Rare case of gemination and fusion involving supernumerary teeth and second mandibular molar - Case report.

This article presents the rare case of a patient with gemination and fusion involving conical supernumerary teeth and the second mandibular molar, along with its treatment. The 13-year-old girl, without any associated syndromes and currently undergoing orthodontic treatment, was referred for evaluation due to the presence of a supernumerary tooth. Following a clinical examination and analysis of a panoramic radiograph, a cone beam computed tomography was requested for a more detailed assessment of the supernumerary tooth and its relationship with adjacent structures. The sagittal sections revealed the presence of two conical paramolar supernumerary teeth, which were geminated and fused to the mesial root of tooth 47. The suggested treatment was the surgical removal of the supernumerary teeth, which was successfully performed without complications and with good healing. After one-year post-procedure, the formation of periodontal ligament was verified at the site where the supernumerary teeth were extracted. The simultaneous occurrence of gemination of two supernumerary teeth and their fusion to a mandibular molar is extremely rare, and their surgical removal provided the patient with better plaque control in the region and contributed to the progress of orthodontic treatment. Key words:Gemination and fusion of supernumerary teeth and second mandibular molar.

Immediate Insertion of Dental Implants Immediate Insertion in Bilateral Traumatic Bone Cysts With or Without a Bone Grafting Material: A 5-Year Follow-Up Case Report.

This case report describes the rehabilitation of a patient who received dental implants in traumatic bone cyst areas (TBC). A 24-year-old male patient sought dental treatment for the bilateral absence of the mandibular second premolars. Radiographic examination revealed bilateral large radiolucent images in the mandible body. Surgical exploration confirmed the diagnosis of TBC. Rehabilitation with dental implants was performed using different approaches on each side. One cystic cavity was filled with blood clot and allogenic bone graft; the other was filled only with blood clot. After 5 years, the implants are osseointegrated and functioning. The filling of the traumatic bone cyst cavity with local blood clot in contact with the implant presented clinical and radiographic success similar to that obtained with filling with bone graft in the same patient. Thus, in this patient, the blood clot-only approach can be considered as a viable, safe-low cost alternative to blood clot and grafting material.

Effect of chronic stress on implant osseointegration into rat's mandible.

PURPOSE: To compare chronic physical stressed with normal tense animals regarding implant osseointegration in the rat mandible. METHODS: Thirty six Wistar rats were anesthesiaded and blunt instruments were used to expose and empty their alveolar inferior nerve. One implant (2.2 x 4mm) was installed into the mandibular canal. Following 72 hours, all rats were equally divided in: Control Group analyzed in 18 days (CG18); Control Group analyzed in 33 days (CG33); Stressed Group with stress during 18 days (SG18) and Stressed Group with stress during 33 days (SG33) - The animals from Stressed Groups (CG 18 and CG33) were placed individually in plastic pipes (PVC) during 12 hours daily to physical restraint. Histomorphometric analysis included bone-implant-contact (BIC) and bone area (BA). RESULTS: In relation to BIC--CG18 (49.8+20.3); SG18 (29.0+16.5)--and BA--CG18 (50.13+21.2); SG18 (23.8+7.8)--, there was a bone repair delayed in SG18 when compared with CG18 (p<0.05). After 33 days, BIC--CG33 (59.6+26.8); SG33 (49.52+17.3)--and BA--CG33 (41.90+17.4); SG33 (43.91+14.7)--showed no difference between groups (p>0.05). CONCLUSION: Chronic physical stress interfere with the initial stage of osseointegration in the rat mandible, but not the final process.

Frequency of Maxillary Sinus Mucous Retention Cysts in a Central Brazilian Population.

STATEMENT OF THE PROBLEM: Mucous retention cysts (MRCs) of the maxillary sinus are lesions with undefined pathogenesis. In recent researches, geographical and climatic aspects have been related as risk factors. PURPOSE: The purpose of this study was to determine the frequency of MRCs of the maxillary sinus using panoramic radiographs. MATERIALS AND METHOD: A total of 631 panoramic radiographs were selected from a secondary database from a private radiology clinic and analyzed by two specialists in dental radiology according to gender, age, month, relative air humidity, and mean temperature. RESULTS: A total of 87 (6.89%) radiographic images were suggestive of MRCs. Thirty-five MRCs (40.22%) were detected on the right side, 10 (11.49%) on the left side and 42 (48.29%) on both sides. A high frequency was detected in female participants (n=45; 51, 72%), those aged 18-35 years (n=31; 35, 63%) and those from August (n=24; 27.59%) and July (n=22; 25.29%). CONCLUSION: The frequency of MRCs was low, and no statistically significant correlation was found between the prevalence of MRCs and the studied variables with the exception of the mean temperature.

Effect of chronic stress on implant osseointegration into rat's mandible

PURPOSE:To compare chronic physical stressed with normal tense animals regarding implant osseointegration in the rat mandible.METHODS:Thirty six Wistar rats were anesthesiaded and blunt instruments were used to expose and empty their alveolar inferior nerve. One implant (2.2 x 4mm) was installed into the mandibular canal. Following 72 hours, all rats were equally divided in: Control Group analyzed in 18 days (CG18); Control Group analyzed in 33 days (CG33); Stressed Group with stress during 18 days (SG18) and Stressed Group with stress during 33 days (SG33) - The animals from Stressed Groups (CG 18 and CG33) were placed individually in plastic pipes (PVC) during 12 hours daily to physical restraint. Histomorphometric analysis included bone-implant-contact (BIC) and bone area (BA).RESULTS: In relation to BIC - CG18 (49.8+20.3); SG18 (29.0+16.5) - and BA - CG18 (50.13+21.2); SG18 (23.8+7.8)-, there was a bone repair delayed in SG18 when compared with CG18 (p<0.05). After 33 days, BIC - CG33 (59.6+26.8); SG33 (49.52+17.3)- and BA - CG33 (41.90+17.4); SG33 (43.91+14.7)- showed no difference between groups (p>0.05).CONCLUSION: Chronic physical stress interfere with the initial stage of osseointegration in the rat mandible, but not the final process.

Ectodermal dysplasia associated with sickle cell disease.

Ectodermal dysplasia and sickle cell anaemia are inherited disorders that affect, respectively, the tissues derived from the embryonic ectoderm and the production of erythrocytes by the bone marrow. The simultaneous occurrence of both disorders is extremely rare. This is a case of both ectodermal dysplasia and sickle cell anaemia reported in a 6-year-old. The patient had been diagnosed with sickle cell anaemia for only six months when he sought treatment presenting with the following: hypotrichosis, dry skin, periocular hyperpigmentation, protruding lips, hypodontia, and morphologically altered teeth. The clinical features combined with his medical history led to the diagnosis of ectodermal dysplasia. Dentists should be prepared to recognise patterns that escape normality to aid in the diagnosis of systemic changes, even in patients with other previous diagnoses.

Dental transposition of canine and lateral incisor and impacted central incisor treatment: a case report.

INTRODUCTION: Dental transposition and impaction are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental and social development and may be difficult to be clinically solved. METHODS: We describe a case of transposition between the upper left canine and lateral incisor associated with impaction of the central incisor on the same side, in a 12-year-old patient. Conservative treatment involving surgical-orthodontic correction of transposed teeth and traction of the central incisor was conducted. CONCLUSIONS: The option of correcting transposition and orthodontic traction by means of the segmented arch technique with devices such as cantilever and TMA rectangular wire loops, although a complex alternative, was proved to be esthetically and functionally effective.

Dental transposition of canine and lateral incisor and impacted central incisor treatment: A case report

INTRODUCTION: Dental transposition and impaction are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental and social development and may be difficult to be clinically solved. METHODS: We describe a case of transposition between the upper left canine and lateral incisor associated with impaction of the central incisor on the same side, in a 12-year-old patient. Conservative treatment involving surgical-orthodontic correction of transposed teeth and traction of the central incisor was conducted. CONCLUSION: The option of correcting transposition and orthodontic traction by means of the segmented arch technique with devices such as cantilever and TMA rectangular wire loops, although a complex alternative, was proved to be esthetically and functionally effective. .

INTRODUÇÃO: transposição e impacção dentárias são distúrbios relacionados à erupção ectópica ou à falha na erupção dentária, que podem afetar o desenvolvimento físico, psíquico e social da criança, e que podem ser de difícil resolução clínica. MÉTODOS: é descrito um caso clínico de transposição entre o canino e o incisivo lateral superior esquerdo, associado à impacção do incisivo superior, do mesmo lado, em uma paciente de 12 anos de idade. Optou-se pela realização de tratamento ortodôntico-cirúrgico conservador, envolvendo a correção ortodôntica dos dentes transpostos e o tracionamento do incisivo central impactado. CONCLUSÃO: a opção pela correção da transposição e tracionamento ortodôntico com a utilização da técnica do arco segmentado com uso de dispositivos como cantiléver e alças em fios TMA retangulares, apesar de ser uma alternativa de execução complexa, mostrou-se efetiva do ponto de vista estético e funcional. .

Growth hormone insensitivity syndrome: unusual oral manifestations.

Children with significant growth retardation and normal levels of growth hormone are diagnosed with growth hormone insensitivity. The main oral findings observed in patients with growth hormone insensitivity syndrome (GHIS) are underdeveloped jaws, crowded teeth and delayed eruption of permanent teeth. This manuscript describes a 9-year-old child diagnosed with GHIS, who had delayed eruption of permanent teeth and 14 unerupted supernumerary teeth. All supernumerary teeth were extracted except for two maxillary and one mandibular teeth which were difficult to identify and access. Multiple supernumerary teeth have never been reported before in patients with GHIS.

A saúde bucal de uma subpopulação de gestantes usuárias do sistema único de saúde: um estudo piloto / Oral health of a sample of pregnant women assisted by the unified health system: a pilot study

Objetivo: Avaliar a saúde bucal de uma subpopulação de gestantes usuárias do Sistema Único de Saúde (SUS) do Estado de Mato Grosso. Método: A população do estudo consistiu de 121 puérperas, com pré-natal de baixo risco, internadas pelo SUS em um hospital do município de Cuiabá, Mato Grosso. Os dados foram coletados através de análise de prontuário, do cartão de pré-natal, de questionário próprio e do exame clínico odontológico das voluntárias. Aos dados obtidos foi dado tratamento estatístico através da análise descritiva, sendo os resultados expressos através de frequência absoluta e relativa. Resultados: A idade média das puérperas foi de 25,68 anos, 76,03% tinham Ensino Médio, 49,60% estavam em união estável e 38,80% eram primíparas. Apenas 4,13% dos cartões de pré-natal continham informações sobre saúde bucal. 24,70% receberam orientação sobre saúde bucal durante a gestação; 4,13% foram orientadas sobre possíveis mudanças na saúde bucal durante a gestação, 52,89% notaram modificações nas estruturas bucais, a mais evidente foi o sangramento gengival (37,19%). 28,09% relataram ter sentido dor de dente durante a gestação; 18,18% tiveram perda de restaurações e 19,83 relataram outras alterações bucais. 28,92% relataram ter alterado sua rotina de higiene bucal durante a gestação. Clinicamente, 72,70% apresentaram biofilme dentário visível após escovação, 69,42% apresentavam restaurações, 62,80% ausência dentária, 61,15% apresentaram lesões de cárie e 12,40% próteses dentárias...

Conclusão: A equipe responsável pelo acompanhamento pré-natal das gestantes não tem dedicado a atenção devida à saúde bucal das mesmas, visto o não preenchimento do local específico no cartão de pré-natal e a pouca orientação em relação à saúde bucal apesar de a maioria delas ter notado alguma alteração bucal durante a gestação e, clinicamente, ser constatada alta ocorrência de biofilme dentário visível e lesões de cárie. Isso reforça a necessidade de maior dedicação da equipe de pré-natal no cuidado com a saúde bucal das gestantes e da inserção de ações específicas voltadas para a manutenção da saúde bucal das gestantes no Brasil...

Objective: To evaluate the oral health of a sample of pregnant women assisted by the Brazilian Unified Health System (SUS, in the Portuguese acronym) in the Mato Grosso State, Brazil. Method: The study population consisted of 121 post-birth women with a low-risk prenatal, admitted in a public hospital in Cuiabá, MT, Brazil. The data were collected from the patientÆs hospital chart, prenatal examination card, specific questionnaire and dental clinical examination of the volunteers. A descriptive statistical analysis was performed and the results were presented as absolute and relative frequencies. Results: The mean age of the post-birth women was 25.68 years, 76.03% had high-school education, 49.60% had stable relationships and 38.80% of them bore their first child. Only 4.13% of the prenatal examinations cards had information on oral health. Only 24.70% were advised on oral health during the pregnancy, 4.13% were warned for eventual oral health alterations during the pregnancy. As much as 52.89% noticed changes in the oral structures/tissues, the most evident being gingival bleeding (37.19%). 28.09% reported toothache during pregnancy; 18.18% had loss of prostheses and 19.83% reported other oral alterations. As much as 28.92% affirmed having changed their oral hygiene routine during pregnancy. In the clinical examination, 72.70% presented visible dental biofilm after toothbrushing, 69.42% had caries lesion, 69.42% had restorations, 62.40% had missing teeth, 61.15% presented caries lesions and 12.40% wore prostheses...

Conclusion: The health team in charge of the pregnant womenÆs prenatal follow up did not show the expected care on their oral health. This was clear by the lack of properly filling out the prenatal cards with dental information and the little advise on oral health, although most patients observed some oral alterations during pregnancy and presented dental biofilm and caries lesions. These findings reinforce the need for a greater attention by the prenatal health team on the pregnant womenÆs oral health care and inclusion of specific actions for the maintenance of the oral health of Brazilian pregnant women...

Tratamento de atresia esquelética em paciente adulto: uma proposta de aparelho expansor não convencional / Treatment of skeletal atresia in an adult patient: a proposal for an unconventional expansion appliance

O uso dos aparelhos disjuntores maxilares é indicado para casos de atresia, normalmente associada com mordida cruzada posterior esquelética. Para corrigi-la, deve-se optar por mecânica de expansão ortopédica da maxila que promova a rápida abertura da sutura palatina mediana. Nos casos de crianças e adolescentes, esse processo é facilmente conseguido simplesmente com o uso de aparelho disjuntor. No entanto, quando se trata de paciente adulto, a união entre os processos palatinos torna mais difícil sua abertura e, em muitos casos, a cirurgia ortognática está indicada. Os modelos de disjuntores maxilares têm em comum o fato de serem adaptados por palatino dos dentes posteriores. O objetivo desse trabalho foi apresentar um aparelho não convencional, com apoio por vestibular e torno expansor localizado na região dos incisivos, como alternativa de tratamento para pacientes que apresentam dificuldade de adaptação aos aparelhos convencionais.

Histological findings following the use of a space-making device for bone reformation and implant integration in the maxillary sinus of primates.

BACKGROUND: Previous studies have shown that membrane elevation results in predictable bone formation in the maxillary sinus provided that implants can be placed as tent poles. In situations with an extremely thin residual crest which impairs implant placement, it is possible that a space-making device can be used under the sinus membrane to promote bone formation prior to placement of implants. PURPOSE: The present study was conducted to test the hypothesis that the use of a space-making device for elevation of the sinus membrane will result in predictable bone formation at the maxillary sinus floor to allow placement of dental implants. MATERIALS AND METHODS: Eight tufted capuchin primates underwent bilateral sinus membrane elevation surgery, and a bioresorbable space-making device, about 6 mm wide and 6 mm in height, was placed below the elevated membrane on the sinus floor. An oxidized implant (Nobel Biocare AB, Gothenburg, Sweden) was installed in the residual bone protruding into the created space at one side while the other side was left without an implant. Four animals were sacrificed after 6 months of healing. The remaining four animals received a second implant in the side with a space-making device only and followed for another 3 months before sacrifice. Implant stability was assessed through resonance frequency analysis (RFA) using the Osstell (Osstell AB, Gothenburg, Sweden) at installation, 6 months and 9 months after the first surgery. The bone-implant contact (BIC) and bone area inside the threads (BA) were histometrically evaluated in ground sections. RESULTS: Histologically there were only minor or no signs of bone formation in the sites with a space-making device only. Sites with simultaneous implant placement showed bone formation along the implant surface. Sites with delayed implant placement showed minor or no bone formation and/or formation of a dense fibrous tissue along the apical part of the implant surface. In the latter group the apical part of the implant was not covered with the membrane but protruded into the sinus cavity. CONCLUSIONS: The use of a space-making device, with the design used in the present study, does not result in bone formation at the sinus floor. However, membrane elevation and simultaneous placement of the device and an implant does result in bone formation at the implant surface while sites with implants placed 6 months after membrane elevation show only small amounts of bone formation. It is suggested that lack of stabilization of the device and/or a too extensive elevation of the membrane may explain the results.

Osseointegração de implantes usinados e oxidados em seio maxilar preenchido por coágulo com ou sem osso autógeno: estudo histológico, histométrico e de RFA em macacos / Osseointegration of machined and oxidized titanium implants placed with maxillary sinus floor augmentation using coagulum with or without autogenous bone: a histologic, histometric and RFA study in monkeys

O objetivo deste estudo experimental foi comparar histologicamente o preenchimento do assoalho do seio maxilar por coágulo local com ou sem a associação de osso autógeno (controle), bem como investigar a osseointegração em duas diferentes superfícies de implante sob essas condições, através de medidas histométricas, análises histológicas e em freqüência de ressonância (RFA). Quatro macacos prego (tufted capuchin) tiveram todos os pré-molares e os primeiros molares superiores extraídos. Após quatro meses de reparo, os animais foram submetidos a cirurgia para acessar o assoalho do seio maxilar, através de uma janela óssea, para elevação da membrana do seio. O seio direito foi deixado para que se reparasse espontaneamente (somente coágulo), enquanto o esquerdo foi preenchido com enxerto ósseo autógeno. A membrana dos seios foram mantidas elevadas pela inserção simultânea de dois implantes (um usinado e outro oxidado eletroliticamente, Sistema Branemark®, Nobel Biocare) em cada lado da maxila. A estabilidade dos implantes foi acessada através da freqüência de ressonância (RFA, Ostell®) no momento da fixação dos implantes e no dia do sacrifício. Com a injeção de fluorocromos foi possível investigar o processo de neoformação óssea nos animais bem como relacioná-lo às diferentes superfícies dos implantes. Os animais foram sacrificados 6 meses após a cirurgia para análise histológica e de histomorfometria (contato-osso-implante - BIC, área de osso nas roscas - BA, e área de osso em um retângulo desenhado - BAR). Concluímos que não houve diferença entre o seio preenchido somente com coágulo local e o seio preenchido com osso autógeno, em relação à RFA, BIC, BA e BAR. O BIC nos implantes oxidados exibiu melhor integração óssea comparado com os implantes usinados. Os implantes oxidados mostraram maior BA nos seios com enxertos ósseos quando comparados com os implantes usinados. A quantidade de osso neoformado não foi diferente do seio preenchido somente com o coágulo...

Fibromatose gengival hereditária: identificaçäo, tratamento e controle / Hereditary gingival fibromatosis: identification, treatment and control

A Fibromatose Gengival Hereditária (FGH) se caracteriza por um aumento gengival causado por uma produçäo excessiva de fibras colágenas no tecido conjuntivo gengival. Pode ocorrer isoladamente ou associada a alguma síndrome. Este artigo descreve a ocorrência da FGH em quatro membros de uma mesma família. A etiologia, aspectos clínicos, radiográficos e histológicos seräo discutidos. O tratamento cirúrgico, gengivectomias e exodontias, foi realizado sob anestesia local e por quadrantes. Controle pós-operatório de 18 meses foi efetuado

Regeneração tecidual guiada aplicada sobre implantes colocados imediatamente após a exodontia: revisão de literatura / Guided tissue regeneration for implants placed into extraction sockets: a literature review

Os implantes imediatos apresentam vantagens em relação aos implantes tardios, pois eliminam o período de reparação do alvéolo e um tempo cirúrgico, diminuindo o período para instalação da prótese. Reduz o custo e preserva a altura e largura óssea alveolar, facilitando, desta maneira, a colocação do implante em relação ao seu comprimento, largura e angulação. Por outro lado, os implantes são apresentados com um número limitado de diâmetros, proporcionando um espaço entre o implante e o local de preparo para sua adaptação nos alvéolos, devido a diferente anatomia dos alvéolos no momento da exodontia. A presença desse alvéolo residual junto ao implante pode dificultar a osseointegração. A regeneração tecidual guiada, através de membranas, aplicada junto aos implantes colocados em alvéolos imediatamente após exodontia, age como barreira mecânica, prevenindo a proliferação do tecido conjuntivo para o interior do defeito ósseo. Desta forma a osteogênese pode ocorrer sem interferências.

Implantes do sistema T.F. (Tissue Functional) em alvéolos imediatamente após exodontia: estudo histológico em cäes / Immediate implantation of T.F. implants into extraction sockets: an experimental study in dogs

O protocolo convencional para que ocorra osseointegraçäo sugere aguardar até 6 meses para o processo de reparo alveolar, antes da colocaçäo de um implante. Os implantes imediatos säo implantes colocados em alvéolos preparados imediatamente após a exodontia. Neste estudo a possibilidade de colocaçäo de um implante de titânio em alvéolos imediatamente após a extraçäo de pré-molares inferiores foi investigada. Oito implantes (9 x 4 mm) foram colocados em alvéolos preparados imediatamente após a exodontia em oito cäes. Um espaço esteve presente nas margens laterais de todos os implantes. Este espaço foi preenchido por coágulo e sutura oclusiva foi conseguida em todos os animais. Os animais foram sacrificados nos períodos de 40, 60 , 90 e 120 dias após a implantaçäo. Avaliaçöes histológicas mostraram que houve áreas de osseointegraçäo. Conclui-se que o implante deve ficar o máximo em contato com o osso alveolar. A partir dos resultados obtidos muitas questöes surgem, gerando a possibilidade de vários outros estudos na tentativa de responder às limitaçöes e dúvidas suscitadas pelo presente estudo