Management Of Ectopic Eruption Of Bilateral Mandibular First Permanent Molars: A Case Report And Literature Review.

Ectopic eruption of the first permanent molars is a local eruption disturbance. The frequency of ectopically erupted first permanent molars is predominant in boys and primarily affects the maxilla. Interceptive treatment for irreversible ectopic eruptions should be initiated early to prevent space loss and the impaction of the second premolars. Herein, we report the case of a six-year-old girl with irreversible ectopic eruption of the bilateral mandibular first permanent molarstreated with a modified lingual arch. The mandibular first permanent molars were successfully distalised after six months of treatment, and one year of follow-up showed a satisfactory outcome. The modified lingual arch satisfies not only the clinical aspects of treatment but also the patient's well-being. However, the lingual arch may disturb tooth eruption in the mixed dentition stage.

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Simple approach for correcting an entrapped ectopic permanent mandibular first molar caused by poor marginal adaptation of a preformed metal crown on an adjacent primary second molar: a case report with a 5-year follow-up.

Ectopic eruption of the permanent first molar can lead to malocclusion if left untreated. Despite several reported etiologic factors and treatment options, ectopic eruption caused by an improper restoration on an adjacent tooth and a simple solution have never been documented. Case report: An 8-year-old boy presented with an entrapped ectopic permanent mandibular first molar under the poorly adapted margin of a preformed metal crown (PMC) on the adjacent primary second molar. Replacement with a PMC that had well-contoured margins followed by inserting a separating module between the proximal contact of the two teeth resulted in successful management of this situation in 1 month. Conclusion: This simple approach with good interdisciplinary communication is practical for correcting eruption problems due to a poorly adapted PMC, with long-term satisfactory results. To avoid subsequent malocclusion and unnecessary treatments, dental practitioners must be vigilant when manipulating PMCs and assessing the marginal adaptation prior to their cementation.

Microdont Developing Outside the Alveolar Process and Within Oral Diffuse and Plexiform Neurofibroma in Neurofibromatosis Type 1.

BACKGROUND/AIM: Numerical aberrations of permanent dentition and dystopic tooth eruption are part of the phenotype of the tumor predisposition syndrome neurofibromatosis type 1 (NF1). In these cases, surplus tooth germs usually develop in the alveolar processes of the jaw. This report attests to the dystopic development of a dysplastic supernumerary tooth in NF1 arising outside the jaw. CASE REPORT: The 8-year-old male patient developed a microdont outside the bone and above the occlusal plane of the retained maxillary right second molar. The supernumerary tooth was completely embedded in oral soft tissue. Hyperplastic oral soft tissue in the molar region and microdont were excised. Specimen of the mucosa surrounding the teeth was interspersed with diffuse and plexiform neurofibroma. The retained upper right first molar emerged spontaneously within a few months after surgery. The upper right second molar did not change position. CONCLUSION: Odontogenesis can take place within tumorous oral mucosa in NF1. Surgical removal of the tumorous mucous membrane facilitates tooth eruption in some cases.

Transposición dentaria. Reporte de un caso / Tooth transposition. Case report

RESUMEN La transposición dentaria se define como una ectopia del germen dentario, es común encontrarla en caninos superiores, pero cuando esta entidad se combina con una transposición se convierte en un dilema para el ortodoncista. Su etiología es multifactorial y no está bien aclarada, es conocido que se produce en el momento de la formación embrionaria por un intercambio en la posición del germen dentario, y con frecuencia, se considera ligado a factores genéticos. Se relaciona con trauma en el área afectada y con interferencias mecánicas. Se presentó un paciente de 14 años de edad, sexo masculino, que solicitó tratamiento por tener los dientes "botados" y un diente "fuera de lugar". Al examen clínico se observó transposición de 23 con 2:4. Se colocó aparatología fija con técnicas de cementado directo y bandas en los primeros molares permanentes superiores, se determinó mesializar el 23 y dejar libre 24, para evitar daño radicular. Una vez colocado 23 en su posición, 24 fue distalado y alineado al arco; para esto se utilizó arcos térmicos de nitinol preformados y secciones con elastómeros. Se logró neutroclusión de molares y caninos sin perjudicar los tejidos de soporte (AU).

ABSTRACT Tooth transposition is defined as an ectopia of the tooth germ, commonly found in upper canines, but when this entity is combined with a transposition, it becomes a dilemma for the orthodontists. Its etiology is multi-factorial and unknown. It takes place at the moment of the embryonic formation due to an interchange in the position of a tooth germ, and it is frequently considered linked to genetic factors. It is related to trauma in the affected area and with mechanic interferences. We present the case of a male patient, aged 14 years, who asked treatment for having buckteeth and a tooth ¨out of place¨. At the clinical examination it was observed the transposition of the 23 with 24. A fixed brace was put with direct cement techniques and bands in the first permanent upper molars. The orthodontist decided to mesialize 23 and let 24 free, to avoid root damage. Once 23 was in its position, 24 was distalized and aligned to the arch using pre-formed thermic nitinol arches and sections with elastomers. The molars and canines neutral occlusion was achieved without damaging the support tissues (AU).

Short-term impact of rapid maxillary expansion on ectopically and normally erupting canines.

INTRODUCTION: The purpose of this study was to evaluate the short-term impact of rapid maxillary expansion (RME) on the eruption paths of ectopically and normally erupting maxillary canines in the mixed dentition. METHODS: Thirty-two patients with 49 ectopically erupting canines (EEC group; age, 9.53 ± 1.10 years) and 18 patients with 27 normally erupting canines (NEC group; age, 9.25 ± 1.06 years) underwent RME. Thirty-six subjects with 54 normally erupting canines composed the untreated control group (UC group; age, 9.03 ± 0.72 years). Horizontal, vertical, and angular positions of canines and adjacent teeth were evaluated in the expanded (EEC and NEC groups) and unexpanded (UC group) patients using panoramic radiographs taken at 2 times with a 1-year interval. The radiographic evaluation methods included score ranking and proportional measurements to minimize panoramic radiograph limitations. Statistical comparisons were performed among the groups (P <0.05). RESULTS: Before expansion, the EEC group's canines were significantly closer to the midline, more distant from the occlusal plane, and more mesially angulated than those in the UC group. After expansion, the canine positions in the EEC and UC groups were similar, whereas the NEC group had a more favorable canine position for eruption. The EEC and NEC groups showed similar canine positional changes, whereas the UC group had the smallest changes. The positions of teeth adjacent to the canine were also significantly affected by RME, and these changes may be associated with improvement of the ectopic canine position. CONCLUSIONS: The changes produced by RME reduced the percentage of ectopic eruption paths and maintained the nonectopic eruption percentage.

Associations between tooth agenesis and displaced maxillary canines: a cross-sectional radiographic study.

BACKGROUND: The aim of present study was to test the association between hypodontia and displaced maxillary canine when compared with a control group. METHODS: The study group was composed of 336 subjects with a mean age of 10.7 ± 1.2 years, presenting with at least one missing tooth. Exclusion criteria included syndromes, craniofacial malformations, extractions and trauma history and previous orthodontic treatment. The control group consisted of 336 subjects with a mean age of 10.7 ± 1.2 years, without agenesis. Stepwise multiple logistic regression using the backwards elimination and the Wald test method was performed to identify the best combination of hypodontia and displaced maxillary canine (P < 0.05). RESULTS: The most represented category in study group consisted in mild agenesis (86.9%); moderate and severe agenesis groups respectively represented the 11.7 and 1.4% of study group. Agenesis was diagnosed in both arches in 46 subjects. Maxillary hypodontia and mandibular hypodontia was respectively detected in 156 and 134 subjects. The most frequent missing teeth were mandibular second premolars (45.8%), lateral incisors (41.7%) and maxillary second premolars (17.8%). A significant correlation between agenesis and displaced maxillary canine was observed in the study group (P < 0.05). Only the agenesis of maxillary lateral incisors remained in the final model during backward stepwise deletion. Significant association between the severity of dental agenesis and prevalence of displaced maxillary canine was not assessed. CONCLUSIONS: The outcomes revealed no difference related to the severity of dental agenesis and prevalence of displaced maxillary canine. Only the agenesis of maxillary lateral incisors should be considered directly connected with displaced maxillary canine.

Transposition of Mandibular Molars in a Dog.

Tooth transposition is a rare anomaly resulting in the interchanged position of 2 permanent teeth. Etiology of tooth transposition is unclear. In human dentistry, multiple influences are described, and there is strong evidence of a genetic basis. This is the first reported case of tooth transposition in a dog.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation.

OBJECTIVE: The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. MATERIAL AND METHODS: Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). RESULTS: There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. CONCLUSIONS: Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Risk of developing palatally displaced canines in patients with early detectable dental anomalies: a retrospective cohort study

ABSTRACT The early recognition of risk factors for the occurrence of palatally displaced canines (PDC) can increase the possibility of impaction prevention. Objective To estimate the risk of PDC occurrence in children with dental anomalies identified early during mixed dentition. Material and Methods The sample comprised 730 longitudinal orthodontic records from children (448 females and 282 males) with an initial mean age of 8.3 years (SD=1.36). The dental anomaly group (DA) included 263 records of patients with at least one dental anomaly identified in the initial or middle mixed dentition. The non-dental anomaly group (NDA) was composed of 467 records of patients with no dental anomalies. The occurrence of PDC in both groups was diagnosed using panoramic and periapical radiographs taken in the late mixed dentition or early permanent dentition. The prevalence of PDC in patients with and without early diagnosed dental anomalies was compared using the chi-square test (p<0.01), relative risk assessments (RR), and positive and negative predictive values (PPV and NPV). Results PDC frequency was 16.35% and 6.2% in DA and NDA groups, respectively. A statistically significant difference was observed between groups (p<0.01), with greater risk of PDC development in the DA group (RR=2.63). The PPV and NPV was 16% and 93%, respectively. Small maxillary lateral incisors, deciduous molar infraocclusion, and mandibular second premolar distoangulation were associated with PDC. Conclusion Children with dental anomalies diagnosed during early mixed dentition have an approximately two and a half fold increased risk of developing PDC during late mixed dentition compared with children without dental anomalies.

AXIAL MODIFICATIONS OF PERMANENT LOWER MOLARS AFTER PREMATURE LOSSES OF TEMPORARY MOLARS.

AIM: The aim of our study was to determine the impact of premature loss of temporary lower molars upon the longitudinal axis of the first and second permanent molars. MATERIAL AND METHODS: The study groups included 61 patients, 6-9 year olds with premature loss of primary molars and a control group of 24 patients with intact temporary teeth. We evaluated the angle between longitudinal axis of first and second lower permanent molars and occlusal plane. RESULTS: It was observed that premature loss of lower second deciduous molar modifies more the vertical axis of first and second permanent molars than the premature loss of first lower primary molar. Reducing space occurs mainly through mesial inclination of molars that separates the edentulous breach. Temporary loss of both lower first molars on the same quadrant causes an accelerated eruption of both premolars increasing the prevalence of eruption sequence: "4-5-3-7". CONCLUSIONS: The preservation of the occlusal morpho-functional complex using space maintainers mainly when the premature loss of the second primary molars occurs is the best interceptive treatment option.

Etiology, Classification and Management of Ectopic Eruption of Permanent First Molars.

Ectopic eruption of a permanent tooth involves abnormal resorption of a portion or all of the adjacent primary tooth. Among the most commonly ectopically erupted teeth are the permanent first molars. Ectopically erupting molars may require intervention to allow for full eruption, or they may spontaneously self-correct and erupt into occlusion. Decisions regarding the necessity of intervention, its ideal timing, and intervention type are multifactorial. Treatment options for the ectopically erupting permanent first molar include the elastomeric separator, brass wire, pre-fabricated clip separator, custom made appliances (Humphrey appliance, Halterman appliance), or extraction of the primary molar. Early intervention when indicated can ensure proper full eruption of the permanent first molar and prevent mesial angulation, arch perimeter loss, tooth impaction and ankylosis. Two cases are described that manage ectopic eruption of the permanent first molar.

Risk of developing palatally displaced canines in patients with early detectable dental anomalies: a retrospective cohort study.

OBJECTIVE: To estimate the risk of PDC occurrence in children with dental anomalies identified early during mixed dentition. MATERIAL AND METHODS: The sample comprised 730 longitudinal orthodontic records from children (448 females and 282 males) with an initial mean age of 8.3 years (SD=1.36). The dental anomaly group (DA) included 263 records of patients with at least one dental anomaly identified in the initial or middle mixed dentition. The non-dental anomaly group (NDA) was composed of 467 records of patients with no dental anomalies. The occurrence of PDC in both groups was diagnosed using panoramic and periapical radiographs taken in the late mixed dentition or early permanent dentition. The prevalence of PDC in patients with and without early diagnosed dental anomalies was compared using the chi-square test (p<0.01), relative risk assessments (RR), and positive and negative predictive values (PPV and NPV). RESULTS: PDC frequency was 16.35% and 6.2% in DA and NDA groups, respectively. A statistically significant difference was observed between groups (p<0.01), with greater risk of PDC development in the DA group (RR=2.63). The PPV and NPV was 16% and 93%, respectively. Small maxillary lateral incisors, deciduous molar infraocclusion, and mandibular second premolar distoangulation were associated with PDC. CONCLUSION: Children with dental anomalies diagnosed during early mixed dentition have an approximately two and a half fold increased risk of developing PDC during late mixed dentition compared with children without dental anomalies.

Decompression as a treatment of odontogenic cystic lesions in children.

PURPOSE: To evaluate the efficiency of decompression in treating odontogenic cystic lesions of the jaws in children. MATERIALS AND METHODS: All consecutive odontogenic cysts occurring in children and treated by decompression from 1994 to 2009 at 1 maxillofacial center were included in the present study. Clinical data included age, gender, jaw, histopathologic diagnosis, and decompression time. Radiologic data from panoramic radiographs before and after decompression included tooth involvement, locularity, location, involvement of adjacent vital anatomic structures, and cyst area. RESULTS: Thirty-two odontogenic cystic lesions from 26 children (14 boys [53.8%] and 12 girls [46.2%]) treated with decompression were included. The average age at the time of presentation was 11.6 ± 3.3 years (range, 7 to 18 yr). The mandible was involved in 13 cases (40.6%) and the maxilla in 19 (59.4%). All cysts were unilocular at presentation. Twenty-seven cysts (84.4%) showed tooth involvement. The diagnoses consisted of dentigerous cysts (20 [62.5%]), keratocysts (9 [28.1%]), and radicular cysts (3 [9.4%]). The mean decompression period was 7.45 ± 2.6 months (2 to 14 months). The mean standard lesion area index changed from 12.7 ± 0.9 mm(2) (3.6 to 44 mm(2)) before compression to 2.3 ± 4.3 mm(2) (0 to 22.3 mm(2)) after decompression. The mean percentage of reduction (POR) was 82 ± 16% (49 to 100%). The POR was ranked as good in 22 lesions (69%), moderate in 9 lesions (28%), and poor in 1 lesion (3%). Surgery was performed for 15 lesions (47%). CONCLUSION: Decompression results in good regeneration potential of the bone in the developing craniofacial skeleton of children. Children might benefit from a less invasive surgical protocol.

Intranasal tooth: ectopic eruption 1 year after maxillofacial trauma.

Injury to the permanent central incisors due to trauma in the maxillofacial region, though common, may result in an uncommon sequel. We report a case of traumatic injury in a 5-year-old child with displacement of the tooth bud into the nasal floor. The identification of ectopic tooth buds poses little diagnostic challenge due to the available imaging facilities, however, in the present case the ectopic bud remained unnoticed and resulted in ectopic eruption of the tooth in the nasal cavity 1 year later. This report highlights a rare case of nasal eruption of a permanent tooth and places stress on the need for close attention to detail during maxillofacial trauma for early detection and proper management.

Transposition of maxillary canine to central incisor site: aetiology, treatment options and case report.

Dental transposition is relatively infrequent anomaly of the developing dentition. This article focuses on canine transposition and explores the aetiology, diagnosis and treatment of this challenging anomaly. Specifically, the management of a case of canine transposition involving an unerupted maxillary central incisor is described.

Teeth erupted from the buccal mucosa: simple odontogenic choristoma or accessory teeth?

The eruption of developed teeth from the buccal mucosa is a rare phenomenon in the head and neck region. Such phenomena are possibly choristomas, tumorlike masses of histologically normal tissue occurring in an abnormal position. However, the accurate classification of this abnormality remains debatable. This report describes a case of a congenital, maldevelopmental, and noncystic lesion in a 4-year-old girl without other anomalies. To the authors' knowledge, this is the first case of multiple supernumerary teeth forming in the buccal and zygomatic regions.

Trastornos eruptivos de segundos molares y terceros molares incluidos. A propósito de un caso / Eruptive disorders of impacted second and third molars. A case study

La literatura determina, que el diente incluido es aquel que permanece completamente rodeado de hueso. Por ello, la erupción fisiológica del molar es interrumpida por diferentes factores que pueden ser de origen físico, dentario, óseo y sistémico. La incidencia de segundos molares inferiores retenidos relacionados con la inclusión de los terceros molares adyacentes, se establece alrededor del 6%.Se presenta un caso clínico donde se exodoncian los segundos y terceros molares del tercer y cuarto cuadrante cerca de la basal mandibular (AU)

The literature determines that the impacted tooth is that which remains completely surrounded by bone. For this reason, the physiological eruption of the molar is interrupted by different factors that may be of a physical, dental, bone and systemic origin. The incidence of retained lower second molars related with the impaction of the adjacent third molars is established at around6%. A clinical case is presented where the second and third molars are extracted from the third and fourth quadrant near the mandibular base (AU)

An ectopic tooth concealing an odontogenic myxoma.

UNLABELLED: This case report presents a 13-year-old girl who attended an orthodontic clinic for an ectopic UR5. After investigation, a diagnosis of an odontogenic myxoma was made and the tumour was excised. A panoramic radiograph taken almost two years earlier for another dental problem was found to show an ectopic UR5 associated with a subtle radiolucency. Odontogenic myxomas may be of higher frequency than once thought in the paediatric population and therefore should always be considered in the differential diagnosis of any intraosseous radiolucency. Any radiolucent area associated with an unerupted tooth should be investigated further or closely followed up. CLINICAL RELEVANCE: The odontogenic myxoma is a rare but potentially serious benign tumour of the jaws.