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Weismann C, Heise K, Aretxabaleta M, Cetindis M, Koos B, Schulz MC. Mini-Implant Insertion Using a Guide Manufactured with Computer-Aided Design and Computer-Aided Manufacturing in an Adolescent Patient Suffering from Tooth Eruption Disturbance. Bioengineering (Basel) 2024; 11:91. [PMID: 38247968 PMCID: PMC10813086 DOI: 10.3390/bioengineering11010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Due to dental diseases, anatomical restrictions, and mixed dentition, the reduction in the number of teeth and the displacement of tooth germs pose challenges in orthodontic treatment, limiting anchorage options. The presented case demonstrates an advanced treatment solution using digital CAD/CAM-technologies and medical imaging for the creation of a mini-implant template. A 12-year-old male patient experiencing delayed tooth eruption, multiple impacted germs, and maxillary constriction underwent intraoral scanning and CBCT. Utilizing coDiagnostiXTM Version 10.2 software, the acquired data were merged to determine the mini-implant placement and to design the template. The template was then manufactured through stereolithography using surgical-guide material. Mini-implants were inserted using the produced appliance, enabling safe insertion by avoiding vital structures. Surgically exposed displaced teeth were aligned using a Hyrax screw appliance anchored on the mini-implants for rapid palatal expansion (RPE) and subsequently used as fixed orthodontics to align impacted teeth. The screw was activated daily for 10 weeks, resulting in a 7 mm posterior and 5 mm anterior maxillary transversal increase. Skeletal anchorage facilitated simultaneous RPE and tooth alignment, ensuring accuracy, patient safety, and appliance stability. The presented case shows a scenario in which computer-aided navigation for mini-implant positioning can enhance precision and versatility in challenging anatomical cases.
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Affiliation(s)
- Christina Weismann
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.A.)
| | - Kathrin Heise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.A.)
| | - Maite Aretxabaleta
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.A.)
| | - Marcel Cetindis
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.C.S.)
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.A.)
| | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany (M.C.S.)
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Khaire SD, Thopte SS, Nisa SUL, Wadde K. Can Histopathological Evidence of Ankylosis of the Tooth be Helpful in the Prevention of a Medicolegal Case in Case of Iatrogenic Fracture of the Mandible during Dental Extraction where Preoperative Radiographs have not been Taken? JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1108-S1110. [PMID: 37694031 PMCID: PMC10485499 DOI: 10.4103/jpbs.jpbs_201_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 09/12/2023] Open
Abstract
A fracture of the mandible is a rare complication that can occur during a dental extraction being carried out under local/general anesthesia. It is always advisable to take a pre-operative radiograph of the tooth to be considered for extraction to study the root configuration and make a surgical plan for the case. Most of the dental extractions carried out without taking a preoperative radiograph are completed uneventfully. However, in rare cases, complications can arise owing to local anatomical variations and lead to medicolegal issues and litigation. This article discusses the management of a case of iatrogenic fracture of the mandible during dental extraction, wherein a pre-operative radiograph was not taken; however, following extraction of the tooth and management of the fracture mandible, the histopathology report of the extracted tooth was suggestive of ankylosis of the tooth.
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Affiliation(s)
- Samir D. Khaire
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Shameeka S. Thopte
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India
| | - Shams UL Nisa
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India
| | - Kavita Wadde
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
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Kuang Q, Zhou H, Hong H, Lin D, You M, Lai W, Long H. Radiographic Features of Mandibular Second Molars with Eruption Disturbances: A Retrospective Study. J Clin Med 2023; 12:jcm12082798. [PMID: 37109135 PMCID: PMC10146564 DOI: 10.3390/jcm12082798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
We aimed to establish the characteristics and potential etiological risk factors of eruption disturbances in mandibular second molars (MM2). We retrospectively enrolled patients with eruption disturbances in MM2. A total of 143 MM2 with eruption disturbances from 112 patients (mean age 17.45 ± 6.35) were included in this study. Panoramic radiographs were employed to determine the risk factor, angulation type, impaction depth, tooth development stage, and associated pathology. The novel classification method of MM2 was based on impaction depth and angulation. Of 143 MM2, 137 and 6 were diagnosed with impaction and retention, respectively. Insufficient space was the most frequent risk factor for eruption disturbances. There were no significant differences between retention and impaction regarding sex, age, or side. The most frequent impaction type was Type I. The most frequent angulation of impacted MM2 was mesioangular. Impacted MM2 with shallower depth were more frequently associated with the presence of first molar undercut. Impaction types did not differ according to age, side, development stage, or distance from the MM1 distal surface to the anterior border of the ramus. Dentigerous cysts were associated with earlier MM2 development stages and greater MM2 depth. In conclusion, MM2 impaction types differed according to the risk factor, angulation type, MM1 undercut, and presence of cysts. Early MM2 development stage and greater MM2 depth were risk factors for MM2 eruption disturbances with cysts.
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Affiliation(s)
- Qianyun Kuang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Huiyi Hong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Donger Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wenli Lai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hu Long
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Yamaguchi T, Hosomichi K, Shirota T, Miyamoto Y, Ono W, Ono N. Primary failure of tooth eruption: Etiology and management. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:258-267. [PMID: 36159186 PMCID: PMC9489741 DOI: 10.1016/j.jdsr.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/01/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Primary failure of eruption (PFE) is a rare disorder defined as incomplete tooth eruption despite the presence of a clear eruption pathway. PFE is known to be caused by rare variants in the parathyroid hormone 1 receptor gene (PTH1R). Although several PTH1R variants have been reported, the etiology of PFE remains unclear. However, important studies that help elucidate the pathology of PFE have recently been published. The purpose of this review is to summarize current treatment options, clinical symptoms or phenotypes for diagnosis, genetic information including solid evidence in mouse disease models and disease-specific induced pluripotent stem cells, thus approaching the etiology of PFE from the perspective of the latest research.
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Affiliation(s)
| | - Kazuyoshi Hosomichi
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Tatsuo Shirota
- Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan
| | - Yoichi Miyamoto
- Department of Biochemistry, Showa University School of Dentistry, Tokyo, Japan
| | - Wanida Ono
- University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
| | - Noriaki Ono
- University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
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Roulias P, Kalantzis N, Doukaki D, Pachiou A, Karamesinis K, Damanakis G, Gizani S, Tsolakis AI. Teeth Eruption Disorders: A Critical Review. CHILDREN 2022; 9:children9060771. [PMID: 35740708 PMCID: PMC9222051 DOI: 10.3390/children9060771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
Dental eruption refers to the vertical displacement of a tooth from its initial non-functional towards its functional position. Tooth eruption disorders may be expressed in various clinical conditions, which may be grouped as “primary retention” and “secondary retention”. The purpose of this article is to review the literature and the clinical parameters of the various conditions related to tooth eruption disorders. Materials and Methods: The search strategy of this critical review included keywords in combination with MeSH terms in Medline, Scopus, and Cochrane Library until February 2022 and only in English. Results: “Primary Failure of Eruption” (PFE) occurs during the eruption process and includes clinical characteristics of both primary and secondary retention, which make diagnosis difficult. PFE is distinguished by Types I and II. In Type I, the defect in the eruption process occurs in all the relative teeth at the same time, whilst in Type II, the clinical expressions vary in multiple quadrants of the mouth, and the second molars erupt more. The variability of the PFE’s clinical spectrum seems to be connected to a genetic origin. The differential diagnosis among single ankylosis, secondary retention, and PFE is based on the occlusal relationship between the upper and the lower teeth distally, most commonly the first molar, which has not yet fully erupted. The treatment approach depends on many factors and combines surgical and orthodontic techniques.
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Affiliation(s)
- Panagiotis Roulias
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.D.); (A.I.T.)
- Correspondence:
| | | | - Dafni Doukaki
- Independent Researcher, 11527 Athens, Greece; (N.K.); (D.D.); (K.K.)
| | - Aspasia Pachiou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - George Damanakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.D.); (A.I.T.)
| | - Sotiria Gizani
- Department of Pediatric Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.D.); (A.I.T.)
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH 44106, USA
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Rege ICC, Botelho TDL, Martins AFL, Leles CR, Mendonça EF. Pixel gray measurement for the diagnosis of dental ankylosis in cone beam computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:721-729. [PMID: 32994089 DOI: 10.1016/j.oooo.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate dental ankylosis in unerupted or partially erupted teeth by using cone beam computed tomography (CBCT) to quantify pixel intensity. STUDY DESIGN In total, 157 CBCT images from individuals with a total of 206 unerupted or partially erupted teeth with suspected ankylosis were evaluated. CBCT images were analyzed for the presence of ankylosis by 2 oral radiologists by quantifying mean pixel intensities (analysis 1) and variations in pixel intensities (analysis 2) in normal and ankylosed regions. The association between ankylosis and demographic and tooth-related factors was also examined. RESULTS Ankylosis was diagnosed in 57 teeth (27.7%). The diagnosis was established with all 3 multiplanar reconstruction views in 22 of these teeth (38.6%). In analysis 1, a higher pixel intensity was observed in areas with ankylosis compared with normal periodontal ligament (PDL) density as a result of bone deposition in this region, which is characteristic of ankylosis (P < .001). In analysis 2, reductions in pixel intensity were greater in the PDL areas than in the ankylosed areas. Ankylosis was significantly associated with the anterior teeth, the maxillary arch, single-rooted teeth, and impacted teeth (P ≤ .026). CONCLUSIONS Our results suggest that CBCT measurement of pixel intensity may be useful for the diagnosis of ankylosis.
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Affiliation(s)
- Inara Carneiro Costa Rege
- Department of Stomatology (Oral Pathology), School of Dentistry, Federal University of Goiás, Goiânia, Brazil; Department of Oral Medicine, Dental School, Paulista University, Goiânia, Goiás, Brazil
| | | | | | - Cláudio Rodrigues Leles
- Department of Oral Rehabilitation, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
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Efficacy of Operculectomy in the Treatment of 145 Cases with Unerupted Second Molars: A Retrospective Case-Control Study. Dent J (Basel) 2020; 8:dj8030065. [PMID: 32630221 PMCID: PMC7558131 DOI: 10.3390/dj8030065] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/14/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study is to assess whether operculectomy in patients with retained second molars eases spontaneous tooth eruption in respect to untreated controls. Two hundred and twenty-two patients with delayed eruption of at least one second molar were selected from the archives of the Department of Orthodontics, Milan, Italy. Eighty-eight patients, 40 males and 48 females (mean age 14.8 ± 1.3 years), met the inclusion criteria. Records were then divided into case and control groups. The case group consisted of patients that underwent removal of the overlaying mucosa over second molars (i.e., operculectomy) and the control group consisted of subjects who retained their operculum over an unerupted second molar and were followed for one year without performing any treatment. A total of 145 impacted second molars were considered (75 cases, 70 controls). A risk ratio with 95% confidence interval was used to compare the prevalence of eruption in the two groups. Spontaneous eruption occurred in 93.3% of cases in the operculectomy group (70/75), while in the control group, 10% teeth erupted spontaneously (7/70). Spontaneous eruption in the upper arch occurred in 95.2% of cases among treated patients (40 out of 42), while in the lower arch, spontaneous eruption occurred in 90.9% of cases (30 out of 33). Spontaneous eruption of the upper second molars in the control group occurred in 8.5% of cases (3 out of 35), while in the lower arch, it occurred in 8.5% (3 out of 35). Operculectomy can ease the spontaneous eruption of retained second molars and reduce the chances of inclusion.
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Hanisch M, Hanisch L, Kleinheinz J, Jung S. Primary failure of eruption (PFE): a systematic review. Head Face Med 2018; 14:5. [PMID: 29544499 PMCID: PMC5856369 DOI: 10.1186/s13005-018-0163-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Lale Hanisch
- Department of Orthodontics, Faculty of Health, School of Dentistry, Witten/Herdecke University, Alfred-Herrhausen-Strasse 44, 58455 Witten, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Susanne Jung
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
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10
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Mistry VN, Barker CS, James Spencer R. The first permanent molar: spontaneous eruption after a five-year failure. Int J Paediatr Dent 2017; 27:428-433. [PMID: 28247574 DOI: 10.1111/ipd.12293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is rare for a first permanent molar (FPM) to temporarily exhibit clinical features of failure of eruption, followed by regeneration of full eruptive capacity 5 years later. Indeterminate failure of eruption (IFE) is a diagnosis of exclusion where the distinction between primary failure of eruption (PFE) and mechanical failure of eruption (MFE) is unclear, including patients too young to specify. CASE REPORT An 11-year-old girl attended the orthodontic clinic at Mid Yorkshire Hospitals NHS Trust regarding an unerupted lower right FPM. Her medical and dental trauma history was unremarkable. She presented with a Class II division 2 malocclusion in the mixed dentition, with all other FPMs fully erupted. CONCLUSION This report documents that an unerupted FPM in an 11-year-old patient may still have the eruptive potential to become functional within the dentition. The period spent monitoring the FPM's outcome prior to surgical intervention has avoided an operation under general anaesthetic and potentially unnecessary orthodontic treatment, as the tooth subsequently erupted without treatment.
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Affiliation(s)
- Vinay N Mistry
- Dental Core Trainee 2 in Oral & Maxillofacial Surgery, The York Hospital, York, UK
| | - Christopher S Barker
- Consultant Orthodontist, Oral & Facial Department, Pinderfields Hospital, Wakefield, UK
| | - R James Spencer
- Consultant Orthodontist, Oral & Facial Department, Pinderfields Hospital, Wakefield, UK
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Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study. Eur J Orthod 2017; 40:231-238. [DOI: 10.1093/ejo/cjx063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kanno CM, de Oliveira JA, Garcia JF, Roth H, Weber BHF. Twenty-year follow-up of a familial case of PTH1R-associated primary failure of tooth eruption. Am J Orthod Dentofacial Orthop 2017; 151:598-606. [PMID: 28257744 DOI: 10.1016/j.ajodo.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Nonsyndromic primary failure of eruption (PFE) is a rare autosomal dominant disorder of dental eruption with no obvious dental or soft tissue interference. The purposes of this study were to genetically and clinically characterize a family with many members affected by PFE and to describe the natural evolution of the disorder. METHODS Three generations of a family with 18 members, 10 of them clinically affected by PFE, were evaluated periodically during 20 years of clinical follow-up. PFE was observed in varying degrees of severity in both sexes. Clinical presentation became more severe in adulthood. One patient had spontaneous reeruption of 2 posterior teeth. Cervical root resorptions were observed in 3 members. Genetic analysis showed a deleterious heterozygous mutation in intron 9 of the PTH1R gene (c.639-2A>G) and diagnosed an additional affected member. CONCLUSIONS The long-term follow-up of PFE cases in this family permitted the following observations: (1) the onset occurred from the preemergence to the postemergence phases, (2) PFE appeared to be closely related to ankylosis, (3) affected teeth maintained the eruptive potential even in adulthood, (4) the earlier the onset the more severe the open bite, and (5) cervical root resorptions occurred in 3 affected members.
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Affiliation(s)
- Cláudia Misue Kanno
- Emergency Department, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, São Paulo, Brazil.
| | - José Américo de Oliveira
- Division of Anatomy, Department of Basic Sciences, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, São Paulo, Brazil
| | - José Fernando Garcia
- Laboratory of Animal Biochemistry and Molecular Biology, Veterinary Medicine School of Araçatuba, Universidade Estadual Paulista, Araçatuba, São Paulo, Brazil
| | - Helmut Roth
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
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Sehra B, Johnson J. The Prosthetic Management of an Infra-Occluded First Permanent Molar: Case Report. ACTA ACUST UNITED AC 2016; 43:482-4, 486. [PMID: 27529916 DOI: 10.12968/denu.2016.43.5.482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This report describes the prosthetic management of a 15-year-old patient with an infra-occluded first permanent molar due to primary failure of eruption (secondary retention). An indirect composite onlay restoration was used to stimulate the periodontal fibres, improve function and restore occlusal stability. This paper describes the clinical technique involved. CPD/Clinical Relevance: Early detection, diagnosis and management of infra-occluded permanent molar teeth is important to avoid occlusal complications, in addition to improving function and stimulating the periodontal fibres.
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14
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Lin F, Sun H, Yao L, Chen Q, Ni Z. Orthodontic treatment of severe anterior open bite and alveolar bone defect complicated by an ankylosed maxillary central incisor: a case report. Head Face Med 2014; 10:47. [PMID: 25414141 PMCID: PMC4289279 DOI: 10.1186/1746-160x-10-47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/11/2014] [Indexed: 11/10/2022] Open
Abstract
Incisor trauma is common in children, and can cause severe complications during adolescent growth and development. This report describes the treatment of a 16-year-old patient with severe anterior open bite due to ankylosis of the maxillary left incisor after dental trauma as an 8-year-old. No examination or active treatment was undertaken until he was 16 years old. Clinical examination revealed that the maxillary left incisor was severely intruded accompanied by a vertical alveolar bone defect. Orthodontic treatment combined with surgical luxation took 3 years and 7 months. During treatment, the intruded incisor was moved to the occlusal level and the alveolar bone defect was restored, achieving normal occlusion. After two years of retention, the maxillary left incisor was retained in a stable normal position with a slightly reduced overbite. This case demonstrates that surgical luxation with orthodontic traction can be an effective approach, especially when the ankylosed tooth has a single root. Long-term monitoring of orthodontic stability and the maintenance of periodontal health are crucial in the post-treatment period.
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Affiliation(s)
| | | | | | | | - Zhenyu Ni
- Orthodontic Department, School of Stomatology, Wenzhou Medical University, No, 113 West Xueyuan Road, Wenzhou, Zhejiang, China.
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15
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Treatment of ectopic mandibular second permanent molar with elastic separators. Case Rep Dent 2014; 2014:621568. [PMID: 25050182 PMCID: PMC4090560 DOI: 10.1155/2014/621568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/09/2014] [Indexed: 12/05/2022] Open
Abstract
Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion.
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Pilz P, Meyer-Marcotty P, Eigenthaler M, Roth H, Weber BHF, Stellzig-Eisenhauer A. Differential diagnosis of primary failure of eruption (PFE) with and without evidence of pathogenic mutations in the PTHR1 gene. J Orofac Orthop 2014; 75:226-39. [PMID: 24825834 DOI: 10.1007/s00056-014-0215-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 10/23/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary failure of eruption (PFE) may be associated with pathogenic mutations in the PTHR1 gene. It has numerous manifestations and is characterized by severe posterior open bite. However, there are also phenotypically similar types of eruption anomalies not associated with a known pathogenic PTHR1 mutation. The purpose of this study was to evaluate whether a distinction can be made between PTHR1-mutation carriers and noncarriers based on clinical and radiological findings. PATIENTS AND METHODS A total of 36 patients with suspected PFE diagnoses were included and analyzed in accordance with specific clinical and radiographic criteria. In addition, all patients underwent Sanger DNA sequencing analysis of all coding sequences (and the immediate flanking intronic sequences) of the PTHR1 gene. RESULTS Of these patients, 23 exhibited a heterozygous pathogenic mutation in the PTHR1 gene (PTHR1-mutation carriers), while molecular genetic analysis revealed nosequence alteration in the other 13 patients (non-PTHR1-mutation carriers). Relevant family histories were obtained from 5 patients in the carrier group; hence, this group included a total of 13 familial and 10 simplex cases. The group of noncarriers revealed no relevant family histories. All patients in the carrier group met six of the clinical and radiographic criteria explored in this study: (1) posterior teeth more often affected; (2) eruption disturbance of an anterior tooth in association with additional posterior-teeth involvement; (3) affected teeth resorbing the alveolar bone located coronal to them; (4) involvement of both deciduous and permanent teeth; (5) impaired vertical alveolar-process growth; and (6) severe subsequent finding of posterior open bite. None of the analyzed criteria were, by contrast, met by all patients in the noncarrier group. All patients in the carrier group could be assigned to one of three classifications indicating the extent of eruption disturbance, whereas 4 of the 13 noncarriers presented none of these three patterns. The clinical and radiographic criteria employed in this study would have correctly identified 10 of the 13 PFE patients in the noncarrier group as possessing no detectable PTHR1 mutation. CONCLUSION The evaluation of clinical and radiographic characteristics can heighten the specificity of ruling out suspected PTHR1 involvement in PFE patients. A hereditary element of PTHR1-associated PFE is clearly identifiable. More studies with more patients are needed to optimize the sensitivity of this preliminary approach on the differential identification of PTHR1-mutation carriers versus noncarriers by multivariate analysis.
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Affiliation(s)
- P Pilz
- Department of Orthodontics, Dental Clinic of the Medical Faculty, University of Würzburg Medical School, Pleicherwall 2, 97070, Wuerzburg, Germany
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17
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Kjær I. Mechanism of human tooth eruption: review article including a new theory for future studies on the eruption process. SCIENTIFICA 2014; 2014:341905. [PMID: 24688798 PMCID: PMC3944225 DOI: 10.1155/2014/341905] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/24/2013] [Indexed: 06/03/2023]
Abstract
Human eruption is a unique developmental process in the organism. The aetiology or the mechanism behind eruption has never been fully understood and the scientific literature in the field is extremely sparse. Human and animal tissues provide different possibilities for eruption analyses, briefly discussed in the introduction. Human studies, mainly clinical and radiological, have focused on normal eruption and gender differences. Why a tooth begins eruption and what enables it to move eruptively and later to end these eruptive movements is not known. Pathological eruption courses contribute to insight into the aetiology behind eruption. A new theory on the eruption mechanism is presented. Accordingly, the mechanism of eruption depends on the correlation between space in the eruption course, created by the crown follicle, eruption pressure triggered by innervation in the apical root membrane, and the ability of the periodontal ligament to adapt to eruptive movements. Animal studies and studies on normal and pathological eruption in humans can support and explain different aspects in the new theory. The eruption mechanism still needs elucidation and the paper recommends that future research on eruption keeps this new theory in mind. Understanding the aetiology of the eruption process is necessary for treating deviant eruption courses.
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Affiliation(s)
- Inger Kjær
- Orthodontics Section, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, 2200 Copenhagen N, Denmark
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18
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Stellzig-Eisenhauer A, Decker E, Meyer-Marcotty P, Rau C, Fiebig BS, Kress W, Saar K, Rüschendorf F, Hubner N, Grimm T, Witt E, Weber BHF. [Primary failure of eruption (PFE). Clinical and molecular genetics analysis]. Orthod Fr 2013; 84:241-50. [PMID: 23993365 DOI: 10.1051/orthodfr/2013055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The term "primary failure of eruption" (PFE) refers to the complete or partial failure of a primary non-ankylosed tooth to erupt due to a disturbance of the eruption mechanism. Up to now, the molecular basis for this failure was unknown. PATIENTS AND METHODS Four families were studied in whom at least two members were affected by non-syndromic PFE as part of a clinical and molecular genetics study. Radiological diagnostics (OPTs) were carried out in all patients and their unaffected relatives (control group). The genetic analysis included a genomewide linkage analysis followed by direct DNA sequencing of positional candidate genes. RESULTS Starting from the index patients, we were able to reconstruct pedigrees over two and/or three generations in the families that indicated an autosomal-dominant mode of inheritance of non-syndromic PFE. Fifteen patients were diagnosed with PFE. Gender distribution was nearly equal (7 female, 8 male). Molecular genetic analysis of the PTHR1 gene revealed three distinct heterozygous mutations (c.1050-3C>G; c.543 + 1G>A; c.463G>T). Unaffected persons exhibited no mutations. CONCLUSION Knowledge of the genetic causes of non-syndromic PFE can now be used for the differential diagnosis of eruption failure. It permits affected family members to be identified early and may lead to new treatment possibilities in the long term. The genetically-verified diagnosis of "primary failure of eruption" can protect patients and orthodontists from years of futile treatment, because orthodontic treatment alone does not lead to success. Moreover, it has a negative influence on unaffected teeth and areas of the jaw.
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19
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Gunda SA, Patil A, Varekar A. First permanent molar root development arrest associated with compound odontoma. BMJ Case Rep 2013; 2013:bcr-2013-010021. [PMID: 23832997 DOI: 10.1136/bcr-2013-010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trauma or infection to the primary tooth may have deleterious effects on the underlying developing tooth buds. Anatomically the root apices of primary teeth are in close proximity to the developing permanent tooth buds; hence spread of infection originating from pulp necrosis of primary tooth may not only affect the underlying tooth bud but may also affect the adjacent tooth buds. The extent of malformation depends on the developmental stage of tooth or the age of patient. Presented here is a rare case of complete arrest of maxillary first permanent molar root growth due to spread of periapical infection originating from second primary molar leading to failure of its eruption and finally extraction. Histopathlogical analysis revealed compound odontoma associated with maxillary first permanent molar.
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Affiliation(s)
- Sachin A Gunda
- Department of Pedodontics, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India
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20
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Management of a severely submerged primary molar: a case report. Case Rep Dent 2013; 2013:796242. [PMID: 23819069 PMCID: PMC3654678 DOI: 10.1155/2013/796242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/31/2013] [Indexed: 11/18/2022] Open
Abstract
Ankylosis is a condition frequently associated with primary molars, wherein the ankylosed primary teeth remain in a fixed position, while the adjacent teeth continue to erupt, moving occlusally. In this case report, a five-year-old boy, who had a retained and submerged left lower second primary molar, was presented. Luxation of ankylosed primary molar was considered as a treatment approach. After four months, the tooth erupted to the occlusal level, and there was evidence of further development of a permanent successor in radiographic evaluation. After one year, tooth mobility, bone formation, and development of a permanent successor were in good condition.
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21
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Anthonappa RP, King NM. Primary failure of eruption or severe infra-occlusion: a misdiagnosis? Eur Arch Paediatr Dent 2013; 14:267-70. [PMID: 23784709 DOI: 10.1007/s40368-013-0056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/23/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The literature considers primary failure of eruption (PFE) and infra-occlusion as two separate clinical entities and there are no clearly identified signs and symptoms that aid to facilitate a definitive diagnosis between these two conditions. Therefore, it is the purpose of this report to illustrate a case to emphasise the potential for misdiagnosis when categorising these conditions as two separate clinical entities. CASE REPORT A 5-year-old Chinese boy was referred for the management of an unerupted primary mandibular left second molar tooth (75). Intra-oral examination revealed a primary dentition, with a PFE of tooth 75. He was scheduled for surgical removal of tooth 75 and placement of a space maintainer. Following improvements in the position of tooth 75 in the subsequent visits, the surgical option was disregarded and eventually tooth 75 erupted and exfoliated despite apparent mechanical obstructions. FOLLOW-UP During the 6-year follow-up period, tooth 75 moved mesially resorbing the distal root of tooth 74 which was later extracted to facilitate the eruption of tooth 75; which then underwent normal exfoliation. CONCLUSION While the present case could indicate the unpredictability of infra-occluded teeth, it is postulated that infra-occluded teeth erupt to the occlusal plane and then remain static due to mechanical obstructions, while the adjacent teeth accompany the growing alveolar bone. Conversely, teeth with PFE do not erupt and the mechanical obstructions are secondary factors. Therefore, the patient's age, at the time of diagnosis, may lead to the diagnosis of infra-occlusion; but it could have been PFE.
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Affiliation(s)
- R P Anthonappa
- Faculty of Medicine, Dentistry, and Health Sciences, Oral Health Centre of Western Australia, School of Dentistry, The University of Western Australia, 17 Monash Avenue, Nedlands, Perth, WA, 6009, Australia,
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22
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Chalmers E, Goodall C, Gardner A. Coronectomy for infraoccluded lower first permanent molars: a report of two cases. J Orthod 2012; 39:117-21. [PMID: 22773675 DOI: 10.1179/1465312512z.00000000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Two cases of infraoccluded lower first permanent molars were treated at Glasgow Dental Hospital and School with a joint orthodontic and surgical approach. Coronectomy, a technique usually reserved for deeply impacted lower third molars, was carried out in both cases; these are discussed.
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23
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Farronato G, Giannini L, Galbiati G, Consonni D, Maspero C. Spontaneous eruption of impacted second molars. Prog Orthod 2011; 12:119-25. [DOI: 10.1016/j.pio.2011.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/01/2011] [Accepted: 04/01/2011] [Indexed: 11/16/2022] Open
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24
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Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod 2011; 81:726-35. [DOI: 10.2319/102010-578.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Cohen-Levy J. Ankylose des premières molaires permanentes : origine génétique ou environnementale ? Rapport de cas d’une paire de jumeaux discordants. Int Orthod 2011. [DOI: 10.1016/j.ortho.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Cohen-Levy J. Ankylosis of permanent first molars: genetics or environment? A case report of a discordant twin pair. Int Orthod 2011; 9:76-91. [PMID: 21288789 DOI: 10.1016/j.ortho.2010.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The rare condition of secondary retention has been reported in the literature as being of genetic origin, with some authors suggesting an autosomal dominant pattern. We report the unusual case of two monozygotic biamniotic, bichorionic male twins, who were discordant for permanent first molar secondary retention, involving ankylosis. Twin A showed normal occlusion and eruption patterns, whereas Twin B displayed a left open bite, in relation with a totally submerged primary second molar leading to retention of the underlying premolar (35), and severe infraocclusion of the adjacent permanent molar (36). After orthodontic failure to close the open bite, ankylosis of 36 was confirmed, whereas 26 became severely infraoccluded.The mother had a history of bilateral molar ankylosis and presented reduced posterior alveolar height. Discordance in this twin pair demonstrates that environmental influences, in addition to epigenetic and local factors, may play a role in secondary retention, which is difficult to diagnose and challenging to treat.
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27
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Rosner D, Becker A, Casap N, Chaushu S. Orthosurgical treatment including anchorage from a palatal implant to correct an infraoccluded maxillary first molar in a young adult. Am J Orthod Dentofacial Orthop 2010; 138:804-9. [PMID: 21130340 DOI: 10.1016/j.ajodo.2008.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 09/01/2008] [Accepted: 09/01/2008] [Indexed: 10/18/2022]
Abstract
Tooth ankylosis during adolescence and early adulthood can lead to infraocclusion and several interrelated, adverse sequelae at the intra-arch and interarch levels. An orthosurgical treatment modality that includes surgical luxation and immediate orthodontic traction is recommended as a conservative approach in many patients. The key to success in this approach is the timely delivery of relatively heavy and continuous forces to the luxated tooth to prevent its reankylosis. Because high reactive forces are inevitably generated, it is crucial to create a reliable source of anchorage. This report describes the successful use of an osseointegrated orthodontic implant to reinforce the anchorage during the orthosurgical repositioning of an infraoccluded molar in a young adult.
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Affiliation(s)
- Dani Rosner
- Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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28
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Kjær I. Phenotypic Classification of 90 Dentitions With Arrested Eruption of First Permanent Mandibular or Maxillary Molars. Semin Orthod 2010. [DOI: 10.1053/j.sodo.2010.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Disruptions of the pulp-dentin complex in an investigated case of pink secondary retained molar. Odontology 2010; 98:177-80. [PMID: 20652799 DOI: 10.1007/s10266-009-0120-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 11/29/2009] [Indexed: 10/19/2022]
Abstract
A pink retained left mandibular first molar without carious lesions was diagnosed in a healthy 12-year-old girl presenting normal clinical tests. An orthopantomogram failed to detect other retained teeth. Both periapical radiography and computed tomography showed the absence of a periodontal ligament space in the bifurcation area and the presence of radiolucency or calcifications in the pulp cavity. The coronal part of the removed tooth was subjected to histological and immunohistochemical analysis using anti-PCNA (proliferation marker) and anti-p53 (apoptosis marker) antibodies. Root surfaces were observed by scanning electron microscopy. The pink color of the molar reflected the extension of resorptive tissue into the clinical crown and the underlining proliferation of pulp vessels. Ankylosis observed in the bifurcation area was also detected in the coronal part of the pulp. Whereas odontoblasts secreted tertiary dentin despite no evidence for a carious lesion, only osteocytes in the newly formed bone were apoptotic and the root surfaces were free of resorption lacunae. The etiopathology of the lesion in this case indicated a pulp origin, suggesting that new therapies targeting this tissue should be developed.
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30
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Cafferty JM, Awadi EA, O’Connell AC. Management of severe posterior open bite due to primary failure of eruption. Eur Arch Paediatr Dent 2010. [DOI: 10.1007/bf03262734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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L’ankylose dentaire : diagnostic par tomodensitométrie et reconstruction tridimensionnelle. ACTA ACUST UNITED AC 2010; 91:707-11. [DOI: 10.1016/s0221-0363(10)70101-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Surgical Extraction of Deeply Horizontally Impacted Mandibular Second and Third Molars. J Craniofac Surg 2010; 21:403-6. [DOI: 10.1097/scs.0b013e3181cfa744] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Primary Failure of Eruption (PFE) – Clinical and Molecular Genetics Analysis. J Orofac Orthop 2010; 71:6-16. [DOI: 10.1007/s00056-010-0908-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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34
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Kenrad J, Vedtofte H, Andreasen JO, Kvetny MJ, Kjær I. A retrospective overview of treatment choice and outcome in 126 cases with arrested eruption of mandibular second molars. Clin Oral Investig 2009; 15:81-7. [DOI: 10.1007/s00784-009-0364-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
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35
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Jenkins FR, Nichol RE. Atypical retention of infraoccluded primary molars with permanent successor teeth. Eur Arch Paediatr Dent 2008; 9:51-5. [PMID: 18328240 DOI: 10.1007/bf03321597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infraocclusion of primary molar teeth is relatively common. The majority of infraoccluded primary molars with permanent successors exfoliate naturally. There are currently no evidence based guidelines for the treatment of infraoccluded primary molars with permanent successor teeth. CASE SERIES The three cases presented demonstrate atypical retention of infraoccluded primary molars, following a conservative approach. In case 1 taking a conservative approach over 5 years, the infraocclusion became gradually more severe. Tilting of the adjacent teeth and the centre-line shift caused by leaving the affected tooth in place during dental and alveolar development was significant. In Case 2 the severely infraoccluded 55 required surgical removal and exposure of the underlying permanent successor (15). Case 3 showed a maxillary premolar (14) and first permanent molar (16) tilted toward the partially erupted, ectopic, rotated 15. Surgical removal of the impacted maxillary primary molar was required. CONCLUSION Although there is evidence available to support the conservative treatment of such cases, it does not always lead to a favourable outcome. Detrimental effects on the adjacent teeth and occlusion were observed and surgical intervention was required.
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Affiliation(s)
- F R Jenkins
- Dept Paediatric Dentistry, Leeds Dental Institute, Leeds, England.
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36
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Lim WH, Kim HJ, Chun YS. Treatment of ankylosed mandibular first permanent molar. Am J Orthod Dentofacial Orthop 2008; 133:95-101. [DOI: 10.1016/j.ajodo.2006.03.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 02/13/2006] [Accepted: 03/10/2006] [Indexed: 11/27/2022]
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37
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Frazier-Bowers SA, Koehler KE, Ackerman JL, Proffit WR. Primary failure of eruption: Further characterization of a rare eruption disorder. Am J Orthod Dentofacial Orthop 2007; 131:578.e1-11. [PMID: 17482073 DOI: 10.1016/j.ajodo.2006.09.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Revised: 09/01/2006] [Accepted: 09/01/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Posterior open bite has several possible causes, including primary failure of eruption (PFE) that affects all teeth distal to the most mesial involved tooth, mechanical failure of eruption (MFE) (primarily ankylosis) that affects only the involved tooth or teeth, and soft-tissue interferences with eruption (other). METHODS Radiographs and other clinical records for 97 cases of failure of posterior eruption submitted for consultation were analyzed to further characterize PFE and distinguish it from MFE. RESULTS Of the 97 cases, 38 were judged to be clear-cut PFE; 19 were diagnosed as MFE; 32 were classified as indeterminate failure because they were too young to be certain of the distinction between PFE and MFE; and 8 were placed in the "other" category. Two subtypes of PFE were observed. In type 1, eruption failure occurred at or near the same time for all teeth in an affected quadrant. In type 2, a gradient of the time of failure was present, so that some further development of the teeth posterior to the most mesial affected tooth was observed before eruption failure. A family history of eruption problems was noted in 10 of the 38 PFE subjects (26%), and a pedigree analysis was done for 4 families. This was consistent with autosomal dominant transmission. CONCLUSIONS The distinction between PFE and MFE is clinically important because it determines whether all posterior teeth, or only individual affected teeth, will not respond to orthodontic force. Certain diagnosis often requires progress radiographs so that the pattern of eruption of teeth distal to the most mesial affected tooth can be observed.
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Affiliation(s)
- Sylvia A Frazier-Bowers
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA.
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38
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Chaushu S, Becker A, Chaushu G. Orthosurgical treatment with lingual orthodontics of an infraoccluded maxillary first molar in an adult. Am J Orthod Dentofacial Orthop 2004; 125:379-87. [PMID: 15014419 DOI: 10.1016/j.ajodo.2003.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The biological mechanism that leads to a cessation in the normal passive eruption of a tooth is unclear, and there are differing views as to whether ankylosis is involved. When infraocclusion of a permanent molar occurs in the permanent dentition, its effects are seen (1) locally, with exaggerated tipping and relative under-eruption of the adjacent teeth; (2) regionally, with overeruption of the opposing tooth or teeth; and (3) farther afield, with deviation of the dental midline to the affected side. Treatment aimed at eliminating these adverse conditions is warranted, and this might involve the skills of both an orthodontist and an oral surgeon. When the condition occurs in an adult, the changes in facial appearance that will be caused by traditional fixed orthodontic appliances might undermine the patient's willingness to accept treatment. This report describes the successful orthosurgical treatment with lingual orthodontics of an infraoccluded maxillary first molar in an adult. The challenges, treatment alternatives, and technical refinements are emphasized.
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Affiliation(s)
- Stella Chaushu
- Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, PO Box 1172, Jerusalem 91010, Israel.
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39
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Abstract
PURPOSE This study evaluated the treatment outcome of intentional replantation of molars. PATIENTS AND METHODS Twenty-nine patients were treated with intentional replantation because conventional apicoectomy was not possible. The success rate was judged by clinical and radiographic parameters. RESULTS One molar (3%) had to be removed because of pain and mobility 4 weeks postsurgery, and three molars (11%) had to be removed during the first year because of periodontal problems. Four molars (14%) showed periodontal problems or root resorption, but are still in function and causing no obvious problems to the patients. Twenty-one molars (72%) were successfully treated. CONCLUSION Intentional replantation is a reliable and predictable treatment for those cases in which conventional apicoectomy is hampered because of anatomic limitations or patient factors.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands.
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40
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Winter GB, Gelbier MJ, Goodman JR. Severe Infra-occlusion and failed eruption of deciduous molars associated with eruptive and developmental disturbances in the permanent dentition: a report of 28 selected cases. BRITISH JOURNAL OF ORTHODONTICS 1997; 24:149-57. [PMID: 9218113 DOI: 10.1093/ortho/24.2.149] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Retrospective analysis of 28 children suffering from severe infra-occlusion and/or primary failure of eruption of deciduous molars revealed an association with eruptive and developmental disturbances in the permanent dentition, including ectopically placed teeth and aplasia of teeth. Taurodont permanent molars were evident in 19 of the 28 selected cases which suggests a possible developmental relationship between these factors. Problems in relation to treatment of these cases are discussed.
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Affiliation(s)
- G B Winter
- Department of Paediatric Dentistry, Eastman Dental Institute and Hospital, London, U.K
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41
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Raghoebar GM, Ten Kate LP, Hazenberg CA, Boering G, Vissink A. Secondary retention of permanent molars: a report of five families. J Dent 1992; 20:277-82. [PMID: 1452865 DOI: 10.1016/0300-5712(92)90045-e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aetiopathogenesis of secondary retention is not fully understood, but heredity is involved in at least some cases. In this study first-degree relatives of 52 patients with secondary retention of permanent molars were screened for the presence of the same phenomenon in their dentition. Familial occurrence could be shown in five families. The pedigrees are compatible with autosomal dominant inheritance. HLA phenotypes and blood groups ABO, rhesus and P1 were studied in two families. The lod scores for linkage with secondary retention were added to previously reported information. The lod score for linkage for blood group system P increased from +0.940 to +1.475 at a recombination fraction of 5 per cent. It is concluded that secondary retention of permanent molars is an aetiologically heterogeneous condition in which some cases are caused by the presence of an abnormal autosomal dominant gene.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands
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42
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Raghoebar GM, Jansen HW, Jongebloed WL, Boering G, Vissink A. Secondary retention of permanent molars: an assessment of ankylosis by scanning electron and light microscopy. Br J Oral Maxillofac Surg 1992; 30:50-5. [PMID: 1550806 DOI: 10.1016/0266-4356(92)90137-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Secondary retention refers to the cessation of eruption of a tooth after emergence. This may be the result of pathological changes in the periodontal ligament. The aim of this study was to describe the morphological and histological aspects of the radicular surface of secondarily retained permanent molars. The roots of 12 secondarily retained molars and two control molars, were examined by means of scanning electron microscopy (SEM) and light microscopy (LM) in order to analyse the occurrence and localisation of ankylosis. With SEM it was observed that the root surface of retained molars showed local areas covered with bonelike tissue. LM of these areas showed that this tissue was bone in direct contact with the root surface (ankylosis). In 11 cases, the areas of ankylosis were observed in the bifurcation area and at the interradicular root surface. In the remaining case, ankylosis was located at the outer root surface. The results of this study endorse the assumption that focal ankylosis is an important factor in secondary retention. Treatment recommendations must be based on this fundamental principle, because orthodontic movement of ankylotic molars is not possible.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands
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Raghoebar GM, Boering G, Vissink A. Clinical, radiographic and histological characteristics of secondary retention of permanent molars. J Dent 1991; 19:164-70. [PMID: 1939817 DOI: 10.1016/0300-5712(91)90007-l] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Secondary retention refers to the cessation of eruption of a tooth after emergence neither due to a physical barrier in the path of eruption nor as a result of an abnormal position. In this study, the clinical and radiographic features of 81 secondary retained permanent molars in a group of 53 patients were evaluated. Retained molars removed for therapeutic reasons (n = 38) were examined histologically to detect any areas of ankylosis. The first molars in the mandible and maxilla were most frequently affected. The mean infraocclusion at the patients' first visit was 4.3 +/- 1.9 mm. After 6 months, infraocclusion increased in adolescents but was stable in adults. Tilting of the adjacent teeth was observed in 39 cases. A sharp, solid percussion sound and a partial absence of the periodontal ligament space on radiographs were noted in less than one-fifth of the affected molars, while histological evaluation revealed that local areas of ankylosis were present in all cases. From the data relating to the 38 molars removed for therapeutic reasons, the sensitivity of the percussion test and radiographic evaluation was found to be 29 and 21 per cent respectively. During a period of 4 years, six new cases of secondary retention were observed in the same population. From this study it is concluded that secondary retention of permanent molars seems to be associated with focal ankylosis and that percussion tests and radiographs are not sufficiently reliable to exclude the presence of ankylotic areas. The presence of ankylotic areas and tendency of infraocclusion to increase in adolescents but to be stable in adults have major implications for therapy.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands
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Abstract
Eruption disturbances of permanent molars may become clinically and radiographically manifest as impaction, primary retention or secondary retention. This may result in clinical problems such as malocclusion and loss of neighboring teeth due to caries and periodontal disease. Which of these disorders will develop, depends primarily on the eruptive stage. Factors that may interfere with the eruptive stages (i.e. follicular growth, pre-emergent eruptive spurt, postemergent eruptive spurt, juvenile occlusal equilibrium, circumpubertal occlusal eruptive spurt, adult occlusal equilibrium) and the clinical consequences of that interference are reviewed. Treatment recommendations are given.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands
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Abstract
The effect of five different treatments for retained permanent molars was evaluated in 59 patients to develop a rational guideline for adequate therapy. The results showed that a prosthetic buildup is the proper treatment if retention develops after the growth spurt, because in these cases the extent of infraocclusion is slight and relatively stable. If retention develops before the growth spurt, immediate removal of the retained molar followed by orthodontic treatment is the way to maximal success. When retention develops during the growth spurt, the tooth affected has to be observed at 6-month intervals. In such a case, no active treatment is indicated if the neighboring teeth show no tilting and the extent of infraocclusion is minor and stable. In all other cases, the teeth affected have to be removed, followed by orthodontic closure of the edentulous space. Finally, all patients must be screened regularly, because in this investigation, new cases of retention were observed relatively frequently.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital, Groningen, The Netherlands
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