Detection and characteristics of the gubernacular tract in supernumerary teeth on cone beam computed tomography.

OBJECTIVES: The aim of this study was to evaluate the prevalence and visualization of supernumerary teeth (ST) and imaging characteristics of their gubernacular tract (GT) using cone beam computed tomography (CBCT). METHODS: Presence and visualization of ST were retrospectively evaluated using 960 CBCT images. The imaging characteristics of GT were analyzed to determine various presentations of GT according to type, shape, and orientation of ST. RESULTS: ST were radiographically detected in 93 patients, for a prevalence of 9.7%. Premolar shaped ST were more common (p = 0.003). GT was detected in 104 (77.2%) of impacted ST and mostly found straight in shape (49.0%). It was most frequently observed in peridens (n = 51, 49.0%) followed by mesiodens (n = 41, 39.4%) and more frequently seen in premolar-like ST (n = 44, 42.3%). The mean length of the GT in mandible was 2.8 mm, the mean length of the GT in maxilla was 1.0 mm (p < 0.001). The mean angle of the GT in mandible was 17.0, and the mean angle of the GT in maxilla was 43.0 (p = 0.004). CONCLUSIONS: CBCT can be used for evaluations in dental practice to provide comprehensive information about ST and their GT characteristics. Clinicians should be able to identify the characteristics of GTs on CBCT for dental treatments, especially traction and extraction of ST.

Imaging characteristics of enamel pearls on CBCT and their co-relation with supernumerary tooth.

OBJECTIVES: Enamel pearl (EP) is an ectopic growth of enamel that is generally round and white and it firmly adheres to the external root surface of tooth. The aim of this study was to assess the prevalence and imaging features of enamel pearls (EPs) and to investigate the potential relationship between EP and supernumerary tooth. METHODS: Cone beam computed tomography (CBCT) images of 1003 patients were evaluated for the presence of EP. Descriptive characteristics of gender and age of patients and imaging features of EPs and presence of supernumerary tooth were recorded. RESULTS: In this study, 72 EPs were radiographically detected in 63 molars in 43 patients, with a person prevalence of 4.29% and tooth prevalence of 0.71%. Most of the EPs (95.83%) were detected in maxillary molars especially in third (n = 42, 58.33%) and second molars (n = 18, 25%). They were more frequently located at mesial (n: = 21; 29.16%); distal (n = 16; 22.22%) proximal surface of roots and the furcation between the disto-buccal and the palatal roots (n = 12; 16.67%) respectively. CBCT images of 109 (10.87%) patients showed supernumerary tooth/teeth and 13 of these also presented EP. A statistical significant relationship between supernumerary tooth and EP was found (p = 0.001). Additionally, CBCT images of four EPs showed corticated hypodens tracts similar to gubernaculum dentis (GD). CONCLUSIONS: Clinicians and radiologists should be aware that EPs are most frequently observed in maxilla especially in third and second molars. Presence of supernumerary tooth might be associated with higher presence of EPs.

Assessment of the reliability of radiographic signs on panoramic radiographs to determine the relationship between mandibular third molars and the inferior alveolar canal.

OBJECTIVE: To assess the reliability of radiographic signs of the relationship between impacted mandibular third molars (IMTMs) and the inferior alveolar canal (IAC), and the vertical relationship between IMTM and IAC on panoramic radiographs (PRs) as risk indicators for IAC exposure during extraction. STUDY DESIGN: Seven radiographic signs regarding the appearance of roots and the IAC were assessed as present or absent on PRs. The vertical relationship between IMTM and the IAC was divided into 3 levels. The correlation between radiographic data and IAC exposure during extraction was analyzed by using χ2 statistics and logistic regression analysis. RESULTS: In total, 198 IMTMs were examined. In 46 cases (23.2%), the IAC was exposed during extraction. Four radiographic signs-darkening of the root, narrowing of the root, narrowing of the IAC, and diversion of the IAC-were associated with IAC exposure (P < .05). Concurrence of 2 or more of 7 radiographic signs increased the risk of IAC exposure (P < .001). The vertical relationship between IMTM and the IAC was found to be a risk indicator for IAC exposure (P < .001). No significant correlation was found between IAC exposure and inferior alveolar nerve damage (P = .148). CONCLUSIONS: Panoramic radiography is useful for assessing the risk of IAC exposure during IMTM extraction.

Squamous cell carcinoma arising in a residual cyst: a case report.

AIM: The purpose of this report is to present a case of squamous cell carcinoma (SCC) arising from a mandibular residual cyst. BACKGROUND: Although rare, SCC may arise in the epithelial lining of odontogenic cysts. The diagnosis of the development of carcinoma from the cyst lining can only be established by histopatologic examination. REPORT: A case of SCC arising from a mandibular residual cyst in a 55-year-old man is presented along with a discussion of the critical elements needed for accurate diagnosis and treatment. SUMMARY: The development of SCC from residual cysts is rare but should always be considered in the differential diagnosis. This case report clearly demonstrates the importance of clinician awareness of the malignant potential of apparently innocuous cystic lesions. It also underscores the importance of a careful histological examination and the necessity of obtaining biopsy materials from various areas to prevent a misdiagnosis of large-sized cysts.