The Role of Family Factors in the Development of Dental Anxiety in Children.

Background and Objectives: In the literature, the influence of parents who suffer from dental anxiety and a previous unpleasant experience at the dentist are cited as the two most common causes of dental anxiety in children. The aim of this study is to investigate the relationship between socioeconomic factors and the development of dental anxiety in children aged 9 to 12 years. Materials and Methods: A total of 131 children and their accompanying parents/guardians participated in the cross-sectional study. The children were divided into an experimental group, which visited a specialised office for paediatric and preventive dentistry for the examination, and a control group, which visited a primary care dental office. During the visit, the children completed questionnaires on dental anxiety (CFSS-DS). Parents completed a socioeconomic questionnaire and a dental anxiety questionnaire for adults (CDAS). Results: The results showed a statistically significant positive predictor: parental dental anxiety as measured by the CDAS. In addition, the t-test showed that children who visited a specialised dental office did not show a statistically significant increase in dental anxiety compared to children who visited a primary care dental office. Conclusions: With this study, we confirm the influence of parental dental anxiety on the development of dental anxiety in children. The socioeconomic status of the family and the type of dental office do not play a statistically significant role in the development of dental anxiety in children.

How to Intervene in the Caries Process: Early Childhood Caries - A Systematic Review.

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child's cooperation, or a general anaesthesia setting.

How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement.

AIM: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. METHODS: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. RESULTS: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement.

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement.

OBJECTIVES: To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS: Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS: Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS: An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE: Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.

The influence of different types of brackets and efficacy of two chlorhexidine mouthwashes on oral hygiene and the incidence of white spot lesions in adolescents during the orthodontic therapy.

BACKGROUND: To detect the effect of two different types of brackets (ceramic and stainless steel) and investigate the effectiveness of two chlorhexidine mouthwashes 0.2% (CHX) on oral hygiene status and incidence of white spot lesions (WSLs) in adolescents wearing fixed orthodontic appliance. SUBJECTS AND METHODS: One hundred and twenty subjects (aged 11 to 18 years, mean age 14.5 years) were divided into six equal groups according to brackets type and to different mouthwashes: Group 1: metal brackets and conventional CHX, Group 2: metal brackets and CHX with anti-discoloration system (CHX-ADS), Group 3: ceramic brackets and conventional CHX, Group 4: ceramic brackets and CHX-ADS, Group 5: metal brackets and water correction flavors mouthwash (placebo), Group 6: ceramic brackets and placebo. Four weeks after the placement of fixed orthodontic appliance the subjects were provided with three different mouthwashes for use during the next two weeks. Assessment was carried out according to oral hygiene index-simplified (OHI-S) and WSL index performed: prior to placement of the appliance (baseline), four weeks, six weeks, eighteen weeks, and thirty weeks after the placement. The data were then subjected to statistical analysis. RESULTS: Group 4 showed reduction in the OHI-S scores when compared to the Group 5 (in the 6th week), and Group 6 (in the 6th and 18th week), which was statistically significant, P<0.05. Group 4 showed decrease in the WSLs scores when compared to the Group 1 (in the 4th, 6th, 18th and 30th week), Group 5 (in the 18th and 30th week) and Group 6 (in the 6th, 18th and 30th week), which was statistically significant, P<0.05. CONCLUSION: The ceramic brackets and the usage of CHX-ADS resulted in better oral hygiene status and lower incidence of WSLs.

Prevalence, Type and Etiology of Dental and Soft Tissue Injuries in Children in Croatia.

The prevalence, type and etiology of dental and soft tissue injuries and relationship between the time of arrival and sustaining soft tissue injury were analyzed in this retrospective study conducted at the Department of Pediatric Dentistry, University Dental Clinic in Zagreb, Croatia, during the 2010-2014 period using documentation on 447 patients (264 male and 183 female) aged 1-16 years with injuries of primary and permanent teeth. The highest prevalence of traumatic dental injury (TDI) was found in the 7-12 age group and maxillary central incisors were most frequently affected (80.9%) in both primary and permanent dentitions. Enamel-dentin fracture without pulp exposure (31.9%) was the most common TDI of dental hard tissue in both dentitions, whereas subluxation (27.3%) was the most common periodontal tissue injury type. The most frequent location, cause and seasonal variation of trauma were at home, falling and spring. Soft tissue injuries were observed in 203 (45.4%) patients. Soft tissue injuries were less likely when fewer teeth were traumatized (p<0.001). Comparison of children with and without soft tissue injuries yielded a statistically significant difference in the time to arrival between primary and permanent teeth (p<0.01). Because soft tissue injuries include bleeding and clinical presentation appears more dramatic, the time elapsed between injury and initial treatment was shorter than in non-bleeding injuries, pointing to the need of education focused on parents and school teachers regarding the importance of immediate therapy for both bleeding and non-bleeding TDIs.

Patients' Reactions to Local Anaesthetic Application Devices in Paediatric Dentistry.

Local anaesthesia is the most common medium for pain control in most dental treatments. Physical appearance of syringe itself can be considered as a provoking factor for the emergence of dental fear and anxiety (DFA). In this research the patient reactions to local anaesthesia application devices, as one of the main causes for DFA emergence, were inquired. The sample comprised of 120 patients, divided in three age groups, formed of 40 patients aged 8, 12 and 15 years. DFA prevalence was quantified by Children Fear Survey Schedule-Dental Subscale (CFSS-DS). Three different syringes were offered to the patients. Reasons for choosing one of the syringes were detected. Patients assigned statistically highest rank to plastic syringe. Boys chose metal and intraligamental syringe statistically more often than girls. Patients with higher CFSS-DS scores chose metal syringe as last option. None of the reasons for selection was dominant, except pain that could be caused by usage of any of the three syringes. A large number of patients did not mention any of the reasons for choosing particular syringes. Plastic syringe represented the most acceptable device for local anaesthetic application to our patients. Patients often linked pain with dental syringes.

The efficacy of gaseous ozone on some cariogenic bacteria.

The aim of this study is to analyze ozone impact on some cariogenic bacteria in ex vivo and in vitro conditions. The in vitro part of study inoculated dentine with strains of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 bacteria. Samples of dentine before and after 40s ozone treatment were collected and anaerobically incubated. Samples of cariogenic dentine (N = 24) were collected from permanent molars within the ex vivo segment of the study, prior and after 40s ozone treatment and a number of colonies were counted after incubation. For the in vitro part of study, results have shown a statistically significant average value of reduction of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 prior and after ozone treatment (p < 0.001). The ex vivo segment of the study has also demonstrated a statistically significant difference in the number of bacteria prior and after ozone implementation (p < 0.001). Gaseous ozone demonstrated a strong antimicrobial effect on cariogenic bacteria in both in vitro and ex vivo conditions and it can be used as an adjuvant in caries therapy.

Measurement of the Dentin Wall Thickness of the Maxillary Central Incisor in Relation to the Stage of Root Development: A Pilot Study.

Objective: The aim of this study was to determine the average dentin wall thickness (DWT) of the maxillary central incisor (MCI) required for performing finite element analysis (FEA) models of root development. Material and methods: A total of 137 intraoral periapical radiographs of MCI in children aged 7 to 11 years were examined and then classified into 5 groups according to root development stages, which included 1/2 of root development (S1), 3/4 of root development (S2), more than 3/4 of root development (S3), complete development with wide-open apex (S4) and complete development with closed apex (S5). DWT was measured at three reference (horizontal) lines: at a distance of 1 mm from the apex (M), 4 mm from the apex (L) and at the cervical line (K). The distal dentin wall thickness (M1, L1, and K1), the pulp thickness (M2, L2, and K2), the mesial dentin wall thickness (M3, L3, and K3), and the apex thickness (N) were measured using the diagnostic software Soredex Scanora 5.1.2.4. Statistical analysis compared the values of the parameters K, L, and M between developmental stages (multivariate ANOVA) and the linear correlations between the parameters (Pearson's correlation analysis). All analyses were performed at significance level α = 0.05. Results: There were statistically significant differences between the developmental stages for parameters L and M, while no significant differences were found for parameter K. Most of the correlations between the parameters were statistically significant, with the values of the Pearson correlation coefficient R > 0.6 considered practically significant. All parameters on the same reference line for distal and mesial dentin wall thickness and for pulp thickness correlated well with each other (R = 0.46 - 0.68), but there was no statistically significant correlation with total root thickness on the same reference line (parameters K, L, or M), except for parameter K3 (R = 0.42). Conclusion: Despite the limitations of this study, the mean values of the selected parameters for the 5 groups of developmental stages of the maxillary central incisor could be used to model dentin wall thickness using finite element analysis.

Restorative treatment decisions of Croatian university teachers.

This study aimed to identify differences in diagnostic criteria and restorative treatment among Croatian university teachers. The questionnaire was distributed to 120 Croatian university teachers in Zagreb and Rijeka. Responses were collected from 59 (49.2%) university teachers. Treatment thresholds for hypothetical approximal and occlusal caries, as well as most favored types of restorative techniques and materials were assessed. The majority (34%) of the respondents would intervene for an approximal caries lesion at the enamel-dentin junction. The leading strategy for occlusal caries was postponing operative treatment until the caries lesion was in the outer third of dentin and removing caries tissue only. Composite resin was the predominant material of choice for restoration of approximal and occlusal caries (70% and 81% respectively). More than half (54%) of Croatian university teachers believed the radiographs underestimated the depth of the caries lesion compared with clinical finding. Findings of this study should be a guideline for Croatian university teachers for a more consistent and modern teaching on the subject of caries management.

Oral health related to demographic features in Bosnian children aged six.

The main aim of this paper is to present epidemiological indicators of oral health among six-year olds in Bosnia and Herzegovina (BH) and to analyze values of dmft index and dental treatment needs in order to identify differences in parts of the country. Another aim is to identify the needs from the public oral health care system in Bosnia and Herzegovina related to early permanent dentition by analyzing the condition of first permanent molars (FPM) as an indicator of oral health of permanent dentition. Survey was carried out in 2004 in 8 cantons of the Federation of BH (FBH) and in the Republic of Srpska (RS). Final sample included 560 participants aged six (mean 6.2, SD +/- 0.87). One dental team clinically examined all participants according to WHO methodology and criteria. The parameters used were: dmft index, DMFT index of first permanent molars (FPM), presence of sealants and treatment needs. A questionnaire about oral health habits had been administered. Dmft was 6.71 in that the d-component constituted the major part of the index. DMFT index of FPM was 0.61 (SD +/- 1.08). Percentage of caries free participants aged 6 was 6.8%. Average number of FPM with fissure sealants in BH was 0.25 (SD +/- 0.78). Significant demographic differences in dmft index, DMFT FPM and treatment needs were identified. Most participants (48.5%) had their first dental visit between the ages of five and seven. National oral health goal for Bosnia and Herzegovina should be to develop and implement disease prevention programs based on education of both parents and dental practitioners. It is necessary to improve access to dental care and shift focus from curative to preventive procedures. It is also necessary to set real goals for improvement of oral health which can be achieved within a desired time frame, as well as to precisely define measures to be taken.

Program for Dental Health Advancement in Children "Dental Passport".

OBJECTIVE: The need for improving oral health in the Republic of Croatia was based on health indicators and poor oral health status and resulted in the implementation of measures to improve the use of dental health care for schoolchildren through the national program called "Dental Passport", which began in the 2017/2018 school year. PURPOSE: The aim of this study was to present the content and results of its implementation and to analyse them with emphasis on the sustainability and inclusion of the program and its implementation in preventive activities and procedures. MATERIAL AND METHODS: The data were collected from the completed "Dental Passport" forms from September 2017 to August 2018. The dental examinations and diagnostic-therapeutic procedures were recorded in The Central Health Information System of Croatia. RESULTS: In the school year 2017/2018, 24,729 6th grade elementary school students visited a dentist. The response rate in the Republic of Croatia was 68%. According to the CEZIH data, in the period from September 1 to December 31 2017, an increase in the number of first examinations and diagnostic-therapeutic procedures was observed in children aged 12 years, compared to the same period in 2015. The least reported preventive procedures in preschool children and 6th grade students were fissure sealing and sealing restorations, while motivating and instructing children on oral hygiene were the most common reported procedures. CONCLUSION: Good organization of work in school medicine provides the basis for the implementation of dental programs involving schoolchildren. However, greater motivation of the dental health care provider in the implementation of preventive procedures and motivation of parents and patients for a more active involvement in the "Dental Passport" program are important determinants in further implementation and improvement of oral health in children.

Randomized Clinical Trial investigating Self-Assembling Peptide P11-4 for Treatment of Early Occlusal Caries.

Non-invasive caries treatment is a major focus in modern dentistry. The present study was designed to evaluate the effectiveness of monomeric self-assembling peptide P11-4 (SAP P11-4) in combination with fluoride varnish or polymeric self-assembling peptide matrix (SAPM) in treatment of non-cavitated occlusal caries. Ninety children and adolescents were included in this randomized, gold-standard-controlled clinical trial. Test Group 1 received SAP P11-4 and twice fluoride varnish at baseline and Day 180, Test Group 2 received SAP P11-4 on baseline and twice weekly SAPM (home-application), and Control Group received fluoride varnish on baseline and Day 180. Caries progression was measured by laser fluorescence, Nyvad Caries Activity, ICDAS-II-codes, and investigator assessments. Laser fluorescence changes demonstrated superior results for Test Group 1 and 2, as values decreased compared to an increase for the Control Group (p < 0.0005). ICDAS-II codes at Day 360 showed partial regression for Test Group 1 (6.7%) and Test Group 2 (20.0%) and partial progression for Control Group (23.3%) (p < 0.01). Nyvad Caries Activity yielded superior caries inactivation for Test Groups, compared to Control Group (p = 0.002). This trial showed that SAP P11-4, applied either in combination with fluoride varnish or twice weekly SAPM, was a superior treatment for early caries compared to fluoride varnish alone.

Incidence of caries in children of rural and subrural areas in Croatia.

The aim of this paper was to determine certain regularities in caries incidence in children in primary and permanent dentition in respect of clinical and non-clinical variables that can be collected in everyday dental practice. This way it could be easier for the operator to adjust individual preventive therapy of patients. The study was conducted on 301 subjects, aged 3-6 (74 subjects) and 11-14 (227 subjects) inhabitants of Petrinja and Topusko, postwar rural and subrural areas in Central Croatia. Using an oral hygiene questionnaire, habits, diet and use of fluoride were assessed. The clinical finding comprised the dental status, amount of stimulated saliva, oral hygiene index and the presence of orthodontic anomaly. Children showed very high values of the dmf-t/DMF-T (decayed, missing, filled index) (7.7/6.7), dmf-s/DMF-S (16.5/11.8), and significant index of caries (SiC = 10.89). The study confirmed correlation between the OHI (oral hygiene index) and dmf-t/DMF-T and dmf-s/DMF-S index, and the influence of the regularity of dental check-ups and frequency of tooth brushing on OHI. Furthermore, the children that started practicing oral hygiene later, brush their teeth irregularly, and visit dentists only when having pain. It can be concluded that Croatia is still very far from achieving the goals set by WHO concerning oral health improvement.

The Reliability and Validity of the Three Modified Versions of the Children's Fear Survey Schedule-Dental Subscale of 9-12 Year Old Children in a Clinical Setting in Bosnia and Herzegovina.

OBJECTIVE: This study sought to obtain a comprehensive, reliable and valid instrument for evaluation of the presence of dental fear and anxiety (DFA) in children, through evaluation of the reliability and validity of three modified versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). MATERIALS AND METHODS: The study sample comprised children aged 9, 10, 11 and 12 years. The first sample group (200 patients) filled in a modified version of the CFSSDS scale, the second sample group (100 patients) filled in a short form of the Dental Fear Survey Schedule, and the third sample group (100 patients) filled in a short version of the CFSS-DS scale, prior to dental treatment, respectively. In order to determine test-retest reliability, the 184 patients from the first sample group filled in the modified version of the CFSS-DS scale again, prior to their next scheduled dental appointment. RESULTS: The modified version of the CFSS-DS scale had the best internal consistency reliability (α=0.907), as well as validity results, compared to the other two instruments used. Test-retest reliability was moderate (Intraclass correlation coefficient: 0.58). CONCLUSIONS: Of the three psychometric instruments used for evaluation of DFA presence in children, the modified version of the CFSS-DS scale showed the most clinically adequate reliability and validity values. This study thus provides a new psychometric instrument that should be considered for clinical use in evaluation of DFA presence in 9-12 year-olds, in a clinical setting sample type of children.

[Combined surgical-orthodontic therapy for compound odontoma]. / Kombinacija kirurske i ortodontske terapije rastavljeno slozenog odontoma (compound odontoma).

Odontogenic tumor is a rare condition in dental medicine that mostly proceeds unrecognized until the occurrence of clinical symptoms such as delayed eruption, or is incidentally detected on routine x-ray examination. The exact cause is not known, however, previous dental trauma and infection have been postulated as the potential factors in the development of odontogenic tumor. The earliest possible operative extirpation of the tumorous growth is recommended to eliminate permanent tooth impaction and to enable normal growth of the teeth. In some cases, corticotomy, including complete removal of the bony coat of the tooth, may be needed to additionally facilitate and precipitate its eruption. Orthodontic therapy is also of great importance in correct alignment of the teeth 'n the dental arch as well as in the management of other anomalies that may be associated with odontogenic tumor. A patient with compound odontoma is presented, along with the course of combined surgical-orthodontic therapy. The patient reported previous intrusion trauma that had occurred at the age of 4 years, which may have been the potential factor in the development of odontoma. In this case, there was a massive odontogenic tumor which had compromised the growth of permanent teeth, and the growth impulse was almost at the end since the patient was 11 years old and the apexes of the upper incisors were partially closed. The first operation included complete removal of the tumorous mass that had interrupted spontaneous eruption of the upper permanent incisors. It did not result in immediate spontaneous tooth eruption, so an additional operation was needed. The objective of the second operative procedure was complete removal of the covering bone over the unerupted upper permanent incisors in order to eliminate the physical barrier to tooth growth and eruption. The objective of fixed orthodontic therapy was full eruption of the partially erupted upper incisors. After 16 months, the upper incisors were regularly located in the dental arch. In this case, orthodontic therapy had another objective, i.e. to ensure rotation of the first upper premolar, to provide space for the upper permanent canine eruption and to establish regular intercuspidation after upper second premolar hypodontia. In colclusion, combined operative and orthodontic therapy can be recommended irrespective of the stage of the impacted tooth development because any treatment to precipitate tooth eruption has favorable effects. Impacted teeth should always be provided all treatment options for faster eruption, as demonstrated in our case where a good clinical result was achieved within 2.5 years. The role of regular clinical and x-ray controls for assessment of the impacted tooth eruption should also be emphasized.