Rara impacção dental de primeiro, segundo e terceiro molares com risco de fratura mandibular ­ relato de caso / Rare dental impaction of first, second and third molares with risk of mandibular fracture ­ case report

Impacções dentais são definidas como a ausência da irrupção dental causada por uma barreira física identificada ou por posição anormal do dente. A presença de impacção nos primeiros e segundos molares inferiores é de baixa incidência representando, respectivamente, 0,01% e 0,06 a 0,3%, sendo ainda, em ambas, mais comum a apresentação de forma unilateral, mésio-angulada com predileção pelo sexo feminino, o que torna as mesmas relativamente raras. Os primeiros e os segundos molares são de grande importância para o desenvolvimento normal da dentição e coordenação do crescimento facial, podendo a impacção destes alterar estes mecanismos e ainda causar problemas como cáries, periodontite, reabsorção de dentes adjacentes, formação de cisto, má oclusão e dor. As opções de tratamento para dentes impactados são exodontia, tracionamento ortodôntico ou cirúrgico- -ortodôntico, e transplante dental. O objetivo deste artigo é relatar um caso clínico de rara impacção dental de primeiro, segundo e terceiro molares com risco de fratura mandibular, em que a paciente compareceu ao ambulatório de Cirurgia Bucomaxilofacial da OSID/UFBA encaminhada para avaliação das unidades dentais impactadas. Ao exame clínico, foi observada ausência das unidades 36 e 37 na cavidade oral e unidade 38 mesioangulada e semierupcionada. O tratamento optado foi a exodontia das unidades impactadas sob anestesia geral. O tratamento mais indicado para a impacção dental é o tracionamento ortodôntico, porém este apresenta limitações frente a alguns fatores que devem ser analisados para a definição da conduta sobre estas impacções, podendo ser indicado em impacções complexas, tratamentos invasivos como a exodontia dental (AU).

Dental impactions are defined as absence of dental eruption caused by an identified physical barrier or abnormal position of the tooth. The presence of impaction in the first and second lower molars is of low incidence representing 0.01% and 0.06%, respectively, and in both cases the most common is unilateral, mesioangulated presentation with female prevalence, what makes them rare. The first and second molars are of great importance for the normal development of the dentition and the coordination of facial growth, the impaction of them may influence these mechanisms and also cause problems such as caries, periodontitis, reabsorption of adjacent teeth, cyst formation, bad occlusion, and pain. Treatment options for impacted teeth are extraction, orthodontic or surgical-orthodontic traction and dental transplantation. The aim of this article is to report a clinical case of rare dental impaction of first, second and third molars with risk of mandibular fracture, in which a female patient came to the ambulatory OSID/UFBA Oral and Maxillofacial Surgery and was referred to evaluate the impacted dental units. Clinical examination showed absence of units 36 and 37 in the oral cavity and that unit 38 was mesioangulated and semi-erupted. The treatment option was exodontia of the impacted units under general anesthesia. The most appropriate treatment for dental impaction is traction, but it has limitations that must be analyzed for definition of conduct on these impactions, it may be indicated in complex impactions and invasive treatments such as dental extraction (AU).

National clinical guidelines for the management of unerupted maxillary incisors in children.

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Primary failure of eruption (PFE): a systematic review.

BACKGROUND: Primary failure of eruption (PFE) is a rare disease defined as incomplete tooth eruption despite the presence of a clear eruption pathway. Orthodontic extrusion is not feasible in this case because it results in ankylosis of teeth. To the best of our knowledge, besides the study of Ahmad et al. (Eur J Orthod 28:535-540, 2006), no study has systematically analysed the clinical features of and factors associated with PFE. Therefore, the aim of this study was to systematically evaluate the current literature (from 2006 to 2017) for new insights and developments on the aetiology, diagnosis, genetics, and treatment options of PFE. METHODS: Following the PRISMA guidelines, a systematic search was performed using the PubMed/Medline database for studies reporting on PFE. The following terms were used: "primary failure of tooth eruption", "primary failure of eruption", "tooth eruption failure", and "PFE". RESULTS: Overall, 17 articles reporting clinical data of 314 patients were identified. In all patients, the molars were affected. In 81 reported cases, both the molars and the premolars were affected by PFE. Further, 38 patients' primary teeth were also affected. In 27 patients, no family members were affected. Additional dental anomalies were observed in 39 patients. A total of 51 different variants of the PTH1R gene associated with PFE were recorded. CONCLUSIONS: Infraocclusion of the posterior teeth, especially if both sides are affected, is the hallmark of PFE. If a patient is affected by PFE, all teeth distal to the most mesial tooth are also affected by PFE. Primary teeth can also be impacted; however, this may not necessarily occur. If a patient is suspected of having PFE, a genetic test for mutation in the PTH1R gene should be recommended prior to any orthodontic treatment to avoid ankylosis. Treatment options depend on the patient's age and the clinical situation, and they must be evaluated individually.

Terapéutica quirúrgico-ortodóntica en adultos con dientes supernumerarios múltiples. Presentación de caso / Surgical-orthodontic therapy on adults with multiple supernumerary teeth

Se presentó a la consulta estomatológica, una paciente femenina de 39 años de edad, sin antecedentes médicos de interés, por presentar pérdida espontánea de un diente temporal. A través del examen físico intrabucal, se pudo corroborar la ausencia clínica del diente número 13, y en su lugar, la presencia de mucosa, que evidenciaba una exfoliación reciente de un diente, con notable disminución del espacio entre el incisivo lateral y la primera bicúspide superior izquierda. El examen radiográfico periapical mostró la presencia de una imagen radiopaca, ubicada entre el incisivo lateral y la primera bicúspide de la hemiarcada superior izquierda, la cual sugiere la presencia de múltiples órganos dentarios. Dada la afectación funcional, estética y psicológica de la paciente, y la existencia de discrepancia negativa moderada hueso-diente, se decidió realizar la exéresis quirúrgica de los dientes supernumerarios y en una segunda etapa, la corrección ortodóncica. El tratamiento quirúrgico se realizó sin complicaciones, pues la paciente mostró una evolución postquirúrgica positiva. Luego de la recuperación total del área intervenida, comenzaron los movimientos ortodóncicos, que finalmente permitieron obtener un resultado estético y funcional óptimo.(AU)

A 39 years old female patient, with no medical records, comes to dentistry consulting because of a temporal tooth loss. During the intraoral physical examination the absence of the 13 tooth was corroborated, and the recently exfoliation of a teeth with a considerable diminish of space between the left upper lateral incisor and the left first upper bicuspid were corroborated. The x-rays showed radiopacity, located between the lateral incisor and the first upper bicuspid of the left hemi-arcade, suggesting several dental organs. Due to functional, aesthetic and psychological influencies on the patient, and the presence of a moderated negative bone-teeth discrepancy, it was decided to practice surgical extraction of supernumerary teeth and the orthodontic correction. Surgical treatment was practiced without complications, and the patient showed a good postsurgical evolution. After a total recovery of the affected area, orthodontic movement began. It allowed an optimum aesthetic and functional outcome.(AU)

Primary failure of eruption: Clinical and genetic findings in the mixed dentition.

OBJECTIVE: To test the hypothesis that mutations in the parathyroid hormone 1 receptor ( PTH1R) include effects in both primary and permanent teeth. MATERIALS AND METHODS: DNA was extracted from saliva samples of 29 patients (8 familial and 21 sporadic) who presented with clinical evidence of infraoccluded teeth, and their unaffected relatives (N = 22). Sequencing followed by mutational analysis of the coding regions of PTH1R gene was completed for all individuals (N = 29). RESULTS: Eight of 29 cases revealed a heterozygous pathogenic variant in the PTH1R gene; five of eight variants represented distinct mutations based on comparison with the dbSNP, HGMD, and ESP databases. One mutation (c.1765 T>C p.Trp89Arg) was found to segregate within a family (n = 3). In silico analyses for all variants revealed a putative pathogenic effect. A genotype-phenotype correlation was reported as defined by a functional mutation in PTH1R and corresponding effects on one or more posterior teeth only; unilateral or bilateral involvement, infraoccluded primary teeth. CONCLUSIONS: Novel mutations were reported in the PTH1R gene that included PFE-affected primary molars, thus providing the basis for using a genetic diagnostic tool for early diagnosis leading to proper management.

[Unerupted first deciduous molar located higher to the first premolar: a case report].

Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones. Of the primary teeth reported as unerupted, second deciduous molars are the teeth most frequently involved, followed by primary central incisors. At present almost no coverage is seen about the impaction of the first deciduous molar. In this case, a 4-year-old boy who presented with an impacted left maxillary first deciduous molar came to the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. This tooth, located higher to the left maxillary first premolar, was well near to the maxillary sinus. The family and medical histories were noncontributory and his physical findings were within normal limits. The mother was reported as having experienced no illness or other complications and taken no medications during pregnancy. His clinical extraoral examination was noncontributory. His clinical intra-oral examination revealed that the maxillary left first primary molar was not present. No enlargement of the area was apparent visually or on palpation. The remaining primary dentition was well aligned and in good condition. His oral hygiene was good, although there were incipient occlusal carious lesions in the mandibular second primary molars. There was no history or evidence of dental trauma. A diagnosis of a left maxillary first deciduous molar was made on the basis of the clinical and radiographic evidence. Numerous local etiologic factors have been described for impacted teeth. These include anomalous teeth, malposition, fusion with adjacent or supernumerary teeth, odontoma, dentigerous cysts, tumors, underdevelopment of the jaws, keratinized epithelial lining, hereditary conditions, and trauma. In this case, the reason for impaction was not clear. After the comprehensive clinical evaluation, treatment consisted of placement of a space maintainer, the periodic examination was indicated for the follow-up, so that early interventions, such as subsequent surgical intervention and orthodontic traction could be recommended timely to manage orofacial disfigurement and to avoid consequent problems with resultant proper functioning and good periodontal health.

Cleidocranial dysplasia syndrome (CCD) with an unusual finding in a young patient.

Cleidocranial dysplasia (CCD), an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals, presents with a wide range of variability. Dentists are often the first to encounter patients with CCD, some of whom do not show typical manifestations. Since it has similar features to other pathologies, CCD is misdiagnosed as other conditions. A 10-year-old boy suffering from CCD was misdiagnosed as having rickets and was referred for non-eruption of a few permanent teeth along with an unaesthetic facial appearance. Clinically and radiologically, a diagnosis of CCD was made. Currently, management of this patient's orofacial manifestations is underway.

Bilateral coronoid hypoplasia and complex odontoma: a rare concurrence of developmental pathology and odontogenic tumour of the mandible.

We present a rare case of concurrent bilateral coronoid hypoplasia and complex odontoma in the mandible, with replacement of missing posterior teeth in both sides of the lower jaw. A 20-year-old woman was diagnosed with bilateral occurrence of coronoid hypoplasia and unerupted complex odontoma after radiographic and histopathological examination. The patient was surgically treated with complete removal of the unerupted complex odontoma and prosthetic replacement of the missing teeth.

External manifestations of Gardner's syndrome as the presenting clinical entity.

Gardner's syndrome is an autosomal dominant disease characterised by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumours. Pathological features such as osteomas of the mandible, skull and facial skeleton are unaesthetic as well as incapacitating. We present the case of a 22-year-old man with pain and discharge from the left eye and a firm swelling in the left infraorbital region leading to proptosis of the left eye. A detailed examination of the patient led to the presence of a large osteoma in the left orbital region, multiple cystic lesion, corneal opacity and parapapillary atrophy in the left eye. Radiography revealed the presence of multiple unerupted supernumerary teeth and osteomas. Colonoscopic findings showed the presence of multiple polyps. Thus, external manifestations of the patient's facial region led to the establishment of the diagnosis of Gardner's syndrome. The importance of our case highlights the necessity of maintaining a high vigilance with regard to the occurrence of such an entity.

[Recognizing and preventing disturbances in eruption]. / Herkennen en voorkomen van eruptiestoornissen.

Disturbances in eruption and related problems are quite common in permanent dentition but rare in deciduous dentition. For the timely recognition of disturbances in eruption, knowledge of the normal development of dentition is essential. Disturbances in eruption comprise disturbances in which eruption does not occur at all, in which it is delayed or incomplete, or in which the normal direction of eruption is influenced. If identified early enough, many undesirable dental conditions can be avoided or their seriousness can be limited. A possible impacting of permanent cuspids, for example, can be avoided by extracting the deciduous cuspids at the right moment; in cases of a large overjet or the threat of a cover-bite, lip interference can be prevented.

[Primary failure of eruption: diagnostics, treatment, casus and review of literature]. / Primair falen van eruptie: diagnostiek, behandeling, casuïstiek en literatuuroverzicht.

Primary failure of eruption is a rare eruption disorder of above all, the permanent second and sometimes the first molars. It is characterized by infra occlusion of the molars resulting in a severe lateral open bite. Primary failure of eruption is a disorders which affects all molars distal to the most mesial involved tooth. Diagnosis is possible both clinically and with radiographs. A panoramic radiograph combined with clinical findings of impaction or infra occlusion can confirm the suspicion of primary failure of eruption. Primary failure of eruption cannot be treated as other eruption disturbances are. The teeth do not respond to orthodontic force. Exposure of the molar and orthodontic traction of a molar affected by primary failure of eruption is discouraged. Observation and extraction, in case the primary failure of eruption poses a risk to the healthy dentition, are the only two treatment options for young patients. Additional treatment of this eruption disorder should be carried out at an adult age and consists of prosthetic closure of the open bite.

Establishing the diagnostic criteria for eruption disorders based on genetic and clinical data.

INTRODUCTION: Proper diagnosis and management of eruption disturbances remains challenging but is critical to a functional occlusion. The objective of this study was to establish definitive criteria to differentiate and diagnose eruption disorders, specifically primary failure of eruption (PFE) and ankylosis. METHODS: Sixty-four affected persons were placed into 3 cohorts: PFE diagnosed through confirmed PTH1R mutation (n = 11), PFE diagnosed based on clinical criteria (n = 47), and ankylosis diagnosed based on clinical criteria (n = 6). These groups were assessed to identify clinical features that differentiate PFE and ankylosis. RESULTS: Ninety-three percent of the subjects in the genetic and clinical PFE cohorts combined (n = 58) and 100% in the genetic PFE cohort had at least 1 infraoccluded first permanent molar. Additionally, a novel functional PTH1R mutation, 1092delG, was identified and linked to PFE in the deciduous dentition. CONCLUSIONS: An infraoccluded, supracrestal first molar is a hallmark of PFE, often involving both arches in the permanent or deciduous dentition, and with unilateral or bilateral affection, infraoccluded second premolar or second molar, and multiple affected adjacent teeth. Our results further suggest that PFE and ankylosis might be clinically indistinguishable without knowledge of prior trauma, treatment history, genetic information, or obliteration of the periodontal ligament space.

Impaction of permanent upper canine causedby supernumerary tooth with talon cusp type III

Introduction: The talon cusp is defined as a developmental anomaly in which an accessory cusp-like structure projects in the area of the cingulum or cementoenamel junction in the anterior teeth attached to the lingual surface of the crown, ranging in size, shape, length and degree of union with the surface. Case report: This study aimed to report a case of a patient who came to Clinic for Preventive Dentistry of Federal University of Pernambuco, Recife-PE, Brazil, complaining of pain in the upper left region. The clinical exam observed the presence of a supernumerary tooth with talon cusp type III in the canine region which had a carious lesion in the developmental groove at the mesial surface and caused a prolonged retention of permanent tooth. Conclusion: With this we want to emphasize that the Dental Surgeon be aware of the changes caused by dental morphological variations, seeking to conduct a proper treatment plan, meeting the functional and aesthetic needs of the patient.

Overlap syndrome: a diagnostic dilemma.

We report an interesting case of a young patient who came with a concern for missing teeth and lack of hair on scalp and body. Examination revealed complete absence of teeth, absence of eyebrows, eyelashes and hair over scalp. He was short-statured, had hyperextensible joints and hyperelastic skin, protuberant lips and many other anomalies such that the overall pattern of defects was not recognisable. A wide array of investigations involving the dental and medical faculties were done; however, the final diagnosis could not be reached, since it appeared to involve features of more than one syndrome, thus the name 'overlap syndrome'.

Avaliação quanto à posição e prevalência de dentes impactados nas radiografias panorâmicas da Clínica Odontológica da Faculdade Ingá-PR / Evaluation of the position and prevalence of impacted teeth in the panoramic radiographs of the Dental Clinic of the Ingá Faculty

Objetivo - Analisar a prevalência dos tipos mais frequentes dos dentes impactados quanto à sua posição no complexo maxilo-mandibular, por meio da visualização dos filmes radiográficos com lupa e negatoscópio e em imagens digitalizadas por meio da máquina fotográfica digital nas radiografias panorâmicas. Métodos - Foram analisadas 341 radiografias panorâmicas, de pacientes abrangendo uma faixa etária de 14 a 49 anos, dos arquivos da Clínica Odontológica da Faculdade Ingá, Maringá-PR. As radiografias foram visualizadas com lupa e negatoscópio e digitalizadas por meio de máquina fotográfica digital amadora (Sony Cybershoot DSC-W320) montada em tripé para avaliar a correlação dos dados observados em filmes radiográficos comparadas com as imagens fotográficas. Resultados - Destas foram encontradas 63,2% mulheres e 36,7% homens, apresentando-se diferença de forma estatística significante aplicando o teste qui-quadrado em nível de significância de 5%, os dentes que mais apresentaram retenção foram o terceiro molar superior direito (26,6%), logo em seguida o terceiro molar superior esquerdo (26,1%), o terceiro molar inferior direito (21,4%) e por fim terceiro molar inferior esquerdo (17,1%). Aplicando-se o coeficiente de correlação de Pearson foi igual a 0,9997, indicando forte correlação entre os filmes radiográficos e as imagens radiográficas digitalizadas. Conclusão - Os terceiros molares foram os dentes com maior prevalência. A maior prevalência foi para o sexo feminino. Com relação aos dentes retidos as imagens fotográficas não apresentaram diferenças comparadas com os filmes radiográficos.

Objective - To investigate the prevalence of the most frequent impacted teeth and their position in the maxillo-mandibular complex and compare the results of visualization of the radiographic films using magnifying glass and light box and scanned images by digital camera. Methods - A total of 341 panoramic radiographs obtained from the patient records seen at the Dental Clinic of the Ingá Faculty were analyzed. The radiographs were evaluated using a magnifying glass and light box and then scanned using amateur digital camera (Sony Cybershoot DSC-W320) attacked on a tripod. Then the observed data found in panoramic radiographic were compared to the scanned images. Results - Of the total patients (aged 14 to 49 years), 63.2% were female and 36.7% were male. The most prevalent impacted teeth was the third molar right (26.6%), followed by the upper left third molar (26.1%), the lower right third molar (21.4%) and the lower left third molar(17.1%), A correlation was observed between panoramic radiographs and scanned radiographs images (r = 0,9997). Conclusion - The third molar teeth were the higher prevalent impacted teeth. The prevalence was higher for females. There were no differences between the evaluation of panoramic radiographs and their respective scanned images.

Report of two Chinese patients suffering from CLCN7-related osteopetrosis and root dysplasia.

Osteopetrosis is a group of genetic bone disorders. There are three types of osteopetrosis: autosomal recessive osteopetrosis (ARO), autosomal dominant osteopetrosis type II (ADO II), and intermediate autosomal recessive osteopetrosis (IARO). The prevalence of ADO II is about 1:100,000, while no more than 20 cases of IARO have been reported worldwide. We present the first Chinese IARO patient with a novel homozygous variant in CLCN7 gene (p. Pro470Leu) and an ADO II patient with a heterozygous variant in CLCN7 gene (p. Arg286Trp). In addition to general osteosclerosis, the striking features of these two patients are unerupted teeth with root dysplasia. We speculate that ClC-7 in different tooth cells may contribute directly to the root development, the defect of ClC-7 may have a dose dependent effect on the phenotype of root dysplasia, and the tooth position may also affect the root phenotype with dysfunctional ClC-7.

Frecuencia de la posición de terceros molares incluidos en pacientes de las Cátedras de Ortodoncia I y II y Clínica integrada de la Facultad de Odontología de la Universidad Nacional de Asunción entre los años 2005-2010 / Frequency of the position of third molars in patients of the Department of Orthodontics I and II and Integrated Clinic, Faculty of Dentistry, National University of Asunción between the years 2005-2010

Los terceros molares incluídos corresponden a una de las patologías más frecuentes encontradas en cirugía oral y maxilofacial. Los terceros molares incluídos se categorizan de acuerdo a su posición y profundidad en relación al segundo molar, su proximidad con la rama ascendente de la mandíbula y su angulación hacia el molar adyacente. Su evaluación generalmente es radiográfica. Las investigaciones sobre el tema presentan resultados variables debido a las diferencias significativas regionales y raciales. Con el objetivo de determinar la frecuencia de la posición de los terceros molares incluidos, según la clasificación de Winter y la de Pell – Gregory, en pacientes que acudieron a la Facultad de Odontología de la UNA en las Cátedras de Ortodoncia I y II y Clínica Integrada entre los años 2005-2010, se planteó la realización de un estudio observacional descriptivo de corte transversal con componente analítico, temporalmente retrospectivo. Para el efecto fueron analizadas radiografías panorámicas de pacientes que acudieron a la institución en el período de tiempo fijado que evidenciaron imágenes de terceros molares incluidos. Se observó que el 54% de los molares incluidos estaban situados en la arcada inferior. Según la clasificación de Winter la mayor proporción de los molares superiores (35,7%) presentó la posición vertical y los inferiores la mesioangular (63%). Según la clasificación de Pell-Gregory las clases más frecuentes fueron la II (49%) para los superiores y la III (56%) para los inferiores. El tipo más frecuente tanto para los superiores como los inferiores fue el C, con 96% y 50% respectivamente. Se resalta la importancia de tomar medidas para un correcto diagnóstico del caso clínico, el planeamiento cuidadoso del acto quirúrgico y la prevención de las complicaciones intra y posoperatorias .