Radiographic assessment and management of two deeply and horizontally impacted maxillary central incisors: A clinical case report.

This case report describes the treatment of a 9-year-old boy with impacted maxillary central incisors due to 2 supernumerary teeth. A sequential approach comprising of surgical removal of the supernumerary teeth and 2 stages of surgical exposure and orthodontic traction of the impacted teeth resulted in correct repositioning of incisors. Close monitoring and multidisciplinary cooperation during various stages of treatment led to a successful esthetic outcome, with optimal periodontal health and functional occlusion.

Proliferative potential of impacted tooth lesions using Ki67 labelling index-A clinicopathological insight.

Tooth impaction is a frequent phenomenon, and the prevalence and distribution of this entity in different regions of the jaws may vary considerably. The third molars, maxillary canines, maxillary and mandibular premolars, and maxillary central incisors are the most commonly affected teeth. Impacted teeth in children and adolescents are rarely associated with pathological changes, but the prevalence of problems has been found to increase in later decades. Impacted teeth are commonly asymptomatic and not associated with any pathologic lesions for years. Proliferative potential of various odontogenic lesions were calculated using Ki-67 labeling index calculation, with the highest index of Unicystic Ameloblastoma followed by Adenomatoid odontogenic tumor, Unicystic Ameloblastoma, followed by the dental follicle. Ki-67 is a marker of cell proliferation, used as an important diagnostic marker in the pathologic differentiation of various lesions. It is always better to orthodontically treat or extract asymptomatic impacted teeth to avoid or to restrict the proliferative capacity of the dental follicle. Treatment decisions about the third molar have important clinical and cost implications.

Strategic treatment for a patient with missing lateral incisor and first molar accompanied by posterior scissor bite and an impacted premolar.

Managing orthodontic treatment for adults with missing permanent teeth can be intricate, especially when dealing with a posterior scissor bite and an impacted tooth. This case report presents successful treatment of a female patient with dental and skeletal Class II malocclusion, high mandibular plane angle, missing maxillary left lateral incisor and mandibular right first molar, as well as right posterior scissor bite, and a deeply impacted mandibular left second premolar. In the maxilla, the right second molar and right lateral incisor were strategically extracted to eliminate the scissor bite and enhance frontal esthetic balance. In the mandible, the edentulous space caused by early loss of the first molar was successfully closed and the impacted second premolar was guided into its proper position after surgical exposure. Finally, symmetric frontal esthetics, well-aligned dentition with ideal intercuspation and an improved profile were achieved, which remained stable in the 17 month follow-up.

Alveolar bone retention following treatment of dilacerated labial inversely impacted maxillary central incisors-a retrospective study.

The root of late-dental-age labial inversely impacted maxillary central incisors (LIIMCIs) typically develops to severe dilacerated morphology. Therefore, reliable posttreatment periodontal estimates of orthodontic treatment prognosis would be critical to the treatment value of impacted incisors. This study aims to analyze further changes in dimensions of the alveolar bone following the closed-eruption treatment of late-dental-age dilacerated LIIMCIs. Cone beam computed tomography (CBCT) scanning data of 16 patients with unilateral dilacerated late-dental-age LIIMCIs were collected, including the pretreatment (T1) and at the 2.23 ± 0.78 years follow-up stage (T2) respectively. Patients underwent closed-eruption treatments to bring the impacted incisor into the dental arch. Dolphin imaging software was used to measure alveolar bone height labially, palatally, and proximally to the site at T1 and T2, as well as alveolar bone thicknesses at 0, 2, 4, 6 and 8 mm below the initial measurement plane (IMP). The alveolar bone heights on the impacted and contralateral sides increased from T1 to T2 (p < 0.05). Alveolar bone growth on both sides had no significant difference. In T2, the mean values of labial and distal alveolar heights on the contralateral sides were greater than on the impacted sides (p < 0.05). The mean values of total alveolar bone thicknesses on the impacted sides in T1 were significantly smaller than those on the contralateral sides in IMP-0, 2, 4, 6, 8 (p < 0.05). The total thicknesses on the impacted sides in T2 increased and were significantly greater than on the contralateral sides (p < 0.05), except for the thickness in IMP-0. The closed-eruption treatment of dilacerated late-dental-age LIIMCIs results in no significant changes to alveolar bone height, except on the labial and distal sides, with increased alveolar bone thickness, suggesting that this approach may be viable first choice therapy for non-extraction orthodontic cases.

Concurrent Impaction of the Mandibular Primary Second Molar and Second Premolar in Close Approximation to the Mental Nerve: A Case Report.

Impacted teeth are those that fail to erupt at the typical age of eruption and remain enclosed in the maxilla or mandible, partially or completely surrounded by bone or soft tissues. Among these, third molars experience the highest incidence of impaction, with maxillary canines and mandibular bicuspids following closely. A 23-year-old female presented to the orthodontics department, expressing concerns about spacing issues in her upper and lower front teeth. During the orthodontic planning process and radiological assessment, two impacted teeth, specifically one primary molar and one permanent premolar, were identified in close proximity to the mental nerve. Both teeth were subsequently extracted with success. This case report underscores the importance of a thorough preoperative radiographic evaluation of the mandibular canal and foramina. Additionally, it stresses the necessity for dissection to prevent unintended injury to the mental nerve during the extraction of the impacted mandibular premolar, which can result in paresthesia affecting the lower lip, mandibular labial gingiva, and chin.

The Enigma Unveiled: Expansile Compound-complex Odontoma in the Anterior Maxilla of a Teenager.

Aim and objective: The objective of this case report is to offer insight into an expansive compound-complex odontoma located in the anterior maxilla of a 15-year-old male. The focus is placed on the importance of early detection and the progressive comprehension of odontomas. Background: Odontomas are common odontogenic lesions that are frequently discovered during examinations for delayed tooth eruption. There are two distinct classifications for odontomas-compound odontomas and complex odontomas. With its own each set of characteristics. A timely diagnosis is critical for avoiding complications. Case description: A male individual aged 15 years exhibited an expansive compound-complex odontoma located in the anterior maxilla. The clinical examination showed delayed tooth eruption and asymptomatic swelling. The radiographic images showed a radiopaque mass with tooth-like structures and radiolucent borders affecting the surrounding dentition. A surgical excision procedure was conducted, followed by a subsequent histopathological examination confirming the diagnosis of compound-complex odontoma. The patient continued orthodontic treatment after a 1-year follow-up without recurrence. Clinical significance: This case emphasizes the importance of regular dental exams in detecting odontomas early. This observation also highlights the growing understanding of odontomas as hamartomatous odontogenic malformations and the challenges of diagnosing them clinically. Additional molecular investigations are required to facilitate the classification and elucidation of genetic factors. How to cite this article: Alhazmi YA. The Enigma Unveiled: Expansile Compound-complex Odontoma in the Anterior Maxilla of a Teenager. Int J Clin Pediatr Dent 2024;17(1):82-85.

Immediate loading of implants inserted through impacted teeth in the aesthetic area: A retrospective study with a mean follow-up period of 7 years.

PURPOSE: To evaluate the survival and success rate of and the incidence of complications affecting implants inserted and immediately loaded in sites where an impacted tooth was present in the maxilla. MATERIALS AND METHODS: A total of 10 patients were treated and 14 implants were inserted, 4 in healed sites and 10 in extraction sites. The implant site preparation started in the crestal bone and continued in the enamel and dentine of the impacted tooth. The radiographic depth of implant penetration into the impacted tooth, peri-implant soft tissue and hard tissue condition at the 1-year follow-up and the last follow-up appointment, marginal bone loss at the 1-year follow-up and the last follow-up appointment, and the final aesthetic result were evaluated. RESULTS: The implants healed uneventfully with an adequate hard and soft tissue response and no adverse clinical or radiographic signs or symptoms. They were in function for a minimum of 3 and a maximum of 11 years (mean 7.2 years). CONCLUSION: Although further studies with a larger sample size are required to validate this unconventional approach, it can be considered a valuable clinical option to replace teeth in an area of impaction.

A comparative evaluation of the effect of addition of 8†mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study.

Background: Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim: To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology: A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results: Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion: The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.

Evaluation of complications and quality of life of patient after surgical extraction of mandibular impacted third molar teeth.

BACKGROUND: The aim of our study is to evaluate the postoperative complications after the extraction of impacted third molar teeth and to investigate the effects of these complications on the quality of life of patients. METHODS: Demographic, clinical, and radiological evaluations were conducted, covering factors like age, gender, and tooth position. Clinical measurements, pain and edema assessments, and quality of life evaluations through OHIP-14 scores were performed. Preoperative and postoperative mouth opening, trismus, alveolitis and dehiscence were evaluated. RESULTS: A total of 100 patients were included in our study. No significant gender-based differences were found in measurements, pain, or swelling. There was no statistically significant difference between the preoperative and postoperative results of difference A-C, difference B-E, difference A-D, and difference mouth opening. Procedure duration correlated positively with age, alveolar osteitis, trismus, and swelling. Postoperative quality of life, assessed by OHIP-14, demonstrated a negative correlation with age and trismus. It was observed that the gender and the tooth positions of the patients had no effect on the severity of postoperative pain and edema. CONCLUSIONS: As the age of the patients increases and the duration of the procedure increases, the rate of postoperative complications increases and it is concluded that the quality of life decreases significantly.

Awareness of patients with impacted teeth about impacted teeth in Turkey: A questionnaire study.

Objective: The aim of this study is to evaluate the knowledge and awareness levels of patients who have at least one impacted tooth and who had previously applied to the dentist. Study design: This study was conducted in patients aged 15 years and older who applied to Ordu University Faculty of Dentistry for routine examination and agreed to fill out the questionnaire form. A total of 325 people participated in the survey conducted to determine the awareness of patients applying to the faculty of dentistry about their existing impacted teeth. A Pearson's chi-square test was used for hypothesis testing when expected frequencies exceeded 5. Results: It was determined that 56.9 % (185) of the participants were aware of their existing teeth, while 43.1 % (140) were not aware. When the patients were evaluated according to the institutions they had visited, it was seen that the group who were most aware of the presence of impacted tooth were those who apply to the faculty of dentistry (74.4 %). The rate of being informed by dentists in the institutions that they had previously visited was higher in patients with university or post-university graduates (p < 0.05). The most common information given by the dentists to the patients about their impacted dental problems was that the tooth should be followed up (40.4 %), while the removal of the tooth constituted 28.4 % of the information given. Conclusion: This study showed that although patients are aware of their existing impacted teeth, their level of knowledge about the risks it may pose is low. For a healthy oral care and health, patients should be adequately informed about impacted teeth.

[Classification of lower impacted third molars position and their interrelationship with mandibular canal]. / Klassifikatsii vidov retentsii nizhnikh tret'ikh molyarov i ikh anatomicheskogo vzaimoraspolozheniya s nizhnechelyustnym kanalom.

Classification of lower Impacted third molars position and their interrelationship with mandibular canal have a great scientific, theoretical and practical importance. An attempt to systematize and classify all anatomical impacted third molars position has been made by many authors. Based on our scientific literature search, we found: 8 impacted third molars classifications, 7 third molars and mandibular canal interposition classifications, as well as 5 classifications of mandibular canal anatomical branching variants. Most classifications are proposed by the author to predict third molar eruption perspective, determine level of operation complexity and prevent mandibular canal damage. New clinical classification development of impacted third molars interrelationship with mandibular canal, which combined the radiological PR, CBCT criteria, neurovascular bundle trauma prognosis, and operative technic choice can be actual.

[Microanatomy features in third molars roots adjacent to mandibular canal]. / Osobennosti anatomii kornei tret'ikh molyarov i nizhnechelyustnogo kanala pri ikh tesnom prileganii.

THE PURPOSE: Of the study is to reduce the risk of postoperative neuropathy of the inferior alveolar nerve by improving diagnostic methods, assessment of individual topographic and anatomical features and extraction technique of impacted teeth adjacent to the mandibular canal. MATERIALS AND METHODS: According to the CBCT examination, orthopantomography and macroscopic examination of removed third molars roots (n=140) the relative position of the mandibular canal and the roots of the third molars were studied. RESULTS: Three variants of close mandibular canal and third molars position have been identified. In the lateral and apical nerve position, the root surface depressions were detected. With inter-radicular position fit, the mandibular canal and the nerve bundle form a «bed¼ in between impacted tooth roots. CONCLUSION: The injury of neurovascular bundle prognosis during extraction with an interadicular mandibular position depends on roots anatomy and their convergence degree. If the interradicular distance is less than the diameter of the mandibular canal, nerve injury during tooth extraction is inevitable, in such cases coronectomy is indicated.

Is There a Relationship Between Unilateral/Bilateral Impacted Maxillary Canines and Nasal Septum Deviation?

Introduction A deviated nasal septum may be associated with some dentofacial deformities. The aim of the study was to determine whether there is a relationship between some craniomaxillary features of unilateral and bilateral maxillary impacted canines and nasal septum deviation. Methods This is a retrospective study consisting of cone beam computed tomography (CBCT) images of 51 patients. All patients were divided into three subgroups: unilateral maxillary impacted canines (UMIC) (n=19) bilateral maxillary impacted canines (BMIC) (n=15), and control group (MC) (n=17). The septal deviation angle and some angular and dimensional measurements were performed. Differences in linear and angular measurements between the groups were analyzed using One-way ANOVA and the Kruskal-Wallis test. Pearson's correlation analysis was performed to determine the relationship between the septal deviation angle, septal deviation direction, nasal floor angle, and other parameters, and multivariate linear regression analysis was performed to determine the effect of variables in the septal deviation angle. Results Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle and the nasal floor angle values were found to be significantly higher in the UMIC and BMIC groups (p<0.001) than in the MC group. Maxillary width was found to be significantly lower in the BMIC group compared to the UMIC (p<0.01) and MC group (p<0.001). Septal deviation angle was positively correlated with septal deviation direction and nasal floor angle (p<0.001). Palatal width and nasal floor angle were found to be negatively correlated (p<0.05), and palatal depth and septal deviation direction were found to be positively correlated (p<0.01). Groups and septal deviation angle, septal deviation direction, and nasal floor angle were found to be negatively correlated (p<0.001). The multivariate linear regression analysis revealed an association between septal deviation angle, group (p<0.01), and nasal floor angle (p<0.05). Conclusion Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle values were found to be higher when the maxillary impacted canine was unilateral. Unilateral or bilateral positions of the impacted canine and the nasal floor angle were found to be factors affecting the formation of septal deviation.

Assessment of the Relation Between Patterns of Third-Molar Impaction and Blood Group: A Retrospective Study.

Background The prevalence of impacted third molars is high in the global general population. The etiology of impacted third molars is not fully understood, but it is thought to result from combined genetic and environmental factors. Some studies have suggested a link between the blood group and the risk of impacted third molars. This study aimed to investigate the association between the blood group and the presence of impacted third molars and its pattern. Method A total of 856 panoramic radiographs were included in the study. The third molars were evaluated for the pattern of third-molar impaction and blood characteristics recorded as ABO group and presence or absence of Rhesus antigen. Results The results showed no significant association between the blood group and the presence of impacted third molars. The prevalence of at least one impacted the third molar was 34.6%. The most common angulation of impacted third molars was vertical (V) (45.1%), followed by mesioangular (MA) (33.7%), distoangular (DA) (13.8%), and horizontal (H) (7.4%). There was no significant association between the blood group and the number of impacted third molars nor between the blood group and the angulation of the impacted third molars. Conclusion This study suggests that the blood group is not a major factor in the development of impacted third molars. However, further studies with larger sample sizes are needed to confirm these findings.

Characteristics of Unilaterally Impacted Maxillary Canines and Effect on Environmental Tissues: A CBCT Study.

BACKGROUND: The prognosis of orthodontic treatment for a patient with impacted canine teeth can be affected by many factors and understanding some of the characteristics of impacted teeth can increase the effectiveness and reduce the duration of treatment. This study aims to explore the effects of positions and dentoalveolar morphological characteristics of impacted maxillary canines on the prognosis of orthodontic treatment. METHODS: In this study, forty-six adolescent individuals who applied for treatment of impacted teeth were divided into three groups: CC (no impacted maxillary canine group), BC (unilateral buccally positioned impacted maxillary canine group), and PC (unilateral palatally positioned impacted maxillary canine group). The impacted canine and adjacent teeth were evaluated in terms of position, angulation, inclination, mesiodistal and buccolingual widths, root length, dilaceration angle, and root resorption. RESULTS: The mean values of U3 Ang (angulation of the maxillary impacted canine) and U3/U2 angles (maxillary impacted canine and lateral incisor angle) were statistically significantly higher in the BC and PC groups (p < 0.001). The mean values of U2 RL (lateral incisor root length) and U3 RD (canine root dilaceration angle) were statistically significantly lower in the BC and PC groups. CONCLUSIONS: The results of this study suggest that shorter root lengths and increased angulation values may lead to the ectopic eruption of canines. The higher canine angulations in the PC group increase the degree of root resorption.

Influence of the maxillary dimensions and anterior teeth anatomy on the buccal impaction of upper permanent canines: A three-dimensional case-control study.

OBJECTIVE: The diagnosis of impacted upper permanent canines (IUPC) is a relatively common clinical finding. The aim of this study was to investigate the association of the buccal impaction of upper permanent canines with their dimensions and the maxilla bone base. MATERIAL AND METHODS: Cone beam computed tomography files of 66 patients were allocated into: impaction group (ICG/n=33/mean age 15.7±3.9 years), with 44 impacted canines by the buccal side; control group (CG/n=33/mean age 15.66±3.99 years), matched for age and sex, with 66 canines normally erupted. The following measurements were obtained from ICG and CG groups: linear and volumetric canine dimensions, linear measurements of upper permanent central and lateral incisors, measurements of the anterior perimeter and transverse segments of the maxilla. Independent Student's t-test was used for intergroup analysis with correction of Bonferroni (α=0,005). RESULTS: Higher values were found in the means of the variables regarding to the anterior teeth crowns in the ICG group, however, without a significant difference (P<0,005). The upper arch anterior perimeter of the individuals with canine impaction through buccal area was reduced compared to CG (P=0.001). CONCLUSIONS: It can be concluded that individuals with upper buccal impacted permanent canine showed a significantly smaller anterior perimeter of the maxillary arch when compared to the control group. Although greater canine mesiodistal diameter was found in this group, there is no statistical association with the occurrence of this condition.

Influence of the maxillary dimensions and lateral incisor anatomy on the palatal impaction of maxillary permanent canines: A three-dimensional case-control study.

OBJECTIVE: The diagnosis of impacted upper permanent canines (IUPC) is a relatively common clinical finding. The aim of this study was to investigate associations between the upper permanent canines palatal impaction, lateral incisors morphology and the maxilla bone base. MATERIAL AND METHODS: Cone-beam tomography files from 62 subjects were divided into 2 groups: impaction group (ICG/n=31; mean age 14.3±2.4) with 45 canines impacted on the palatal side and age- and sex-matched control group (CG/n=31; mean age 14.3±2.3), with 62 normally erupted canines. Linear and volumetric measurements of the lateral incisors, linear transversal measures and the maxillary anterior perimeter were taken. Independent Student's t-test was used for intergroup analysis with correction of Bonferroni. RESULTS: Significant differences were found for crown length and root diameter (buccal-palatal) (P<0.005). The maxillary anterior perimeter in the ICG was reduced in relation to the GC but not significantly (P=0.008). The transverse skeletal variables of the maxilla were equivalent in the intergroup comparison (P>0.005). CONCLUSION: Smaller dimensions in the crown length and in the upper permanent lateral incisors root buccal-palatal diameter were associated with the impaction of upper permanent canines on the palatal side. The maxillary transverse morphology did not show any association with the occurrence of this condition.

[Dental implant placement in the area of ectopic and impacted teeth]. / Dental'naya implantatsiya v oblasti retenirovannykh i distopirovannykh zubov.

The paper presents two clinical cases demonstrating the effectiveness of using surgical templates for the installation of dental implants in the areas of ectopic and impacted teeth in case of patient's disagreement on their removal or other methods of treatment.