: Pre-eruptive intracoronal radiolucency (PEIR) poses a challenge to paediatric dentists as it cannot be clinically detected. AIM: To estimate the prevalence and coexisting factors of PEIR in permanent teeth of children and adolescents in western Tamil Nadu, India. DESIGN: This cross-sectional study assessed 5012 digital panoramic radiographs of children and adolescents below 14 years of age obtained from private digital imaging centers, dental clinics, and dental colleges located in five districts of western Tamil Nadu. The prevalence and PEIR and its coexisting factors were assessed by two independent calibrated investigators. Data were analyzed using the chi-square test. RESULTS: The subject prevalence and tooth prevalence of PEIR were estimated to be 3.2% and 0.4%, respectively. Maxillary canines and mandibular premolars were commonly involved. Majority of the lesions were limited to less than one-third of dentin thickness (74%) and distal aspect of the crown (45.1%). Ectopic positioning (9.3%) and dental caries in the preceding primary tooth (9.9%) were the most common coexisting factors. CONCLUSION: Pre-Eruptive Intracoronal Radiolucency defects were commonly seen in maxillary canines, mandibular premolars, and distal aspect of the crown involving less than one-third dentin thickness. Ectopic positioning and caries in primary teeth were commonly seen along with the PEIR defects.

Estimating the size of unerupted teeth: Moyers vs deep learning.

INTRODUCTION: This study aimed to design a deep learning (DL) system for estimating the sum of the mesiodistal widths (MDWs) of unerupted mandibular canines and premolars in the mixed dentition period and to clarify its performance by comparing DL estimates with Moyers' table (MT) results. METHODS: The training dataset was obtained from 974 patients with permanent dentition. On the 3-dimensional digital models, MDWs of the mandibular right teeth were measured using Ortho Analyzer software (3Shape, Copenhagen, Denmark). A system was designed that could predict the total width of the mandibular canines and premolars using the mandibular central, lateral incisor, and first molar MDWs. This artificial neural system had 5 layers (4 hidden and 1 output) and 886 neurons. The MDWs of the mandibular teeth were introduced to the DL system in the form of datasets. The DL system's predicted results for 100 randomly selected patients were compared with the probability values obtained from the MT. RESULTS: The estimation performance of the DL system for the unerupted mandibular canines and premolars was acceptable, with 49.5% accuracy. The success rate for the MT, in comparison, was 45.0%, with an error margin of 1.00 mm. CONCLUSIONS: The DL system offers a potential alternative to current methods in estimating unerupted tooth size. The results of the DL system are expected to provide diagnostic support for mixed dentition analysis on dental casts.

Use of 3D printing in the planning of a patient with unerupted maxillary central incisors.

Impacted central incisors are a clinical dilemma faced by orthodontists, oral and maxillofacial surgeons, paediatric and restorative dentists. Successful management requires a robust diagnosis and treatment planning process. This case report highlights the use of 3D printing to aid the treatment planning of a patient with bilateral unerupted maxillary central incisors due to two supernumerary teeth acting as a physical obstruction. The preoperative cone beam computed tomography scan allowed for production of the printed model to the exact size and dimensions of the unerupted teeth and supernumeraries to facilitate the planning of the case and to aid in consenting the patient for treatment.

Large Dentigerous Cyst Associated to Maxillary Canine.

Dentigerous cysts are defined as a cyst originated by separation of the follicle of dental crown of a tooth unerupted. Although most dentigerous cysts are considered developmental cysts, some cases seem to have an inflammatory origin. The aim of this study was to show a case of an 8-year-old patient, male, presenting a lesion in maxilla with large proportions. Computed tomography scans showed a hypodense image, well-defined, associated to unerupted teeth. The case was treated by enucleation of the lesion under local anesthesia. Histopathological examination confirmed the diagnostic suspicious of dentigerous cyst. Currently, 3-year follow-up period showed no signs of recurrence, and it was observed eruption of the teeth associated to the lesion. This case highlights the importance of the association between clinical and radiographic analysis together to the surgical findings, aiming the best treatment for the patient.

A Controlled Study of Pre-Eruptive Intracoronal Resorption and Dental Development.

AIM: To compare the prevalence of PEIR in Australian and Saudi Arabian children and to investigate the relationship of PEIR with dental development. STUDY DESIGN: Panoramic (PAN) radiographs of 842 Australian and 456 Saudi children were screened for PEIR. The dental ages of the children with and without PEIR were assessed from the PAN radiographs using the method of Demirjian and co-workers. RESULTS: The subject prevalence of PEIR was not statistically significant between Australian (2%) and Saudi children (0.6%) (p>0.1). The teeth most commonly affected by PEIR were the mandibular second molars and premolars. Dental impaction was observed in 31% of teeth with PEIR compared to only 0.1% of control teeth (p<0.0001). Children with PEIR showed a mean delay in dental development of 0.54±0.85 years compared with ageand gender-matched controls (p<0.0001). CONCLUSIONS: The present study provides the first evidence that there are no differences in PEIR prevalence between Australian and Saudi populations, and that dental development is significantly delayed in children with PEIR.

Primordial Odontogenic Tumor: Report of a Case.

Primordial odontogenic tumor (POT) was first described in 2014. It typically presents in the posterior mandible of a child or adolescent as a "dentigerous cyst-like" well-circumscribed radiolucency associated with an unerupted molar. POT consists of an ellipsoidal mass of dental papilla-like myxoid connective tissue entirely enveloped in a delicate membrane of ameloblastic epithelium. It shows features of a developing tooth with a huge dental papilla, and because it is devoid of dental hard tissue, it could be regarded a soft tissue odontoma. The lesion histologically mimics early (primordial) stages of tooth development. This report describes a case of POT and POT-like proliferations in an unrelated complex odontoma.

Cone-Beam Computed Tomography Study Of Crown Dilaceration With a Talon Cusp in an Unerupted Permanent Maxillary Tooth.

This article describes a rare case of crown dilaceration with a talon cusp in an unerupted permanent maxillary central incisor. Our patient was a 7-year-old boy with a history of trauma to his primary maxillary teeth (#51 and 52), at 3 years of age complaining of failure of eruption of tooth #11. Periapical radiography showed incomplete formation of tooth root #11 and more superior position of tooth bud #11 relative to tooth bud #12. A cone-beam computed tomography was ordered, which revealed crown dilaceration with a talon cusp in tooth bud #11. The patient was scheduled for follow-up at 6 months.

A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption.

OBJECTIVE: This study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) using cone beam computed tomography (CBCT) and panoramic radiography and to compare the findings of these imaging techniques. METHODS: This retrospective study consisted of 733 patients who had at least one unerupted tooth and had undergoneimaging with both three-dimensional (3D) CBCT and two-dimensional (2D) panoramic radiography. In all the images, the number of teeth with intracoronal resorption, affected tooth type and number, and size and location of the PIR defects were recorded. The McNemar test was used to compare the prevalence of PIR in the CBCT and panoramic images. RESULTS: Fewer PIR defects were detected in the panoramic images (3.1% of the patients) than in the CBCT images (9.5% of the patients) (p< .001). According to the CBCT images, the distribution of PIR defects was as follows: third molars (59.5%), canine teeth (11.4%), second molars and premolars (7.6% for both), supernumerary teeth (5.1%), second molars (3.8%), central incisors (2.5%), and first premolar and primary second molar teeth (1.5% for both). According to the scoring classification system for PIR defects, PIR 1 defects were the most common (65.8%), followed by PIR 3 (24.1%) and PIR 2 (10.1%). Of these defects, 69.6% were located in the central aspect of the crown. Ectopically positioned teeth showing intracoronal resorption accounted for 51.9% of the cases of PIR. CONCLUSIONS: CBCT detected more cases of PIR than panoramic radiography. The mandibular third permanent molar was the most commonly affected tooth.

Dental clearance unsuccesful: cleidocranial dysplasia diagnosed at a relief of pain clinic.

A 55-year-old woman presented to Whangarei Base Hospital Emergency Department with a mandibular swelling adjacent to her unerupted tooth 48. She had never had dental radiographs taken, having had a dental clearance 20 years earlier. She wore full dentures. A panoramic dental radiograph revealed 44 unerupted teeth. Based on the clinical, oral and radiographic examinations a diagnosis of cleidocranial dysplasia (CCD) was confirmed. The patient had not been diagnosed with CCD prior to her hospital visit. Treatment included staged extractions of superficial mandibular supernumeraries and enucleation of the mandibular cyst, attempting to avoid pathological fracture. This would be followed by a six-month review and then annually as required. The case outlines the value of dental radiography in dental practice. Little is known about the prevalence of CCD in New Zealand and this is an area where future research could be conducted.

Comparative study of dental anomalies assessed with panoramic radiographs of Down syndrome and non-Down syndrome patients.

AIM: The aim of this study was to compare the prevalence of dental anomalies from panoramic radiographs of age-matched individuals with and without Down Syndrome (DS). STUDY DESIGN: This is a retrospective cross-sectional study. A group of 41 patients (19 female and 22 male) with Down Syndrome (DS), mean age 10.6 ± 1.4 and a control group of 42 non- DS patients (26 female and 16 male), mean age 11.1 ± 1.3 were studied. METHODS: This study examined the medical history and a panoramic radiograph of each patient. The dental anomalies studied were agenesis of permanent teeth (except third molars), size and shape maxillary lateral anomalies and maxillary canine eruption path anomalies. STATISTICS: The groups were compared using Mann-Whitney and Wilcoxon non-parametric tests (p<0.05). Rho Spearman correlation coefficient was applied for associations. Results Agenesis of one permanent tooth was found in 73.17% of DS subjects and two or more permanent teeth in more than 50% (p<0.001). Maxillary lateral incisor was the most frequently absent tooth followed by mandibular second premolar, mandibular lateral incisor, maxillary second premolar and mandibular central incisor. No significant differences were detected between maxilla and mandible on either side. No differences in gender were observed. Significant differences were found for size and shape anomalies of maxillary lateral incisors, as well as for canine eruption anomalies (p<0.05). No gender differences were observed for either variable. No association was found between these two variables in the DS group. CONCLUSIONS: More dental anomalies were present in the DS group than in the control group, which implied that DS patients need periodical dental and orthodontic supervision so as to prevent or control subsequent oral problems.

A computed tomographic, mixed dentition, space analysis comparison.

INTRODUCTION: A considered space analysis aims to predict the combined mesiodistal widths of unerupted permanent canine and premolars. A miscalculation can lead to the application of inadequate and irreversible treatments. OBJECTIVE: To assess the level of agreement between predictions generated by three methods (Moyers' predictive tables at the 50th and 75th percentiles and Tanaka-Johnston's equations) on the sum of unerupted teeth compared with measurements derived from cone beam computed tomography, considered in the present study as a 'gold standard'. MATERIALS AND METHODS: The study sample was comprised of children (N = 26) aged 8-13 who visited the Department of Dentistry. Moyers' predictive tables and the Tanaka-Johnston equation were applied to ascertain the space requirements. Cone beam computed tomography was performed on each patient and the volumetric data analysed. A concordance correlation coefficient between each method's predictions was applied. RESULTS: The three methods tended to overestimate the cone beam computed tomography readings and were not able to entirely capture the variability of the sum of the unerupted teeth. Moyers' 50th percentile estimate revealed a more balanced distribution between over- and underestimation. CONCLUSION: The present study suggested that Moyers' 50th percentile is the predictive method with the lowest absolute error and is preferred for clinical use.

Age Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition.

OBJECTIVE: The present study aimed to determine if the prevalence of pre-eruptive intracoronal radiolucent defects is higher for young age groups, in which there are more unerupted teeth. STUDY DESIGN: A retrospective study of panoramic and bitewing radiographs was conducted. An inclusion criterion was the presence of un-erupted permanent teeth with a formed and clearly visible crown. Age groups were: young (6-8 years), intermediate (9-12 years) and adults (13-53 years). Significance level was set at p≤0.05. RESULTS: Thirteen (3.9%) pre-eruptive lesions were detected in 335 records. No lesions were found in the young group (7.4%), in the intermediate and adult age groups six and seven lesions were found, respectively. In most cases the pre-eruptive lesion was found in a third molar. CONCLUSION: The prevalence of pre-eruptive intracoronal lesions was not higher for young age groups. The prevalence of pre-eruptive intra coronal radiolucent lesions is 3.9%, irrespective of age.

Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs.

Medical records and radiographs were retrospectively reviewed over a 3-year period (2012-2015) from dogs presented to a private dental referral practice. Medical records were evaluated for the diagnosis of impacted or embedded teeth. The identified dogs' radiographs were reviewed for the presence of radiographically significant cystic lesions that were associated with the impacted or embedded teeth. Radiographic criteria were established by the authors for the purposes of identifying cystic lesions in dogs of different breeds and sizes, using established indices from human dental pathology as a basis. When histopathology results were available, they were reviewed and reported. In this study, 136 dogs ranging in age from 3 months to 17 years were diagnosed with 213 unerupted teeth during the study period. There were 62 (29.1%) of the 213 radiographically apparent cystic lesions identified based on the criteria proposed in this study. In this study, 146 (68.5%) of the 213 unerupted teeth were identified as mandibular first premolar teeth. Histopathology was obtained on 28 (45.1%) of the 62 diagnosed cystic lesions. Dentigerous cysts accounted for 20 (71.4%) of the 28 cystic lesions. Brachycephalic breeds were overrepresented in this study. Boxer, pug, Shih Tzu, and Boston terrier dogs were most likely to present with cystic lesions associated with unerupted teeth. Seventeen (85%) of the 20 cases with a histopathologic diagnosis of dentigerous cyst were found within these 4 brachycephalic breeds.

Effects of Lower Third Molar Angulation and Position on Lower Arch Crowding.

UNLABELLED: The role of the third molars in lower arch crowding has been debated for more than a century. OBJECTIVES: The aim of this study was to determine the relationship between lower arch crowding and the presence of angulation and position of lower third molar. METHODS AND MATERIALS: The measurements of the dental arch were made in 120 subjects aged 16 to 21 years, with average age to 18 years. The subjects were divided into two groups: Class I normal occlusion comprised 35 male and 25 female with mean age 18.87years, whereas Class I crowding comprised 27 males and 33 females with mean age 18.5 years. The dental pantomogram (DPT) were used to calculate the ratio of retromolar space (Ganss ratio), angulation of third molar to second molar and third molar to the base of the mandible. RESULTS: The results showed that measurements of Ganss ratio, third molar angulation to the base of the mandible, and third molar to second molar inclination, was statistically significant between crowded and normal groups. CONCLUSION: It can be concluded that there was a strong relationship between angulation and position of third molars and lower arch crowding. Key words: Third molars, angulation, lower arch, crowding

Mesial inclination of impacted third molars and its propensity to stimulate external root resorption in second molars--a cone-beam computed tomographic evaluation.

PURPOSE: To investigate the presence of external root resorption (ERR) in second molars adjacent to horizontally and mesioangular impacted mandibular third molars by cone-beam computed tomography. In addition, patient characteristics (age and gender) and third molar depth were correlated with the presence of ERR. MATERIALS AND METHODS: The sample consisted of 116 scans (58 acquired on the i-CAT Classic and 58 on the Picasso-Trio) of 70 women and 46 men (mean age, 23.7 yr). Two observers recorded the presence of ERR in the second molars, inclination and depth of third molars in relation to bone and soft tissues, third molars classification according to Pell and Gregory, and location and severity of ERR. Data were analyzed by analysis of variance, Mann-Whitney test, and χ(2) test. The κ test was used to analyze intraobserver agreement. RESULTS: The overall prevalence of ERR was 49.43%. There were no statistically significant differences in the detection of ERR by gender, images from the 2 devices, or third molar inclination (P > .05). The κ test showed excellent reproducibility values (κ = 0.7778). There was a smaller proportion of affected patients 14 to 24 years old and ERR in teeth adjacent to Class C third molars. CONCLUSION: Mesially inclined third molars (mesioangular and horizontal) have a greater potential of being associated with ERR in second molars, which was shown by the high prevalence of the condition in the overall sample. Class A and B third molars in patients older than 24 years were more associated with the presence of ERR in adjacent teeth.

A retrospective analysis of prevalence and characteristics of pre-eruptive intracoronal resorption in unerupted teeth of the permanent dentition: a multicentre study.

AIM: This multicentred study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) in unerupted teeth of the permanent dentition using a large sample of panoramic radiographs of a Turkish population. METHODOLOGY: Records of 28 612 patients from three cities in the different regions of Turkey were screened retrospectively in this multicentred study. Patient records and panoramic radiographs were evaluated by three oral and maxillofacial radiologists in the sites. The following data were recorded: age, gender, number of unerupted teeth, number of teeth showing intracoronal resorption, affected tooth type and number of intracoronal resorptions in each case. RESULTS: Overall, 5554 patients had at least one unerupted tooth in 28 612 patients, with a prevalence of 19.4%. Of the 5554 patients screened, 2267 were female and 3287 were male. Intracoronal resorption was observed in 40 of 5554 subjects, with a frequency of 0.7%. The mean age of the patients was 35.9 years. CONCLUSION: Pre-eruptive intracoronal resorption defects occurred in 40 subjects. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PIR defects.

Formation and development of maxillary first molars with delayed eruption.

Cases of congenitally missing and delayed eruption of the maxillary first molar are rare. However, in recent years, we have experienced cases of suspected delayed eruption of or congenitally missing first molars. The purpose of this study was to analyze the formation of delayed erupted maxillary first molars (M1) (>2 standard deviations), which play important roles in occlusion, and normal eruption of the maxillary first molars (U6). The frequency of M1 among patients born between 1974 and 1994 in one institution with a clear total patient number and personal oral histories was 1.55 % [80 % bilateral eruption in 8 of 806 male patients (0.99 %) and 23 of 1195 female patients (1.92 %)]. To evaluate the formation and eruption of M1 according to Moorrees's tooth formation stages, panoramic X-ray films were obtained every year for 73 patients with M1 from 3 institutions (20 male and 53 female patients, total 131 M1s) without systematic histories or genetic disorders. The development/growth curve of M1 was fitted to both the logistic curve and U6 curve. The M1 development/growth curve was started behind with U6 curve; however, the straight part of the M1 curve exhibited steep inclination compared with the straight part of the U6 curve. The curve of the eruption pathway of M1 also exhibited a sigmoid S shape. These results indicate that the development and migration speed of M1 are faster than that of U6, excluding the delayed start point. These results may help orthodontists in treatment planning for patients with M1.