A rare find of a maxillary third molar with five roots: a case report of an unusual morphology.

Third molars are frequently absent or impacted; their unpredictable prevalence and morphology, with frequent anatomical variations, is a challenge for the practitioner. The number of roots of the upper third molars vary from one to five, but five roots upper third molars' cases are extremely rare. The case reported here is of a normotrophic male patient, with no significant general medical history, having extracted an impacted maxillary upper molar, with an unusual position and dimensions and five completely separated formed roots, orientated in diverse directions. It highlights the importance of using the correct surgical technique, without excessive pressure, for avoiding the fracture of the maxillary tuberosity, the displacement of the molar into the pterygopalatine fossa or the opening of the maxillary sinus, especially in the absence of good quality imagistic information like cone-beam computed tomography. The case presented in this paper is very rare and highlights the significance of anatomical knowledge, which is mandatory for managing these cases, to avoid trauma, accidents, and complications and to maintain an optimal time of extraction, since such variations occur, and the conventional radiographs do not offer enough data to clarify the diagnosis.

Base Materials' Influence on Fracture Resistance of Molars with MOD Cavities.

The aim of this study was to compare fracture resistance of teeth presenting medium-sized mesial-occlusal-distal (MOD) cavities using different base materials. Thirty-six extracted molars were immersed for 48 h in saline solution (0.1% thymol at 4 °C) and divided into six groups. In group A, the molars were untouched, and in group B, cavities were prepared, but not filled. In group C, we used zinc polycarboxylate cement, in group D-conventional glass ionomer cement, in group E-resin modified glass ionomer cement, and in group F-flow composite. Fracture resistance was tested using a universal loading machine (Lloyd Instruments) with a maximum force of 5 kN and a crosshead speed of 1.0 mm/min; we used NEXYGEN Data Analysis Software and ANOVA Method (p < 0.05). The smallest load that determined the sample failure was 2780 N for Group A, 865 N for Group B, 1210 N for Group C, 1340 N for Group D, 1630 N for Group E and 1742 N for Group F. The highest loads were 3050 N (A), 1040 N (B), 1430 N (C), 1500 N (D), 1790 N (E), and 3320 N (F), the mean values being 2902 ± 114 N (A), 972 ± 65 N (B), 1339 ± 84 N (C), 1415 ± 67 N (D), 1712 ± 62 N (E), and 2334 ± 662 N (F). A p = 0.000195 shows a statistically significant difference between groups C, D, E and F. For medium sized mesial-occlusal-distal (MOD) cavities, the best base material regarding fracture resistance was flow composite, followed by glass ionomer modified with resin, conventional glass ionomer cement and zinc polycarboxylate cement. It can be concluded that light-cured base materials are a better option for the analyzed use case, one of the possible reasons being their compatibility with the final restoration material, also light-cured.

Supernumerary permanent maxillary canine - a rare finding: case report and literature review.

Supernumerary teeth are dental units that appear in addition to the regular number of teeth. Their most frequent location is the anterior maxilla, especially on the maxillary midline, being called mesiodens, but also paramedian or in the position of a lateral incisor. On the other hand, the permanent canine is one of the most stable teeth regarding the number, with very few cases reported about hypo- or hyperdontia. This article reviews the few data found in the literature about the supernumerary permanent maxillary canine and also presents the case of an 8-year-old female patient with a supplemental permanent canine in the upper left maxilla. The patient was non-syndromic and did not present any other supernumerary teeth in the permanent dentition; she had only one in the temporary dentition. Using cone-beam computed tomography (CBCT) of the region, we were able to evaluate the position, structure, and shape of the supplemental canine and also to establish a treatment plan. The aim of this paper was to present this extremely rare case of a non-syndromic Romanian adult female patient with a unilateral supplemental permanent maxillary canine, and to include a literature review of the few reported such cases.

A rare case of transmigrated mandibular canine and combined orthodontic-surgical management.

Canines are paramount teeth for esthetics and function. Transmigration of the lower permanent canine is a rare process of alteration of the eruption path toward the opposite part of the mandible. The position of the migrating tooth varies at different ages, so early detection of the tendency to cross the midline is crucial; canines that have already passed through the center of the mandible can be impossible to realign. Transmigration can start any time before the normal age of eruption. Comparing two radiographic images taken at different ages offers important diagnosis information. Camilleri & Scerri (2003) described a progressive alteration of the tooth position in four steps, from the normal appearance to a low position inside the corpus of the mandible. Following this classification, this article's aim was to present a case of an impacted lower canine that was diagnosed between the second and third stage of transmigration, around the age of 10, and to detail the combined orthodontic-surgical treatment strategy for "recapturing" and the orthodontic mechanics used to align it. After the examination of cone-beam computed tomography, we have decided to use a lingual arch as a space maintainer and anchorage tool and to surgically expose the tooth. The canine's initial position and the direction of the force of traction used allowed a proper alignment of the tooth inside the dental arch. The periodontal tissues management was important for good healing, stability, and aesthetics. The early detection allowed a proper interdisciplinary orthodontic-surgical management, and a successful outcome.

Unilateral agenesis of permanent superior canine in familial peg-shaped lateral incisors: rare case report and literature review.

Agenesis of permanent maxillary and mandibular canines is very rare; one to all four can be missing, isolated or in association with other missing teeth or with dental morphology abnormalities. Such cases can present functional, esthetic, and psychological problems, since the canine's role in functional occlusion and in obtaining an aesthetic smile is crucial. Frequently, the canine's absence from the arch is caused by impaction; its congenital absence is extremely rare in patients with no associated syndrome. The aim of this paper was to present a very rare case of a non-syndromic Romanian adult female patient with a unilateral permanent maxillary missing canine, in association with peg-shaped maxillary lateral permanent incisors, which can have a genetic cause, since the same morphological abnormality was present in her father and her younger sister, who also presented a rare situation of bilateral upper transposition between the canines and lateral incisors. The association of a permanent maxillary canine hypodontia with bilateral "peg laterals" and transposition between the maxillary canine and the peg-shaped lateral incisors is also rare as a family character in healthy patients. Future statistical studies are necessary to establish the incidence of permanent maxillary canine agenesis in Romanian population. Also, the article includes a detailed literature review of reported cases of agenesis of permanent maxillary canines.

Periodontal clinico-morphological changes in patients wearing old nickel-chromium and copper alloys bridges.

Elderly population frequently presents more than one prosthetic restoration realized from different types of dental alloys which, in time, suffer various alterations in the oral environment. Metallic ions are released in saliva due to its electrolytic qualities, interacting with the contact tissues. Studies regarding cytotoxicity of dental alloys are providing contradictory results. Besides biocompatibility, the microbial factor is also greatly influencing the long-term success of the prosthetic rehabilitation. This study's aim was to assess the response of the gingival tissue to nickel-chromium (Ni-Cr) and copper (Cu)-based dental casting alloys from fixed dentures present in many patients from Romania. Gingival samples were taken from 124 patients wearing fixed dental restorations made from these two types of alloys from injured areas surrounding the abutment teeth; histological specimens were prepared, fixed in 10% neutral buffered formalin, paraffin-embedded and stained with Hematoxylin-Eosin (HE). Histological analysis showed the existence of a chronic inflammatory infiltrate in the gingival chorion, necrosis areas, and vascular congestion. Various morphological alterations appeared, depending on the intensity of the inflammation and the immune response. The surface epithelium suffered a hyperplasic reaction, either limited to acanthosis or involving the whole epithelium, the release of the Cu(2+) and Ni(2+) ions from the dental alloys used in bridges and crowns being responsible for inducing gingival hyperplasia and a chronic inflammation in the areas situated around the abutment teeth. The immunohistochemical study allowed us to observe an increased number of positive cluster of differentiation 3 (CD3) T-lymphocytes in periodontium, proving that the cellular immune response is rapid and intense.

Non-syndromic familial hypodontia: rare case reports and literature review.

Congenital absence of the teeth, affecting both physiognomy and mastication, can have a great impact on patients' quality of life. It may appear unilateral or bilateral; frequently, it associates with certain general conditions. Familial hypodontia in clinically healthy patients is rare. Genetic transmission, as a determinant factor in missing teeth, can be autosomal dominant, recessive, or related to the sex chromosomes. In case of congenitally missing permanent teeth, the corresponding deciduous teeth can be still found on the arch at adult age. The aim of this article is to present rare cases of familial non-syndromic unilateral and bilateral hypodontia in Romanian adult siblings, highlighting also a cross gene transmission between aunt and niece and evaluating the treatment options in accordance with patient's age and oral status. It shows that early diagnosis of hypodontia is crucial for the patient's future oral health. The decision to keep the temporary teeth or to extract them is influenced by the presence and status of the deciduous teeth, patient's access to treatment and parent's agreement. Asymptomatic adult patients, in which hypodontia was diagnosed during a routine control, do not usually solicit therapeutic intervention until the deciduous teeth are also lost; still, in situations where complications arise through their loss, the treatment of hypodontia is complex, involving a close collaboration between a team of specialists. The article also includes a detailed review of literature referring to the prevalence of hypodontia among different populations.

Pontic morphology as local risk factor in root decay and periodontal disease.

INTRODUCTION: In absence of treatment, old single edentulous spaces are subjected to progressively decrease in length due to tilting and rotation of the teeth situated mesial and distal. Lately when these spaces are prosthetically restored with a bridge and these teeth are becoming abutments, sanitizing of the prosthetic restoration is achieved with difficulty, the space between the pontic and the gingival surface becoming an area rich in pathogens that can cause various complications on the abutments. AIM: Considering these aspects, in this study we wanted to highlight the presence and the types of the microorganisms that can be found under the pontic even in an ideal situation, selecting only young adult patients with a good oral hygiene and only with metal-ceramic bridges. MATERIALS AND METHODS: Determination of microorganisms was achieved by growing on BD Columbia Agar with 5% sheep blood. Incubation was done in anaerobe condition using GENbag system produced by BioMérieux Company. RESULTS: The microorganisms that we determined were Streptococcus mutans, S. mitis, S. oralis, Gram-negative bacilli (Bacteroides ovatus, B. thetaiotaomicron) and Gram-positive bacilli (Bifidobacterium spp., Actinomyces israelii, Clostridium butyricum / beijerinckii) with relevance in the carious and periodontal disease. CONCLUSIONS: In cases of single unit bridges with very narrow pontics, even in patients with a very good oral hygiene and metal-ceramic restorations, we can still find micro-organisms that can potentially generate decay or periodontal disease on the abutments, located in the gingival area underneath these pontics. These bacteria can have negative implications on the long-term prognosis of prosthetic restorations.