Agenesis of maxillary lateral incisors: diagnosis and treatment options.

INTRODUCTION: There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases. OBJECTIVES: To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.

Agenesias dentárias atípicas: relato de caso clínico / Atypical dental agenesis: clinical case report

A agenesia dentaria é uma anomalia de desenvolvimento caracterizada pela determinação congênita de menor numero de dentes, podendo estar associada a síndromes genéticas ou ocorrer isoladamente. Embora seja considerada uma das anomalias mais frequentes quando envolve terceiros molares, segundo pré-molares e incisivos laterais, sua ocorrência em dentes estáveis, tais como o canino e o primeiro molar permanente é rara. Desta forma, este relato apresentará o caso de uma paciente do sexo feminino, 8 anos idade, que iniciou tratamento de rotina na Clínica de Odontopediatria da UNIFENAS. Na anamnese não foi relatada pela responsável a ocorrência de alterações sistêmicas, nem queixa ou histórico odontológico relevante. No exame clínico odontológico, notou-se o não irrompimento do primeiro molar permanente superior direito (16). Diante dos exames de imagem, foi confirmada a agenesia do dente 16 e também do canino permanente superior direito (13). A agenesia, sobretudo de dentes estáveis e relevantes no arco dentário, pode comprometer o desenvolvimento adequado da oclusão, mastigação, fonação e estética. Desta maneira, é importante o diagnóstico precoce desta ocorrência com o objetivo de favorecer a elaboração de um adequado plano de tratamento e, minimizar as sequelas destas agenesias atípicas(AU)

Dental agenesis is a developmental anomaly characterized by the congenital determination of fewer teeth, may be associated with genetic syndromes or occur in an isolated form. Although it is considered one of the most frequent anomalies when it involves third molars, second lateral premolars and incisors, the occurrence in stable teeth, such as the permanent canine and the permanent first molar is rare. This report will present the case of an 8-year-old female patient who started routine treatment at the Pediatric Dentistry Clinic of UNIFENAS. In the anamnesis, the responsible person did not report the occurrence of systemic alterations, or a relevant dental complaint or history. On dental clinical examination, it was noticed the non-rupture of the permament maxillar right first molar (16). In view of the imaging tests, the agenesis of tooth 16 and also of the permanent maxillary right canine (13) was confirmed. Agenesis, especially of stable and relevant teeth in the dental arch, may compromise the proper development of occlusion, chewing, phonation and aesthetics. Thus, it is of paramount importance to early diagnosis of this occurrence in order to favor the development of an appropriate treatment plan in order to minimize the sequelae of these atypical agenesis(AU)

Síndrome GAPO, a propósito de un caso / GAPO syndrome: case report

El síndrome GAPO es una rara enfermedad autosómica recesiva caracterizada por retraso en el crecimiento, alopecia, pseudoanodoncia y atrofia óptica. Se han descrito mutaciones en el gen ANTXR1 como origen etiológico. Presenta afectación de múltiples aparatos, por lo que requiere un manejo multidisciplinar para lograr su adecuado tratamiento.

GAPO syndrome is a rare autosomal recessive disease characterized by growth retardation, alopecia, pseudoanodontia and optic atrophy. Gene alterations in the ANTXR1 gene have been reported to be causative of this disorder. Abnormalities of diverse organs and systems have been described. A multidisciplinary management to achieve an adequate treatment is required.

Implante dentário e carga imediata após a extração do incisivo lateral superior decíduo: quatro anos de acompanhamento / Immediate dental implant and loading after extraction of a maxillary lateral incisor deciduous tooth: 4 years of follow-up

Quando bem indicado, o implante imediato com carga é uma opção segura e eficiente para substituição de elementos dentais unitários condenados, com previsibilidade e altas taxas de sucesso quando se buscam fatores como conforto, estética, função e fonética. Uma técnica atraumática, aliada à habilidade do operador, e um bom remanescente ósseo são fatores determinantes no sucesso do tratamento. O objetivo desse trabalho foi apresentar um caso clínico de instalação de implante imediato em região anterossuperior com carga imediata, provisionamento com dente decíduo e prótese definitiva livre de metal, com acompanhamento de quatro anos.

When properly indicated, the immediate dental implant with loading is a safe and efficient option with predictability and high success rates for patients in need of comfort, esthetics, function, and phonetics. An atraumatic technique allied to the operator's skill and a good bone site are mandatory to the treatment success. This case reports the 4-year follow-up on the use of an immediate implant/loading procedure after extracting a maxillary deciduous lateral incisor and delivery of a metal-free restoration.

Hypohidrotic and hidrotic ectodermal dysplasia: a report of two cases.

Ectodermal dysplasias are a large group of syndromes characterized by anomalies in the structures of ectodermal origin. There are 2 major types of this disorder, based on clinical findings: hypohidrotic ectodermal dysplasia and hidrotic ectodermal dysplasia. This clinical classification is very important because clinical professionals involved with this disease need first a clear and practical method of diagnosis. The main oral manifestation of ectodermal dysplasia may be expressed as hypodontia. Thus, dental professionals may be the first to diagnose ectodermal dysplasia. The present article reports one case of each of the main types (hypohidrotic and hidrotic) of ectodermal dysplasia and the authors review the literature regarding the pathogenesis, clinical features, and therapeutic management of this condition.

Oral findings in patients with mucolipidosis type III.

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

Dentistry and molecular biology: a promising field for tooth agenesis management.

Tooth agenesis is the failure of tooth bud development, causing definitive absence of the tooth. It is the most common dental anomaly, affecting up to one-quarter of the general population. The main cause is related to abnormal function of specific genes which play key roles during odontogenesis, particularly MSX1 and PAX9. MSX1 is a transcription factor highly expressed in the mesenchyme of developing tooth germs, whereas PAX9 is a transcription factor that shows a direct relationship with craniofacial development, particularly the formation of the palate and teeth. Despite the high frequency of tooth agenesis, there are as yet only a restricted number of mutations in MSX1 and PAX9 that have been associated with non-syndromic tooth agenesis. Thus, a deeper analysis of the gene networks underlying this anomaly is imperative. By means of a literature review based on Medline, PubMed, Lilacs, NCBI, and STRING, performed between 1991 and 2010 and focused on etiologically associated mutations, this work aimed to assess the latest advances in the genetic etiology of tooth agenesis and to offer an insight into how they can assist dental practice in the near future. A better knowledge of the genetic networks underlying tooth agenesis will lead to better treatment options and, perhaps, a tool for early diagnosis possibly related to DNA examination based on polymorphic variants. Such a test based on DNA analysis may be available to and accessible by clinicians, resulting in a more accurate diagnosis and allowing for a better approach to this anomaly.

Oral findings in patients with mucolipidosis type III

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

A mucolipidose tipo III é uma doença rara, autossômica recessiva, que faz parte de um grupo de doenças de depósito, decorrentes do erro inato do metabolismo das enzimas lisossômicas. Caracteriza-se pelo aparecimento progressivo de sinais e sintomas com repercussão no desenvolvimento físico e mental, bem como alterações visuais, cardíacas, esqueléticas e articulares. Apesar de achados bucais estarem bem relatados em associação à mucolipidose tipo II, esse artigo descreve achados radiográficos e histológicos de múltiplas lesões radiolúcidas, associadas a dentes inclusos nos maxilares, em uma jovem de 16 anos de idade com mucolipidose tipo III.

Focal dermal hypoplasia: a case report and literature review.

Focal dermal hypoplasia (FDH), also known as Goltz-Gorlin syndrome, is an autosomal dominant disease affecting tissues derived from the ectoderm and mesoderm. Knowledge and early diagnosis of the craniofacial alterations commonly found in patients with FDH provide oral health care professionals with effective preventive and therapeutic tools. This article aims to review the craniofacial characteristics present in FDH and the main systemic manifestations that have implications for dental management, while presenting a new case of the syndrome with novel oral findings.

Ocular hypertelorism in an orthodontic patient.

Ocular hypertelorism is a congenital craniofacial malformation characterized by excessive distance between the eyes. It is one of the most expressive deformities of the human face. The aim of this case report was to discuss clinical aspects associated with the diagnosis, planning, and treatment of an orthodontic patient with ocular hypertelorism.

Severe oligodontia and dental anomalies in a child with a history of multiple natal teeth: An eight-year retrospective.

This article reports the case of a boy born with 11 natal teeth who had many alterations in his permanent dentition. In this case, 22 teeth were missing and a shape anomaly was detected in eight teeth. The treatment consisted of prosthetic rehabilitation and follow-up of teeth eruption and jaw growth.

Alterações do desenvolvimento dentário em pacientes portadores de fissuras de lábio e/ou palato: revisão de literatura / Dental abnormalities in patients with cleft lip and palate: literature review

A fissura labiopalatal é uma das anomalias congênitas mais frequentes no ser humano, capaz de comprometer o lábio e/ou palato de forma completa ou incompleta. Sua etiologia não é totalmente conhecida, no entanto, é considerada multifatorial, com envolvimento de fatores genéticos e ambientais. Inúmeras alterações sistêmicas decorrentes dessa malformação são encontradas nestes indivíduos. Além disso, a fala, a estética e a posição dos dentes normalmente estão afetados. Sabe-se que uma alta prevalência de anomalias dentárias, como, por exemplo, agenesias, microdontias, dentes supranumerários e hipoplasias são achados comuns na cavidade bucal destes indivíduos. O objetivo deste trabalho é apresentar uma revisão de literatura sobre as anomalias dentárias mais frequentemente observadas em pacientes portadores de fissuras labiopalatais e destacar a importância do diagnóstico precoce realizado pelo cirurgião-dentista no decorrer do tratamento desses pacientes.

Cleft lip and palate is one of the most common congenital anomalies in humans, affecting the lip and/or palate with a cleft completeness or incompleteness. Its etiology is unknown, however, is considered multifactorial, with genetic and environmental components. Many systemic abnormalities arising from this malformation are found in these individuals. Also, speech, esthetics and the position of teeth are usually affected. It is known that a high prevalence of dental anomalies such as agenesis, supernumerary tooth and hypoplasia are common findings in the oral cavity of these individuals. The aim of this article is to present a review of the literature considering the higher prevalence of dental anomalies in patients with oral clefts and highlighted of early diagnosis performed by the dentist during the dental treatment of these patients.

Dental evaluation of Kabuki syndrome patients.

Kabuki syndrome is a genetic disorder of unknown etiology characterized by mental retardation, growth deficiency, and peculiar face (i.e., long palpebral fissures, eversion of the lateral third of the lower eyelids, prominent ears, and broad and depressed nasal tip). Oral manifestations commonly observed in Kabuki syndrome may comprise cleft lip/palate, bifid tongue and uvula, malocclusion, and dental abnormalities. We evaluated the dental findings of eight patients with Kabuki syndrome. One presented cleft palate; three presented caries; and seven had missing teeth, with the upper lateral incisors and inferior central incisors being the most commonly absent. All missing teeth were permanent, and there was no alteration of dental chronology or morphology. Because most patients had mixed dentition, the presence or absence of primary teeth was assessed through the parents' reports. One patient presented an absent upper canine, which had not been reported previously in the literature. Dental findings may be helpful for clinical diagnosis, or they may be an additional finding to substantiate the diagnosis of Kabuki syndrome in children with mild phenotype.

Erupción y retención del tercer molar en jóvenes entre 17 y 20 años: Antofagasta, Chile / Eruption and retention of third molars in young people between 17 and 20 years of age: Antofagasta, Chile

La retención intraósea y la erupción en malposición de 3Ms han sido muy estudiadas. Son causadas, probablemente, por disminución del tamaño de maxilares por cambios de hábitos alimentarios, reduciendo el espacio retromolar, lo que dificulta la erupción normal entre 15 y 25 años de edad, y produce patologías o molestias por comprometer estructuras orofaciales próximas. Lo anterior, ha promovido la exodoncia profiláctica u ortodóncica, incluso del germen dentario, con altos costos clínicos, hospitalarios, laborales, comprometiendo parte de los recursos destinados a financiar otros procedimientos quirúrgicos orales, además de riesgos durante cirugía, postoperatorio y lesiones iatrogénicas temporales o permanentes. La muestra consistió en 100 jóvenes de 17 a 20 años de edad (50 mujeres y 50 hombres) de la ciudad de Antofagasta, sanos, sin malformaciones general y maxilofacial, sin haber presentado enfermedades infecciosas que alteraran odontogénesis y períodos eruptivos, sin exodoncias de 3M ni tratamientos ortodóncicos previos al examen de la radiografía panorámica y clasificando erupción de 3Ms según tablas de Pell-Gregory y Winter. Se determina 49,1 por ciento de 3Ms retenidos con p<0,05 significativo respecto dientes erupcionados, predominando retención maxilar, especialmente en mujeres. En todos los casos y en mandíbula predominan 3Ms con impactación mesioangulada (p<0,05 significativa) y en maxilares la retención vertical (p<0,05 de significancia). Prevalecen 3Ms distoangulados en maxilares, posición que predispone a complicaciones operatorias y postoperatorias en exodoncias. La retención horizontal se aprecia en mandibula, siendo el segundo tipo de retención (21,5 por ciento en toda la muestra y 30 por ciento en hombres). Sin una decisión clínica que indique la cirugía, se sugiere postegar la exodoncia profiláctica de 3Ms, esperando posible erupción tardía (Hattab, 1997; Ventã et al. 1999, 2004 y Kruger et al.). Meta-análisis demuestra: mínima morbilidad...

Intraoseous retention and anomalous eruption position of 3Ms had been widely studied. They are probably produced by reducing the size of jaws by changes in eating habits, reducing the retro molar space, making it difficult normal eruption between 15 and 25 years old, producing pathologies or discomfort by compromising nearly orofacial structures. The above, has promoted the extraction or prophylactic orthodontic, even from the dental germ, with expensives clinical cost, hospital surgery, compromising part of the resources to finance other surgical oral procedures, in addition to risks during surgery, postoperative and iatrogenic injuries temporary or permanent. The sample consisted in 100 young people aged 17 to 20 years of age (50 women and 50 men) of the city of Antofagasta, healthy, without general and maxillofacial malformation, without having submitted infectious diseases that distort odontogenesis and periods of eruption, without extractions of 3M nor orthodontic treatments prior to the examination of the x-ray overview and classifying eruption of 3Ms as tables of Pell-Gregory and Winter. It was determined that 49.1 percent of 3Ms were retained, with p<0.05 significant with regard to erupted teeth, predominate maxillary retention, especially in women. In all cases and in maxilla predominate 3Ms with mesiangular position (p<0.05 of significance) and in maxillary vertical retention (p<0.05 of significance). Prevailing 3Ms maxilla with distoangular position, a position that predisposes surgical complications and postoperative extractions. The horizontal retention is apparent only in mandible, being the second type of retention (21.5 percent in all cases and 30 percent in men). Without a clinic decision to indicate surgery, we suggest to postpone the prophylactic extraction of 3Ms, awaiting possible late eruption (Hattab, 1997; Ventã et al., 1999, 2004; Kruger et al., 2001). Meta-analyzes show minimum morbidity in 3Ms extractions in...

Estágio atual sobre o conhecimento da agenesia de incisivos laterais superiores permanentes / Current stage of knowledge of agensis of upper lateral incisors permanent

A agenesia de incisivos laterais superiores permanentes é uma anomalia frequente, que pode acarretar alterações oclusais, estéticas e funcionais. As duas alternativas de tratamento comumente utilizadas são o fechamento do espaço ortodôntico e a abertura oumanutenção deste, sendo a primeira delas a de maior relevância.

Congenittally absent maxillary lateral incisors is a common anomally andfrequently introduces an imbalance in occlusion, aesthetics andfunctional factors. Purposes of treatment are the possibility of orthodontic space closure or a space opening, as an alternativeapproach, the first one is the more relevance.

Prevalência dos diversos tipos de disgenesias presentes em um grupo de pacientes tratados ortodonticamente nas clínicas da Universidade Paulista de São Paulo e Campinas / Prevalence of the several types of present dysgenesis in a group of patients treated at the Orthodontic-Facial Orthopedics Clinics of University Paulista, both at Campinas and São Paulo Campus

Introdução -Os tipos de disgenesias podem ser classificados de diversas formas. O presente estudo teve como princípio dividi-las em quatro grupos: tamanho, forma, número e estrutura. Material e Métodos - Foram analisadas 504 radiografias panorâmicas em pacientes com idade entre 6 a 14 anos, já tratados ou em tratamento, nas clínicas de Ortodontia-Ortopedia Facial da Universidade Paulista, ambos nos Campus de Campinas e São Paulo. Resultados - Na amostra de 504 pacientes, encontrou-se 59 indivíduos com algum tipo de disgenesia, 30 do gênero masculino correspondendo a 51 % do total e 29 do gênero feminino. Conclusão - Diante dos valores encontrados pode-se comprovar que 11% de qualquer amostra não viciada apresentarão algum tipo de disgenesia, e que dentre eles a de número (agenesias) respondem por aproximadamente 66% desse total e 7,70% de toda a amostra.

Introduction - The dysgenesis types can be classified in several ways. The aim of the present study was to divide them in four groups: size, form, number and structure. Material and Methods - Five hundred four panoramic radiographs were analyzed from patients ranging from 6 to 14 years old, already treated or under treatment, at the Orthodontic - Facial Orthopedics Clinics of the University Paulista, both at Campinas and São Paulo Campus. Results - In the sample of 504 patients,we find 59 individuals with some type of dysgenesis, 30 of the masculine sort corresponding 51% of total and 29 of the feminine sort. Conclusion -Ahead of the joined values we could prove that 11% of any vitiated sample will not present some type of dysgenesis, and that among them of number (agenesis) answer approximately for 66% of this total and 7.70% of the entire sample.

Prevalência de Anomalia Dentária de Número em Pacientes Submetidos a Tratamento Ortodôntico: um Estudo Radiográfico / Prevalence of Dental Anomalies of Number in Orthodontic Patients

Objetivo: Avaliar a prevalência das anomalias dentárias de número em pacientes de 6 a 16 anos de idade, atendidos no serviço de Ortodontia do Hospital da Polícia Militar de Niterói/RJ, no período de2002 a 2006. Método: Foram feitas análises de radiografias panorâmicas, determinando quais os dentes afetados, a sua localização e a distribuição entre os sexos. Resultado: Das 402 radiografias panorâmicas analisadas, 5,97% apresentavam anomalia de número de dentes, sendo 4,73% de hipodontia, com distribuição semelhante entre os sexos e 1,24% de hiperdontia, com uma prevalência maior entre os meninos. Das 19 radiografias com hipodontia, 11 tinham mais de 1 elemento dentário ausente e 8 tinham ausência de somente 1 dente. Das 5 radiografias com hiperdontia, 3 tinham somente 1 supranumerário(o 4º. Molar de Bolk) e 2 tinham 2 supranumerários (uma média de 1,4 dentes por paciente). Conclusão: As radiografias panorâmicas se mostram como um método de escolha para o diagnóstico das anomalias de número, juntamente com a avaliação da ficha clínica elaborada através de uma boa anamnese.