New teeth from old: treatment options for retained primary teeth

Maintaining retained infra-occluded primary molars in hypodontia patients to reduce surgical complexity of dental implant surgery: a retrospective study

Introduction When a permanent premolar is absent, the ultimate treatment goal is often replacement with an implant-retained restoration. Before this, the retained primary molar (RPM) may undergo infra-occlusion and be extracted early. This retrospective study looked at the influence of early extraction or maintenance and restoration of RPMs on the requirement for grafting in the implant site.Patients and methods From a large cohort of implant recipients, 273 RPMs from 84 patients were replaced with implants and the interventions before implant placement recorded.Results The most common RPM was the lower second primary molar and 189 (69%) had some degree of infra-occlusion. Additionally, 47 (17%) of RPMs were extracted early, and this was significantly associated with the need for grafting at the implant site (p <0.00001). Sinus lifts were not associated with early RPM extraction. Also, 25 infra-occluded RPMs were restored with onlays, but this had no ultimate influence on grafting at the implant site.Conclusion Maintenance of an RPM with no permanent successor, even when infra-occluded, has a significant beneficial effect on preserving bone volume for implant placement.

Retained Primary Teeth and Their Complication and Treatment: A Case Report

In dentistry, over-retained deciduous teeth pose a distinct issue due to their endurance during the expected exfoliation period. This case study describes a clinical situation with a male patient who is seven years old and complaining of painful swelling over the maxillary anterior region of the jaw and clinically showing dark red-colored, firm, non-tender, purulent swelling extending from alveolar mucosa of the upper anterior to the gingival margin of the 51, 52, 53 region. The treatment plan includes the extraction of the primary teeth. This case report also highlights the importance of minimal surgical intervention for treating peri-radicular cysts to minimize healing time and damage to the underlying developing permanent tooth.

Prevalence and local causes for retention of primary teeth and the associated delayed permanent tooth eruption

BACKGROUND

This study aimed to evaluate the prevalence of retained primary teeth (RPT) associated with delayed permanent tooth eruption and the factors associated with this condition in German children.

METHODS

This is a cross-sectional retrospective study that evaluated panoramic radiographs from orthodontic patients. The diagnosis of RPT was established according to Nolla developmental stage. The primary tooth was considered retained when its successor permanent tooth was in Nolla stage 8, 9, or 10. Statistical analysis was performed with an α of 5% (p < 0.05).

RESULTS

A total of 102 children (48 girls and 54 boys), and 574 primary teeth and their respective permanent successor teeth were evaluated. We classified 192 teeth as RPT. Sixty-one (59.8%) children presented one or more RPT. Gender was not significantly different between RPT and control teeth (p = 0.838; odds ratio 0.95, confidence interval 95% 0.44-2.16). In the majority of the RPT cases (68.7%), no clear cause to explain the prolonged retention was identified. The pathological problems most commonly observed with RPT were dental fillings (19.3%), followed by dental caries (4.6%), and ectopic tooth eruption (2.1%).

CONCLUSIONS

The incidence of RPT associated with delayed permanent tooth eruption in German children was high and the most common pathological condition associated with RPT was dental caries.

Restorative dentistry clinical decision-making for hypodontia: retained primary molars

Primary molar teeth that are retained beyond their exfoliation pose a clinical decision-making challenge for dental teams. The retention of these teeth may be due to absence of a permanent successor. As a result, careful planning is required to determine if retention or extraction is necessary. This article aims to discuss the prevalence of retained primary molars, assessment and treatment planning considerations, from both orthodontic and restorative perspectives.

Primary Teeth Supported Fixed Prosthesis—A Predictable Treatment Alternative

Background: Individuals with tooth agenesis often present a significant clinical challenge for dental practitioners. This retrospective study evaluated clinical and radiological long-term functional and esthetic outcomes following restoration using primary teeth to support fixed all-ceramic prosthesis in patients with teeth agenesis. Methods: Patients with teeth agenesis and at least one year follow-up were included. Examinations included panoramic X-ray, clinical examination and family history records. Only primary teeth without permanent teeth underneath were chosen. All ceramic fixed restorations were used. All data were collected from patient files. Outcome parameters included: restoration parameters (restoration survival, restoration fractures, restoration detachment, restoration replacement, and secondary caries), plaque index, and gingival index. Results: The study included 58 porcelain restorations inserted in 25 individuals; mean age 12 ± 2.1 years (range 10–19 years); mean number of missing teeth 12.3 ± 9 (range 6–12). Mean follow-up 48 ± 6 months (range 12–60 months). All restorations survived up to last follow-up, rendering a survival rate of 100%. Restorations outcome—porcelain chipping (9%), detachment (2%), no restoration replacement nor secondary caries, mean gingival index—0.7 ± 0.5 and mean plaque index—0.9 ± 0.3. Conclusions: In tooth agenesis, restoration using primary teeth to support fixed all-ceramic prosthesis is a viable treatment alternative.

Pattern and prevalence of dental anomalies among a paediatric population in Lagos, Nigeria

BACKGROUND

Dental anomalies are craniofacial abnormalities in the size, structure or number of the teeth. This study was conducted to assess the prevalence of dental anomalies among children aged 0-16 years attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria.

METHODS

A cross-sectional design was used and data were obtained from the dental records of the Dental Clinic from January 2014 to August 2019 by two calibrated examiners, who are co-authors of the manuscript. To test for statistical differences, Chi-squared test was utilised for the categorical variables. The prevalence of the different dental anomalies was estimated and presented with frequencies. P < 0.05 was considered statistically significant.

RESULTS

Among the 6175 patients' dental records reviewed, 50.85% (n = 3150) were male and the highest proportion of 45.4% (n = 2807) were aged between 6 and 10 years, with a mean age of 8.62 ± 3.85 years. A total of 1090 (17.52%) had dental anomalies; 465 (7.53) anomalies were in the maxilla, 263 (4.6) were in the mandible while 360 (5.83) were in both. The most common anomaly was hypoplasia 550 (9.06%), followed by retained primary tooth 546 (8.84%) and hypodontia 84 (1.36%). Dentinogenesis imperfecta 1 (0.02) and transposition 1 (0.02) were the least prevalent anomalies. Retained primary teeth (5.8%) and the cusp of Carabelli (0.4%) were slightly more prevalent among males. However, females had a higher prevalence of natal/neonatal teeth (0.4%), fusion/germination (0.4%), hypodontia (1.5%) and peg-shaped lateral incisors (0.9%).

CONCLUSION

Dental anomalies' prevalence in this study was 17.52%, with a higher occurrence of anomalies in the maxilla. Hypoplasia was the most prevalent anomaly, after which was retained primary tooth, then hypodontia. Prompt diagnosis and preventive interventions are crucial for the appropriate management of these dental anomalies.

Interdisciplinary treatment with implant-supported two-unit cantilever prosthesis for a patient with hypodontia: A clinical report

A 21-year-old woman with multiple congenitally missing maxillary anterior teeth received interdisciplinary treatment to restore function and esthetics. The treatment was initiated with orthodontic treatment, followed by implant placement, bone and soft-tissue augmentation, and prosthetic treatment including a screw-retained implant-supported 2-unit cantilever fixed dental prosthesis.

An analysis of clinical and imaging features of unilateral impacted maxillary central incisors: A cross-sectional study

INTRODUCTION

This cross-sectional study sought to assess clinical features and 3-dimensional distribution of unilateral impacted maxillary central incisors and identify factors associated with the root morphology.

METHODS

Cone-beam computed tomography (CBCT) images from 94 subjects exhibiting unilateral impacted maxillary incisors were selected and evaluated. Original CBCT data were reconstructed using Mimics software (version 17.0; Materialise, Belgium). Clinical features and 3-dimensional distribution of impacted maxillary central incisors and factors associated with the root morphology were observed and analyzed by 2 orthodontists.

RESULTS

This patient cohort included 52 male patients and 42 female patients. Thirty-three incisors (35.11%) with dilacerated roots, 17 incisors (18.09%) with retained deciduous teeth, 15 incisors (15.96%) with supernumerary teeth, and 15 incisors (15.96%) with a history of trauma were identified in the study. Of the 94 impacted incisors, the most common were labially impacted (n = 65; 69.15%), followed by vertically impacted (n = 17; 18.09%) and palatally impacted (n = 12; 12.77%). Chi-square tests revealed that differences in subjects with supernumerary teeth, buccolingual position, sagittal position, and axial position in the upright and dilacerated root groups were statistically significant (P <0.05). Logistic regression analysis indicated that the incidence of dilacerations was higher in the inverted position than in the inclined position and horizontal position (P <0.05).

CONCLUSIONS

Labially impacted maxillary incisors were more common than vertically or palatally incisors. Dilaceration was most commonly observed in patients with inverted incisors. In clinical practice, CBCT is a valuable tool for diagnosing impacted maxillary central incisors and for making appropriate treatment plans for patients.

Nonsyndromic delayed eruption of multiple teeth: A rare case report

Dental eruption is a very finely regulated process. A delay in tooth eruption may be due to a disturbance caused by local, systemic, or genetic abnormalities. Delayed eruption of multiple teeth in the absence of any etiology is very rare. Here, we report a case of delayed eruption in a 16-year-old female patient with multiple congenitally missing teeth and bilaterally ankylosed deciduous teeth with no underlying systemic or genetic disease.

A case report of cleidocranial dysplasia: A noninvasive approach

Cleidocranial dysplasia (CCD) is a rare bone disorder. The main dental features are the presence of multiple retained deciduous teeth and supernumerary teeth, as well as unerupted permanent teeth. To date, CCD is managed by a combination approach, which consists of the extraction of deciduous and supernumerary teeth, followed by orthodontic traction of unerupted permanent teeth. This case highlights the management of a girl with CCD, who refused the recommended protocol. A 15-year-old Malay female presented with a complaint of retained deciduous teeth. Intraoral examination revealed multiple retained deciduous teeth. Radiographs showed numerous impacted supernumerary and unerupted permanent teeth. The patient opted to improve her facial appearance with a less aggressive treatment option. A composite build-up on all anterior maxillary deciduous teeth was carried out until the patient was ready to undergo surgical intervention.

Retained primary teeth in STAT3 hyper-IgE syndrome: early intervention in childhood is essential

BACKGROUND

STAT3 hyper-IgE syndrome (STAT3-HIES) is a rare primary immunodeficiency that clinically overlaps with atopic dermatitis. In addition to eczema, elevated serum-IgE, and recurrent infections, STAT3-HIES patients suffer from characteristic facies, midline defects, and retained primary teeth. To optimize dental management we assessed the development of dentition and the long-term outcomes of dental treatment in 13 molecularly defined STAT3-HIES patients using questionnaires, radiographs, and dental investigations.

RESULTS

Primary tooth eruption was unremarkable in all STAT3-HIES patients evaluated. Primary tooth exfoliation and permanent tooth eruption was delayed in 83% of patients due to unresorbed tooth roots. A complex orthodontic treatment was needed for one patient receiving delayed extraction of primary molars and canines. Permanent teeth erupted spontaneously in all patients receiving primary teeth extraction of retained primary teeth during average physiologic exfoliation time.

CONCLUSIONS

The association of STAT3-HIES with retained primary teeth is important knowledge for dentists and physicians as timely extraction of retained primary teeth prevents dental complications. To enable spontaneous eruption of permanent teeth in children with STAT3-HIES, we recommend extracting retained primary incisors when the patient is not older than 9 years of age and retained primary canines and molars when the patient is not older than 13 years of age, after having confirmed the presence of the permanent successor teeth by radiograph.

Considerations in the replacement of over-retained primary teeth with implant restorations in the esthetic zone: A case report

OBJECTIVE

There exist several treatment planning and clinical challenges when treating over-retained primary teeth with dental implants-especially in the esthetic zone where the existing hard and soft tissue positions are not in harmony with adjacent dentition and do not serve as reliable landmarks for implant placement and restoration. In this report, we highlight some of the key aspects for achieving predictable treatment outcomes for implant restorations replacing over-retained primary teeth in the esthetic zone.

CLINICAL CONSIDERATIONS

This clinical report describes the treatment of a patient who presented with over-retained deciduous canines consequent to congenitally missing maxillary lateral incisors. The deciduous canines were deemed hopeless, and subsequently replaced with immediately placed implants following a computer-guided protocol. The optimal implant positions were determined through a diagnostic wax-up correcting the existing gingival discrepancies with the adjacent teeth. Existing periapical infections were addressed utilizing a vestibular approach to minimize the postoperative recession and scarring and achieve a more predictable esthetic outcome. Final restorations were fabricated with all ceramic materials for optimal esthetics.

CONCLUSION

When planning for implants to replace over-retained primary teeth, it is essential to visualize the desired contours of the final restorations and correct the level of the existing gingival discrepancies by planning the proper implant position and angulation in relation to the adjacent teeth and gingival positions.

CLINICAL SIGNIFICANCE

Careful treatment planning coupled with a guided implant workflow allows for a successful surgical and esthetic outcome for the replacement of over-retained primary teeth with implant restorations.

Are Increased Masticatory Forces Risk for Primary 2nd Molars without Successors? A 3D FEA Study

OBJECTIVE

Persistent primary teeth with healthy crown-root structures and acceptable functional and esthetic properties may be preserved over a long-term period if needed. However, they may experience root resorption, ankylosis or infraocclusion especially in the second or third decades of life. Despite a lack of sufficient detailed data, increases in occlusal forces by age are known to cause destructive stresses on root surfaces and periodontal tissue. The aim of this study was to evaluate the effect of increasing occlusal forces on mandibular persistent primary molars by using 3D finite element analysis.

STUDY DESIGN

The impact of increased masticatory forces on compressive and tensile stresses in tooth and surrounding tissue was simulated in two different models (simulating child and adult mouths) by using 3D finite element analysis.

RESULTS

In both models, the stress values increased by age and compressive stresses were seen on internal root surfaces, while the tensile stresses focused on the furcation area and external root surfaces.

CONCLUSION

It was concluded that practices such as reducing occlusal surface width may be used to diminish the occlusal forces for long-term tooth survival in persistent primary molars.

Reshaping a retained deciduous canine with a semidirect composite resin veneer: A clinical report

The presence of a retained primary canine in an adult, although not frequent, affects esthetics. Choosing the optimal restorative treatment is a challenge. The present clinical report describes a treatment for tooth reshaping with a semidirect composite resin technique, achieving an excellent esthetic result. The treatment was successful at the 18-month follow-up.

Retained Primary Molars and Related Reasons in Umm Al-Qura University, Makkah: A Retrospective Study

Background:

Retention of primary molars beyond the expected time of exfoliation is uncommon; this condition is known as persistence. A retained primary tooth, with the crown in good condition, roots, and supporting alveolar bone can serve adults for many years.

Objective:

To determine the prevalence of retained primary molars and investigate the reasons for their persistence in Umm Al-Qura University.

Methods:

Overall, 500 extra-oral panoramic radiographs were assessed to investigate whether primary molars persisted beyond the expected exfoliation period. Dental records were also reviewed to investigate the possible reasons for persistence. The collected data were tabulated and statistically analyzed, with P < .05 considered significant.

Results:

Seventy-six retained primary molars were identified (39 in females and 37 in males) in 500 panoramic radiographs (from 260 females and 240 males). Agenesis of the permanent successor tooth was the most frequently encountered reason for the retention of primary molars (19%). The second most frequent reason was ectopic deviation of the path of eruption of the successor (11%). The third most common reason was impaction of the successor (10%).

Conclusion:

The incidence of retained primary molars in the investigated population was 15.2%. The most common reason for the persistence of primary molars was agenesis of the permanent successor, followed by ectopic eruption and impaction of the successor teeth. These data highlight the need for education and awareness of dentists and patients to preserve the primary tooth when there is no permanent successor present and support an appropriate treatment plan for each case.

Bimaxillary concomitant hypohyperdontia in a 10-year-old child

Numerical anomalies, either addition or deletion, are quite a common findings in human dentition. However, it is extremely rare to find both hypodontia and hyperdontia simultaneously in the same individual. This condition is referred as concomitant hypohyperdontia (CHH). Aetiology of this condition is still obscure. The prevalence of CHH has been reported to be between 0.002% and 3.1%. This case report highlights a rare occurrence of bimaxillary CHH represented by the absence of both mandibular central incisors and presence of two supernumerary teeth in the maxillary anterior segment. The rarity of such condition of mixed hypodontia as well as hyperdontia in single human dentition prompted the author to report the case.

Resin Nanoceramic CAD/CAM Restoration of the Primary Molar: 3-Year Follow-Up Study

This case report presents the clinical use of a resin nanoceramic CAD/CAM restoration of a primary second molar without successor in the form of a permanent second premolar tooth in a patient. Three-year follow-up of the case revealed that resin nanoceramic CAD/CAM restoration of the primary molar without successor achieved both aesthetics and function. Despite the high cost of treatment, this type of restoration should be considered if the retained tooth is expected to maintain functionality over the long term.

Ceramic Veneers for Esthetic Restoration of Retained Primary Teeth: A 4-year Follow-up Case Report

Retained primary teeth in the smile zone can cause patient dissatisfaction, especially if associated with malposition of teeth. Orthodontic and prosthetic treatment options to treat the situation may not be accepted by some patients. Therefore, these patients tend to maintain their primary teeth and seek different esthetic options. Ceramic veneers may provide an esthetic treatment option to restore these teeth. However, the survival rates of ceramic restorations in such cases have not yet been established. This case report provides a step-by-step clinical description of the use of ceramic veneers for the restoration of retained primary canines and mild teeth malalignment, with a 4-year follow-up report, in a 28-year-old female patient. During restorative treatment, an effort was made to maintain the occlusion in group function to minimize stress and eliminate destructive forces on the retained primary teeth. After 4 years of function, the patient was still satisfied with the provided treatment.

Permanent Maxillary Canine Agenesis: A Rare Case Report

Congenitally missing teeth (CMT) are among one of the commonly known dental anomalies. The most frequently missing teeth in the permanent dentition, excluding the third molars, are mandibular second premolars and maxillary lateral incisors. Exclusive agenesis of both maxillary canines is an extremely rare occurrence and only a few cases have been reported. Previous studies showed that the prevalence of maxillary canine agenesis varies between 0.07 and 0.13%. In recent studies on Indian population, no cases of maxillary canine agenesis have been documented. This paper reports a case of non-syndromic bilateral agenesis of permanent maxillary canines, along with agenesis of both mandibular central incisors in a healthy 13-year-old Indian female patient; and a brief literature review on prevalence, etiology and treatment modalities of the condition.

How to cite this article: Kambalimath HV, Jain S, Patil RU, Asokan A, Kambalimath D. Permanent Maxillary Canine Agenesis: A Rare Case Report. Int J Clin Pediatr Dent 2015; 8(3):242-246.

The management of severe hypodontia. Part 1: Considerations and conventional restorative options

Severe hypodontia is the absence of six or more permanent teeth and is relatively uncommon (estimated prevalence of 0.1-0.2%). This condition may have considerable functional, aesthetic and psychological implications for the patient, as well as presenting a significant challenge for the restorative dentist. There are a number of additional dental and craniofacial features that are seen frequently in patients with severe hypodontia that may complicate the provision of restorative treatment. These patients typically present at a young age and are likely to require lifelong support from the dental team. Initially this may be limited to oral health education and delivery of effective preventative regimes in childhood. Where required, missing teeth may be replaced using conventional removable and fixed prosthodontics as well as implant retained restorations. This article, part one of a two-part series, deals with the assessment of patients and factors to consider when treatment planning for the provision of conventional restorative solutions in severe hypodontia.

Orthodontic Considerations in Restorative Management of Hypodontia Patients With Endosseous Implants

The use of implant-supported restorations in patients with hypodontia remains challenging and requires a multistage treatment that begins in late mixed dentition and continues into late adolescence. The aim of this article is to review the role of orthodontics in endosseous implant rehabilitation of patients with hypodontia. The MEDLINE, Web of Science, Scopus, Cochrane databases, and necessary scientific textbooks were searched for relevant studies and reviews, and as far as possible, they were only included if they had been cited at least once in the literature. Dental implants are susceptible to overloading as the periodontal ligament is absent and the proprioceptive nerve endings are either lacking or very limited. Patients with hypodontia may present with skeletal features such as short and retrognathic maxilla, prognathic mandible, and shorter lower anterior facial height, and they sometimes need orthognathic correction as part of their overall treatment. Dental problems vary and include bimaxillary retroclination of incisors, spacing, centerline discrepancies, microdontia, hypoplastic enamels, ankylosis of the retained primary teeth, overeruptions, and volume deficiencies of alveolar ridges. The challenges mentioned, as well as bone volume deficiencies, compromise the successful placement of implants. Orthodontic strategies and techniques, such as uprighting mechanics, extrusion/intrusion, delayed space opening, and orthodontic implant site-switching, can be used to create, preserve, or augment the implant site. After orthodontic site development, the final planned position of the teeth should be maintained with a rigid bonded retainer; overlooking this stage may compromise the implant site and require orthodontic retreatment.

Periodontal tissue engineering with stem cells from the periodontal ligament of human retained deciduous teeth

BACKGROUND AND OBJECTIVE

Periodontal ligament stem cells from human permanent teeth (PePDLSCs) have been investigated extensively in periodontal tissue engineering and regeneration. However, little knowledge is available on the periodontal ligament stem cells from human retained deciduous teeth (DePDLSCs). This study evaluated the potential of DePDLSCs in periodontal tissue regeneration.

MATERIAL AND METHODS

DePDLSCs were isolated and purified by limited dilution. The characteristics of DePDLSCs were evaluated and compared with PePDLSCs both in vitro and in vivo.

RESULTS

DePDLSCs presented a higher proliferation rate and colony-forming capacity than PePDLSCs in vitro. During the osteogenic induction, alkaline phosphatase (ALP) activity, mineralized matrix formation and expression of mineralization-related genes, including runt-related transcription factor 2 (RUNX2), ALP, collagen type I (COLI) and osteocalcin (OCN) were significantly enhanced in DePDLSCs compared with PePDLSCs. Furthermore, DePDLSC cell sheets showed a stronger synthesis of collagen type I in the extracellular matrix than did PePDLSC cell sheets. After in vivo transplantation, DePDLSC cell sheets recombined with human dentin blocks were able to generate new cementum/periodontal ligament-like tissues.

CONCLUSION

Our findings suggest that DePDLSCs can be used as a promising candidate for periodontal tissue engineering.

Resin bonded bridges: techniques for success

Resin bonded bridges are a minimally invasive option for replacing missing teeth. Although they were first described over 30 years ago, evidence regarding their longevity remains limited and these restorations have developed an undeserved reputation for failure. This article provides a brief review of the literature regarding bridge success and continues to highlight aspects of case selection, bridge design and clinical procedure which may improve outcome.