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.

Glandular odontogenic cyst: An updated analysis of 169 cases reported in the literature.

OBJECTIVE: To integrate the available data published on glandular odontogenic cyst (GOC) into a comprehensive analysis of its clinical/radiological and histopathological features. METHODS: An electronic search was undertaken in May/2017. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis. RESULTS: Fifty-eight publications (169 GOCs) were included. The lesion was slightly more prevalent in men than in women. There was a high prevalence in the fifty/sixth decades of life, in the anterior regions, and in mandibles. Lesions were commonly associated with bone expansion (73%) and unilocular radiological appearance (61.5%). GOC was found to be associated with tooth displacement or an unerupted tooth (30.9%), cortical bone perforation (26%), presence of clinical symptoms (24.3%), root resorption (13.9%). Microscopic parameters most commonly were observed in GOCs-in at least 95% of the lesions: presence of hobnail cells, intraepithelial microcysts, epithelial lining with variable thickness. The presence of apocrine snouting was the microscopic parameter less often found (40.4%). CONCLUSION: Although the recurrence rate of GOCs is not as high as previously believed, it is a relevant phenomenon (21.6%). Adjunctive procedures after enucleation should be considered. None of the clinical/radiological and histopathological features evaluated had a statistically significant effect on the recurrence rate.

Delayed Eruption of Maxillary Central Incisors Associated with the Presence of Supernumerary Teeth: A Case Report with 18 Months Follow-up.

AIM: The aim of this study is to discuss a case of an 11-year-old pediatric patient, who was diagnosed with delayed eruption of the permanent maxillary central incisors because of palatally impacted supernumerary teeth. BACKGROUND: The delayed eruption of permanent teeth can be a result of blocking by supernumerary teeth and over-retained primary teeth. Early diagnosis can help in avoiding the complications. The management of such cases depends on the stage of teeth development, teeth position, and space availability. Treatment may combine both surgical and orthodontic interventions. CASE DESCRIPTION: The case was managed by surgically removing the primary retained teeth and supernumerary teeth in two visits then allowing the impacted permanent incisors to erupt without any intervention. CONCLUSION: After 18 months follow-up, the two permanent incisors erupted spontaneously with no orthodontic intervention. CLINICAL SIGNIFICANCE: dentists should be aware of the importance of early diagnosis of supernumerary teeth. The management of such cases should be designed by a multidisciplinary team decision.

"Maxillary lateral incisor partial anodontia sequence": a clinical entity with epigenetic origin

ABSTRACT The relationship between maxillary lateral incisor anodontia and the palatal displacement of unerupted maxillary canines cannot be considered as a multiple tooth abnormality with defined genetic etiology in order to be regarded as a "syndrome". Neither were the involved genes identified and located in the human genome, nor was it presumed on which chromosome the responsible gene would be located. The palatal maxillary canine displacement in cases of partial anodontia of the maxillary lateral incisor is potentially associated with environmental changes caused by its absence in its place of formation and eruption, which would characterize an epigenetic etiology. The lack of the maxillary lateral incisor in the canine region means removing one of the reference guides for the eruptive trajectory of the maxillary canine, which would therefore, not erupt and /or impact on the palate. Consequently, and in sequence, it would lead to malocclusion, maxillary atresia, transposition, prolonged retention of the deciduous canine and resorption in the neighboring teeth. Thus, we can say that we are dealing with a set of anomalies and multiple sequential changes known as sequential development anomalies or, simply, sequence. Once the epigenetics and sequential condition is accepted for this clinical picture, it could be called "Maxillary Lateral Incisor Partial Anodontia Sequence."

RESUMO A relação entre a anodontia parcial do incisivo lateral e o deslocamento palatino do canino superior não irrompido não pode ser considerada uma anomalia dentária múltipla com etiopatogenia genética definida, a ponto de ser considerada como uma "síndrome". Os genes envolvidos sequer foram identificados e localizados no genoma humano, e nem mesmo presumiu-se em qual cromossomo se localizaria o gene responsável. O deslocamento palatino do canino superior em casos de anodontia parcial do incisivo lateral superior está potencialmente associado às mudanças ambientais provocadas pela sua ausência no local de formação e erupção, o que caracterizaria uma etiologia epigenética para essa associação. A falta do incisivo lateral superior na região canina implica em tirar um dos guias referenciais da trajetória eruptiva do canino superior, que ficaria, assim, não irrompido e/ou impactado no palato. Como consequência, e em sequência, promove-se uma má oclusão, atresia maxilar, transposição, retenção prolongada do canino decíduo e reabsorções nos dentes vizinhos. Dessa forma, pode-se afirmar que estamos frente a um conjunto de anomalias e alterações múltiplas sequenciais conhecido como anomalias de desenvolvimento sequencial ou, simplesmente, sequência. Uma vez aceita a condição epigenética e sequencial para esse quadro clínico, ele poderia ser chamado de "Sequência da Anodontia Parcial do Incisivo Lateral Superior".

Craniofacial and Dental Features in Six Children With Cherubism.

Cherubism is an autosomal-dominant benign bone disorder, characterized by fibro-osseous lesions in the mandible and maxilla commonly caused by mutations in the SH3-binding protein 2-gene. The purpose of the authors' study was to analyze craniofacial and dental features of children diagnosed with cherubism, describe their treatment, and assess their dental age compared with norms for Finnish children. Six children were diagnosed, followed up and treated due to dental and skeletal disorders caused by cherubsim. The patients were followed up for an average of 91.5 months with emphasis on the skeletal changes and development of dentition. The treatment consisted of minor orthodontic treatment, dental extractions, and exposures. One patient underwent cosmetic mandibular surgery. All patients had lesions in the lower jaw and 5 of 6 patients had lesions in the maxilla as well. The patients were characterized by varying swelling of the jaws, premature loss of deciduous teeth in the affected area and widely spaced, displaced, un-erupted, or absent permanent teeth. The dental age was delayed at younger age but near to normal or even a little ahead at older age. Even though cherubism affects the jaws, jaw positions, and malocclusion, no common dentofacial proportions associated with the disease could be confirmed by cephalometric analysis. The surgical interventions did not provoke adverse reactions or local growth of the lesions.

Actualización de los factores etiológicos de segundos molares incluidos / Update on etiological factors of impacted permanent second molars

El objetivo de este trabajo es realizar una revisión bibliográfica que actualice y englobe todos los factores etiológicos locales y generales de la inclusión de los segundos molares mandibulares. Se define como inclusión dentaria al proceso patológico eruptivo por el que el diente se encuentra rodeado de saco pericoronario, conservando su lecho óseo intacto y produciendo su ausencia en la arcada dentaria. Si bien este fenómeno es bastante frecuente en algunos grupos dentarios como los terceros molares, caninos superiores y/o premolares inferiores, la inclusión del segundo molar, con una prevalencia próxima al 0,03-0,21%, resulta todavía un desafío tanto para cirujanos orales como para ortodoncistas. Para la prevención de este tipo de alteraciones son necesarias revisiones periódicas durante el inicio del periodo de transición dentaria para así poder detectar algún tipo de anomalía eruptiva y realizar un tratamiento precoz ortodóntico. El factor local que más condiciona a este tipo de patología parece ser la falta de espacio, mientras que las anomalías genéticas serían las responsables principales de producir la inclusión del segundo molar desde el punto de vista sistémico y general según los estudios más recientes (AU)

The objective was to perform a literature review that updates the local and general etiological factors of the inclusion of the second molars. It is defined as dental inclusion to the pathological eruptive process by which tooth is surrounded by pericoronal sack, preserving its bone bed intact and producing his absence in the dental arch. Though this phenomenon is quite common in some groups of teeth as third molars, upper canines or lower premolars, the inclusion of the second molar, with a prevalence next to 0,03- 0,21%, it turns out to still being a challenge for oral surgeons and for orthodontists. For the prevention of this type of alterations, periodic check-ups are necessary during the beginning of the dental transition period in order to detect some type of eruptive anomaly and to perform an early orthodontic treatment. The local factor that most affects this type of pathology seems to be the lack of space, while genetic abnormalities would be the main responsible for producing the inclusion of the second molar from the systemic and general point of view according to the most recent studies (AU)

"Maxillary lateral incisor partial anodontia sequence": a clinical entity with epigenetic origin.

The relationship between maxillary lateral incisor anodontia and the palatal displacement of unerupted maxillary canines cannot be considered as a multiple tooth abnormality with defined genetic etiology in order to be regarded as a "syndrome". Neither were the involved genes identified and located in the human genome, nor was it presumed on which chromosome the responsible gene would be located. The palatal maxillary canine displacement in cases of partial anodontia of the maxillary lateral incisor is potentially associated with environmental changes caused by its absence in its place of formation and eruption, which would characterize an epigenetic etiology. The lack of the maxillary lateral incisor in the canine region means removing one of the reference guides for the eruptive trajectory of the maxillary canine, which would therefore, not erupt and /or impact on the palate. Consequently, and in sequence, it would lead to malocclusion, maxillary atresia, transposition, prolonged retention of the deciduous canine and resorption in the neighboring teeth. Thus, we can say that we are dealing with a set of anomalies and multiple sequential changes known as sequential development anomalies or, simply, sequence. Once the epigenetics and sequential condition is accepted for this clinical picture, it could be called "Maxillary Lateral Incisor Partial Anodontia Sequence."

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors.

BACKGROUND: Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required. REVIEW: The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed. RECOMMENDATIONS: (1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption. CONCLUSION: Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Transposition of maxillary canine to central incisor site: aetiology, treatment options and case report.

Dental transposition is relatively infrequent anomaly of the developing dentition. This article focuses on canine transposition and explores the aetiology, diagnosis and treatment of this challenging anomaly. Specifically, the management of a case of canine transposition involving an unerupted maxillary central incisor is described.

Case series: conditions inhibiting eruption of permanent first molars.

PURPOSE: The purpose of this study was to evaluate the radiological and histopathological findings of 11 patients with unerupted first molars to verify the factors obstructing spontaneous eruption. METHODS: The patients' clinical, radiological, and histopathological data were evaluated retrospectively to determine histopathological diagnosis, radiographic findings, methods of surgical management, and postoperative course. RESULTS: This study involved 4 male and 7 female patients (mean age=9.5 years old). Nine cases involved the mandible. The patients' histopathological diagnoses included 3 odontogenic tumors, 2 odontogenic cysts, and 6 hyperplastic dental follicles. Radiographically, 10 cases showed characterless enlargement of the follicular space, while only 1 displayed radiopaque bodies. One patient with a tumor underwent enucleation, and 1 with a cyst underwent cystectomy and tooth extraction. The others underwent wide excision or partial excision of the surrounding tissue at the top of the impacted tooth. Tumor relapse was observed in 3 cases. CONCLUSION: Surgeons should perform aggressive treatment for patients with unerupted teeth because spontaneous eruption is rare in cases involving non-neoplastic lesions such as hyperplastic dental follicles.

Erupted complex odontoma delayed eruption of permanent molar.

Odontomas, benign tumors that develop in the jaw, rarely erupt into the oral cavity. We report an erupted odontoma which delayed eruption of the first molar. The patient was a 10-year-old Japanese girl who came to our hospital due to delayed eruption of the right maxillary first molar. All the deciduous teeth had been shed. The second premolar on the right side had erupted, but not the first molar. Slight inflammation of the alveolar mucosa around the first molar had exposed a tooth-like, hard tissue. Panoramic radiography revealed a radiopaque mass indicating a lesion approximately 1 cm in diameter. The border of the image was clear, and part of the mass was situated close to the occlusal surface of the first molar. The root of the maxillary right first molar was only half-developed. A clinical diagnosis of odontoma was made. The odontoma was subsequently extracted, allowing the crown of the first molar to erupt almost 5 months later. The dental germ of the permanent tooth had been displaced by the odontoma. However, after the odontoma had been extracted, the permanent tooth was still able to erupt spontaneously, as eruptive force still remained. When the eruption of a tooth is significantly delayed, we believe that it is necessary to examine the area radiographically. If there is any radiographic evidence of a physical obstruction that might delay eruption, that obstruction should be removed before any problems can arise. Regular dental checkups at schools might improve our ability to detect evidence of delayed eruption earlier.

Odontomas--silent tormentors of teeth eruption, shedding and occlusion.

Odontomas are the most common odontogenic tumours of the jaws, characterised by their slow growth and non-aggressive behaviour. They usually remain asymptomatic, and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. The purpose of this paper is to review the literature and report two cases of odontomas. In the first case, a compound odontoma was associated with an unerupted maxillary permanent right central incisor, in an 11-year-old boy. In the second case, a 12-year-old girl had retained mandibular primary left central incisor and its unerupted successor was associated with a compound odontoma, a site considered rare for compound odontoma to occur. The clinical features, diagnosis and treatment of these cases have been discussed.

[Prevention of the eruption of an upper later incisor by a compound odontoma. Case report]. / Durchbruchsbehinderung eines lateralen Inzisiven im Oberkiefer aufgrund eines zusammengesetzten Odontoms. Ein Fallbericht.

Odontomas are the most common odontogenic tumours. They are considered as hamartomas - a local tissue malformation without autonomous growth potential - and are non-neoplastic. Clinically and histopathologically, compound and complex odontomas can be differentiated. Compound odontomas consist of a varying number of tooth-like structures and histology show dental tissues in an orderly pattern. Most often compound odontomas are diagnosed in young patients in the anterior maxilla. Patients are rarely complaining of symptoms and they are usually diagnosed during routine radiographic examinations or due to late eruption of permanent or persistence of deciduous teeth. The following case report presents a disturbed eruption of a lateral right incisor of the maxilla in a 8-year old female patient. Clinical, radiological and histopathological characteristics of this lesion will be discussed as well as therapy and follow-up.

Fibroma ameloblástico. A propósito de un caso / Ameloblastic fibroma. A case report

El fibroma ameloblástico es un tumor benigno mixto. Se trata de una lesión poco frecuente que afecta a pacientes jóvenes y se localiza con mayor frecuencia en la zona molar mandibular, pudiendo bloquear la erupción de algún diente permanente. Se presenta el caso de un niño de 15 años de edad, sin antecedentes médicos ni odontológicos de interés, que acudió al servicio de cirugía remitido por su ortodoncista (..) (AU)

The ameloblastic fibroma is a mixed benign tumor. It is an unusual injury that often affects young patients and it is frequently located in the mandible molar region and it could block the eruption of any permanent tooth. A fifteen years old child with nomedical history or dentistry interest arrived at the emergency department. He was referred by the orthodontist for the extraction of the lower left wisdom tooth germ and value second lower left molar which is impacted. Clinical intraoral examination revealed the absence of the second lower left molar with no inflammation in the area. Radiographic examination confirmed a multilobulated radiolucent area surrounded by (..) (AU)

Enamel renal syndrome: a rare case report.

Enamel renal syndrome is a very rare disorder associating amelogenesis imperfecta with nephrocalcinosis. It is known by various synonyms such as amelogenesis imperfecta nephrocalcinosis syndrome, MacGibbon syndrome, Lubinsky syndrome, and Lubinsky-MacGibbon syndrome. It is characterized by enamel agenesis and medullary nephrocalcinosis. This paper describes enamel renal syndrome in a female patient born in a consanguineous family.

Orthodontic-restorative treatment as an option for biologic replacement of a maxillary central incisor: 5-year follow-up.

The maxillary central incisor is the tooth most often affected by trauma, especially in the age range of 7 to 10 years, when high-impact sports are prevalent. The options for conservative treatment should be prioritized in these patients, aiming to achieve a biologic response that might provide continuity of growth of the alveolus, to provide functional and esthetic development of the affected region. This case report describes a patient with a history of trauma during the deciduous dentition with consequent intrusion, root dilaceration, and retention of the maxillary left central incisor. The treatment involved extraction of the traumatized tooth and mesial movement of the lateral incisor and posterior segments.

Cleidocranial dysostosis: a case report / Disostosis cleidocraneal: reporte de caso

Cleidocranial dysostosis is a congenital condition that results from faulty development of membranous bones, mainly the clavicles and skull. The clavicular abnormality may range from a small defect in one clavicle to complete absence of both, but most frequently an absence of the central clavicular segment, as was seen in our patient. A review of the literature has revealed only one previous report a cleidocranial dysostosis syndrome...

La disostosis cleidocraneal es una condición congénita que resulta de un desarrollo defectuoso de los huesos con osificación membranosa, principalmente las clavículas y el cráneo. La anormalidad clavicular puede ir desde un pequeño defecto en una clavícula hasta la total ausencia de ambas, pero con mayor frecuencia se observa la ausencia del segmento clavicular central, como se observó en nuestro paciente. Una revisión de la literatura reveló sólo un caso previo con un síndrome de disostosis cleidocraneal de características similares...

Trauma, solitary bone cyst and delayed eruption of permanent mandibular incisors. an unusual case in a 7-year-old patient.

BACKGROUND: Solitary bone cysts (SBC) are uncommon non-neoplastic bone lesions, which present mainly in the mandible. Their aetiology is still obscure, but it has been suggested that they may be a result of trauma in the region. Due to their asymptomatic nature, SBCs are revealed mainly accidentally during routine radiographic examination. Sometimes, patients complain of pain or delayed eruption of teeth. Treatment is recommended because, otherwise, the cyst may become symptomatic or cause a pathologic mandibular fracture. CASE REPORT: A 7-year-old Caucasian boy presented with delayed eruption of his permanent incisors. His parents reported a history of trauma at 3 years of age. The radiographic examination revealed a bony lesion, largely displacing the permanent incisors and preventing their eruption. TREATMENT: Surgical exploration of the lesion was carried out and the histopathological examination result was consistent with a SBC. FOLLOW-UP: Two years after the surgical curettage there was radiographic evidence of considerable bony regeneration. The permanent incisors erupted and were vital. CONCLUSION: Clinicians should be aware that SBC is associated with trauma, mainly of the mandible, and with a possible delay of eruption of the corresponding teeth.