The ectopic mandibular canines can start tooth formation in three different locations: a case series study based on single orthopantomograms from 47 individuals

INTRODUCTION

A former study on orthopantomograms from young children with abnormal dental development (not canine ectopia) demonstrated that the tooth bud of the mandibular canine, compared to a stable longitudinal canine axis, could be located normally, anteriorly or posteriorly, with close relation to the first premolar.

AIM

The aim of the present study is to analyse on orthopantomograms if the canine axis can demonstrate where the ectopic mandibular canine started tooth formation.

MATERIALS

The material consists of orthopantomograms with ectopic mandibular canines and presence of primary mandibular canines from 47 cases (29 cases 9-21 years old and 18 cases with unknown ages). The primary canines demonstrated from minor apical resorption to more severe apical resorption.

METHODS

Based on canine maturity, location of the canine axes and the interrelationships between the roots of the permanent canine and first premolar, the location from where the canine started tooth formation was determined. Canine maturity. Maturity stage below half root length and maturity stage above half root length revealed that 11 ectopic canines had less than half root length and 36 cases more than half root length. Canine axes. The canine axis, through the length of the primary canines Ax, is inserted on drawings of the orthopantomograms using the tracing programme Inkscape®. Interrelationship between roots. By visual inspection, the distance between the canine and first premolar was designated close distance, normal distance and extended distance.

RESULTS

The results are divided into 3 groups. Group 1: The initial site of the permanent ectopic canine is located within the canine axis (6 cases). Group 2: The initial site of the permanent ectopic canine is located posterior to the canine axis (36 cases). Group 3: The initial site of the permanent ectopic canine is located anterior to the canine axis (5 cases).

CONCLUSION

The study explained that the canine axis could divide cases of ectopic canines into three groups according to the location from where tooth formation starts. For getting closer to the pattern of the ectopic canine eruption, it is necessary to analyse series of orthopantomograms taken from the same individual over several years.

Factors influencing root resorption in retained mandibular second deciduous molars with congenital absence of second premolars: a cross-sectional study

BACKGROUND

There are currently no studies that quantitatively compare the relationship of root resorption to the patient's systemic history or craniofacial and intraoral morphology, especially in relation to possible host factors. Thus, this study aimed to clarify the factors associated with root resorption in retained mandibular second deciduous molars with the congenital absence of second premolars and predict the prognosis of retained mandibular second deciduous molars.

METHODS

A cohort of 5547 patients who visited the orthodontic clinic at Tokyo Medical and Dental University Dental Hospital between 2013 and 2022 was screened. Lateral cephalometric radiographs, panoramic radiographs, upper and lower dental models, and orthodontic treatment questionnaires were used as reference materials to apply the inclusion and exclusion criteria. Ultimately, 111 patients were included in the analyses. The patients were divided into two groups based on the root resorption levels of the retained mandibular second deciduous molars. Those with less root resorption were classified under the good condition (GC) group, whereas those with more root resorption were classified under the poor condition (PC) group. Demographic, clinical, and cephalometric parameters were compared between the groups. A multivariate logistic regression model was used to predict the probability of root resorption.

RESULTS

The prevalence of congenitally missing mandibular second premolars with persistent mandibular second deciduous molars was 2.0%. In a total of 111 patients, eighty-three teeth (53.2%) were classified into the GC group, whereas 73 teeth (46.8%) were classified into the PC group. The Frankfort-mandibular plane angle (FMA) [odds ratio (OR): 0.87], Frankfort-mandibular incisor angle (FMIA) (OR: 0.93), overbite (OR: 1.38), adjacent interdental space (OR: 1.46), distance from occlusal plane (OR: 0.80), and caries treatment (OR: 7.05) were significantly associated with the root resorption of the retained mandibular second deciduous molars.

CONCLUSIONS

Our findings suggest that skeletal morphology, oral morphological patterns, and history contribute to root resorption in retained mandibular second deciduous teeth with congenital absence of subsequent permanent teeth.

Patterns and sexual dimorphism of non-syndromic hypodontia among a French orthodontic population

OBJECTIVES

This retrospective study aimed to estimate the prevalence of non-syndromic congenitally missing teeth (CMT) and to explore the frequency of CMT patterns in a French orthodontic population. In addition, the study sought to assess sex-based differences in CMT patterns.

DESIGN

Panoramic radiographs of 4569 orthodontic patients between 9 and 21 years-old performed over a 16-year period (2006-2022) were examined to identify non-syndromic tooth agenesis, excluding third molars. A chi-square test or a Fisher exact test were used to determine the difference in the prevalence of tooth agenesis between sex and between arches.

RESULTS

Tooth agenesis was observed in 7.3% of the sample (7.9% for females and 6.6% for males). Approximately 86% of the included subjects presented 1 or 2 missing teeth. Single tooth agenesis was significantly more frequent in females than males (p = 0.002, χ2). In total, 23 of the 67 different patterns of CMT observed, were present more than once. 75.5% of male patients and 79.5% of female patients presented one or both missing lateral incisors or second premolars, rarely affected at the same time. This study showed no sex difference in the patterns of tooth agenesis.

LIMITATIONS

This study has limitations due to its retrospective nature and our findings apply solely to an orthodontic population from a white ethnic background.

CONCLUSIONS

Clinicians should be aware of this particular incisor/premolar phenotype regardless of biological sex. Issues associated with congenitally missing teeth can be managed more effectively with early teenage diagnosis.

Status of retained deciduous second molars in subjects with agenesis of second premolars in relation to age

AIM

To evaluate the presence and status of retained DM2 without permanent successors in relation to age.

BACKGROUND

Preservation of retained deciduous second molars (DM2) can be applied to treat congenital absence of second premolars (PM2). However, the consequences of caries and progressing root resorption or infraocclusion may affect their survival.

METHODS

Panoramic radiographs of individuals >10 years of age with agenesis of at least one PM2 were evaluated and divided into three groups according to age. The presence and location of retained DM2, caries/restorations, infraocclusion and root resorption were investigated.

RESULTS

A total of 131 subjects with PM2 agenesis were included (mean age: 13 years 11 months). The majority were missing one or two PM2. In total, 174 retained DM2 were present (33%), and their incidence was higher in the younger age groups. Caries/restorations were found in 88 (50.6%) and infraocclusion in 21 (12%) retained DM2. The roots were resorbed mostly for ½ of the root length (35%).

CONCLUSION

Long-term prognosis of retained DM2 without permanent successors seems uncertain, especially within the younger age group. In individuals older than 17 years, the prognosis for a healthy DM2 is favorable, if no distinct infraocclusion or extensive root resorption is present.

Mesiodistal angulation and developmental stages of unerupted mandibular second premolars in nonsyndromic oligodontia

INTRODUCTION

Oligodontia is a serious developmental dental anomaly that requires long-term multidisciplinary treatment, but its clinical characteristics are not well understood because it is rare. This study evaluated the mesiodistal angulation and developmental stages of unerupted mandibular second premolars (MnP2s) in orthodontic patients with nonsyndromic oligodontia.

METHODS

Thirty-seven patients with oligodontia with at least 1 unerupted MnP2 in Demirjian's developmental stages between D and G were selected. Age- and sex-matched patients without tooth agenesis, excluding third molars, were selected as the control group. Mesiodistal angulation between the long axis of the available MnP2 and the mandibular plane was measured on panoramic radiographs.

RESULTS

The MnP2 was significantly more distally angulated in the oligodontia group than in the control group. The developmental stage of the MnP2 in the oligodontia group was significantly delayed (1.04 ± 0.26 years; 95% confidence interval, 0.53-1.55 years). No correlation between the mesiodistal angulation and the developmental stage of the MnP2 was found in both groups.

CONCLUSIONS

Significant distal angulation and delayed developmental stages of MnP2s were found in patients with nonsyndromic oligodontia compared with age- and sex-matched patients without agenesis of permanent teeth, excluding third molars. However, no significant correlation was found between them. Regardless of the severity of the distal angulation of MnP2, observing delayed dental development in each patient is important.

Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis

INTRODUCTION

Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. Managing DE should be primarily based on the clinical diagnosis of the pulp.

METHODS

The literature search in prevalence, prophylaxis, and management of dens evaginatus was performed in PubMed database as well as by manual search, in which the related contents were collected and descriptively analyzed.

RESULTS

Of the 264 searched literatures, 62 articles were included for this scoping review. The prophylactic management of the tubercle of DE teeth with a normal pulp should be performed as early as possible by the prep-and-fill technique or the reinforcement technique to preserve tooth vitality and continued root development, with the former reported to be superior compared with the latter. Furthermore, DE teeth with reversible pulpitis should be managed with the prep-and-fill technique. For DE teeth with irreversible pulpitis, vital pulp therapy, ie, partial or full/coronal pulpotomy, should be considered when the pulpal inflammation is limited to the coronal pulp to preserve the vitality of the radicular pulp that induces apexogenesis. A pulpectomy should be performed if the pulpal inflammation has progressed into the radicular pulp. For DE teeth with pulpal necrosis (or after pulpectomy) and immature roots, mineral trioxide aggregate apexification or regenerative endodontic procedures are the treatment options. For DE teeth with pulpal necrosis and complete root formation, nonsurgical root canal treatment is the treatment of choice. A flow chart of the decision-making for managing DE teeth based on pulpal diagnosis is proposed.

CONCLUSION

DE teeth should be properly managed, by prophylaxis or treatment, depending on pulpal diagnosis and related factors.

Contemporary endodontic treatment choices for adult patients with dens evaginatus and apical periodontitis: a case report with a 2-year follow-up

Dens evaginatus (DE) frequently leads to pulp exposure and subsequent pulpal inflammation, pulpal necrosis, and periapical inflammation. This case report describes the application of regenerative endodontic therapy and mineral trioxide aggregate (MTA) apexification in a 22-year-old man with mandibular second premolars affected by DE and apical periodontitis. Regenerative endodontic therapy was performed after thorough debridement and placement of calcium hydroxide in the root canal of the left premolar. In contrast, an apical plug of MTA was placed prior to gutta percha compaction in the root canal of the right premolar. Both teeth were restored with adhesive composite resin. A 2-year follow-up examination revealed complete periapical healing.

A Technique for Utilizing Ankylosed Teeth for Anchorage

We present a novel method of reinforcing anchorage by utilizing ankylosed teeth. This technique provides simple solutions in otherwise challenging and complex cases.

Root canal preparation in 3-rooted maxillary premolars through hand, rotary, and reciprocating techniques: a microcomputed tomography evaluation

Endodontic management of 3-rooted maxillary premolars is a challenge due to their complex anatomy and narrow root canal walls. This study aimed to evaluate, by microcomputed tomography (μCT), the apical enlargement and centering ability promoted by hand, rotary, and reciprocating instrumentation in 3-rooted maxillary premolars. Eighteen teeth were divided into 3 groups (n = 6) according to the preparation technique: crown-down hand, rotary, and reciprocating instrumentation. Instruments with similar apical diameters were used (25 and 40 mm for buccal and palatal canals, respectively). Centering ability and canal enlargement were evaluated through the comparison of μCT images obtained before and after instrumentation. Distances of 0, 2, 4, and 6 mm from the apical stop were considered. Differences between canal areas before and after instrumentation were calculated. In addition, distances between the original canal center and the prepared canal center at the apical stop were measured in both the mesiodistal and buccopalatal directions. Significant differences in enlargement areas and centering ability among the techniques were determined using 2-way analysis of variance and Tukey post hoc test (P > 0.05). Root canal enlargement was similar for all techniques. Excessive enlargement was observed in only a few specimens, and root perforation did not occur. Some specimens presented untreated canal areas. In mesiobuccal and distobuccal roots, reciprocating instrumentation promoted more centered preparations than hand instrumentation when measured in the mesiodistal direction (P > 0.05). There were no other statistically significant differences. The results established that hand, rotary, and reciprocating techniques presented similar safety margins for instrumentation of the apical third of 3-rooted maxillary premolars. Reciprocating instrumentation presented some advantages over hand preparation regarding centering ability.

Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up

Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP.

[Maxillary first premolar with four canals: a case report]

This article presented a case of discovering and diagnosing three roots with four canals of the maxillary first premolar. We found and located the extra root canal by clinical diagnosis, careful observation during the operation, and multiangle X-ray. We further confirmed the existence of the three roots with four canals with the help of cone-beam computed tomography. Finally, we verified the success of the high-quality root-canal therapy through root optical microscopy.

Combined Surgical/Orthodontic Treatment and Autotransplantation of a Premolar in a Patient with Unilateral Cleft Lip and Palate

Objective

The treatment of a patient with a complete unilateral left cleft lip and palate, agenesis of the left upper second premolar, and a severely malformed left upper lateral incisor is reported. Treatment included placement of an autologous bone graft from the left iliac crest into the alveolar cleft at 8 years of age and transplantation of a lower premolar into the reconstructed alveolar process at 10 years of age. During the succeeding orthodontic treatment, the dental arches were aligned and corrected toward a Class I molar occlusion. One year after the end of treatment, the status of the transplanted premolar was good.

Bilateral Maxillary Paramolars in an Adolescent

Paramolars are relatively uncommon supernumerary molars. Limited cases of bilateral maxillary or mandibular paramolars have been reported. This case report describes bilateral maxillary premolars and their management in a 15-year-old girl, whose chief complaint was food lodgment in these regions. After a diagnosis of bilateral maxillary premolars was made and confirmed by orthopantomogram, both of the paramolars were extracted.

Association Between Odontoma and Impacted Teeth

Odontoma is considered to be the most common odontogenic tumor of the oral cavity. Most odontomas are asymptomatic and are discovered during routine radiographic investigations and can cause disturbances in the eruption of the teeth, most commonly delayed eruption or deflection. By a retrospective study design, demographic and clinical data regarding patients who presented odontomas from year 1995 to 2015 were obtained in order and the influence of active therapy on the dentition and on the treatment of impacted teeth was analyzed. Forty-five patients (mean age 14.2 years) with 29 complex and 16 compound odontomas were included in this retrospective study. Initial symptoms were delayed eruption of permanent teeth (n = 25), pain (n = 6), swellings (n = 4), and no symptoms (n = 10); 31 patients were discovered by incidence, all of them via panoramic radiographs. The mandible/maxilla ratio was about 2:1 (31/15). Thirty-two out of 45 odontomas were in close proximity of at least 1 tooth (n = 21 at incisive). A total of 12 teeth were extracted (complex: n = 8; compound: n = 4). Of the nonextracted teeth, 33 teeth were displaced and retained. Of those, 29 teeth were aligned through orthodontic-surgical approach and 4 teeth erupted spontaneously after surgery during the follow-up period. An early detection of odontoma is more likely an accidental radiological finding, hence the need for routine radiographic analysis should be emphasized. Early diagnosis of odontomas in primary dentition is crucial in order to prevent later complications, such as impaction or failure of eruption of teeth.

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population

OBJECTIVE

The aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group.

DESIGN

A record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria.

RESULTS

In the 414 subjects with tooth agenesis, approximately 70% presented 1-2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form.

CONCLUSIONS

Although there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted. The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

Management of missing mandibular second premolars: a review

Tooth agenesis is the most common developmental dental anomaly and it is frequently associated with other dento-skeletal disturbances, such as structural variations of other teeth, late dental eruption, transpositions and crowding. Except for the third molars, the mandibular second premolars are the most commonly missing teeth. Oral rehabilitation of patients with missing mandibular premolars often requires a multi-disciplinary approach, and usually results in prolonged treatment time and a greater burden of care. An understanding of the aetiology and clinical features of hypodlontia is essential for the planning phase and the outcome of treatment. The purpose of the present review is, therefore, to discuss the aetiology of hypodlontia as well as to evaluate the clinical options available for the treatment of missing mandibular second premolars. An insight into future research directions and their clinical applications will also be discussed.

Cost-Effective Management of Patients with Unilateral Congenitally Missing Second Maxillary Premolars

Two case presentations are utilized to review the cost-effective treatment options in patients with unilateral congenitally missing second maxillary premolars. Once diagnosed, the dentist can either preserve or remove the respective primary molar. Preservation will lead to a tooth-size discrepancy. To limit the size of the second primary molar to the dimension of the contralateralpremolar, and to allow the preservation of alveolar bone, removal of its mesio-distal aspect should be performed. Later on, the primary molar may become infraoccluded or lost, and it will be necessary to do a coronal built-up or a prosthetic replacement respectively. Any type ofprosthetic replacement will significantly increase the total cost of treatment. Clinicians should aim for ideal occlusion and profile and take into account other orthodontic problems and propose the most appropriate treatment plan for each patient.

Moving a Blocked-Out Bicuspid into the Arch Using the"Sleeze"

Dental crowding can frequently result in a tooth becoming palatally blocked-out. When the tooth is displaced too far, tying the tooth to the archwire can become unfeasible. A modified "singshot" technique is presented to bring a blocked-out bicuspid into the arch. The lastomeric chain acted as a "sling shot" squeezing the bicuspid in, hence the name "sleeze."

[Limiting factors in the class III camouflage treatment: a potential protocol]

The Class III skeletal malocclusion has been traditionally treated with a combined approach of orthodontics and orthognathic surgery or with a strategy of orthodontic camouflage. Some severe cases can be identified as ideal candidates for a surgical treatment whereas some others can be handled with orthodontics alone, with a reasonable expectation of an acceptable result. However, the problem remains for the borderline patient. In fact, limited information is available in the literature regarding the identification of the factors that can help in establishing the limits for one treatment modality or the other. Furthermore, the quantification of some of these factors, for practical purposes, is practically missing or very seldom suggested. Therefore, the decision making process remains a subjective reflection based on the "good clinical sense" of the orthodontist or just reduced to an "educated guess". In order to add some information, hopefully useful in deciding the most suitable treatment option for the individual patient, we propose a clinical protocol based on four different factors. Namely: the skeletal discrepancy, the occlusal discrepancy, the periodontal condition and facial aesthetics. For each one of these factors several parameters will be evaluated and, for some of them, an attempt to provide some reference numerical values will be made. Finally, clinical examples will be presented to illustrate the concepts discussed and the treatment alternatives, final treatment plan and treatment outcome will be analyzed for each one of them.

Effect of rapid palatal expansion in early tratment and spontaneous correction of maxillary canine-first premolar transposition

BACKGROUD

The aim of this study was to describe an experimental study carried out in a group of young patients with an early diagnosis of atypical eruption pattern of the maxillary canines and first premolars, identified and treated by rapid palatal expansion (RPE) interceptive therapy.

METHODS

This study involved 20 young patients aged between 8 and 12 years (mean age 10±0.3 years). Patients were randomly divided into two equal groups (10 patients in each group). The patients in the first group underwent a rapid palatal expansion with an hyrax-type expander. The appliance was activated twice a day for 15 days in order to obtain 7.5 mm of palatal expansion. Then, it was left in situ for six months. The second group was the control group and patients were not treated but only observed. The total number of dental transposition were 30 couple (15 in the first group and 15 in the control group).

RESULTS

Among the first group, 13 couple of dental transposition reached the right position in the arch. Two of them remained transposed. Among the control group, 12 of them remained transposed and 3 reached the right position.

CONCLUSIONS

Transpositions of the maxillary canines and first premolar is a common tooth malposition in children. Early diagnosis will permit to perform an interceptive treatment that will prevent the full development of transposition.

Comparative study of dental anomalies assessed with panoramic radiographs of Down syndrome and non-Down syndrome patients

AIM

The aim of this study was to compare the prevalence of dental anomalies from panoramic radiographs of age-matched individuals with and without Down Syndrome (DS).

STUDY DESIGN

This is a retrospective cross-sectional study. A group of 41 patients (19 female and 22 male) with Down Syndrome (DS), mean age 10.6 ± 1.4 and a control group of 42 non- DS patients (26 female and 16 male), mean age 11.1 ± 1.3 were studied.

METHODS

This study examined the medical history and a panoramic radiograph of each patient. The dental anomalies studied were agenesis of permanent teeth (except third molars), size and shape maxillary lateral anomalies and maxillary canine eruption path anomalies.

STATISTICS

The groups were compared using Mann-Whitney and Wilcoxon non-parametric tests (p<0.05). Rho Spearman correlation coefficient was applied for associations. Results Agenesis of one permanent tooth was found in 73.17% of DS subjects and two or more permanent teeth in more than 50% (p<0.001). Maxillary lateral incisor was the most frequently absent tooth followed by mandibular second premolar, mandibular lateral incisor, maxillary second premolar and mandibular central incisor. No significant differences were detected between maxilla and mandible on either side. No differences in gender were observed. Significant differences were found for size and shape anomalies of maxillary lateral incisors, as well as for canine eruption anomalies (p<0.05). No gender differences were observed for either variable. No association was found between these two variables in the DS group.

CONCLUSIONS

More dental anomalies were present in the DS group than in the control group, which implied that DS patients need periodical dental and orthodontic supervision so as to prevent or control subsequent oral problems.

Rapid Maxillary Expansion without Posterior Anchorage

This work aimed to evaluate an alternative form of maxillary expansion anchored with mini-implants. A patient 12 years, class III in permanent canine teeth, with multiple agenesis of upper posterior teeth was treated with the aid of four mini-implants in the palate and Haas modified type appliance. During the period of expansion, an interincisal diastema was observed as the first clinical sign of disjunction of the sutures. After correction of cross bite, the expansion of the palate was confirmed by upper occlusal radiographs. Thus, the evaluations showed that the technique was effective and that new scientific studies should be conducted to further develop this subject. Keywords: Appliances; Biomechanics; Implants; Malocclusions

Hypophosphatemic Rickets and Pre-eruptive Spontaneous Dental Abscess

The purpose of this report is to describe the diagnosis and dental treatment of a medically complex 14-year-old boy with X-linked hypophosphatemic rickets who presented with a pre-eruptive abscess on a mandibular molar and facial swelling.

Angled Screw Channel: An Alternative to Cemented Single-Implant Restorations--Three Clinical Examples

This article presents three cases of single labially tilted implants restored with screw-retained single crowns. Individualized abutments with an angled screw channel were used to avoid an unesthetic vestibular access channel. This individualized abutment allows the dentist and dental technician to use the screw-retained restorations where a cemented reconstruction would otherwise have been needed.

A multi-centre evaluation of multiple supernumerary premolar prevalence

AIM

The occurrence of multiple supernumerary teeth is rare and often found in association with syndromes such as cleidocranial dysplasia, Gardner's syndrome or cleft lip and palate. Few examples of non-syndromal multiple supernumerary teeth have been reported. The aim of this multi-centre study was to investigate the prevalence of supernumerary premolar teeth in non-syndromic patients and to investigate the association between the presence of supernumerary premolar teeth and malocclusion type in a Turkish population.

MATERIALS AND METHODS

The clinical records and panoramic radiographs of 10,700 patients (referred to three different university hospitals) were retrospectively examined for the presence of supernumerary premolars. Age, gender, orthodontic malocclusion type, the number of supernumerary premolars (two or more), the distribution, location, position (vertical, horizontal, inverted, mesio-angular), surgical approach, and related complications (pain, cystic changes, root resorption, or eruption disturbance of adjacent teeth) were recorded.

RESULTS

Forty-two cases (13 Class I, 17 Class II, 12 Class III) of multiple mandibular supernumerary premolars in patients without an associated syndrome were detected. A total of 97 (27 Class I, 41 Class II, 29 Class III) supernumerary premolar teeth were found, with a prevalence of 0.39%. No statistical difference was found related to gender, malocclusion type and supernumerary premolars (p > 0.05). The majority of the extra premolars were located in the mandible, which was statistically significant (p < 0.05).

CONCLUSION

The present study revealed that the prevalence of multiple supernumerary teeth was 0.39%. The most frequently impacted premolars were found in the mandible and more often associated with Class II malocclusions in the examined Turkish population.

Double Roots of Mandibular Premolar in Full-mouth Periapical Films

OBJECTIVE

To evaluate the incidence of two-rooted mandibular premolar morphology using full-mouth periapical film series in a Chinese population, with particular emphasis on bilateral incidence, so as to provide a clinical anatomical basis for root canal treatment in mandibular premolars.

METHODS

A total of 2015 patients who underwent dental treatment and had full mouth periapical radiographs at the Peking University School of Stomatology from April 2011 to April 2012 were enrolled in this study. Three experienced dentists reviewed the patients' periapical films and classified the root morphology of mandibular premolars bilaterally. The incidence of unilateral and bilateral double roots were recorded and calculated, including confirmed and suspected bucco-lingual root types.

RESULTS

In terms of the morphology of two-rooted mandibular first premolars, of the 2015 cases with complete root formation, two-rooted first premolars were detected in 120 cases, with a total number of 159 teeth. According to the number of teeth, the overall incidence of double roots was 4.03% (159/3972). In terms of the morphology of two-rooted mandibular second premolars, of the 2015 cases with complete root formation, two-rooted second premolars were detected in 24 cases, with a total number of 33 teeth. According to the number of teeth, the overall incidence of double roots was 0.85% (33/3880).

CONCLUSIONS

The roots of mandibular premolars display specific morphological patterns. Based on a large sample, we observed and calculated not only the occurrence rate of bucco-lingual and mesio-distal double roots in first and second mandibular premolars, but also the incidence of unilateral or bilateral double roots within the same mandible. These findings could provide useful information on the anatomical structure of mandibular premolars for endodontic, prosthodontic and surgical procedures, and could improve the quality of treatment and reduce complications.

Agenesis of maxillary second premolar--diagnosis and clinical management

Controlling the eruption and development of dentitions is fundamental for a good oral health. The early diagnosis and adequate treatment of occasional developmental disorders are essential to achieve occlusal, functional and esthetic harmony. Abnormality is the term used for classification of alterations and is the most common developmental anomaly in humans. Even though several factors causing tooth malformations have been identified, many are still partially understood, thus requiring a more thorough study. Anyway, the available knowledge provides bases to attempt the early diagnosis of tooth abnormalities, to allow the adoption of preventive and effective therapeutic approaches.

Ectopia or concomitant hypohyperdontia? A case report

This report describes the unusual appearance seen on a panoramic radiograph of an orthodontic patient which the authors argue may represent ectopia or concomitant hypohyperdontia of the mandibular premolar teeth. A literature review describes the frequency of such anomalies in this area from previous studies. The presenting features of the patient and the differential diagnoses are explored. Treatment planning is discussed and treatment carried out in this particular case is detailed. The unusual symmetrical bilateral anomalies in this patient may point to a genetic determinant of tooth germ position and/or movement.

Maturation of teeth adjacent to dental agenesis site

OBJECTIVE

The purpose of this study was to evaluate the developmental stage of teeth adjacent to the agenesis site in comparison to their antimeres.

MATERIALS AND METHODS

Panoramic views of 39 patients with unilateral dental agenesis and 42 normal controls were evaluated. The dental developmental stage (normal or delayed) of the teeth adjacent to the agenesis site was determined for each patient using the Haavikko's method, while the overall dental age was determined by Becker's method.

RESULTS

No statistically significant difference was found in the developmental stage of teeth adjacent to the agenesis, compared to their antimere and to the same teeth in the normal control group. However, the prevalence of cases with no difference in development was almost double for the tooth distal to the agenesis site compared to the tooth mesial to the agenesis site in the hypodontia group (84.6% distal and 43.6% mesial; p < 0.001) and in the control group (83.3% distal and 52.4% mesial; p < 0.002). In most of the cases the tooth distal to the agenesis site was the 1st permanent molar.

CONCLUSIONS

(1) No difference was found between the developmental stage of teeth adjacent to the agenesis site and their antimeres. (2) Teeth mesial to the agenesis site showed some delay in development compared to teeth distal to the agenesis site, in this study. (3) The 1st molars, which were in most of the cases the distal adjacent tooth to the site of agenesis, showed developmental stability. (4) Additional longitudinal studies are needed to examine the dental developmental pattern in patients with agenesis.

Primary molar infraocclusion: frequency, magnitude, root resorption and premolar agenesis in a Spanish sample

AIM

This study was conducted to determine frequency, distribution and magnitude of infraocclusion in primary mandibular molars; to evaluate root resorption, the frequency of premolars agenesis and the association between primary molar infraocclusion and premolar agenesis.

MATERIALS AND METHODS

The sample consisted of 472 children who were subdivided in 3 age groups. The magnitude of infraocclusion was determined following the Bjerklin and Bennett method modified by the authors. Radicular resorption was determined using the rating scale proposed by Bjerklin and Bennett evaluating mesial and distal roots separately. The development degree of corresponding premolars was determined using the Demirjian method.

RESULTS

One hundred and three (21.8%) children presented infraocclusion. The first primary molar presented infraocclusion in a significantly higher frequency. Considering the 3 scores of infraocclusion, 61.1% of the affected molars were classified as mild infraocclusion. No differences were found considering the root resorption pattern for primary molars, infraoccluded or not. Significant differences were found in the presence of agenesis in the group of infraoccluded molars.

CONCLUSION

The present study identified a high percentage of infraocclusion, demonstrating that the type of molar is an influent variable, that the first primary molar is the most affected one, especially mandibular molars, and that the majority was mainly of a mild degree. There were no significant differences between the exfoliation of infraoccluded and non infraoccluded primary molars. However, radicular resorption of infraoccluded molars presented a clear delay or was totally absent in infraoccluded molars associated with premolar agenesis. Significant differences in the presence of agenesis beneath infraoccluded molars were observed.

Hypodontia prevalence and pattern in women with epithelial ovarian cancer

OBJECTIVE

To analyze the possible association between hypodontia and epithelial ovarian cancer (EOC), with the special interest in hypodontia pattern.

MATERIALS AND METHODS

One hundred twenty women with EOC treated at the Department of Gynecologic and Breast Oncology at the University Clinical Centre and 120 gynecologically healthy women of the same average age were reviewed for the presence and pattern of hypodontia. Collected data were analyzed for frequency, tooth type, location per jaw and side, number of missing teeth per person, and family history of hypodontia.

RESULTS

The results of the study showed prevalence of hypodontia in 19.2% of women with EOC and in 6.7% of women in the control group (P  =  .004). The most frequently missing teeth for women with EOC and women in the control group were maxillary second premolars and maxillary lateral incisors, respectively. Unilateral occurrence of hypodontia was more common than bilateral occurrence in women with EOC (P  =  .034). Of women with EOC and hypodontia, 21.7% reported a positive family history of hypodontia compared with no report in the control group of women with hypodontia (P  =  .150).

CONCLUSIONS

The results statistically support possible association between EOC and hypodontia. Because hypdontia can be recognized early in life, this finding could possibly help in earlier detection of EOC, resulting in better prognosis and treatment in earlier stages of the disease. Earlier EOC diagnosis and treatment could save many lives.

Absence of multiple premolars and ankylosis of deciduous molar with cant of the occlusal plane treated using skeletal anchorage

Ankylosis and the absence of premolars are two relatively common conditions encountered in the field of orthodontics. However, the absence of multiple premolars, particularly two adjacent premolars, along with ankylosis of deciduous teeth, is unusual. Herein, we present a case report and discuss some aspects related to these abnormalities. A 15-year-old boy was missing the upper right first and second premolars and the lower right and left second premolars. In addition, the deciduous lower left second molar was ankylosed and in infraocclusion, causing canting of the occlusal plane. The patient was treated with a mini-implant to correct the Class II malocclusion on the left side and a miniplate to correct the cant of the occlusal plan. After treatment, the upper right space was kept closed, with the canine in contact with the first molar, and the lower left space was opened to an implant-prosthetic rehabilitation.

Wassmund osteotomy for excessive gingival display: a case report with three-dimensional facial evaluation

AIMS

This case report describes the management of an adult patient presenting with a skeletal Class II malocclusion with congenitally missing lower second premolars, maxillary dentoalveolar protrusion, and an excessive gingival display in full smile.

METHODS

The treatment plan consisted of a combination of a segmental osteotomy to reposition the anterior part of the maxilla after upper premolar extractions and a bilateral sagittal split osteotomy (BSSO) to advance the mandible. Because the upper left permanent second molar required extraction, the upper left third molar was moved mesially during post-surgical orthodontic treatment.

RESULTS

After active treatment, bilateral Class I molar and canine relationships were achieved. Two years after retention, a satisfactory facial profile and dental occlusion remained with optimum overjet and overbite. Treatment also produced changes in the threedimensional (3D) configuration of the face, which was characterised by decreased labial protrusion, increased protrusion of the chin, and increased cheek prominence.

CONCLUSION

A segmental osteotomy of the anterior part of the maxilla produced favourable treatment results by reducing excessive gingival display, but also by a relative improvement in cheek prominence.

Long-term evaluation and clinical outcomes of children with dental transplants in Temuco city, Chile

AIM

To assess the clinical and radiographic outcomes of 36 transplanted teeth and the possible factors affecting the results.

MATERIALS AND METHODS

In 26 children, 36 teeth transplants were performed. The main reason for transplantations was the loss of anterior teeth due to trauma; 80.5% of transplanted teeth were immature bicuspids. The transplants were clinically and radiolographycally monitored in respect of pulp vitality, root canal obliteration, periradicular changes and root formation. Fisher Exact Test and Kaplan-Meier analyses were performed to determine the association between the variables and estimation of survival rates, respectively.

RESULTS

Thirty (83.3%) of the transplantations were recorded as successful and six as unsuccessful (16.7%). The survival rate was 97.2% during average time of 47.5 months ± 27.8 SD. Only one tooth had been extracted and 5 had survived in not ideal conditions. The majority of immature transplanted teeth developed pulp canal obliteration.

CONCLUSION

Factors associated to successful outcome were immature root formation of donor tooth and short flexible splinting period. The main factor associated to failure was replacement resorption. The surgical technique did not present statistical significance in the clinical outcome. Tooth transplantation has shown high success and survival rates, and should be considered as a real option in growing patients.

Deep submersion: severe phenotype of deciduous-molar infraocclusion with biological associations

OBJECTIVE

To evaluate the clinical manifestation of and treatment modalities for this severe phenotype of infraocclusion and to examine relationships between deep submersion and the occurrence of other dental anomalies.

MATERIALS AND METHODS

The experimental sample consisted of 25 orthodontic patients with at least one deciduous molar in infraocclusion greater than 5 mm. Dental records were used to assess severity of infraocclusion, treatment modality, and presence of other dental anomalies (tooth agenesis, small maxillary lateral incisors, palatally displaced canines, and distal angulation of mandibular second premolars).

RESULTS

The sample included 14 females and 11 males, age 7 to 14 years (mean age 10.1 years). The mean infraocclusion depth was 9 mm, with a range of 5-18 mm. The crowns of the adjacent teeth were severely tilted toward the infraoccluded tooth, space was lost in the dental arch, and the successor premolars were impacted in all cases. Treatment consisted of space regaining, surgical extraction of the deciduous molar, and space maintenance. The impacted premolar erupted spontaneously in 95% of the cases. There was a significant increase in prevalence of dental anomalies in the deep-submersion sample compared with that of reference values (P < .001).

CONCLUSIONS

The treatment modality used in this sample resulted in spontaneous eruption of the impacted premolar in most cases. Markers for early diagnosis of deep submersion include other dental anomalies, severe tilt of adjacent teeth, and local space loss. The increased prevalence of other dental anomalies supports a shared genetic etiology.

Prosthetic rehabilitation of a patient with a unilateral cleft palate: a clinical report

Cleft palate is a congenital disorder characterized by maxillary growth defect and dental anomalies. Its correction requires an interdisciplinary approach, which includes surgical, orthodontic, and prosthetic treatments. This clinical report describes the prosthetic management of a 19-year-old woman with a unilateral cleft palate defect that had not been closed completely with surgical repair. The deficient maxillary residual anterior ridge was restored with a tooth-supported overdenture that improved her facial appearance, speech, and masticatory functions.

Craniofacial morphological changes of familial bilateral hypodontia of maxillary premolars

The hypodontia of a permanent tooth from a dental group represents a normal evolution in human dentition morphology. Nevertheless, the hypodontia of two teeth within a dental group is a rare developmental anomaly when not associated to a systemic syndrome. The aim of this study was to report two rare cases of four maxillary premolars hypodontia, not including the third molar, of two white women from the same family. There were presented clinical, radiological and genetic findings. These cases are of interest to practitioners for four aspects: the atypical phenotype of hypodontia, the complexity of craniofacial morphological changes, the autosomal dominant familial inheritance with variable expressivity and the difficult classification of diagnosis.

Regional odontodysplasia: literature review and report of an unusual case located in the mandible

The purpose of this report was to describe the clinical, radiological, and histopathological features of a case of regional odonto- dysplasia (RA) in a seven-year-old boy who was followed for approximately two years. The case is unusual in that the dysplasia occurred in the mandible, and there was a normal-appearing tooth within the lesion, suggesting that there may be local factors that determine susceptibility of individual teeth in RA. The diagnosis of RA was based on the typical features of "ghost" teeth and evidence of disrupted calcification characterized by psammomatous bodies, hypomineralization of enamel, and the presence of interglobular dentin. Sequential orthopantomograms provide evidence of delayed dental development.

Management of a 3-canal mandibular premolar in a patient with unusual root canal anatomy in all mandibular premolars

Endodontic treatment of mandibular premolars can be difficult due to their aberrant root canal anatomy. Successful nonsurgical root canal treatment requires knowledge of basic root and root canal morphology, and possible anatomical variations of the root canal system. Mandibular second premolars usually have a single root and a single canal, and the presence of 3 canals in separate roots is very rare. Nonsurgical endodontic treatment of such teeth is a challenge. This article presents a rare case of a mandibular second premolar with 3 root canals in separate roots and its endodontic management, with a special emphasis on radiographic interpretation and access refinement during treatment.

Ameloblastic fibrodentinoma with a congenitally missing second premolar tooth: a case report

Ameloblastic fibrodentinoma (AFD) is a rare benign mixed odontogenic tumor that occurs predominantly in children and young adults. AFD is usually associated with delayed eruption of the tooth and shows painless swelling. We present a case of AFD affecting an 8-year-old Japanese girl with a complaint of delayed eruption of her left mandibular second premolar tooth. Intraoral examination did not reveal any sign of pain or swelling in the left mandible. Panoramic radiography revealed a radiolucent and well-circumscribed lesion, which contained radiopaque material at the premolar lesion of the left mandible. The second deciduous molar tooth was unerupted and the second premolar tooth was congenitally lacking. Our provisional diagnoses were odontogenic tumor. The biopsy confirmed AFD. The treatment included total excision of the tumor and the second premolar tooth. No recurrence has been noted during the 2 years of follow-up.

Clinical record-keeping for monitoring treatment outcomes in implant dentistry: a case study

Sound clinical practice in implant dentistry depends upon defining the methodology that can successfully be used. This can be achieved by identifying literature relating to a specific technique prior to its use. However, clinical observations of outcomes within one's own practice are also very effective. This is particularly true as it becomes specific, by eliminating numerous confounding factors. Appropriate documentation, both clinical and radiographic, permits the practitioner to review clinical cases and establish the efficacy of the methodology used. This is most effective in terms of evaluating survival as well as determining aesthetic and functional outcomes. Software programs such as ImpDAT (Kea Software, Poecking, Germany) provide a platform that easily allows both accurate record-keeping and, importantly, retrieval of data for purposes of review and publication. This paper presents a case report that uses radiographic and photographic records to monitor the ongoing response of the patient to the specific treatment that was carried out; in this case, autogenous onlay bone grafts for the management of congenital partial anodontia.

Implant dentistry: a technician's perspective

TEAMWORK BETWEEN THE DENTIST AND THE LAB IS ESSENTIAL TO CREATE A SUCCESSFUL OUTCOME. WE SPOKE TO PREM-PAL SEHMI, FOUNDER AND CEO OF TBR IMPLANTS, BDS DENTAL LABORATORY AND ZEN DENTAL SOFTWARE, ABOUT ONE OF HIS RECENT CASES.

The prevalence of dental anomalies in orthodontic patients at the State University of New York at Buffalo

OBJECTIVE

To determine the prevalence of permanent tooth anomalies in patients attending the graduate orthodontic clinic at the State University of New York at Buffalo.

MATERIALS AND METHODS

Charts of 496 subjects (310 females and 186 males) met the inclusion criteria for this study. The mean ages were 16 years and 3 months for the combined gender sample that received orthodontic treatment in the graduate orthodontic clinic between 2007 and 2010. Full pretreatment records (intraoral photographs, digital study models, lateral cephalograms and panoramic radiographs) were used for the assessment. Charts were examined for these anomalies: agenesis, supernumerary, impaction and delayed tooth eruption. Subjects were categorized by gender and ethnicity. The percentages of the anomalies were assessed according to type of malocclusion, gender, race, location, tooth class and region in the dental arches.

RESULTS

Sixty-four subjects (12.9%) had at least one occurrence of delayed eruption and impaction (DEI), followed by 47 subjects (9.5%) who had at least one occurrence of agenesis, and seven (1.4%) had a supernumerary condition. Approximately 80% of the subjects had no dental anomalies. The presence of more than one anomaly was observed in 61 subjects. Twelve subjects (2.4%) had both agenesis and DEI. Agenesis tended to be more common in class II malocclusions (p=0.012).

CONCLUSION

The prevalence of permanent tooth anomalies was (20.4%). The percentage occurrence of DEI was the highest (12.9%) followed by dental agenesis (9.5%) and supernumerary teeth (1.4%) in the orthodontic patients at the State University of New York at Buffalo.

[Prevalence of hypodontia at the department of pedodontics and orthodontics of Semmelweis University]

Examination of hypodontia as one of the most frequent developmental disorder receives high importance in the national as well as in the international literature. As the disorder can affect the dental and mental development of the children therefore early diagnosis and treatment are necessary. The authors analyzed the OP radiograms of patients aged 6 to 18 who were registered between 2006 and 2011 at the Department of Pedodontics and Orthodontics of Semmelweis University, excluding children suffering from general diseases or other syndromes. The aim of the examination was to determine the occurrence of missing teeth germ cases in the registered database of the Department, diagnose the prevalence of aplasia and compare the results with the national and international literature. Out of the 900 patients (372 boys and 528 girls) included in the examination missing germs were diagnosed in 94 cases (10,44%). In most cases the germ of the lower second premolars was missing (34,64%), then came the upper lateral incisors (27,38%) and the aplasia of the upper second premolars (21,23%). There was no relevant difference between the two sides. The number of affected girls was higher by 25% than the number of boys. Most of the results are close to the result in international literature.

Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations

Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

Endodontic management of two-rooted mandibular premolars using spiral computed tomography: a report of two cases

AIM

To present a unique case of mandibular first and second premolars with two roots and two root canals with the aid of spiral computed tomography (SCT).

BACKGROUND

Confirmation of morphology of mandibular first and second premolars with the aid of SCT.

CASE DESCRIPTION

Mandibular premolars usually have a single root and a single canal. The occurrence of two roots with two separate root canals is extremely rare. The use of SCT in this rare case greatly contributed toward making a confirmatory diagnosis and successful endodontic management.

CONCLUSION

Successful nonsurgical endodontic management of mandibular first and second premolars with two separate roots and root canals has been presented. In this case, exact root canal anatomy could not be confirmed by using radiographs alone. Hence, the use of SCT helped us in making a confirmatory diagnosis.

CLINICAL SIGNIFICANCE

Developmental anomalies can occur in any tooth and two rooted premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment using latest diagnostic equipment to increase the chances of success.