Minimally invasive intraoral removal of mesiodens via a transnasal, non-endoscopic approach: a systematic review on the purpose of 10 cases.

Mesiodens, which emerge towards the nasal cavity, often require consultation in maxillofacial practice. Typically accessed through wide palatal flaps with ostectomy, this method involves limited visibility and poses the risk of damaging the roots and apex of adjacent dental structures. This study advocates a minimally invasive technique that involves vestibulotomy between the central incisors, facilitating direct and rapid access through nasal floor dissection, minimizing comorbidities. A systematic review was performed, following the PRISMA guidelines, apropos on ten clinical cases reported in this study. The MEDLINE/Pubmed and Web of Science databases were searched. Several variables were considered and are presented comprehensively in tables and figures. Additionally, 10 case reports with mesiodens in the maxilla were submitted to surgical treatment using a minimally invasive intraoral transnasal disinclusion. The initial literature search resulted in 37 articles, of which 9 met the inclusion criteria for the analysis. Regarding postoperative complications, no bone exposure, incisor root damage, extensive surgical approach, palatal or vestibular hematoma, or palatal necrosis was observed. However, 10% experienced superficial damage to the nasopalatine neurovascular, while 80% and 20% presented mild and moderate postoperative facial edema, respectively. Hypoesthesia in 20% of patients recovered in the first week, 40% in the first month and 40% at 3 months. The minimally invasive intraoral, transnasal, non-endoscopic approach emerges as a safe and predictable alternative to conventional surgical techniques. Presumes minimal postoperative complications, mitigating the risk of excessive bone removal and damage to adjacent structures.

Human diprosopus: Case report of a rare congenital abnormality.

Diprosopus is a congenital anomaly in which partial or complete duplication of craniofacial structures occurs. Because it is rare, the mortality rate is high, and information concerning this anomaly is scarce. This study describes a case of human diprosopus in a 9-year-old male individual, who has severe complications associated with the central nervous, cardiovascular, respiratory, and digestive systems. Since birth, he has been monitored in a specialized hospital environment, where he has undergone several surgeries and multidisciplinary treatments. Regarding the craniofacial aspects, he had agenesis of the corpus callosum, floor of the nasal cavity, and floor of the anterior cranial fossa, in addition to the presence of bone dysplasia, ocular hypertelorism and cleft palate with nasal and oral teratoma. Regarding dental characteristics, the patient has duplication of the maxilla, mandible, tongue, and some teeth. After complementary imaging exams, several supernumerary teeth were found, with some being impacted and in complex regions, with an indication for extraction due to the risks of impaction, irruptive deviation, root resorption, and associated cystic or tumoral lesions. Because of the numerous complications, knowledge, and preparation of the entire team is necessary for the correct management of the case.

Exodoncia de diente supernumerario geminado en maxilar superior / Extraction of a geminated supernumerary tooth in upper jaw

Introducción: Los dientes supernumerarios constituyen una anomalía de número en la cual se excede la cantidad normal de piezas dentales. La geminación es una anomalía de forma que se caracteriza por la presencia de una corona bífida y una raíz común. Los dientes supernumerarios geminados son de rara aparición; indicar exámenes imagenológicos son importantes para determinar sus características y su relación con las estructuras vecinas. Objetivo: Presentar el caso clínico de un paciente con un diente supernumerario geminado. Caso clínico: Paciente de sexo masculino de 23 años de edad, acude a la consulta odontológica por presentar una elevación del lado izquierdo en el paladar, sin molestias. En el examen clínico se observa un aumento de volumen de mucosa palatina de piezas dentales 24 y 25. Los exámenes de imagen fueron realizados y se diagnosticó un diente supernumerario geminado retenido, se realizó tratamiento quirúrgico y el paciente evolucionó favorablemente. Conclusión: Los dientes supernumerarios geminados son poco frecuentes, una oportuna y correcta evaluación imagenológica, le permitirá al clínico realizar un adecuado diagnóstico y tratamiento(AU)

Introduction: Supernumerary teeth constitute an anomaly of number where the normal number of teeth is exceeded and gemination is an anomaly of shape characterized by the presence of a bifid crown, a common root. Geminate supernumerary teeth are of rare occurrence; indicating imaging examinations are important to determine their characteristics and their relationship with neighboring structures. Objective: To present the clinical case of a patient with a geminate supernumerary tooth. Clinical case: A 23-year-old male patient came to the dental office due to an elevation on the left side of the palate, without discomfort. In the clinical examination, an increase in the volume of the palatal mucosa of teeth 24 and 25 was observed. The imaging examinations were performed and a retained geminated supernumerary tooth was diagnosed, surgical treatment was performed and the patient progressed favorably. Conclusion: Geminate supernumerary teeth are rare; a timely and correct imaging evaluation will allow the clinician to make an adequate diagnosis and treatment(AU)

Tratamento cirúrgico de mesiodentes sob sedação consciente com óxido nitroso: relato de caso clínico / Surgical treatment of mesiodens under conscious sedation with nitrous oxide: clinical case report

Dentes supranumerários são caracterizados como um excesso no número de dentes da série normal. Os mesiodentes, definidos pela sua localização mediana aos incisivos centrais superiores, referem-se ao tipo de dente supranumerário mais comumente encontrado na cavidade oral, normalmente intraósseo e assintomático. A presença desses dentes pode ocasionar alterações na dentição permanente, mas a abordagem cirúrgica na fase da dentição mista mostra resultados satisfatórios no alinhamento dental espontâneo. Em pacientes pediátricos, a sedação consciente com óxido nitroso tem demonstrado ser uma alternativa segura e eficaz no controle do medo e da ansiedade. Objetivo: relatar um procedimento cirúrgico de remoção de dois mesiodentes em paciente pediátrico sob anestesia local associada à sedação com óxido nitroso. Relato de caso: paciente do sexo feminino, 11 anos de idade, necessitava de remoção cirúrgica de dois dentes supranumerários localizados em região anterior de maxila. Com a avaliação da tomografia computadorizada, pôde-se observar a posição em que ambos se encontravam. Realizou-se também a exodontia do elemento dentário 14, como solicitado pela ortodontista, para posterior continuidade do tratamento ortodôntico. Devido à complexidade cirúrgica e ao tempo operatório, considerando a idade da paciente e o possível aumento nos níveis de ansiedade, optou-se pela realização de sedação consciente com óxido nitroso. Conclusão: clinicamente, dentes supranumerários podem causar danos locais. O tratamento cirúrgico associado à sedação consciente mostrou-se bastante seguro e efetivo no controle comportamental, além de poder ser implementado na rotina ambulatorial.(AU)

Supernumerary teeth are defined as those in addition to the normal series. The mesiodens, is the most common supernumerary tooth and it is present in the midline between the two central incisors. It is usually intraosseous and asymptomatic. The presence of these teeth may cause changes in permanent dentition and the surgical approach in the mixed dentition phase shows satisfactory results in spontaneous dental alignment. In pediatric patients, conscious sedation with nitrous oxide has been shown to be a safe and effective alternative in controlling fear and anxiety. Objective. To report a surgical procedure for the removal of two mesiodens in a pediatric patient under local anesthesia associated with nitrous oxide sedation. Case report. 11-year-old female patient required surgical removal of two upper mesiodens. The computed tomography images assisted to indicate their exact position. The extraction of the upper right premolar (tooth #14) was also performed as requested by the orthodontist. Considering the patient's age and the possible increase in anxiety levels, along with surgical complexity and operative time, the conscious sedation with nitrous oxide was selected. Conclusion. Clinically, supernumerary teeth cause local damage and surgical treatment associated with conscious sedation has proved to be quite safe and effective in the behavioral control besides being able to be implemented in the outpatient routine.(AU)

Odontoma complejo en posición supernumeraria. Reporte de caso / Complex odontoma in supernumerary position. Case report

RESUMEN Fundamento: Los odontomas son entidades odontogénicas benignas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas, las mismas pueden ser compuestas y complejas. Los hallazgos radiográficos de estos tumores en posiciones supernumerarias son raras menores al 1 %. Objetivo: Describir el caso clínico de un odontoma complejo infrecuente. Presentación de caso: Paciente femenina de 18 años con un trauma facial, que durante el diagnóstico imagenológico se le encontró una imagen anterosuperior de aspecto tumoral en posición supernumeraria, por lo que se decidió realizar la exéresis quirúrgica de la lesión después de finalizado el tratamiento del trauma. El diagnóstico clínico histopatológico fue de un odontoma complejo. Conclusiones: Se recomienda realizar las vistas imagenológicas tipo ortopantomografías o panorámicas a cada paciente que vaya a ser operado de cirugía bucal a fin de poder detectar de forma precoz cualquier alteración en la anatomía y de esta manera estudiar tanto el comportamiento de los odontomas como de otras lesiones intraóseas, lo que puede garantizar un tratamiento temprano y con ello un mejor pronóstico para el paciente.

ABSTRACT Background: Odontomas are mixed benign odontogenic entities, composed of a mixture of odontogenic epithelial and differentiated mesenchymal cells, they can be compound and complex. Radiographic findings of these tumors in supernumerary positions are rare, less than 1%. Objective: To describe the clinical case of a non-frequent complex odontoma. Case report: 18-year-old female patient with facial trauma, during the imaging diagnosis it was found an anterosuperior tumor image in supernumerary position, thus decided to perform the surgical excision of the lesion after the trauma treatment. The histopathological clinical diagnosis was a complex odontoma. Conclusions: It is recommended to perform standard panoramic radiograph imaging for each patient to be operated on oral surgery to detect any early anatomy alteration, so this way to study both, the behavior of odontomas as well as other intraosseous lesions, which can guarantee an early treatment and a better prognosis for the patient.

Queratoquiste Odontogénico en un Paciente con Displasia Cleidocraneal: reporte de un Caso / Odontogenic Keratocyst in a Patient with Cleidocranial Dysplasia: case Report

RESUMEN: La displasia cleidocraneal (DCC), es un trastorno autosómico dominante poco común, que involucra principalmente a los huesos que se osifican por vía membranosa; afectando el cierre de fontanelas craneales y el desarrollo de las clavículas, además de anomalías dentales y vertebrales. El objetivo de este manuscrito fue reportar el caso de una paciente con DCC que presentó un queratoquiste odontogénico (QQO) intrasinusal. Presentamos el caso de una paciente de 81 años, diagnosticada en su niñez con DDC, que consultó por un desajuste protésico y molestias en relación a la zona del seno maxilar derecho. Clínicamente se observó desajuste de la prótesis y aumento de volumen de márgenes poco definidos en la zona maxilar derecha, color rosa coral; que se extendía por todo el margen hemimaxilar derecho hasta el fondo de vestíbulo; doloroso a la palpación, con un mes de evolución. Se solicitó CBCT, con el que se pudo verificar la presencia de un desarrollo tumoral de contenido similar a dentículos, ubicado en la totalidad del seno maxilar derecho; extendiéndose hasta el piso de la cavidad nasal y orbitaria. Se estableció la hipótesis diagnóstica de "odontoma compuesto". Se le intervino quirúrgicamente, bajo anestesia general, realizándose una excisión de la lesión; la que era de márgenes definidos, con cambios de coloración en tonos oscuros, con la inclusión de tres piezas dentarias; de aspecto maligno. Se logró enucleación completa, dejando remanente óseo limpio. La pieza fue enviada a estudio histopatológico. En informe histopatológico, describió la presencia de una lesion quistica con pared compatible con queratoquiste.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disorder that mainly involves bones that ossify via the membrane, affecting the closure of cranial fontanels and the development of the clavicles, as well as presenting dental and vertebral anomalies. The aim of this manuscritpt was to report a case of a patient with CCD who presented an intrasinusal odontogenic keratocyst.We present an 81-year-old female patient, diagnosed with this syndrome in childhood, who comes to our service for a prosthetic misalignment and discomfort of the right maxillary sinus area. Clinically, there was a mismatch of the prosthesis and an increase in the volume of undefined margins under it, coral pink color, which extended all over the right hemimaxillary margin to the bottom of the vestibule, painful on palpation, with a one month evolution. A CBCT was requested, which revealed the presence of a tumor development with content similar to denticles, located in the entire right maxillary sinus, extending to the floor of the nasal and orbital cavity. The diagnostic hypothesis of "compound odontoma" was established. The patient was operated on in the central ward, under general anesthesia performing the excisional biopsy of the lesion, which showed changes in coloration in dark tones, with defined edges, with the inclusion of three teeth showing malignancy aspects. Complete enucleation was achieved, leaving tumor-free clean bone remnant. In a histopathological report, the presence of a keratocyst wall was described, which is not very compatible given the appearance of the lesion, the presence of the dental pieces included in it, and the behavior of the lesion.

Fechamento de diastema interincisal superior associado a dente supranumerário com intervenção ortodôntica: relato de caso clínico / Closure of superior intercernal diastema associated to supranumerary tooth with orthodontic intervention: clinical case / Cierre de diastema interincisal superior asociado a diente supernumerario con intervención ortodóntica: reporte de caso

A abordagem correta e precoce de paciente infantil frente a alteração de desenvolvimento como a presença de dentes supranumerários modificando a oclusão normal tem apresentado resultados satisfatórios e importantes para manter a função e estética da cavidade bucal. O objetivo deste trabalho é apresentar um caso clínico com tratamento multidisciplinar envolvendo dente supranumerário e diastema interincisal em paciente infantil. Paciente com 7 anos de idade, gênero masculino, compareceu a clínica de Odontopediatria da Faculdade Morgana Potrich, com a queixa de um dente da frente torto. O exame clínico e radiográfico revelou a presença de um mesiodens causando um diastema na região anterior da maxila, com evidentes transtornos estéticos. O plano de tratamento estabelecido foi a remoção cirúrgica do dente supranumerário e tratamento ortodôntico para fechamento do diastema, possibilitando um resultado funcional e estético satisfatório, melhorando a qualidade de vida deste paciente. Dessa forma, o tratamento em paciente com pouca idade propiciou uma intervenção simples e com boa resolubilidade, devolvendo sua autoestima e bem-estar no seu convívio social(AU)

The correct and early approach on children patient in relation to developmental alteration as the presence of supernumerary teeth modifying normal occlusion has presented satisfactory and important results to maintain the function and aesthetics of the oral cavity. The objective of this work is to present a clinical case with multidisciplinary treatment involving supernumerary tooth and interincisal diastema in a child patient. A 7-year-old male patient attended the pediatric dentistry clinic at Morgana Potrich College, complaining of a crooked front tooth. The clinical and radiographic examination revealed the presence of a mesiodens causing a diastema in the anterior region of the maxilla, causing evident aesthetic disorders. The treatment plan established was the surgical removal of the supernumerary tooth and orthodontic treatment for closure of the diastema, allowing a satisfactory functional and aesthetic result, improving the quality of life of this patient. Thus, the treatment in a patient at young age provided a simple and good solvability intervention, giving back his self-esteem and well-being in his social life(AU)

El abordaje correcto y temprano del paciente infantil frente a las alteraciones de desarrollo como la presencia de dientes supernumerarios que modifican la oclusión normal ha presentado resultados satisfactorios e importantes para mantener la función y estética de la cavidad oral. El objetivo de este trabajo es presentar un caso clínico con tratamiento multidisciplinar que involucra un diente supernumerario y diastema interincisal en un paciente infantil. Paciente con 7 años de edad, género masculino, compareció a la clínica de odontopediatría de la facultad Morgana Potrich, con queja de un diente al frente del otro. Al examen clínico y radiográfico se reveló la presencia de un mesiodens causando diastema en la región anterior del maxilar, con evidentes trastornos estéticos. El plan de tratamiento establecido fue la remoción quirúrgica del diente supernumerario y tratamiento ortodontico para cierre del diastema, posibilitando un resultado funcional y estético satisfactorio, mejorando la calidad de vida de este paciente. De esta forma, el tratamiento en un paciente con poca edad propicio una intervención simple y con buena resolución, devolviendo su autoestima y bienestar en su convivencia social(AU)

Prevalence of Dental Anomalies in Indonesian Individuals with Down Syndrome

Abstract Objective: To determine the frequency distribution of dental anomalies in people with Down syndrome. Material and Methods: This cross-sectional study was developed in Jakarta, Indonesia, and evaluated 174 individuals with Down syndrome aged 14-53 years. Were collected information regarding the tooth number, tooth size, shape, and structure. Descriptive statistics were used to calculate the absolute and relative frequencies. The Pearson chi-square test was used in bivariate analysis. The significance threshold was set at 5% Results: There were 70 female subjects (40.2%) and 104 male subjects (59.8%) with an average age of 19.2 years. In terms of anomalies of tooth number, hypodontia (80.9%), supernumerary teeth (12.4%), and combined hypodontia and supernumerary teeth (12.4%) were identified. In terms of anomalies of tooth size, microdontia (98.8%) is the most common anomaly. Anomalies of tooth shape included fusion (66.67%) and talon's cusp (33.3%), whereas anomalies of tooth structure included enamel hypoplasia (70.8%), enamel hypocalcification (4.2%), combined enamel hypoplasia and hypocalcification (12.5%), and tooth discoloration (12.5%) Conclusion: Individuals with Down syndrome in Jakarta showed a high prevalence of dental anomalies, with hypodontia and microdontia being the most common anomalies showing a tendency to occur predominantly in males.

Supernumerario distomolar en rama mandibular asociado a quiste dentígero. Presentación de un caso / Distomolar Supernumerary in the mandibular ramus associated with a dentigerous cyst. A case presentation

Introducción: Los dientes supernumerarios son anomalías donde hay un aumento de la fórmula dental normal. Ocasionalmente provocan complicaciones, como la formación de un quiste dentígero. Por lo infrecuente del hallazgo, y más aún del reporte de esta asociación, se realizó la presentación del caso. Objetivo: Describir el manejo de un supernumerario distomolar en rama mandibular asociado a un quiste dentígero, enfatizando en la importancia de los estudios imaginológicos preoperatorios y el abordaje quirúrgico endobucal. Presentación del caso: Paciente femenina de 34 años, que se extrajo los terceros molares en la adolescencia, y que 3 meses atrás presentó una celulitis facial por la que se le realizó una ortopantomografía, y se detectó un molar en la rama mandibular. Al examen bucal se encontró ligera expansión de la tabla vestibular de rama mandibular izquierda. Se constató en la ortopantomografía la presencia de una estructura dentaria del grupo molar asociada a área radiolúcida, lo que se corroboró en una tomografía. Se planificó la exéresis de ambos mediante abordaje endobucal bajo anestesia general. No se presentaron complicaciones. La paciente fue egresada a las 24 horas y fue seguida evolutivamente por consulta externa durante 6 meses. El diagnóstico histopatológico indicó la presencia de un quiste. Conclusiones: La detección de un diente supernumerio distomolar en rama mandibular asociado a quiste dentígero es una situación clínica infrecuente que permite explotar los beneficios de estudios imaginológicos digitales y crear un plan de tratamiento que culmine en la exéresis exitosa por vía endobucal, sin complicaciones(AU)

Introduction: Supernumerary teeth are anomalies in which there is an increase of the normal dental formula. They occasionally cause complications, such as the formation of a dentigerous cyst. Because of the unusual finding, and even more because of the report of this association, a case presentation is carried out. Objective: To describe the management of a supernumerary distomolar in the mandibular ramus associated with a dentigerous cyst, making emphasis on the importance of the preoperative imaging studies and the endo-buccal surgery approach. Case presentation: 34 years old female patient from whom the third molars were removed during adolescence, who presented facial cellulitis 3 months before the molars removal, which was a reason to perform an orthopantomography. Then, a molar in the mandibular ramus was detected. During oral examination, a light vestibular table expansion in the left mandibular ramus was found. The presence of a dental structure from the molar group which was associated with a radiolucent area was confirmed by orthopantomography, and was also confirmed by CT-scan. Exeresis of both molars under general anesthesia was planned, with an endo-buccal approach. There were no complications. The patient was discharged 24 hours later, and was treated in the outpatient consulting room for 6 months. Histopathological diagnosis revealed the presence of a cyst(AU) Conclusions: The finding of a supernumerary distomolar tooth in the mandibular ramus associated with a dentigerous cyst is an infrequent clinical situation that allows to make good use of the benefits of digital imaging studies, and implement a treatment plan that ends in a successful exeresis via an endo-buccal route, without any complications(AU)

Taking advantage of an unerupted third molar: a case report.

INTRODUCTION:: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. OBJECTIVE:: To report a clinical case that took advantage of an unerupted third molar. CASE HISTORY:: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. RESULTS:: After 12 months, the third molar reached the proper position. CONCLUSION:: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

Taking advantage of an unerupted third molar: a case report

ABSTRACT Introduction: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. Objective: To report a clinical case that took advantage of an unerupted third molar. Case history: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. Results: After 12 months, the third molar reached the proper position. Conclusion: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

RESUMO Introdução: o objetivo do tratamento odontológico cirúrgico é deslocar os dentes para a posição correta na arcada dentária. Objetivo: relatar um caso clínico de aproveitamento de terceiro molar não irrompido. Histórico do caso: paciente do sexo masculino, com 18 anos de idade, foi encaminhado, pelo dentista responsável pelo caso, para avaliação dos terceiros molares. Ao exame clínico, os terceiros molares inferiores não eram visíveis. Com a tomografia computadorizada (TC), foi possível identificar a presença de um dente supranumerário na região do lado esquerdo do ramo da mandíbula, além de impacção do terceiro molar, causadora de reabsorção radicular no segundo molar, tornando impossível a permanência desse dente na cavidade bucal. Logo, optou-se pela remoção tanto do segundo molar quanto do dente supranumerário, além da instalação de um aparelho no terceiro molar, durante o procedimento cirúrgico, para posterior tracionamento. Resultados: após 12 meses, o terceiro molar alcançou a posição adequada. Conclusão: nos casos em que o segundo molar inferior permanente apresenta reabsorção radicular atípica, um terceiro molar impactado pode substituir o dente reabsorvido, de maneira eficaz, através de uma abordagem ortocirúrgica apropriada.

Dientes supernumerarios en la región del tercer molar inferior: etiología y manejo quirúrgico: presentación de dos casos / Supernumerary teeth in the lower third molar region: etiology and surgical management: report of two cases

Los dientes supernumerarios en la región del tercer molar inferior sonpoco frecuentes. Cuando se presentan en posición distal se les denominadistomolares o distodens. Algunos autores los denominan cuarto molar; ésta denominación es la menos aceptada, ya que el cuarto molarno forma parte de la fórmula dental permanente, sino que es un dientesupernumerario. Cuando éste se presenta paralelo a los molares, en lacara externa o interna de la mandíbula, se denomina paramolar. El manejo quirúrgico suele ser complejo y requiere consideraciones especiales. Presentamos dos casos de dientes supernumerarios en la región del tercer molar: distomolar y paramolar; describimos su diagnóstico, etiología y la técnica quirúrgica empleada.

Supernumerary teeth in the lower third-molar region are rare. When these are located in the region posterior to the third molar, they are known as ®distomolars¼ or ®distodens¼. Some authors refer to them as ®fourth molars¼, a term that is somewhat less accepted due to the fact that the fourth molar is not part of the permanent dentition, but rather a supernumerary tooth. When a distomolar occurs parallel to the molars, either on the outer or inner surface of the jaw, it is known as a ®paramolar¼. Surgical management is often complex and requires special considerations. We report two cases of supernumerary teeth in the third-molar region, one distomolar and one paramolar, and describe their diagnosis, etiology, and the surgical technique employed.

Combined Surgical Removal of a Supernumerary Tooth and Orthodontic Traction of an Impacted Maxillary Central Incisor.

Impaction of permanent maxillary central incisors is a rare condition that can affect esthetics and oral function. The etiology of impaction is multifactorial and may be related to embryologic reasons, hereditary factors, mechanical obstacles, and pathologic elements, such as the presence of supernumerary teeth. The purpose of this report is to discuss the case of a 10-year-old patient who presented an impacted permanent maxillary right central incisor due to a supernumerary tooth. Surgical removal of the supernumerary tooth and orthodontic traction of the impacted central incisor by the closed eruption technique were performed. After 12 months, the permanent maxillary right central incisor was adequately positioned in the arch. The multidisciplinary treatment allowed the functional and esthetic rehabilitation to happen in a short period of time, thus reducing the patient's psychological impact caused by the lack of an anterior tooth.

Supernumerarios múltiples: reporte de un caso / Multiple supernumeraries: report of a case

El siguiente trabajo tiene por finalidad presentar la resolución de un caso clínico de supernumerarios múltiples. Los trastornos causados por los mismos incluyen retenciones y distopías dentarias. Tras haber realizado un correcto diagnóstico clínico y radiográfico con tomas periapicales y panorámica, siendo localizados tanto en maxilar superior, zona de la premaxila y en ambas regiones de premolares inferiores, se procedió a realizar remoción de los mismos en tres tiempos quirúrgicos diferentes.

Bilateral mandibular fourth molars: A case report.

INTRODUCTION: Fourth molars are supernumerary teeth located distal to the third molars that may cause local alterations. Therefore an adequate diagnosis and treatment are essential. Removal of the supernumerary tooth and, in selected cases, maintenance of the tooth on the arch and frequent observation are the preferred treatments. If the extraction is recommended, it should be performed carefully by experienced oral surgeons to prevent damage to the anatomical structures. OBSERVATION: The oral examination of a 26-year-old woman revealed a left partially impacted mandibular molar responsible for pain and infection. Although it was assumed it was a third molar, the panoramic radiograph showed that the real third molar was completely impacted and that two partially impacted mandibular fourth molars were present bilaterally. Both of them were removed without complications and the left third molar was extracted after fragmentation to avoid any injury of the contiguous inferior alveolar nerve. DISCUSSION: The extraction of the left fourth molars solved the pain. Even if the right fourth molar was asymptomatic, the patient accepted its extraction because of the evident radiographical pericoronitis and to avoid further complications. "Asymptomatic" does not mean absence of disease, but the patient's consent is mandatory before any decision.

Influence analysis of cleft type and supernumerary teeth eruption in the prognosis of bone graft in patients with cleft palate.

OBJECTIVE: The aim of this study was to investigate the influence of cleft type and supernumerary tooth eruption on the treatment of palatal clefts with alveolar bone grafts. MATERIALS AND METHODS: In this article, medical records of 40 patients with palatal clefts and associated supernumerary teeth who were treated with alveolar bone grafting in the Hospital for Craniofacial Anomalies Rehabilitation were assessed. The patients were studied to assess the influence of supernumerary teeth and the cleft severity on the prognosis of the alveolar bone graft. RESULTS: Forty medical records were included in the assessment. When the teeth in the cleft had an anatomic shape close to canine, we called them precanine. When they were very small or malformed, we called them anomalous lateral incisors. The teeth studied showed good prognoses and were more expressive in the preforaminal clefts (87.5%) than in the transforaminal ones (62.5%). Moreover, the transforaminal clefts presented a higher percentage in satisfactory and poor prognoses (37.5%). The authors found that supernumerary teeth influenced the maintenance of alveolar bone graft height and that transforaminal clefts presented a worse prognosis than preforaminal clefts.