Dental clearance unsuccesful: cleidocranial dysplasia diagnosed at a relief of pain clinic

A 55-year-old woman presented to Whangarei Base Hospital Emergency Department with a mandibular swelling adjacent to her unerupted tooth 48. She had never had dental radiographs taken, having had a dental clearance 20 years earlier. She wore full dentures. A panoramic dental radiograph revealed 44 unerupted teeth. Based on the clinical, oral and radiographic examinations a diagnosis of cleidocranial dysplasia (CCD) was confirmed. The patient had not been diagnosed with CCD prior to her hospital visit. Treatment included staged extractions of superficial mandibular supernumeraries and enucleation of the mandibular cyst, attempting to avoid pathological fracture. This would be followed by a six-month review and then annually as required. The case outlines the value of dental radiography in dental practice. Little is known about the prevalence of CCD in New Zealand and this is an area where future research could be conducted.

Treatment of Combined Primary Impaction of Primary Second Molars and Permanent First Molars

Tooth impaction is defined as any tooth that fails to erupt into a normal functional position and remains unerupted in the jaw beyond the time of its normal eruption. Primary impaction of primary teeth is rare. Furthermore, a combination of eruption failure of primary second molars and horizontally impacted permanent first molars has not yet been reported. The purpose of this study was to present the treatment of two cases of primary impaction of primary second molars combined with horizontally impacted permanent first molars. The impacted primary second molars were extracted, and orthodontic traction was performed to induce normal eruption of the permanent first molars. We then regained space for the eruption of the second premolar and applied a space maintainer to secure the space and induce successful eruption of succedaneous teeth and normal function of permanent first molars in their positions.

Evaluation of the position of unerupted mandibular third molars with and without root dilacerations: a study on panoramic radiographs

BACKGROUND

Factors that can directly influence the extraction of third molars include the position of the tooth and the presence of root dilacerations. Knowledge of these features favors an accurate therapeutic evaluation of third molars; therefore, the aim of this study was to evaluate, using panoramic radiographs, the positioning of unerupted third molars with and without root dilacerations and to verify a possible association between these two variables.

METHODS

In this study, 16,136 panoramic radiographs were analyzed, including 1756 lower third molars, in which the positioning was assessed according to the Winter classification and the presence of root dilacerations was determined. The data obtained from the assessments of the frequencies of the positions and the presence of root dilacerations of impacted mandibular third molar was described. A χ2 test was applied to verify a possible association between the variables.

RESULTS

The results indicated that the most frequent position was mesioangular (44.5%), followed by horizontal (24.9%), vertical (17.4%), distoangular (12.5%), inverted (0.4%), and linguoangular (0.3%). Of the mandibular third molars evaluated, 35% had root dilacerations. The chi-square test revealed a significant association between the position of the tooth and the presence of root dilacerations (P<0.0001, χ2=34.28). The frequency of root dilaceration was statistically higher for the vertical (45.5%) and distoangular positions (40.9%).

CONCLUSIONS

The mesioangular position was the most prevalent location for lower third molars, and the highest frequencies of root dilacerations were observed in the vertical and distoangular positions. Knowledge about the prevalence of root dilacerations and the significant association between the position of the third molars and root dilacerations will allow safer surgical planning for dental extractions of third molars.

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.

Evaluating success of autotransplantation of embedded/impacted third molars harvested using piezosurgery: a pilot study

OBJECTIVE

To evaluate the success of autogenous transplantation of embedded/impacted third molars harvested using piezosurgery.

MATERIALS AND METHODS

This prospective pilot study enrolled 20 healthy patients with non-restorable first/second molars and a caries-free retrievable embedded/impacted third molar. Piezosurgery was used for removing inter-radicular bone at the recipient socket as well as for bone removal around the donor teeth.

RESULTS

After an average follow-up of 16.4 months (SD = 1.9), 18 cases were successful with formation of periodontal ligament around the teeth. One tooth was lost due to infection at 1 month. One patient was lost to follow-up. There was no root resorption or ankylosis in any of the cases. In six donor teeth with complete root formation, root canal treatment was carried out. All the remaining teeth responded positively with vitality testing.

CONCLUSION

Piezosurgery is an effective device if embedded/impacted third molars are to be harvested for successful autogenous transplantation.

Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures

AIM

To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment.

METHODS

Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm).

MAIN OUTCOME MEASURES

Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant.

RESULTS

Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P<0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P<0.001). There was also a significant difference (P<0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P<0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery.

CONCLUSION

Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Case series: conditions inhibiting eruption of permanent first molars

PURPOSE

The purpose of this study was to evaluate the radiological and histopathological findings of 11 patients with unerupted first molars to verify the factors obstructing spontaneous eruption.

METHODS

The patients' clinical, radiological, and histopathological data were evaluated retrospectively to determine histopathological diagnosis, radiographic findings, methods of surgical management, and postoperative course.

RESULTS

This study involved 4 male and 7 female patients (mean age=9.5 years old). Nine cases involved the mandible. The patients' histopathological diagnoses included 3 odontogenic tumors, 2 odontogenic cysts, and 6 hyperplastic dental follicles. Radiographically, 10 cases showed characterless enlargement of the follicular space, while only 1 displayed radiopaque bodies. One patient with a tumor underwent enucleation, and 1 with a cyst underwent cystectomy and tooth extraction. The others underwent wide excision or partial excision of the surrounding tissue at the top of the impacted tooth. Tumor relapse was observed in 3 cases.

CONCLUSION

Surgeons should perform aggressive treatment for patients with unerupted teeth because spontaneous eruption is rare in cases involving non-neoplastic lesions such as hyperplastic dental follicles.

Transplantation of a tooth involved in dentigerous cyst

To salvage an uneruputed tooth within a dentigerous cyst, the retransplantation of the unerupted premolar involved in the dentigerous cyst was performed. In the present case a dentigerous cyst with the impacted maxillary second premolar of a 10-year-old boy was removed, because of the missing eruption after marsupialisation of the premolar 4 months earlier. Covering the crown and the one third of root, the cyst was removed from the tooth, and the premolar was retransplanted into a cavity created between the premolar and first molar in the maxilla. The tooth was fixed with resin and a twisted wire for 1 month. Two years after transplantation, the tooth responded positively to pulp vitality tests but did not move toward the occlusal line, and dental X-ray showed a lamina dura, mineralisation of the pulp cavity, no root resorption and development.

Adenomatoid odontogenic tumor associated with unerupted first primary molar

Adenomatoid odontogenic tumors (AOTs) are an uncommon benign odontogenic tumor. Both central and peripheral forms occur. Radiographically, the central variants are comprised of a follicular type (those associated with the crown of an embedded tooth) and an extrafollicular type (those with no embedded tooth). A review of the literature showed that only 3 cases of an association between AOT and unerupted primary teeth have been published. The purpose of this paper was to report a rare case of adenomatoid odontogenic tumor associated with an unerupted primary first molar in a 7-year-old boy.

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

AIM

Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity [Massler et al., 1941]. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage [Andreasen et al., 1997]. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001].

CASE REPORT

This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars

The objective of this study was to verify, using periapical radiographs, whether a partially erupted mandibular third molar is a factor in the presence of dental caries on the distal surface of the adjacent second molar. Two-forty six high quality periapical radiographs were selected, each showing a partially erupted mandibular third molar. The variables analyzed were: tooth number; gender; age; radiographic presence of caries on the distal surface of the adjacent molar; Pell and Gregory classification; Winter classification; angulation and distance between the second and mandibular third molar. The examiners were previously calibrated to collect data (kappa statistics from 0.87 to 1.0). The prevalence rate of caries on the distal surface of the second molar was 13.4%. In the logistical multivariate regression analysis, the angulation (OR=8.5; IC95%: 1.7-43.8; p=0.011) and the gender (OR=3.3; IC95%: 1.4-7.7; p=0.005) remained statistically significant after an age adjustment was made. The results indicate that the presence of a partially erupted mandibular third molar with an angulation of 31 degrees or more, is a risk factor for caries on the distal surface of the mandibular second molars.

Dental management in autosomal recessive (intermediate) osteopetrosis: a case report

Osteopetrosis (Albers-Schonberg disease) is the name given to a group of diseases that affect the growth and remodeling of bones. It is characterized by overgrowth and sclerosis of bone, resulting in thickening and narrowing of the marrow cavities throughout the skeleton. The exact cause is unknown, although failure of bone resorption related to defective osteoclasts is considered to be the basis of the problem. These patients present a significant challenge to the dentist for management of jaw and dental problems, as the disease process demands special strategies which are often at variance with conventional dentistry. The purpose of this paper was to report the management and follow-up of a child with intermediate autosomal recessive osteopetrosis who primarily complained of dental problems.

Segmental repositioning combined with orthodontic fine adjustment of nonerupting permanent molars: a case report

Eruption disturbance of a permanent tooth is challenging to clinicians. Eruption failure of a posterior tooth causes lateral open bite that severely interrupts function. This case report describes the treatment of nonerupting permanent molars by segmental repositioning followed by orthodontic fine adjustment. Two nonerupting permanent molars at different eruption stages were repositioned with a one- or two-step single-tooth segmental osteotomy technique. Final location of the repositioned tooth-alveolar bone segment was adjusted via orthodontic means.

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

PURPOSE

The purpose of this study was to determine the optimum time for surgical removal of unerupted maxillary anterior supernumerary teeth.

METHODS

The study population consisted of 126 children. Stages C to H of the Demirjian classification were used to classify the dental development of the adjacent incisors. Associations were sought between the complications and the developmental stage of the adjacent maxillary incisors at the time of surgical removal. Tests of association were carried out using Fisher's exact test with a probability level of P=.05 for statistical significance.

RESULTS

Significant differences were evident: for mature maxillary central incisors (N=170); between all the proportions for root resorption, with the greatest difference being between stages E and H (P<.001); for arrested root development between stages D and E (P=.013), and D and H (P=.02); and for persistent malocclusion between stages E and G (P=.004), E and H (P=.02), F and G (P=.005), and F and H (P=.01).

CONCLUSION

Early removal of unerupted maxillary supernumerary teeth seems to be advantageous with a cutoff point of approximately 6 to 7 years old, after which more complications are expected.

Prediction of postoperative pain after mandibular third molar surgery

AIMS

To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS).

METHODS

Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44 degrees C to 48 degrees C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery.

RESULTS

Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (> 30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28/38) during eating. In a multiple regression model, the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to .001).

CONCLUSION

Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery. J Orofac Pain 2010;24:189-196.

The unerupted maxillary canine--a post-surgical review

The orthodontic records of 685 patients referred for surgical exposure of an unerupted impacted maxillary canine tooth were examined. The condition was more common among females than males, slightly less than 2:1. The impacted teeth had a palatal-labial ratio of 3:1. All of the teeth were exposed using the open surgical technique and in 98% of cases the tooth erupted and was orthodontically aligned. In 2% of cases ankylosis occurred and the teeth were subsequently extracted. The presence of peg-shaped lateral incisors associated with the impacted maxillary canine tooth was 3.4% of the total number of impacted teeth and congenital absence was found in 1.7% of impacted teeth.

Autotransplantation of an unerupted wisdom tooth germ without its follicle immediately after removal of an impacted mandibular second molar: a case report

An impacted left mandibular second molar (tooth 37) was extracted, but most of its dental follicle remained in the socket. The crown and dental papilla of an unerupted, left mandibular third molar (tooth 38) were then placed into the socket of tooth 37. Successful interaction between the dental follicle of tooth 37 and the crown and dental papilla of tooth 38 led to the formation of a new tooth 37 at the recipient site. This suggests that the dental follicle may function non-specifically with the crown and dental papilla of other tooth germs.

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

Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related.

OBJECTIVES

We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered.

MATERIALS AND METHODS

A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, position-axis, radiological study, surgical treatment, related pathologies, and surgical complications.

RESULTS

Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding).

CONCLUSION

Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%.

[Lincomycin applied to the alveolus on TCP carrier and its effect on wound healing after surgical extraction of a third molar]

INTRODUCTION

The dental surgeon is often confronted by complications particularly after extraction ofunerupted lower third molars. The most common complication is alveolar periostitis. The healing process after extraction is accompanied by physiologic atrophy of the alveolus involving on the average 30% of bone tissue. Beta-tricalcium phosphate (TCP) is a synthetic material used in medicine to fill up bone defects caused by pathologic processes. The properties of TCP are appropriate for the material to be used as a carrier for drugs, in particular antibiotics. This study was undertaken to determine whether lincomycin applied to the alveolus on TCP carrier can be used to accelerate wound healing and reduce inflammation after surgical extraction of a third molar.

MATERIALS AND METHODS

We enrolled 80 patients (males and females between the age of 18 and 50 years) who underwent extraction of a third molar at the Department of Dental Surgery, Pomeranian Medical University in Szczecin. Surgical difficulty in the patients according to the Pederson scale corresponded to grade 2 or 3 (medium or high difficulty). The study group consisted of 40 patients who received lincomycin on TCP. Beta-tricalcium phosphate (300-700 microm pores) obtained from the Department of Technology of Ceramics and Refractories, AGH University of Science and Technology in Cracow, was soaked with 500 mg of lincomycin in solution and applied to the dental alveolus after tooth extraction. The alveolus was tightly sutured. The control group comprised 40 patients not treated with lincomycin. The patients reappeared for examination on the first, third, and seventh day after surgery. Attention during follow-up was directed to alveolar periostitis, pain, and trismus. Pain intensity was assessed with the 10-degree Visual Analog Scale (VAS).

RESULTS

We analyzed the subjective pain intensity reported during follow-up by the patients. In the study group, 20 patients reported no pain 24 hours after extraction. On the third day after surgery, alveolar periostitis was present in 15% of patients in the study group and 75% of patients in the control group. On the last day of follow-up, periostitis was present in only 2.5% of patients in the study group as opposed to 45% of patients in the control group. The differences were statistically significant (chi-square 36.05, p < 0.0001).

CONCLUSIONS

(1) Lincomycin on TCP can be used to prevent alveolar periostitis. (2) Lincomycin on TCP reduces complications in the form of pain and trismus. (3) Beta-tricalcium phosphate prevents atrophy of the alveolar process.

Impacted maxillary anterior supernumerary teeth: a survey of forty-two cases

The purpose of this retrospective study was to examine the location of impacted maxillary anterior supernumerary teeth that subsequently were removed from pediatric patients at Children's Hospital of New York-Presbyterian. The study population consisted of 42 children diagnosed with impacted maxillary anterior supernumerary teeth. The impacted maxillary anterior supernumerary teeth were surgically removed by one faculty member in the hospital operating room with the aid of general anesthesia between 1994 and 2000. The total number of impacted maxillary anterior supernumerary teeth was 51. All were located palatally on either side of the midline and were surgically removed from a palatal access. In the absence of clear imaging evidence to the contrary, it is recommended that the preferred surgical approach for the removal of impacted maxillary anterior supernumerary teeth should be the palatal approach. Relatedly, the term mesiodens is misleading and is generally inaccurate for describing impacted maxillary anterior supernumerary teeth. Palatodens would be a more appropriate descriptive term.

[Aplication of demineralized human bone matrix in the surgical dental fusion treatment. Report of a case]

The purpose of this work is to present a surgical alternative in the treatment of the dental fusions through the placement of demineralized human bone matrix (DHBM) (Grafton Putty)*, immediately after the separation and extraction of the fused tooth to the permanent one. The dental fusion is a dental anomaly of union, that consists in the union of two dental germs during development. It could happen at any of the dental germ evolution stages from the dental sheet or from more advanced processes of differentiation. For the clinical treatment, an allograft of DHBM with osteoinductive and osteoconductive properties was used. This had several factors of bone growth, it allowed the gradual growth of a new bone that helped to correct the bone defects post-extraction and to cover the exposed distal wall of the remaining permanent tooth. The clinic evaluation and the periapical and panoramic radiographies images were used for the clinical control. It can be concluded that the surgical separation and the extraction of the tooth with less anatomical likeness to the contralateral and the placement of the DHBM, represent a surgical treatment alternative of the dental fusion.

A familial case of popliteal pterygium syndrome

Popliteal pterygium syndrome (PPS) is a rare malformation disorder characterized by autosomal dominant inheritance, highly variable expressivity and incomplete penetrance. The disorder is caused by the mutation of the IRF6 gene and the respective protein, which belongs to a family of nine transcription factors and is involved in the differentiation and proliferation of keratinocytes. Mutations in the IRF6 gene give rise to popliteal pterygium syndrome, Van Der Woude syndrome and nonsyndromic orofacial clefts. The anomalies from which affected patients suffer can be subdivided into alterations of the orofacial region, the musculoskeletal system and the genitals. Diagnosis is difficult, as is differential diagnosis, due to the variability of the manifestations. Prenatal diagnosis is possible by means of sequence analysis of the IRF6 gene in DNA extracted from the chorionic villus or amniotic fluid, or by means of intrauterine ultrasound. The prognosis is generally good, with normal mental development and the possibility to correct most of the alterations through targeted surgery. The case presented in this study involves two patients: a father and daughter who suffer from PPS, of whom the former was not diagnosed at birth. The two patients have undergone numerous operations over the years on various parts of the body and sequence analysis of the IRF6 gene, which revealed the presence of a mutation in the target site.

Prophylactic third molar extractions: US dental school departments' recommendations from 1998/99 to 2004/05

OBJECTIVE

To review the recommendations by dental faculties regarding prophylactic removal of third molars (PR-3M) and to determine if the recommendations at institutions differed and whether there have been changes since 1998/99.

METHOD AND MATERIALS

In 1998/99 and 2004/05, a questionnaire was sent to department chairpersons of oral surgery, orthodontics, and restorative dentistry/prosthodontics of US dental schools. They were asked to characterize their department's PR-3M recommendations for adolescents (< 21 years of age), young adults (21 to 35 years), and adults (> 35 years). Third molars were categorized as fully erupted, semierupted, and unerupted. Participants also were to indicate their rationale for PR-3M. Nonparametric and independent t tests were applied to the data (P<or= .05).

RESULTS

Response rates for 1998/99 and 2004/05 were 64% and 66%, respectively. There continues to be significant differences among the departments in PR-3M recommendations, especially for adolescents. There were fewer departmental differences for young adults and adults, with a majority recommending removal of semierupted and unerupted third molars for young adults. Of the chairpersons changing their recommendation, although not significant, more changed to remove than to retain. There was a significant decrease in recommendations to extract fully erupted third molars of young adults and adults. Nevertheless, recommendations to remove semierupted and unerupted third molars of adolescents and young adults remain high.

CONCLUSIONS

The level of recommendations to electively remove third molars is inconsistent with the current nonintervention literature. Intramural departmental inconsistencies can result in confusion for students and patients. Hence, dental faculties may wish to reevaluate their curricula regarding third molar management.

Chirurgische Verlaufsbeobachtung eines adenomatoid odontogenen Tumors (AOT) im Unterkiefer: Ein Fallbericht

The AOT is a relative rare benign odontogenic tumor. It most often appears in the canine region of the maxilla and mandible in young patients. Radiolucencies in the region of non-erupted or vital teeth may produce diagnostic problems. The histological diagnosis of AOT is characterised by odontogenic epithelium, ductlike structures, amyloid-like material and calcifying areas. Case report A female patient of eleven years and ten months was referred for surgical exposure of the left mandibular canine by an orthodontist. This tooth was retained and root formation was incomplete. Radiologically, a radiolucency was seen, extending distally from the crown of the tooth towards the root. The deciduous tooth 73 was extracted and the retained left mandibular canine was surgically exposed. Healing was without result and the tooth was moved orthodontically. Two years later the tooth was seen in regular position and occlusion. Vitality tests were positive, distally to the tooth a 1.5[Symbol: see text]mm periodontal pocket was disclosed. A large radiolucency around the root of the tooth was seen. Supposing a cystic lesion a surgical intervention was performed without removal of the tooth. Histopathologically, an AOT was revealed. Conclusions In the sequence of surgical interventions it is highly likely that already at the first operation an AOT was present, however, went unnoticed clinically. The histological diagnosis of an AOT was only revealed after a second operation including tumor removal. In spite of surgical removal of the AOT the involved tooth found its position in the dental arch.

Extraction of "killer" teeth: the case of two Somali siblings

Many cultures present several intriguing ethnic dental practices. Therefore, in a multiethnic society, health care professionals have to be attuned to the patients' cultural values and traditions because they impact their attitude in seeking care and the implementation of the professionals' recommendations. Before seeking medical or dental care in the formal health system, families may rely first on an elder or healer for advice and interventions. In East Africa, the unerupted primary canines may be extracted in the first days or months of life because it is believed that they cause persistent fever, vomiting, diarrhea, weight loss, dehydration, infectious diseases and death. The practice is done using nonsterilized instruments leading to harmful localized and systemic sequelae, including fatalities. The purpose of this manuscript was to discuss the case of two Somali siblings who had tooth buds enucleated at a young age, leading to significant dental problems.

Postoperative prognosis of unerupted teeth after removal of supernumerary teeth or odontomas

INTRODUCTION

Impacted teeth do not always erupt spontaneously after removal of supernumerary teeth or odontomas. The purpose of this study was to examine the effect of several variables on eruption of impacted teeth in children with supernumeraries or odontomas.

METHODS

The sample consisted of 53 patients with 69 impacted teeth; the supernumeraries or odontomas were removed without other interventions. The patients were identified retrospectively and followed until the impacted teeth erupted to their correct positions or until orthodontic traction was started.

RESULTS

Loss of space, a second surgical procedure, a third surgical procedure, and orthodontic treatment were recorded in 77.6%, 53.8%, 9.4%, and 85% of the patients, respectively. Spontaneous eruption occurred in 83%, 75%, 46%, 19%, and 32% of the impacted teeth with normal and small size superlative, conical, tuberculated, and odontoma forms, respectively. In the univariate analysis, spontaneous eruption correlated with apex distance of the impacted tooth relative to its estimated position (P <.001), extent of vertical impaction (P <.001), obstacle form (P <.019), stage of root development of supernumerary tooth (P = .006), angle of impaction relative to the midline (P = .015), and time of surgery (P = .05). In the multivariate logistic regression analysis, higher distraction of the apex of the impacted tooth relative to its estimated correct position and the obstacle form (tuberculated and odontomas) were independently associated with impediment of spontaneous eruption (P = .03 and P = .04, respectively).

CONCLUSIONS

Spontaneous eruption of impacted teeth correlated mostly with lower distraction of the impacted tooth apex and obstacle form (conical and superlative). Immediate orthodontic traction is recommended concomitantly with the first surgery to remove supernumerary teeth.

Laser exposure of unerupted teeth

Surgical soft tissue exposure of impacted teeth can now be performed with little to no discomfort and excellent postoperative healing. This paper focuses on the techniques used in performing this procedure.

Treatment of space loss caused by submerged maxillary second primary molar

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.

Dentigerous cyst associated with multiple mesiodens: a case report

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete dentition the diagnosis is a surprise; as about 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. More frequently the mesiodens occurs unilaterally, but it may also be bilateral, while three or more supernumerary teeth in the median region of the palate are more rarely found. We report a rare case of dentigerous cyst in association with multiple mesiodens in a 14-year-old female patient.

Delayed-onset infections after lower third molar extraction: a case-control study

PURPOSE

To identify possible risk factors for delayed-onset infections and to develop a model for explaining the effects of these risk factors on the occurrence of delayed-onset infections in an outpatient clinic.

MATERIALS AND METHODS

A retrospective case-control study comprising a total of 178 lower third molar extractions performed between 2001 and 2004 in the Oral Surgery and Orofacial Implantology Department of the School of Dentistry of the University of Barcelona, Spain.

RESULTS

Bivariate analysis showed tooth sectioning, soft tissue and bone retention, and the position of the lower third molar (according to the classifications of Pell and Gregory, and of Winter) to be significantly associated with the development of delayed-onset infections. A logistic regression model included the following independent variables: position of the lower third molar according to Winter, and Pell and Gregory Classes I, II, and III, and degree of soft tissue retention.

CONCLUSIONS

Lower third molars with total soft tissue retention, a lack of distal space and with a vertical or mesioangular tilt are more likely to develop delayed-onset infections. Tooth sectioning, bone retention, and depth of inclusion could also be risk factors for such infections. Heavy smokers seem to be more prone to this complication.

[Orthodontic and oral surgery therapy in cleidocranial dysplasia]

A cleidocranial dysplasia is an autosomal dominant inherited condition consisting of generalized skeletal disorder. Associated dental signs are present in 93,5%; failure of tooth eruption with multiple supernumerary teeth, dilaceration of roots, crown germination, microdontia, high arched palate, midface hypoplasia, high gonion angle. The molecular- genetic analysis revealed a missense mutation in the CBFA1 gene located on chromosome 6p21, which is considered to be etiological factor for CCD. Orthodontic and oral surgery therapy of a 13 year-old child with CCD was performed due to aesthetic and functional problems. The supernumerary germs were removed and the teeth were aligned with orthodontic appliances. Temporary functional rehabilitation was solved with partial denture. The presented case and the literature data support the importance of early diagnosis of CCD. The good collaboration of the orthodontic and maxillo-facial surgery specialists help achieve the correct rehabilitation of the patient.

Regional odontodysplasia: report of case

A case of regional odontodysplasia in an 8 year-old male whose chief complaint was the absence of eruption of permanent teeth is presented. The regional odontodysplasia is a rare development anomaly of the dental tissues that affects the primary and permanent dentitions involving several adjacent teeth without crossing the midline. The clinical, radiographic and histological aspects are described as well as the treatment accomplished through surgery and prosthetic rehabilitation.

Dilacerated unerupted central incisor: A case report

Dilaceration of permanent successors is one of the most common complications of trauma to the deciduous teeth. It is advisable to keep these patients under observation post-trauma and to consult an orthodontist at an early stage to prevent unfavorable sequelae. Presented here is a typical case of dilaceration.

Using qualitative methodology to elucidate themes for a traditional tooth gauging education tool for use in a remote Ugandan community

The gauging of unerupted deciduous canine teeth occurs in approximately one in three children in some areas of Uganda. It is believed that such teeth are 'maggots' that cause fever, diarrohea and vomiting. Traditional healers use knitting needles, bicycle spokes, scissors or broken glass to extract the teeth. Post-ebino extraction complications include septicaemia, anaemia, difficulties in feeding and pain. Some children require hospitalization. Health is further compromised when multiple ebino extractions occur at one time, increasing the risk of human immunodeficiency virus/acquired immunodeficiency syndrome transmission. An ebino education initiative was developed in the southwest Ugandan province of Rukungiri, based on the findings of five community-based focus group discussions. The initiative involved role-plays, didactic presentations and discussion/debate workshops to 23 women's groups in 15 communities (total number of women exposed = 1874). After 1.5 years of the programme's inception, community awareness of the scientific causes and alternatives to ebino extractions had increased (as gauged by follow-up focus group discussion findings) and the number of hospital admissions for traditional tooth extraction complications had reduced. The appropriateness of the model in exploring and addressing ebino extraction beliefs and attitudes is discussed, as are implications of the strategy in its implementation in other communities where ebino extractions are prevalent.

Eruption cyst treated with a laser powered hydrokinetic system

Eruption cysts are benign cysts that appear on the mucosa of a tooth shortly before its eruption. The majority disappear on their own. If they hurt, bleed or are infected they may require surgical treatment to expose the tooth and drain the content. Here we present a clinical case of a six-year-old child with an eruption cyst on the permanent maxillary central left incisor, which was handled using treatment with an Er,Cr-YSGG laser. It did not require suture, there was no haemorrhage, swelling, infection or postoperative pain. The treatment of eruption cysts with this technique facilitates obtaining the cooperation of pediatric patients and makes behavior management by the pediatric dentist easier.

Orthodontic treatment protocol of Ehlers-Danlos syndrome type VI

Ehlers-Danlos syndrome (EDS) type VI is an autosomal recessive disorder of the connective tissue characterized by joint hypermobility, muscle hypotonia, scoliosis, and ocular fragility. In this case report, an EDS type VI patient with a skeletal and dental Class III malocclusion is presented and the clinical approach to his orthodontic problem is emphasized. A 17-year-old male patient presenting some major and minor symptoms of the syndrome was referred to our orthodontic department for diagnosis and treatment. The typical clinical signs confirmed the diagnosis of EDS type VI. He was a skeletal and dental Class III malocclusion patient (both mandibular protrusion and maxillary retrusion) with a noncontributory family history. He had severe crowding in the lower and upper dental arches with retruded incisors. His first treatment plan included orthognathic surgery, but because of the risks of bleeding and poor healing, we elected to treat the patient without surgery.

Assessment of periodontal status following the alignment of impacted permanent maxillary canine teeth

PURPOSE

The aim of the study was to assess the effect of orthodontic movement of the impacted canines after surgical exposure and alignment on the periodontal status of the transpositioned and adjacent teeth as well as to compare certain parameters with those of spontaneously erupted teeth.

MATERIAL AND METHODS

Twenty-four patients (mean age 18.4 +/- 3.66) with unilaterally impacted 24 canines were enrolled in the study. The following parameters were assessed: pocket depth (PD), clinical attachment level (CAL), platelet index (PI) of Silness and Löe, and modified sulcus bleeding index (SBI). Optic density of the alveolar bone along the root surface of the aligned canine was analysed based on digital radiological images made with the right angle technique. Control group consisted of spontaneously erupted teeth.

RESULTS

In comparison to the control group, in the orthodonticaly treated group PD was found to increase on the mesial buccal and palatal surfaces of the first premolar (p < 0.003, p < 0.04), on the treated side; on the distal buccal (p < 0.01), mesial buccal (p < 0.0005), mesial palatal (p < 0.02) and distal palatal surfaces of the canine (p < 0.02); and on the distal buccal (p < 0.04) and distal palatal surfaces of the lateral incisor (p < 0.048). CAL was statistically significant on the mesio-buccal and mesio-palatal surfaces of the aligned canine (p < 0.02). PI was statistically insignificant, while SBI values at the aligned tooth were statistically significant (p < 0.0004). Positive correlation was found between treatment duration and distance to the occlusal plane (d) expressed by the correlation coefficient r = 0.49 (p < 0.02). No relationship was observed between bone density within the canine alignment zone and the control, and there was no link between the method of treatment and periodontal status, either.

CONCLUSIONS

The alignment of the impacted permanent maxillary canines poses a risk of periodontal deterioration. Patients subjected to surgical-orthodontic treatment require periodic periodontal follow-ups.

Oral reconstructive and corrective considerations in periodontal therapy

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.