Odontomas: un reto para el tratamiento interdisciplinario del paciente de ortodoncia / Odontomas: a challenge for the interdisciplinary treatment of the orthodontic patient

El objetivo del presente trabajo es describir las técnicas para el diagnóstico y tratamiento de 3 casos clínicos de odontoma en pacientes ortodóncicos. En el caso 1, se trató a un paciente masculino de 17 años, que acudió para interconsulta con el servicio de ortodoncia, ya que no había erupcionado el canino superior izquierdo y el primer premolar superior izquierdo. El estudio anatomopatológico reveló odontoma complejo con áreas pindborgoides y acumulación de células fantasma. En al caso 2 se trató a un paciente femenino de 15 años. El estudio anatomopatológico reveló odontoma complejo. En el caso 3, se trató a un paciente masculino de 28 años que acudió a rehabilitación integral de su boca, y fue derivado a la cátedra de ortodoncia. En la radiografía panorámica se observó una imagen compatible con odontoma. Se remitió una muestra a anatomía patológica que confirmó el diagnóstico de odontoma. Conclusión: el conocimiento adecuado de las características clínicas, radiológicas y patológicas es necesario para un correcto diagnóstico y tratamiento. Es importante el trabajo interdisciplinario ortodoncista - cirujano para tratar estos casos (AU)

The objective of this work is to describe the techniques for the diagnosis and treatment of 3 clinical cases of odontoma in orthodontic patients. In case 1, a 17-year-old male patient was treated who came for consultation with the orthodontic service, since the upper left canine and the upper left first premolar had not erupted. Pathological study revealed complex odontoma with pindborgoid areas and accumulation of ghost cells. In case 2, a 15-year-old female patient was treated. The anatomopathological study revealed a complex odontoma. In case 3, a 28-year-old male patient was treated who attended comprehensive rehabilitation of his mouth and was referred to the orthodontic department. In the panoramic radiography, an image compatible with odontoma was observed. A sample was sent to pathological anatomy, which confirmed the diagnosis of odontoma. Conclusion: Adequate knowledge of the clinical, radiological and pathological characteristics is necessary for a correct diagnosis and treatment. Interdisciplinary orthodontist-surgeon work is important to treat these cases (AU)

Delayed Eruption of Maxillary Central Incisors Associated with the Presence of Supernumerary Teeth: A Case Report with 18 Months Follow-up.

AIM: The aim of this study is to discuss a case of an 11-year-old pediatric patient, who was diagnosed with delayed eruption of the permanent maxillary central incisors because of palatally impacted supernumerary teeth. BACKGROUND: The delayed eruption of permanent teeth can be a result of blocking by supernumerary teeth and over-retained primary teeth. Early diagnosis can help in avoiding the complications. The management of such cases depends on the stage of teeth development, teeth position, and space availability. Treatment may combine both surgical and orthodontic interventions. CASE DESCRIPTION: The case was managed by surgically removing the primary retained teeth and supernumerary teeth in two visits then allowing the impacted permanent incisors to erupt without any intervention. CONCLUSION: After 18 months follow-up, the two permanent incisors erupted spontaneously with no orthodontic intervention. CLINICAL SIGNIFICANCE: dentists should be aware of the importance of early diagnosis of supernumerary teeth. The management of such cases should be designed by a multidisciplinary team decision.

[Unerupted first deciduous molar located higher to the first premolar: a case report].

Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones. Of the primary teeth reported as unerupted, second deciduous molars are the teeth most frequently involved, followed by primary central incisors. At present almost no coverage is seen about the impaction of the first deciduous molar. In this case, a 4-year-old boy who presented with an impacted left maxillary first deciduous molar came to the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. This tooth, located higher to the left maxillary first premolar, was well near to the maxillary sinus. The family and medical histories were noncontributory and his physical findings were within normal limits. The mother was reported as having experienced no illness or other complications and taken no medications during pregnancy. His clinical extraoral examination was noncontributory. His clinical intra-oral examination revealed that the maxillary left first primary molar was not present. No enlargement of the area was apparent visually or on palpation. The remaining primary dentition was well aligned and in good condition. His oral hygiene was good, although there were incipient occlusal carious lesions in the mandibular second primary molars. There was no history or evidence of dental trauma. A diagnosis of a left maxillary first deciduous molar was made on the basis of the clinical and radiographic evidence. Numerous local etiologic factors have been described for impacted teeth. These include anomalous teeth, malposition, fusion with adjacent or supernumerary teeth, odontoma, dentigerous cysts, tumors, underdevelopment of the jaws, keratinized epithelial lining, hereditary conditions, and trauma. In this case, the reason for impaction was not clear. After the comprehensive clinical evaluation, treatment consisted of placement of a space maintainer, the periodic examination was indicated for the follow-up, so that early interventions, such as subsequent surgical intervention and orthodontic traction could be recommended timely to manage orofacial disfigurement and to avoid consequent problems with resultant proper functioning and good periodontal health.

Unilateral delayed eruption of a mandibular permanent canine and the maxillary first and second molars, and agenesis of the maxillary third molar.

Delayed tooth eruption can affect the accuracy of orthodontic diagnosis and treatment planning and could delay overall treatment. A girl, aged 7 years 4 months, who had unilateral delayed eruption of several teeth was successfully treated. The evaluation of delayed tooth eruption should be considered by the orthodontist because the role of these teeth can affect the overall treatment of malocclusion. In patients with delayed tooth eruption, careful and accurate diagnosis and treatment planning will allow the orthodontist to start treatment at the proper stage and might reduce the overall orthodontic treatment time.

Conservative approach for a patient with extreme delay in maxillary lateral incisor development.

The purpose of this article is to report the orthodontic treatment of a patient with extremely delayed development of the maxillary lateral incisors. At 7 years of age, the boy's permanent maxillary lateral incisors had not erupted. A radiograph showed no tooth germs in place, although well-defined radiolucent areas were evident. Removal of the radiolucent areas was contemplated, but it was rejected in favor of a conservative approach. At age 13, peg-shaped maxillary lateral incisors erupted; they were positioned during orthodontic treatment and reshaped with composite restorations, providing good esthetics and function.

Modified distal shoe appliance--fabrication and clinical performance.

When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

Conservative management of a large dentigerous cyst in a 6-year-old girl: a case report.

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are usually characterized as unilocular radiolucent lesions and are rarely seen during childhood. The purpose of this article was to report the case of a 6-year-old girl with a dentigerous cyst associated with the tooth buds of premolars. The therapeutic approach included extraction of the primary molar involved and marsupialization of the lesion. After 21 months of follow-up, spontaneous eruptions of the impacted premolars were noticed. In conclusion, marsupialization might be the first treatment option for conservative management of dentigerous cysts in children.

The effect of unerupted permanent tooth crowns on the distribution of masticatory stress in children.

Human mothers wean their children from breast milk at an earlier developmental stage than do ape mothers, resulting in human children chewing solid and semi-solid foods using the deciduous dentition. Mechanical forces generated by chewing solid foods during the post-weaning period travel through not only the deciduous teeth, but also the enamel caps of the developing permanent teeth within the maxilla and mandible, which are not present in the adult face. The effects of mechanical stress propagating through these very stiff structures have yet to be examined. Based on a heuristic model, we predicted that the enamel of the embedded developing teeth would act to reduce stresses in the surrounding bony elements of the juvenile face. We tested this hypothesis by simulating occlusal loading in a finite element (FE) model of a child's cranium with a complete set of deciduous teeth and the first permanent molars embedded in the bony crypt in the maxilla. We modeled bone and enamel with appropriate material properties and assessed the effect of embedding high-stiffness enamel structures on stress distribution in the juvenile face. Against expectation, the presence of unerupted enamel caps does not affect the magnitude or location of stresses in the juvenile face. Our results do not support the hypothesis that the unerupted secondary teeth act to moderate stresses in the juvenile face.

Effect of lower third molars on the incidence of mandibular angle and condylar fractures.

PURPOSE: Numerous previous studies already have proven that mandibles with a third molar are significantly more susceptible to angle fracture by external force. Similarly, other data suggest that the absence of a third molar increases the risk of condylar fracture, while concurrently decreasing the risk of angular fracture. We attempt to characterize the effect of a third molar on the incidence of mandibular angle and condylar fractures. METHODS: This retrospective study reviews data from 385 patients, all of whom were seen in our clinics between February 2006 and November 2009. All data were collected from clinical examination notes and panoramic radiographs, with third-molar state evaluated by the Pell and Gregory classification system. RESULTS: Our results mirror those of previous studies. The incidence of mandibular angle fracture was significantly greater on sides with a third molar, whereas the condylar fracture rate significantly increased in mandibles lacking a third molar or without a fully erupted third molar. The rate of symphysis and mandibular angle fracture was also high in cases of multiple comorbid fractures. CONCLUSIONS: Both the presence and the state of the lower third molar affect the risk of future mandibular angle and condylar fracture.

An unusual presence of primary retention of permanent teeth in subject with hyperthyroidism.

To date neither the eruption mechanism nor the factors controlling eruption have been completely understood. Primary retention of permanent teeth is an isolated condition associated with a localized failure of eruption with no other identifiable local or systemic involvement. Multiple primary retention may be related to lack of eruptive force, rotation of tooth buds, syndromes and metabolic disorders. This article reports an unusual case of primary retention of permanent teeth inclusion in a 21-year-old woman with hyperthyroidism, diagnosed at 14 years of age.

Effects of orthodontic treatment and premolar extractions on the mandibular third molars.

BACKGROUND: The space available for an unerupted mandibular third may depend on the choice of premolar extracted. AIMS: To investigate the effects of orthodontic treatment and premolar extractions on the inclinations of the mandibular third molars and the space available for their eruption, and to compare these changes with a nonextraction group. METHODS: The pre- and post-treatment panoramic radiographs of 54 subjects (20 males, 34 females) were used. Eighteen of these subjects had the four first premolars extracted, 16 subjects had four second premolars extracted and 20 subjects were treated nonextraction. Changes in the inclinations and spaces available for the unerupted third molars were compared. RESULTS: In the nonextraction group the third molars uprighted approximately 1 degree and in the second premolar extraction group the third molars uprighted 10 degrees. The spaces available for the third molars increased significantly in the first and second premolar extraction groups as compared with the space available in the nonextraction group. CONCLUSIONS: Orthodontic treatment and extraction of the second premolars improved the inclinations of unerupted third molars and the space available for their eruption into the arch. The changes in inclination and eruption space were less marked following first premolar extractions.

Spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst.

A dentigerous cyst is the most common developmental odontogenic cyst. It is a benign and asymptomatic intraosseous lesion that affects the bones of the maxillofacial complex, interfering with tooth eruption. This article reports the spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst and extraction of the deciduous teeth. A radiograph showed a large cyst with a radiolucent area involving the mandibular left deciduous canine and first molar, and the permanent canine and first premolar. Although enucleation is the treatment of choice, marsupialization is the best option for large cysts involving an unerupted permanent tooth, as in this case. The patient was followed for 1 year, and eruption of the permanent canine and first premolar and gradual reduction of the radiolucent area were observed.

Avaliação da maturação pós-eruptiva do esmalte de dentes humanos hígidos e sua resposta frente a um desafio cariogênico in vitro por meio da microdureza longitudinal / Assessment of maturity post-eruptive enamel of healthy enamel human teeth and its response against a in vitro cariogenic challenge through longitudinal microhardness

Sabe-se que dentes recém-irrompidos são mais susceptíveis a lesões cariosas comparados aos dentes mais velhos. O risco elevado à desmineralização tem sido também comprovado por experimentos in vitro. No entanto, a maioria dos trabalhos é realizada com amostras polidas provenientes de diferentes tipos de dentes. Adicionalmente, não há dados comparativos entre a mesma amostra hígida e desmineralizada. Portanto, este estudo teve como objetivo avaliar o impacto da maturação pós-eruptiva do esmalte humano hígido sobre a desmineralização in vitro por meio da microdureza longitudinal. Cada grupo de dentes foi composto por 12 espécimes de esmalte de terceiros molares: não irrompidos, com 1 a 6 meses de erupção e com 2 a 3 anos de erupção. As amostras foram protegidas em 2/3 da superfície e submetidas à formação de lesão cariosa artificial (gel de metilcelulose com ácido lático, pH 4,6, 14 dias). A microdureza longitudinal foi realizada na superfície hígida e desmineralizada nas distâncias de 10 a 220µm. Os dados foram analisados por ANOVA/Tukey ou Kruskall-Wallis/Dunn (p<0,05). As médias de dureza da superfície hígida (KHN), o KHN (superfície cariada) e a profundidade da lesão (m) para os grupos submetidos ao desafio cariogênico foram, respectivamente: incluso (333,2/13.567/81,67), 1-6m (355,9/13.332/78,33) e 2-3a (382,9/14.019/73,33). Concluiu-se que dentes com diferentes idades pós-eruptivas apresentam diferenças em relação à microdureza longitudinal do esmalte hígido que podem não refletir em maior susceptibilidade à desmineralização quando um gel acidificado é utilizado para provocar lesão de cárie artificial.

It is known that newly erupted teeth are more susceptible to carious lesions compared to older teeth. The high risk of demineralization has also been proven by in vitro experiments. However, most work is performed with polished samples from different types of teeth. Additionally, there is no comparative data between sound and demineralized enamel from the same tooth. Therefore, this in vitro study evaluated enamel maturation at different depths in sound and demineralized human teeth at different posteruptive ages by cross-sectional hardness (CSH). Each group was composed by 12 enamel samples from 3rd molars: unerupted, with 1-6 months and 2-3 years. The samples had two thirds of the surface protected and were subjected to demineralization (methylcellulose gel/lactic acid, pH 4.6, 14 days). Cross-sectional hardness was performed on sound and demineralized enamel on distances from 10 to 220µm. Data were analyzed by ANOVA/Tukey or Kruskall-Wallis/Dunn (p<0.05). Means of sound enamel hardness (KHN), KHN (demineralized surface) and lesion depth (m) for the groups submitted to acid gel were: unerupted (333.2/13,567/81.67), 1-6 m (355.9/13,332/78.33) and 2-3y (382.9/14,019/73.33). It was concluded that teeth with different post-eruptive ages differ regarding to the cross-sectional hardness of sound enamel, which in turn may not reflect a higher susceptibility to demineralization when an acidified gel is used to provoke artificial carious lesion.

Physical properties of root cementum: part 12. The incidence of physiologic root resorption on unerupted third molars and its comparison with orthodontically treated premolars: a microcomputed-tomography study.

UNLABELLED: INTRODUCTION Root resorption can occur as a physiologic or a pathologic process, and it is an unwanted side effect of orthodontic treatment. No baseline studies have assessed this phenomenon in the absence of force variables such as mastication, parafunction, and soft-tissue pressure. In this study, we investigated the incidence and quantitative value of root resorption on unerupted third molars with normal development using microcomputed tomography. METHODS: Nine unerupted, nonimpacted maxillary third molars were collected from 6 patients (ages, 19.47 plus /minus 1.89 years). The teeth were examined with microcomputed tomography and compared with teeth from other studies. (The other teeth had been treated with buccally directed light [25 g] or heavy [225 g] forces applied for 28 days, or light [25 g] or heavy [225 g] intrusion forces for 28 days.) RESULTS: Imaging and volumetric analyses showed resorption craters in many locations and with various magnitudes. Analysis of variance was completed by position (P = 0.04), surface (P = 0.07), height (P = 0.045), left or right side of the mouth (P = 0.85), and subject (P = 0.70). The midroot region on the mesial surfaces of the third molars, near the root structure of adjacent erupted second molars, had the greatest statistical significance. When compared with crater volumes of fully erupted first premolars, we found that the unerupted third molar sample had a slightly greater cube root volume per tooth than the erupted first premolars not subjected to orthodontic force and a similar cube root volume per tooth as did first premolars subjected to light (25 g) buccal and intrusive orthodontic forces. CONCLUSIONS: Root resorption as a consequence of orthodontic treatment might be added to a baseline level of root resorption. The elevated results suggest that resorption might occur as part of hard-tissue remodeling and turnover, eruption, or transmission of masticatory forces through the dentition to the alveolar bone.

Eruption prediction of mandibular premolars associated with dentigerous cysts.

OBJECTIVE: A tooth with a dentigerous cyst (DC) does not always erupt by marsupialization. The eruption duration and conditions of DC-associated premolars were examined to predict such eruption following marsupialization. STUDY DESIGN: The eruption and conditions including depth, root formation, inclination, and eruption space were examined retrospectively in 21 DC-associated mandibular premolars using dental and panoramic radiograms. RESULTS: Fifteen of 21 premolars erupted half within 3 months and all 15 erupted completely within 10 months after marsupialization, without orthodontic traction. The age of the patients, tooth depth, and inclination were significantly different between the erupted and non-erupted groups, whereas there was no significant difference in the root formation or the eruption space between the 2 groups. CONCLUSIONS: The successful eruption of a DC-associated premolar can be predicted within 3 months after marsupialization. Furthermore, the eruption may be affected by the patient's age, tooth depth, and tooth inclination.

Etiología del retraso de la erupción dental. Revisión bibliográfica / No disponible

La erupción dental supone el movimiento del diente en dirección axial desde su posición original en el maxilar hasta su posición funcional en la cavidad oral. Este es un proceso local y programado dentro de la edad cronológica del paciente; sin embargo, existen variaciones de la norma en cuanto al tiempo de erupción. Estas variaciones pueden ser debidas a factores locales, sistémicos o genéticos; pero en algunos casos, no existe causa conocida para el retraso de la erupción dental. En estos casos, la etiología podría deberse a alguna alteración en el proceso de erupción a nivel celular. El propósito de este artículo es realizar una revisión bibliográfica del retraso de la erupción dental, su etiología y mecanismos celulares implicados (AU)

Eruption is the axial movement of a tooth from its nonfunctional position in the boné to functional occlusion. It is a local and programmed process within the chronologic age of the patient but there are variations in time of eruption. These variations may be caused by local, systemic or genetic factors but there are many cases in which cause of delayed tooth erupcion is unknown. In these cases, the etiology may be acelular alteration during tooth eruption. The purpose of these study is make a review of the etiology of delayed tooth eruption (AU)

Caries experience and periodontal pathology in erupting third molars.

PURPOSE: This study was conducted to document the prevalence of occlusal caries experience and periodontal pathology for erupting third molars in young adults. PATIENTS AND METHODS: The data are from 49 subjects enrolled in an institutional review board-approved trial with at least one third molar below the occlusal plane at baseline that erupted by longest follow-up. Teeth were considered erupted if they reached the occlusal plane. Caries experience on the occlusal surface of third molars was assessed by a visual-tactile examination. At least 1 periodontal probing depth (PD) >or=4 mm in the third molar region was considered indicative of periodontal pathology. The third molar region was defined as the 6 probing sites around third molars and 2 sites on the distal of second molars. The prevalence of third molar caries experience and periodontal pathology at longest follow-up was assessed. RESULTS: Most of the 49 subjects were female (51%), Caucasian (76%), and educated at least through high school (82%). Median age was 20.5 years (interquartile range [IQR] 18.4 to 24.1 years). Median follow-up was 5.1 years (IQR = 3.4 to 6.9 years). At baseline, none of the subjects had occlusal caries experience in a third molar; 51% of subjects had at least 1 PD >or=4 mm in a third molar region. At follow-up, 27% of the subjects had occlusal caries experience in at least 1 third molar that erupted to the occlusal plane; 61% had at least 1 PD >or=4 mm in a third molar region. Twenty-nine percent had occlusal caries in at least 1 third molar at the occlusal plane and at least 1 PD >or=4 mm in a third molar region. Thirty-seven percent had no third molar occlusal caries experience and all third molar region PD <4 mm. CONCLUSIONS: For third molars that erupted "late," periodontal pathology was more prevalent than occlusal caries.

The unerupted maxillary second molar, due to an overlying and malformed upper third molar: treatment and follow-up.

This retrospective study presents the treatment and follow-up of 20 young patients with 23 impacted upper second molars, due to overlying, impacted upper third molars. The third molars were removed surgically under local anaesthesia. After removal of these palatally obstructing teeth, radiographic and clinical follow-up was performed. The purpose of this study was to evaluate the eruption progress of the upper second molars after surgery. Radiological and/or clinical follow-up showed complete eruption of 19 (83%) of the upper second molars. For those cases treated before the age of 12 years and 4 months (the mean eruption age), all the upper second molars erupted completely. For those cases where surgical removal was undertaken after the mean eruption age, four (17%) of the upper second molars did not completely erupt. It was concluded that early treatment of impacted upper second molars, due to overlying third molars, may lead to more rapid eruption. Further prospective research is necessary to develop guidelines for the removal of palatally obstructing third molars to avoid eruption problems.

Evaluation of superficial microhardness in dental enamel with different eruptive ages.

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.

Evaluation of superficial microhardness in dental enamel with different eruptive ages

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.