Decompression as a treatment of odontogenic cystic lesions in children.

PURPOSE: To evaluate the efficiency of decompression in treating odontogenic cystic lesions of the jaws in children. MATERIALS AND METHODS: All consecutive odontogenic cysts occurring in children and treated by decompression from 1994 to 2009 at 1 maxillofacial center were included in the present study. Clinical data included age, gender, jaw, histopathologic diagnosis, and decompression time. Radiologic data from panoramic radiographs before and after decompression included tooth involvement, locularity, location, involvement of adjacent vital anatomic structures, and cyst area. RESULTS: Thirty-two odontogenic cystic lesions from 26 children (14 boys [53.8%] and 12 girls [46.2%]) treated with decompression were included. The average age at the time of presentation was 11.6 ± 3.3 years (range, 7 to 18 yr). The mandible was involved in 13 cases (40.6%) and the maxilla in 19 (59.4%). All cysts were unilocular at presentation. Twenty-seven cysts (84.4%) showed tooth involvement. The diagnoses consisted of dentigerous cysts (20 [62.5%]), keratocysts (9 [28.1%]), and radicular cysts (3 [9.4%]). The mean decompression period was 7.45 ± 2.6 months (2 to 14 months). The mean standard lesion area index changed from 12.7 ± 0.9 mm(2) (3.6 to 44 mm(2)) before compression to 2.3 ± 4.3 mm(2) (0 to 22.3 mm(2)) after decompression. The mean percentage of reduction (POR) was 82 ± 16% (49 to 100%). The POR was ranked as good in 22 lesions (69%), moderate in 9 lesions (28%), and poor in 1 lesion (3%). Surgery was performed for 15 lesions (47%). CONCLUSION: Decompression results in good regeneration potential of the bone in the developing craniofacial skeleton of children. Children might benefit from a less invasive surgical protocol.

Unerupted lower third molar extractions and their risks for mandibular fracture.

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.

Oral pain due to severe pre-eruptive intracoronal resorption in permanent tooth.

BACKGROUND: Pre-eruptive intracoronal resorption is a dental lesion located within the dentin. This defect is usually discovered incidentally on routine dental radiographs. Occasionally this process may be associated with oral pain in advanced lesions. CASE REPORT: This case report describes a 12-year-old boy whose chief complaint was a diffuse oral pain due to a severe pre-eruptive intracoronal resorption in a permanent second molar. The previous radiographs, taken at the age of nine years, showed no evidence of the lesion. After surgical exposure, a pulp-like tissue under the crown was removed and analyzed; subsequently the tooth was extracted due to extensive resorption. A follow-up of the unerupted third molar, still in formation process, allowed to see that it was favourably positioned for replacing the extracted molar.

[Terminology and manifestations of eruption disturbances]. / Terminologie en vormen van eruptiestoornissen.

Eruption disturbances of teeth are not unusual; many variations are encountered and eruption disturbances can negatively influence the development of the tooth and jaw system. Causes of eruption disturbances can be categorized into general and local factors. The clinical spectrum of eruption disturbances involves syndromic and non-syndromic problems for both kinds of factors, varying from delayed eruption to primary failure of eruption. The following types of eruption disturbances should be distinguished: impaction, primary retention, secondary retention and primary failure of eruption. Early detection of eruption disturbances and timely and appropriate treatment of the various eruption disturbances play an important role in preventing the negative effects of eruption disturbances on the development of the dentition and the craniofacial skeleton.

Life threatening hemorrhage associated with a dentigerous cyst in a dog: Case report.

Dentigerous cysts are the most common type of odontogenic cysts and arise from an unerupted tooth. These cysts have stereotypical radiographic and clinical findings. They can be extremely invasive but rarely present as a life-threatening emergency. This case report describes the stabilization and treatment of a 6-year-old mixed breed dog with a dentigerous cyst with concurrent life-threatening hemorrhage. The dog presented with severe oral hemorrhage from the mandibular artery and required multiple blood transfusions. It was ultimately diagnosed with a dentigerous cyst. Complications from dental issues and potential life-threatening complications, such as this case, can be prevented by routine annual oral examination and full mouth dental radiographs if an unerupted tooth is suspected.

Unilateral delayed eruption of a mandibular permanent canine and the maxillary first and second molars, and agenesis of the maxillary third molar.

Delayed tooth eruption can affect the accuracy of orthodontic diagnosis and treatment planning and could delay overall treatment. A girl, aged 7 years 4 months, who had unilateral delayed eruption of several teeth was successfully treated. The evaluation of delayed tooth eruption should be considered by the orthodontist because the role of these teeth can affect the overall treatment of malocclusion. In patients with delayed tooth eruption, careful and accurate diagnosis and treatment planning will allow the orthodontist to start treatment at the proper stage and might reduce the overall orthodontic treatment time.

Bilateral Dentigerous Cysts of the Permanent Mandibular First Molars Treated with Marsupialization.

Bilateral dentigerous cysts (DC) associated with unerupted mandibular first molars in a non-syndromic pediatric individual are rare. Secondary infections may lead to complications, such as discomfort due to pain, disfigurement caused by enlargement of the cyst with cortical expansion of the jawbone, displacement of teeth and paraesthesia of the adjacent nerve. This case report describes the occurrence of bilateral DC in an eight-year-old patient. Marsupialization was the treatment of choice to preserve the permanent teeth and other adjacent tissues.

A rare case of unerupted second deciduous molar located inferior to the second premolar: case report.

AIM: 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 [Massler et al., 1941]. 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 [Andreasen et al., 1997]. 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 [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001]. CASE REPORT: This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

The earliest known reported occurrence of dentigerous cyst in a six-month-old child.

The earliest reported case of the occurrence of a dentigerous cyst is described; the cyst surrounded an unerupted permanent tooth bud in a 6-month-old infant. Most commonly these lesions present between the second and third decades of life. They rarely occur before 10 years of age and have not been documented prior to 1 year of age. In the case reported here, the treatment instituted was extraction of the adjacent deciduous tooth and enucleation of the cyst along with the permanent molar tooth bud. Clinicians should be aware of the potential for this lesion to occur across a wide range of ages and the importance of prompt diagnosis and treatment to prevent complications and reduce morbidity.

Surgical management of compound odontoma associated with unerupted tooth: a case report.

Compound odontoma has been reported to be the most common of all odontogenic neoplasms and tumor- like lesions. It is a slow-growing, asymptomatic neoplasms found incidentally during a routine radiography examination. In general, the clinical indicators of odontoma may include eruption disturbance (non-eruption of permanent teeth, retention of deciduous teeth), expansion of the cortical bone, teeth malposition and pain. In this case, the presence of odontoma prevented the physiological eruption of permanent mandible incisor. We describe the surgical procedure to remove a compound odontoma of 21 small tooth-like structures localized in the mandible of a child boy associated with an unerupted permanent mandible incisor.

Partially erupted third molars as a potential source of infection in patients receiving peripheral stem cell transplantation for malignant diseases: a retrospective study.

Forty-four patients with malignant diseases for which they received peripheral stem cell transplant therapy (PSCT) were retrospectively studied regarding local and systemic infection originating from around partially erupted third molars (PEMs). Twenty-two patients had one or more PEMs, while 22 patients had none. Data were retrieved from medical and dental records. Systemic and local signs of infection and treatment were assessed. We recorded the number of transplanted CD34(+) blood stem cells, days with white blood cell counts < 0.5 x 10(9) l(-1), days until engraftment, maximum level of C-reactive protein (CRP), days with fever, positive blood cultures, days taking antibiotics, days drinking < 0.5 l, days of total parenteral nutrition, days receiving intravenously administered analgesics, and number of admission days. No statistically significant difference was detected between patients with PEMs and those without PEMs regarding any of the studied parameters. Of patients with PEMs, 36% (8 of 22) developed local infections around PEMs during the PSCT period. The study indicates that PEMs pose no significant risk of causing systemic infection in patients receiving PSCT for malignant diseases but increase the risk of developing a local infection, justifying close supervision and early treatment in cases of local infection during PSCT treatment.

Conservative treatment of unicystic ameloblastoma.

INTRODUCTION: Ameloblastomas are benign asymptomatic intraosseous lesions that affect the bones of the maxillomandibular complex, interfering both in function and facial esthetic appearance. A 14-year-4-month-old girl was referred by her clinician complaining her anterior teeth were crooked and inclined forward. The lower left mandibular tooth presented with increased pericoronal space compatible with dentigerous cyst. METHODS AND RESULTS: The aim of this report is to relate a case of unicystic ameloblastoma with conservative treatment and with indication for orthodontic treatment. The conservative therapy was performed and the lesion had been completely removed. The need for radiographic and clinical follow-up for up to 10 years, initially performed every 6 months during the first 2 years and afterwards annually, in addition to the risk of late recurrence were explained for patient and her guardian. CONCLUSION: The histopathologic exam of the surgical tissue provided the final diagnosis of ameloblastoma, as the lesion had not presented in its classical form and in atypical locations, as in this case involving a tooth that had not yet erupted.

Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth.

PURPOSE: The purpose of this study was to determine the optimum time for surgical removal of unerupted maxillary anterior supernumerary teeth. METHODS: The study population consisted of 126 children. Stages C to H of the Demirjian classification were used to classify the dental development of the adjacent incisors. Associations were sought between the complications and the developmental stage of the adjacent maxillary incisors at the time of surgical removal. Tests of association were carried out using Fisher's exact test with a probability level of P=.05 for statistical significance. RESULTS: Significant differences were evident: for mature maxillary central incisors (N=170); between all the proportions for root resorption, with the greatest difference being between stages E and H (P<.001); for arrested root development between stages D and E (P=.013), and D and H (P=.02); and for persistent malocclusion between stages E and G (P=.004), E and H (P=.02), F and G (P=.005), and F and H (P=.01). CONCLUSION: Early removal of unerupted maxillary supernumerary teeth seems to be advantageous with a cutoff point of approximately 6 to 7 years old, after which more complications are expected.

BOS MOrth cases prize 2008.

This paper describes the clinical orthodontic treatment of two cases that were successfully entered for the 2008 intercollegiate MOrth cases prize. The first case describes the management of a 12-year-old female with an increased overjet treated using a Dynamax functional appliance followed by fixed appliances. The second case involves the management of a class II division I malocclusion complicated by an unerupted maxillary central incisor and a mandibular first molar of poor prognosis.

A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona.

UNLABELLED: Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related. OBJECTIVES: We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered. MATERIALS AND METHODS: A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, position-axis, radiological study, surgical treatment, related pathologies, and surgical complications. RESULTS: Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding). CONCLUSION: Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%.

International collaborative study on ghost cell odontogenic tumours: calcifying cystic odontogenic tumour, dentinogenic ghost cell tumour and ghost cell odontogenic carcinoma.

BACKGROUND: Calcifying odontogenic cyst was described first by Gorlin et al. in 1962; since then several hundreds of cases had been reported. In 1981, Praetorius et al. proposed a widely used classification. Afterwards, several authors proposed different classifications and discussed its neoplastic potential. The 2005 WHO Classification of Odontogenic Tumours re-named this entity as calcifying cystic odontogenic tumour (CCOT) and defined the clinico-pathological features of the ghost cell odontogenic tumours, the CCOT, the dentinogenic ghost cell tumour (DGCT) and the ghost cell odontogenic carcinoma (GCOC). METHODS: The aim of this paper was to review the clinical-pathological features of 122 CCOT, DGCT and GCOC cases retrieved from the files of the oral pathology laboratories from 14 institutions in Mexico, South Africa, Denmark, the USA, Brazil, Guatemala and Peru. It attempts to clarify and to group the clinico-pathological features of the analysed cases and to propose an objective, comprehensive and useful classification under the 2005 WHO classification guidelines. RESULTS: CCOT cases were divided into four sub-types: (i) simple cystic; (ii) odontoma associated; (iii) ameloblastomatous proliferating; and (iv) CCOT associated with benign odontogenic tumours other than odontomas. DGCT was separated into a central aggressive DGCT and a peripheral non-aggressive counterpart. For GCOC, three variants were identified. The first reported cases of a recurrent peripheral CCOT and a multiple synchronous, CCOT are included. CONCLUSIONS: Our results suggest that ghost cell odontogenic tumours comprise a heterogeneous group of neoplasms which need further studies to define more precisely their biological behaviour.

Surgical extrusion of a partially erupted and crown dilacerated incisor.

A case report of treatment for an incompletely erupted maxillary central incisor with crown dilaceration in a 12-year-old boy is described. The tooth was repositioned with surgical extrusion and endodontically treated through use of calcium hydroxide paste. Clinical and radiographic examination 2 years after completion of combined surgical and endodontic treatment revealed periapical healing and no signs of root resorption.

Replantation of an immature permanent central incisor following pre-eruptive traumatic avulsion.

Tooth avulsion represents 0.5-16% of traumatic injuries. Avulsion of a pre-eruptive left permanent maxillary incisor in a 6-year-old boy is presented. The immature tooth was replanted after rinsing with saline following 10 min dry extra-oral time. This case report describes treatment and a 2-year follow-up of the tooth. During the follow-up period, continuation of root development, pulp revascularization, and irregular dentin formation were demonstrated. The tooth is vital, functional, and esthetic. To the best of our knowledge, no such case of replantation of a pre-eruptive tooth has been reported previously.

Idiopathic generalized apical root resorption: a report of three cases.

BACKGROUND: Idiopathic apical root resorption usually presents as a chance radiographic finding. It may be widespread, affecting the majority of teeth, with implications for the longevity of the dentition. CASE REPORT: Three cases of significant idiopathic apical resorption resulting, respectively, in prevention, abandonment, and alternative methods of orthodontic treatment are described. CONCLUSION: Significant idiopathic resorption may present as a chance radiographic finding, as pain, or excessive mobility. The prognosis for affected teeth is often poor with very limited scope for orthodontic movement due to the likelihood of uncontrolled resorption. Definitive prosthetic rehabilitation is often best deferred until adulthood due to the potential for further resorption during adolescence in addition to vertical growth considerations.

Orthodontic therapy in patients with pericoronal hamartoma.

Pericoronal lesions are undesirable for dental eruption, and they are always associated with unerupted teeth. Pericoronal lesions are common and are usually treated by extraction of the permanent tooth. Pericoronal hamartoma is a special type of pericoronal lesion, and little information about it is available in the orthodontic literature. This report presents a patient with pericoronal hamartoma on the mandibular left permanent first molar who had orthodontic treatment. Because of the similarity of the radiographic radiolucency of pericoronal hamartoma and other lesions, a differential diagnosis must be made to avoid extraction of permanent teeth.