Application of cryopreservation to tooth germ transplantation for root development and tooth eruption.

We cryopreserved mouse tooth germs with widely open cervical margins of the enamel organ to overcome difficulties in cryoprotectant permeation and tested their efficacy by transplanting them into recipient mice. The upper right first molar germs of 8-day-old donor mice were extracted and categorized into the following four groups according to cryopreservation time: no cryopreservation, 1 week, 1 month, and 3 months. The donor tooth germs were transplanted into the upper right first molar germ sockets of the 8-day-old recipient mice. The upper left first molars of the recipient mice were used as controls. The outcome of the transplantation was assessed at 1, 2, and 3 weeks after transplantation. Stereomicroscopic evaluation revealed that most of the transplanted teeth erupted by 3 weeks after transplantation. Micro-computed tomography analysis revealed root elongation in the transplanted groups as well as in the controls. There was no significant difference between the cryopreserved and non-cryopreserved transplanted teeth, but the roots of the cryopreserved teeth were significantly shorter than those of the control teeth. Histological examination revealed root and periodontal ligament formations in all the transplanted groups. These results suggest that the transplantation of cryopreserved tooth germs facilitates subsequent root elongation and tooth eruption.

Microdont Developing Outside the Alveolar Process and Within Oral Diffuse and Plexiform Neurofibroma in Neurofibromatosis Type 1.

BACKGROUND/AIM: Numerical aberrations of permanent dentition and dystopic tooth eruption are part of the phenotype of the tumor predisposition syndrome neurofibromatosis type 1 (NF1). In these cases, surplus tooth germs usually develop in the alveolar processes of the jaw. This report attests to the dystopic development of a dysplastic supernumerary tooth in NF1 arising outside the jaw. CASE REPORT: The 8-year-old male patient developed a microdont outside the bone and above the occlusal plane of the retained maxillary right second molar. The supernumerary tooth was completely embedded in oral soft tissue. Hyperplastic oral soft tissue in the molar region and microdont were excised. Specimen of the mucosa surrounding the teeth was interspersed with diffuse and plexiform neurofibroma. The retained upper right first molar emerged spontaneously within a few months after surgery. The upper right second molar did not change position. CONCLUSION: Odontogenesis can take place within tumorous oral mucosa in NF1. Surgical removal of the tumorous mucous membrane facilitates tooth eruption in some cases.

Impactación dentaria por odontoma compuesto: reporte de caso y revisión de literatura / Dental impactation caused by odontoma: case report and literature review

Resumen Actualmente los odontomas son los tumores odontogénicos más frecuentes. Son considerados hamartomas, compuestos por células epiteliales odontogénicas y mesenquimatosas diferenciadas, y muestra tejidos dentales en su estructura. Se presenta una revisión de la literatura seguido por un reporte de caso de un odontoma compuesto en el maxilar inferior de un paciente de 13 años asociado a la inclusión del segundo molar inferior derecho (4.7). Se realizó la exéresis del tumor y la correspondiente biopsia para confirmar el diagnóstico.

Abstract At present time odontomas are the most common odontogenic tumors. They are hamartomas, composed of epithelial odontogenic and mesenchymal cells, presenting dental tissue in their structure. A literature review followed by a case report are presented. The case report presents a compound odontoma in the inferior maxillary of a 13-year-old patient, associated with the inclusion of the second right inferior molar (4.7). The exeresis followed by the biopsy of the tumor were performed to confirm the clinical diagnosis.

Orthognathic Surgery Has a Significant Positive Effect on Perceived Personality Traits and Perceived Emotional Facial Expressions in Subjects With Primary Mandibular Deficiency.

This study tested the hypothesis that a layperson's social perceptions of a dentofacial deformity (DFD) patient with primary mandibular deficiency (PMD) are more positive after bimaxillary orthognathic surgery.A survey was implemented comparing layperson's social perceptions of emotional expressions and personality traits before and >6 months after orthognathic surgery when viewing standardized facial photographs. The study sample comprised 20 patients selected randomly from a larger primary mandibular deficiency database, treated by 1 surgeon after orthognathic surgery. The outcome variable was change in 6 perceived emotional expressions and 6 personality traits studied. Descriptive and bivariate statistics were computed (P < .05).Five hundred respondents (raters) completed the survey. The respondents were 52% male with 44% aging from 25 to 34. After bimaxillary and chin orthognathic surgery, primary mandibular deficiency patients were perceived to be significantly more dominant, trustworthy, friendly, intelligent, attractive, and less threatening (P < .05). They were also perceived as happier and less angry, surprised, sad, afraid, or disgusted than before surgery (P < .05).Laypeople consistently report improved social traits in primary mandibular deficiency patient's perceived emotional expressions and perceived personality traits after bimaxillary and chin orthognathic surgery.

Combined Orthodontic-Surgical Sequential Treatment of Cleidocranial Dysplasia: A Case Report With 7-Year Follow-up and Review of the Literature.

Cleidocranial dysplasia (CCD) is a rare hereditary disorder characterized by skeletal malformations and dental abnormalities. Mutations of the transcription factor RUNX2 are responsible for the pathogenesis of CCD. We present a case of a 10-year-old boy with CCD, presenting with hypoplastic clavicles, delayed closure of the fontanelles, retarded exfoliation of the deciduous teeth, retarded eruption of the permanent teeth, and multiple impacted supernumerary teeth. Based on the clinical and radiographic examination results showing abnormalities of the bones and teeth, a diagnosis was reached easily, but it was difficult to achieve a complete curative effect. We carried out a highly organized schedule of treatment, including extraction of the deciduous and supernumerary teeth, partial resection of alveolar bone, distraction of impacted teeth, and orthodontic surgery. After 7-year follow-up, the patient has achieved acceptable occlusion and midfacial appearance. The main objectives of this study were to present the diagnosis and treatment of CCD and to emphasize the benefits of combined orthodontic-surgical sequential treatment.

Quality of occlusal outcome following space closure in cases of lower second premolar aplasia using lingual orthodontic molar mesialization without maxillary counterbalancing extraction.

BACKGROUND: Controlled space closure in cases of isolated lower second premolar aplasia (ILSPA) without maxillary counterbalancing extraction is challenging. Anterior anchorage loss may occur during space closure resulting in compromised occlusal results in terms of an absence of proper canine guidance during laterotrusive mandible movements. In order to evaluate the effectiveness of Herbst telescope anchorage in combination with double-cable, pull mechanics and a completely customized lingual appliance for orthodontic space management in cases of ILSPA, we tested the null hypothesis that there is a significant deterioration in the sagittal canine relationship towards an Angle-Class-II occlusion expressed as a loss of anterior anchorage following space closure with molar mesialization. METHODS: Twenty-five consecutively de-bonded subjects (female / male 17 / 8; aged at T0 (start of MB Tx) 12.3 to 20.6 years; mean age 15.0 / SD 1.7 years) were included in this retrospective analysis using the inclusion criteria of least of one lower second premolar aplasia; completed treatment with a totally customized lingual appliance (CCLA) in combination with Herbst telescopes. Exclusion criteria were the absence of counterbalancing maxillary extractions, as well as additional tooth aplasia other than lower second premolars. A total of 33 single, lower premolar aplasia space closures (right / left sided 17 / 16) were assessed using plaster casts and intra-oral photographs scaled to the plaster casts, at bonding (T0), Herbst insertion (T1), following gap closure (T2) and de-bonding (T3). Parallelism of roots was controlled by panoramic x-rays at T3. RESULTS: The mean aplasia space at T0 was 7.5 mm (SD 2.6). Complete space closure was achieved in all 33 situations. The null hypothesis was rejected. There was a significant improvement in the initial canine relationships (mean 3.5 mm distal occlusion at T0) to a mean 0.1 mm at T3. When evaluated against the individual treatment plan, the following amounts of planned improvements were achieved: space closure 100%, canine relationship 97.5%, overjet 93.9%, overbite 96.4%, parallel roots in space closure site 93.9%. CONCLUSION: Herbst telescope anchorage in combination with double-cable pull mechanics and a CCLA for orthodontic space closure can deliver predictable, high-quality treatment results.

Immediate Implant Placement and Provisionalization Using the Patient's Extracted Crown: 12-Month Follow-Up.

STATEMENT OF PROBLEM: Immediate placement and provisionalization of implants in fresh sockets has been previously demonstrated to be a predictable treatment in the restoration of non-recoverable teeth in the anterior regions of the maxilla. PURPOSE: This article reports a clinical case in which an immediate implant placement protocol was used in combination with two distinct and sequential grafts (bovine bone and connective tissue, respectively) followed by immediate implant provisionalization using the patient's crown of an extracted tooth. CLINICAL REPORT: Physical, clinical, and image examinations of the patient (female, 23 years old) revealed a maxillary central incisor (tooth No. 8) with slight mobility due the presence of extensive cervical resorption. The treatment proposed was the atraumatic extraction of the tooth followed by immediate implant placement and provisionalization. Two grafts (bovine bone and connective tissue) were used due to the presence of a very thin maxillary bone plate associated with a thin gingival biotype. RESULTS: The use of the extracted crown as a temporary crown after immediate implant placement resulted in immediate attainment of an esthetically pleasing outcome and long-term favorable results. CONCLUSION: The treatment protocol proposed can be efficiently used to immediately restore the patient's esthetics and function while maintaining the health, volume, and contours of gingival tissues over a 12-month follow-up period. CLINICAL IMPLICATIONS: Anterior teeth extractions typically require the execution of single-unit prostheses using dental materials of synthetic origin (such as polymers), which often are incapable of achieving the esthetic and physiological results patients expect. The use of the patient's own crown was demonstrated, which allowed good clinical results to be achieved and the natural shape and function of tissues to be maintained.

Case of Inverted Supernumerary Tooth in Nasal Cavity.

The eruption of a tooth into the nasal cavity is a rare clinical entity. We report a case of an inverted supernumerary tooth in the nasal cavity. A 2-year-old boy was referred to our institution after examination at a local otorhinolaryngology department for otitis media. Radiological examination revealed a tooth-like structure in the right nasal cavity. The tooth was protruding from the floor of the nasal cavity along with granulation tissue. The diagnosis was an inverted tooth in the right nasal cavity. Forceps extraction was performed under general anesthesia.

Extraction of mandibular third molars: proposal of a new scale of difficulty.

We evaluated the accuracy of a new scale of surgical difficulty for the extraction of impacted mandibular third molars, which includes consideration of previously underestimated variables. Two hundred patients with impacted third molars were enrolled, and a preoperative clinical and radiographic assessment of difficulty was made by an oral surgeon using the new index. Five oral surgeons with similar degrees of experience then evaluated the surgical difficulty during operation. The kappa test and weighted kappa were used to evaluate the level of agreement between the preoperative and postoperative evaluations. This was 0.73, which indicated a substantial concordance between the preoperative and postoperative assessments of difficulty indicated by the new scale. The linear weight of kappa was 0.8 and the quadratic weight 0.87. We recommend this new scale of surgical difficulty for the extraction of impacted third molars for use in clinical practice.

Prevalencia de dientes supernumerarios en pacientes con labio y paladar hendido mediante el análisis de ortopantomografías / Prevalence of supernumerary teeth in cleft lip and palate patients by analysing orthopantomographies

Introducción. Algunos pacientes con labio y paladar hendido presentan anomalías dentales, principalmente aquellas que incluyen anomalías de número, como, por ejemplo, el diente supernumerario. El diagnóstico y tratamiento son importantes, ya que ayudan a minimizar problemas funcionales y estéticos. Objetivo. Determinar la prevalencia de dientes supernumerarios mediante el análisis radiográfico, en la población con labio y paladar hendido que asiste al Hospital Nacional de Niños (Costa Rica), durante el período agosto de 2009 - julio de 2010. Metodología. El estudio se basó en escoger un expediente de cada 4 pacientes de la consulta externa, con el fin de revisar este y analizar la ortopantomografía. Las técnicas estadísticas para el análisis fueron las distribuciones de frecuencia, cruce de variables, comparación de medias con base en el análisis de variancia. El nivel mínimo de confianza para las comparaciones fue del 95%. Resultados. La muestra total comprendió 180 expedientes con una confianza del 95% y un error máximo permisible del 5%. Un 32% de la población presentó dientes supernumerarios; destacándose el grupo de pacientes con hendidura labial, alveolar y palatina. Los dientes supernumerarios se localizaron en un 100% a nivel maxilar, con el diente ubicado dentro de la zona de la hendidura principalmente (77%), específicamente en la región del canino (51%). Conclusiones. El diente supernumerario es una anomalía que se presenta en los pacientes con labio y paladar hendido, por lo que es pertinente el buen diagnóstico clínico y radiográfico para determinar su presencia, y así escoger la más apropiada opción de tratamiento según las necesidades del caso (AU)

Introduction. Patients with cleft lip and palate usually have dental abnormalities, particularly supernumerary tooth anomalies. The diagnosis and treatment are important, since it helps to minimise functional and aesthetic problems. Objective. The purpose of this study was to determine the prevalence of supernumerary teeth by radiographic analysis in patients with cleft lip and palate, who were treated in the Hospital Nacional de Niños, Costa Rica, during the period August 2009-July 2010. Methodology. The study was based on choosing a record of every 4 patients of the outpatient department, in order to review and analyse the orthopantomography. The statistical techniques used were frequency distributions, cross variables, and comparison of means based on the analysis of variance. The minimum level of confidence for comparisons was 95%. Results. The total sample comprised 180 records with a confidence of 95% and a maximum permissible error of 5%. Almost one-third (32%) of the population had supernumerary teeth, particularly the group of patients with cleft lip, alveolar and palate. Supernumerary teeth were 100% located on the maxillary arch, and mainly within the area of the alveolar cleft (77%), specifically in the region of the canine (51%). Conclusion. The supernumerary tooth is an anomaly that occurs with cleft lip and palate, so a good clinical and radiographic diagnosis is important to determine its presence, and thus to choose the most appropriate treatment option according to the needs of the case (AU)

Molar incisor malformation in six cases: description and diagnostic protocol.

OBJECTIVE: The term molar-incisor malformation (MIM) has recently been presented in the scientific literature, where it is described as a condition with localized impaired root development. Here we present 6 recently discovered cases referred to our departments. STUDY DESIGN: The patients were enrolled in the study after referral and were examined clinically and radiologically. Two extracted teeth were further examined with micro-computed tomography or microscopy. RESULTS: Affected teeth were first permanent molars with hypoplastic roots, narrow pulp chambers, and a hypercalcified dentine layer cervical to the pulp chamber. Two of the cases also had cervical constrictions on the upper incisors. The patients were 8 to 12 years of age and healthy, but had experienced serious medical conditions of the head and neck region in their first year of life. Some of the cases had been referred because of acute infection and pain. CONCLUSION: In 5 out of 6 patients, severe health problems in the head and neck region early in life may have been associated with root malformation in molars and incisors. Patients with MIM need to be followed closely, and extractions should be planned at the right time to avoid unnecessary infection and pain in addition to orthodontic problems.

A Morphological Classification Scheme for the Mandibular Hypoplasia in Treacher Collins Syndrome.

BACKGROUND: Mandibular hypoplasia is a hallmark of Treacher Collins syndrome (TCS), and its severity accounts for significant functional morbidity. The purpose of this study is to develop a mandibular classification scheme. METHODS: A classification scheme was designed based on three-dimensional computed tomography (3D-CT) scans to assess 3 characteristic features: degree of condylar hypoplasia, mandibular plane angle (condylion-gonion-menton), and degree of retrognathia (sella-nasion-B point angle). Each category was graded from I to IV and a composite mandible classification was determined by the median value among the 3 component grades. RESULTS: Twenty patients with TCS, aged 1 month to 20 years, with at least one 3D-CT prior to mandibular surgery were studied. Overall, 33 3D-CTs were evaluated and ordered from least to most severe phenotype with 10 (30%) Grade 1 (least severe), 14 (42%) Grade 2, 7 (21%) Grade 3, and 2 (7%) Grade 4 (most severe). Seven patients had at least 2 longitudinal scans encompassing an average 5.7 (range 5-11) years of growth. Despite increasing age, mandibular classification (both components and composite) remained stable in those patients over time (P = 0.2182). CONCLUSION: The authors present a classification scheme for the TCS mandible based on degree of condylar hypoplasia, mandibular plane angle (Co-Go-Me angle), and retrognathia (SNB angle). While there is a natural progression of the mandibular morphology with age, patients followed longitudinally demonstrate consistency in their classification. Further work is needed to determine the classification scheme's validity, generalizability, and overall utility.

Swinging Replantation: A Possible Protocol for the Management of Inverted Impacted Upper Central Incisor Tooth.

INTRODUCTION: Inverted tooth impaction is a rare occurrence. Third molar impaction is the most extensively studied, and only eight cases of inverted third molars have been reported in a literature search of 40 years from 1973 to 2013. In a study, 43.4% of the premaxillary supernumeraries were inverted and 21.1% were transversely oriented, while occasional inverted central incisors have been mentioned in the literature. Severe dilaceration makes the management of this case a big challenge. The case of an 8-year-old boy with an inverted, rotated, and impacted upper left central incisor obstructed by an odontome is presented here. Under local anesthesia, the odontome was excised; the inverted tooth was swung and repositioned. The patient experienced uneventful healing, and with 30 months follow-up, progressive tooth eruption has been observed. Vitality test is positive, while radiologically there was no sign of resorption. Swinging replantation is a protocol that has been used for the management of an inverted, rotated, and impacted central incisor. Open root apex is an important factor in the selection of the method. The minimal periodontal damage prevents inflammatory and replacement resorption. With some clear advantages over options like orthodontic and prosthetic replacement, it could be a method to be considered in the management of severely dilacerated central incisors. The clinical significance is that even though management of a severely malpositioned tooth has always been a big challenge in dental practice, requiring extraction and prosthodontic replacement, swinging replantation provides a possible protocol of tooth retention, i.e., less expensive and associated with fewer hospital visits.

Endodontic Treatment of Hypertaurodontic Mandibular Molar Using Reciprocating Single-file System: A Case Report.

Taurodontism is a developmental tooth disorder characterized by lack of constriction in the cementoenamel junction and consequent vertical stretch of the pulp chamber, accompanied by apical displacement of the pulpal floor. The endodontic treatment of teeth with this type of morpho-anatomical anomaly is challenging. The purpose of this article is to report the successful endodontic treatment of a hypertaurodontic mandibular molar using a reciprocating single-file system.

Correlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting.

Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting. Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up. Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up. Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning.

A Mouthful of Anomalies.

Isolated bilateral macrodontia of the mandibular second premolars is a rare condition. We believe that the case reported here is the first in which isolated bilateral macrodontia of the mandibular second premolars presents with numerous dental anomalies affecting other teeth. A 14-year-old boy was referred to the Paediatric Dental Department of King's College Hospital with a partially erupted mandibular left second premolar. Clinical and radiographic examination subsequently revealed macrodontia of both mandibular second premolar teeth and multiple other dental anomalies. This report discusses the presentation and multidisciplinary management of this case. Clinical relevance: This case report describes an already rare condition made even more extraordinary owing to its presentation with multiple other dental anomalies.

Combined Endodontic Therapy and Intentional Replantation for the Treatment of Palatogingival Groove.

A palatogingival groove is an anatomic malformation that predisposes the involved tooth to a severe periodontal defect. When the condition is complicated by pulpal necrosis, affected teeth often present a dilemma in terms of diagnosis and treatment planning. In this report, we describe the case of a patient with a maxillary lateral incisor with a deep palatogingival groove extending to the root apex and severe periodontal destruction (local pocketing). Suggested treatment modalities included curettage of the affected tissues, elimination of the groove by grinding and/or sealing with a variety of filling materials, and surgical procedures. In this case, a combined treatment approach, involving both endodontic therapy and intentional replantation after restoration with a self-etching flowable composite, resulted in periodontal healing and significant healing of the periradicular radiolucency at 12 months. In short, intentional replantation offers a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves, especially for single-rooted teeth.

Dientes Supernumerarios y su relación con el pie Plano: reporte de dos casos, Manzanillo, 2012 / Supernumerary teeth and their relation to the flatfoot. Two-case report. Manzanillo. 2012

Paciente DRP masculino, de 20 años de edad, raza blanca, procedencia urbana,residente del Reparto Taino, municipio Manzanillo, presenta 8 dientes supernumerarios, 3 en el maxilar y 5 en la mandíbula, así como mala oclusión en dientes antero superiores y apiñamiento severo en el mismo sector;con antecedentes de 3 meses antes de realizar la exodoncia, presentaba movilidad dentaria grado IV y síntomas de dolor provocado durante la masticación en el (36) molar inferior izquierdo, acude al área de salud de la Clínica Estomatológica del Policlínico 2 Ángel Ortíz Vázquez del municipioManzanillo, el 15 de Enero del 2012 para examen, diagnóstico y tratamiento en APS. Paciente de 24 años de edad, raza blanca, procedencia urbana, residente del Reparto Céspedes, municipio Manzanillo, presenta dientes supernumerarios, 4 en la mandíbula ocasionándole molestia durante la masticación. Acude a consulta el 23 de abril del 2012 para examen, diagnóstico y tratamiento en APS acompañado de su esposa por presentar dificultad para deambular debido a deformidad en miembros inferiores. Concluimos que ambos pacientes fueron diagnosticados clínicamente con una anomalía dento-maxilofacial de número y de posición asociado a otros signos del síndrome cleidocraneal(AU)

A 20 year-old DRP male patient of urban origin, in Manzanillo Municipality, Taino Neighborhood, white race, who presented 8 supernumerary teeth, 3 of them in the maxilla and 5 in the jaw, abad occlusion in the anterosuperior teeth, and severe teeth crowding in this area; with antecedents of 3 months before carrying out the exodontics, he presented dental mobility of grade IV and symptoms of pain provoked during mastication in the (36) lower left molar. The patient went to the health area on January 15, 2012, (dental clinic of Angel Ortiz Vazquez polyclinic in Manzanillo Municipality) for the exams, diagnosis and treatments in the PHC, accompanied by a relative because the patient had difficulties to walk due to a deformity on the lower limbs. Patient of 24 years old, urban origin, in Manzanillo, Cespedes neighb orhood, white race, who presented supernumerary teeth, 4 in the jaw, withproblems during mastication, this patient went to the dentistry on April 23rd, 2012 for better exams, diagnosis and treatments in PHC, accompanied by his wife because he had difficultiesto walk due to a deformity on the lower limbs. We concluded that both patients were clinically diagnosed with a dental-maxillofacial anomaly of number and position associated to other signs of the cleidocranial syndrome(EU)