Multidisciplinary management of Blepharo-Cheilo-Dontic Syndrome and the role of overdenture in dental management.

AIM: Blepharo-Cheilo-Dontic (BCD) syndrome is a rare condition characterised by abnormalities of the eyelid, lip and teeth. A 12-year-old girl with BCD syndrome presented at the Dental Hospital following referral from the multi-disciplinary cleft lip and palate clinic. She had skeletal Class III relation, with left posterior cross bite, occlusal contacts on the second permanent molars with poor oral hygiene. The permanent units missing were 15, 14, 13, 12, 11, 21, 22, 25, in the upper arch and 35, 34, 32, 44 and 45 in the lower arch. This patient presented a complex aesthetic problem, which through multi- disciplinary care resulted in a satisfactory aesthetic outcome. In this case report we present the clinical management and the role of the overdenture in her dental management.

Severe hypodontia in a set of triplets.

Hypodontia is the developmental absence of one or more teeth from the dentition and constitutes one of the most common developmental anomalies in humans with a reported prevalence of 1.6 to 9.6% in the permanent dentition. Hypodontia may occur in association with other genetic diseases, or as an isolated familial or sporadic form. This article describes the rare phenomenon of severe hypodontia in a set of triplets. The triplets presented with congenital absence of the second molars, second premolars in all quadrants and lower central incisors. An additional five teeth (upper canines, upper lateral incisors and upper left first premolar) were missing in one of the triplets. The treatment plan and the possible genetic mode of inheritance are discussed.

Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal.

AIM: This was to assess the predictability of eruption of delayed permanent incisors after supernumerary removal and creation of adequate space, in relation to: root maturity, degree of vertical impaction, and degree of angulation of impaction. METHODS: The dental records of children with supernumerary teeth delaying the eruption of permanent incisors were analysed. The type of a supernumerary tooth, its location and position were recorded, along with the stage of root maturation, angulation and vertical distance of impaction of the permanent incisor. At the initial surgery, the unerupted supernumerary tooth and any retained primary incisors were removed. The unerupted permanent incisor was not exposed. If necessary, the maxillary primary canines were removed to create sufficient space for eruption of the delayed permanent tooth. A secondary surgical procedure was planned after 18 months if there was no significant progress of the permanent tooth towards eruption. STATISTICS: All data were entered onto a Microsoft Excel spread sheet and analysed using Fisher's Exact Tests throughout due to the small numbers. RESULTS: Sixty-six supernumerary teeth were removed, 22 from boys and 44 from girls with ages ranging from 6 to 10 years 6 months at the time of surgery. Primary canines were extracted in 59.1% of cases. Spontaneous eruption occurred in 89.4% of delayed permanent teeth. The mean time to eruption was 9.2 months (median = 7 months). There was no statistically significant association between tooth eruption and root maturity or the degree of vertical impaction. There was an association between eruption and the degree of the angle of impaction of the permanent incisor (p<0.05). CONCLUSION: The majority of delayed permanent teeth erupt spontaneously if sufficient space is available or created at the time of removal of the unerupted supernumerary. The angulation of impaction of the permanent incisor is associated with a delay in eruption.

Factors affecting outcomes of traumatically extruded permanent teeth in children.

PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.

The role of magnets in the management of unerupted teeth in children and adolescents.

This case report describes the use of magnets in the management of teeth that fail to erupt. Eight children aged between 10 and 15 years were treated. Magnetic traction was applied to two premolars and six molars. Seven teeth (one premolar and six molars) erupted successfully (mean treatment time with magnetic traction: 7.5 months). One premolar failed to erupt; serial radiographic assessment over a 9-month period revealed no evidence of movement and so the magnetic fixture was removed. Histological evaluation of tissue samples taken from around the fixture revealed no evidence of abnormal pathology.

Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption.

OBJECTIVE: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption. SETTING: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne. DESIGN: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome. RESULTS: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29. CONCLUSION: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Dental manifestations in severe combined immunodeficiency following bone marrow transplantation.

Severe combined immunodeficiency (SCID) is a rare primary immunodeficiency disorder with an estimated overall frequency of 1 in 75 000 live births. Bone marrow transplantation is the only curative treatment available. Using T cell-depleted HLA non-identical bone marrow requires preconditioning with a short course of cytotoxic chemotherapy. We report severe dental developmental anomalies in three such patients under long-term follow up.

The atraumatic restorative treatment (ART) technique: does it have a place in everyday practice?

The ART technique was introduced in the early 1990s. It involves the removal of carious tooth tissue with hand instruments followed by restoration with an adhesive material (glass-ionomer cement). Local anaesthetic is not always required for treatment and the technique has helped to bridge the gap in the provision of treatment to rural communities, senior citizens and dental phobic patients. This article looks at the development of the technique, its performance and potential areas of application.

A grading system in day surgery: effective utilization of theatre time.

An in-house audit revealed a theatre utilization time in the day surgery unit of 70%. The reason identified for this poor theatre utilization was patient selection by the clerical staff based on a fixed number of cases per session. A grading system which estimated the anticipated duration of operation time was introduced as the basis for patient selection in the day surgery. A pilot study of 20 patients revealed that the system was both effective and simple to implement. It was therefore adopted. A re-audit of a further 299 patients treated using the grading system revealed that theatre utilization time had increased from 70 to 98%. The number of patients treated per session also increased, thus effectively reducing the waiting list. The grading system can be used in all clinical specialities providing day case surgery and we recommend it.