Iatrogenic displacement of an impacted third maxillary molar in the parapharyngeal space: A case report

Accidental iatrogenic displacement of third molars in peripheral soft tissues is a major intraoperative complication, but is considered rare. A young women reported discomfort during mandibular lateral movements since she underwent the extraction her impacted third molars under general anesthesia, 2 years before. The clinical examination was not specific except for a laterality limitation of the right mandibular movements. The germ of 28 appeared radiologically encapsulated in the peripheral muscle tissues in the left parapharyngeal space and showed no signs of ankylosis. After measurement of the benefit-risk balance the surgical extraction of the foreign body has been successfully carried out. After 6 weeks the patient was able to regain bilateral symmetrical mandibular laterality movements. It appeared that tooth 28 was interfering with the movements of the manducatory function, either by obstructing the mandibular path, and/or by irritating the pterygoid muscles or other peripheral tissues .

Evaluation of the relationship between dermatoglyphics and mandibular third molar impaction: A cross-sectional study

Background: Dermatoglyphics can be utilised in clinical settings to identify those who are more likely to have impacted teeth. Additionally, dermatoglyphics looks to have potential as a non-invasive diagnostic method for predicting the presence or absence of an impacted tooth. The goal of this study was to look at the most common dermatoglyphic pattern in people who had or didn't have an impacted mandibular third molar teeth and see if there was a dermatoglyphic signature. Methods: A cross-sectional study with 180 participants was conducted (90 cases and 90 controls). The rolling impression technique was used to apply blue duplicating ink to participants' fingertips, which was then recorded. There was an increase in the frequency of the whorl-plain pattern in the right-hand ring finger (60%; p=0.028) and left-hand little finger (33.3%; p=0.009), as well as the loop-ulnar pattern in the right-hand middle finger (74.4%; p=0.024) in individuals with a predisposition to the presence of impacted teeth. Results: The left-hand little finger was found to be the most predictive for impaction in a forward stepwise binary logistic regression analysis. Conclusions: Dermatoglyphics could be used as a non-invasive sign to predict whether or not a tooth is affected. Its value comes in early detection, which helps to avoid the surgical problems that come with symptomatic extraction of an impacted tooth.

Delayed Eruption of Maxillary Central Incisors Associated with the Presence of Supernumerary Teeth: A Case Report with 18 Months Follow-up

AIM

The aim of this study is to discuss a case of an 11-year-old pediatric patient, who was diagnosed with delayed eruption of the permanent maxillary central incisors because of palatally impacted supernumerary teeth.

BACKGROUND

The delayed eruption of permanent teeth can be a result of blocking by supernumerary teeth and over-retained primary teeth. Early diagnosis can help in avoiding the complications. The management of such cases depends on the stage of teeth development, teeth position, and space availability. Treatment may combine both surgical and orthodontic interventions.

CASE DESCRIPTION

The case was managed by surgically removing the primary retained teeth and supernumerary teeth in two visits then allowing the impacted permanent incisors to erupt without any intervention.

CONCLUSION

After 18 months follow-up, the two permanent incisors erupted spontaneously with no orthodontic intervention.

CLINICAL SIGNIFICANCE

dentists should be aware of the importance of early diagnosis of supernumerary teeth. The management of such cases should be designed by a multidisciplinary team decision.

Inverted and horizontal impacted third molars in an Early Modern skull from Wroclaw, Poland: a case report

BACKGROUND

An impacted tooth is one of the most commonly occurring dental anomalies, although some types of impaction (i.e. inverted angulation) may be considered rare finding. There are many hypotheses regarding impaction aetiology. One of the most popular hypotheses suggested that this condition may result from insufficient space in retromolar space, other: improper angulation of tooth bud, malposition of the tooth germ or hereditary factors, insufficient interproximal attrition, ectopy or dysfunction of genes necessary for proper tooth eruption. This study aims to present the odontological and paleopathological assessment of the impacted molars observed within the skull excavated from an early modern cemetery in Wroclaw.

MATERIALS AND METHODS

The skull used in the study was complete and in a good state of preservation. It belonged to an adult individual whose body was buried at the former Salvator Cemetery (currently Czysty Square). The individual's dentition was almost completely lost antemortem. Only second molars preserved within the maxillae (bilaterally) and the mandible was almost edentulous as well. The morphometric traits have been taken according to standards established by R. Martin. Macroscopic observations were supported by X-rays and computed tomography imaging.

RESULTS

The age at death was estimated at 20-35 years. Comparison of the metric characteristics of skull with the reference material reveals that it is much smaller than the average female skull from this series. Morphometric indices calculated for both splanchocranium and neurocranium allow defining the skull and jaw as short, which could be an important factor involved in the teeth impaction.

CONCLUSIONS

Atypical impaction of the third molars could result from small size of skull and could have significantly deteriorated the quality of life of the individual.

Multidisciplinary management of an impacted maxillary central incisor associated with supernumerary teeth: a case report

Permanent maxillary central incisor impaction is a rare condition of multifactorial etiology that should be treated on diagnosis. This article describes multidisciplinary treatment of an 11-year-old patient presenting with a permanent maxillary right central incisor that was impacted due to the presence of 2 supernumerary teeth. The diagnosis was reached through clinical evaluation, radiography, and cone beam computed tomography. Treatment involved the surgical removal of the supernumerary teeth followed by traction of the impacted tooth through a combination of removable and fixed orthodontic appliances. Orthodontic treatment was completed after 18 months, resulting in adequate positioning of the right central incisor in the arch. Periodic follow-up visits were scheduled for prophylaxis and oral hygiene reinforcement. After 2 years, the teeth were adequately aligned, the gingiva was healthy, and the patient was esthetically satisfied. The multidisciplinary approach allowed functional and esthetic oral rehabilitation, thus helping the patient to avoid the psychological impact of a missing anterior tooth.

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.

Clinicopathologic correlation: mixed-density lesion in the posterior mandible

A middle-aged man presented for evaluation of a mixed-density lesion of the left posterior mandible. This clinicopathologic correlation presents the radiographic, clinical, and histopathologic findings; differential diagnosis; and treatment plan for this case. The lesion was deemed to be of bacteriologic origin, likely a polymicrobial infection containing actinomycetes. Clinical care and follow-up for the patient are discussed.

Even a Tooth Slips Sometimes

While impaction of a tooth or two in dentoalveolar region is common, ectopic presence of them in non-dentate area is less commonly reported. A 45-year-old female reported to the department with pain on right back teeth region since two days. On examination, grossly decayed 46, root stump 47, missing 48, with poor periodontal status were noted. Panoramic radiograph was advised for screening, which revealed an inverted impacted 48 at the right ramus just below subcondylar region. However, it was an incidental finding and the patient was asymptomatic, she was informed about the pros and the cons of her case and kept under close monitoring.

Impacted Teeth: An Interdisciplinary Perspective

A tooth normally erupts when half to three-quarters of its final root length has developed. Tooth impaction is usually diagnosed well after this period and is generally asymptomatic. It is principally for this reason that patients seek treatment later than optimal. Tooth impaction is a common problem in daily orthodontic practice and, in most cases, it is recognized by chance in a routine dental examination. Therefore, it is very important that dental practitioners are aware of this condition, since early detection and intervention may help to prevent many harmful complications. The treatment of impacted teeth requires multidisciplinary cooperation between orthodontists, oral surgeons and sometimes periodontists. Orthodontic treatment and surgical exposure of impacted teeth are performed in order to bring the impacted tooth into the line of the arch. The treatment is long, more complicated and challenging. This article presents an overview of the prevalence, etiology, diagnosis, treatment and complications associated with the management of impacted teeth.

Amelogenesis Imperfecta with Coronal Resorption: Report of Three Cases

Intracoronal resorption of the permanent dentition in cases of amelogenesis imperfecta (AI) is a rare finding which poses an added complication to the already complex management of this condition. This paper presents three cases of AI associated with delayed eruption of permanent teeth in which asymptomatic intracoronal resorption occurred. CPD/Clinical Relevance: This paper highlights the fact that teeth affected with amelogenesis imperfecta may undergo asymptomatic intracoronal resorption which is only identifiable radiographically.

Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population

OBJECTIVES

The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population.

MATERIAL AND METHODS

A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test.

RESULTS

The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05).

CONCLUSION

The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

[Application of Low Dose Spiral CT in Diagnosing Impacted Teeth in Children and Adolescents]

[ABSTRACT]

OBJECTIVE

To determine the value of low dose spiral CT scanning in diagnosing impacted teeth of children and adolescents.

METHODS

A total of 153 children and adolescents with confirmed impacted teeth in West China Second University Hospital, Sichuan University were enrolled in this study. They were divided into 5 groups according to the different spiral CT scan parameters (tube current time product, scanning thickness and collimation value): Group A (n=30, 330 mAs, 6 X 0. 75 mm and 3. 0 mm), Group B (n=30, 140 mAs, 6 X 0. 75 mm and 3. 0 mm), Group C (n=30, 80 mAs, 6 X 0. 75 mm and 3. 0 mm), Group D (n=31, 80 mAs, 6 X 1. 50 mm and 5. 0 mm), and Group E (n=32, 50 mAs, 6 X 1. 50 mm and 5. 0 mm). There were no significant differences in general clinical features (P>0. 05) among the participants of the five groups. The phantoms were used to measure spatial resolution and contrast resolution of the scan images. Dose length product (DLP) was recorded during CT scanning for calculating effective dose (ED) of exposure. The quality of images was evaluated using a list of quality scoring criteria.

RESULTS

(1) Under 330, 140, 80, 80 and 50 mAs, the images had a spatial resolution of 1.0 mm, with contrast resolution of 2. 0, 3. 0, 4. 5, 4. 5 and 6. 0 mm, respectively. (2) Significant differences in ED values were found among the five groups (F=1 064. 119, P=0. 000) and between every two of those groups (P<0. 05). Group E had the lowest ED (0. 19 mSv), 86. 52%, 67. 24%, 45. 71%, and 38. 71% lower than that in Group A, B, C and D, respectively (P<0. 05). (3) All of the five groups obtained an image quality score above 3, and no statistical differences appeared among the 5 groupl (F=1. 978, P>0. 05). The diagnostic results of the spiral CT were consistent with those of orthodontic surgery.

CONCLUSION

Low dose spiral CT scanning can meet the image quality requirements for diagnosing impacted teeth, minimizing radiation exposure effectively.

Management of Multiple Impacted Teeth Associated with a Large Dentigerous Cyst in the Maxilla

Impaction of multiple permanent incisors associated with a dentigerous cyst is a rare entity, and its management is challenging to any dentist. Proper diagnosis and treatment planning are critical for the best treatment outcome. The purpose of this case report is to describe a step-by-step approach to managing impacted teeth associated with a large dentigerous cyst in the maxilla of a young female patient.

Relationship between the positions of impacted third molars and the presence of dentigerous cysts

The objective of this study was to assess the association between the histopathological diagnoses of dentigerous cysts and pericoronal follicles and the positions of impacted third molars. The sample comprised 151 cases, diagnosed as dentigerous cysts and pericoronal follicles. Most patients were female (70.9%), white (90.1%), and age 20 years or older (63.6%). Ninety-eight cases (64.9%) were diagnosed as pericoronal follicles and 53 (35.1%) as dentigerous cysts. Teeth that developed dentigerous cysts were predominantly located in the mandible (84.9%), in a mesioangular position (49.1%), and in the 20- to 29-year age group (66.0%). The mandible seems to be the most frequent location of impacted teeth, probably because mandibular tooth eruption is more difficult, as well as dentigerous cysts, probably because the long duration of impaction increases the exposure to inflammatory stimuli and, thus, the potential for formation of dentigerous cysts. The findings also suggest that the incidence of dentigerous cysts tends to increase with age, especially for mandibular teeth in mesioangular positions.

Unusual cases of transmigrated mandibular canines

Transmigration, an extremely rare anomaly that happens almost exclusively with mandibular canines, is defined as a pre-eruptive migration across the midline. It can lead to various restorative, surgical, orthodontic, and interceptive problems. This condition usually is not related to any painful symptoms and cannot be detected on clinical examination. This article presents 3 cases of transmigration. In 1 case, the right canine was involved, which is considered to be especially rare. This case series also highlights the importance of early diagnosis for the interceptive treatment of transmigration.

Kissing dentigerous cysts involving mandibular canines: report of unusual case with review of literature

Dentigerous cysts are odontogenic developmental cysts, which mostly surround the crown of unerupted teeth, odontomas or supernumerary teeth. These cysts are mostly solitary in occurrence and their bilateral presentation is rare, especially in the absence of syndromes such as Maroteaux-Lamy, basal cell nevus or cleidocranial dysplasia. We present an unusual case of a 24-year-old female with nonsyndromic bilateral dentigerous cysts associated with unerupted mandibular canines that were diagnosed histopathologically as dentigerous cysts.

[Contemporary approach to diagnosis and treatment of impacted teeth]

BACKGROUND

Goal of the research was to study occurrence frequency of impacted teeth, to develop rational methods of diagnostics and treatment of denotalveolar and facial anomalies caused by impacted teeth.

PATIENTS AND METHODS

From 1989 for 2013 period of time 7172 patients with dentoalveolar anomalies, referred to our clinic for the orthodontic help were surveyed.

RESULTS

At 899 (12.53 +/- 0.39%) patients it is revealed 1405 impacted teeth, from them on the maxilla--623, on mandible--752 teeth. The most widespread impacted teeth on the maxilla were canines, on the mandible--the second premolars and the third molars. Treatment of impacted teeth by stimulation of their eruption by low-frequency ultrasound with a frequency of fluctuations of 26.5 kHz, intensity of 1 W/cm, with an amplitude of 40-60 microns and wave of 0.012 m long, daily or within 1 days, with period of 3-10 seconds with the course of treatment averaging 1-5 procedures, until a tooth eruption is carried out.

CONCLUSION

The way of stimulation developed by us for late erupted impacted permanent teeth on the basis of application physiologic for an organism low-frequency ultrasound promotes increase of efficiency and reduction of treatment terms of dentoalveolar and facial anomalies. The received positive results allow to recommend this method for adoption in orthodontic practice.

Panoramic radiography in evaluating the relationship of mandibular canal and impacted third molars in comparison with cone-beam computed tomography

This study evaluated the validity of panoramic radiography and cone beam computed tomography (CBCT) in the assessment of mandibular canal and impacted third molar. In this descriptive-analytical study, 58 mandibular third molars from 42 patients who showed a close relationship between impacted third molar and canal on panoramic radiographs were selected. They were then classified into seven radiographic markers in panoramic radiographs (superimposition, darkening of the root, interruption of the white lines, root narrowing, canal diversion, canal narrowing, and also closed distance in OPG <1mm). The groups of markers were further assessed with CBCT to see presence or absence of contact. The three most common markers seen in panoramic images are superimposition, interruption of white line and root darkening. In CBCT, superimposition marker always presented higher frequency of contact with canal compared to non-contact group. There are 31% of teeth presented with interruption of white lines and there are 29.3% of teeth presented with superimposition. About 55.6% and 35.3% of the impacted mandibular third molars which indicated interruption of white lines and superimposition also indicated contact in the CBCT respectively. Presence or absence of radiological sign in panoramic radiography was not properly predict a close relationship with third molar and it is suggested that in case of tooth-canal overlapping, the patient should be referred for CBCT assessment.

Pindborg tumor arising in association with an impacted supernumerary tooth in the anterior maxilla

Pindborg tumor/Calcifying Epithelial Odontogenic Tumor (CEOT) is a benign epithelial odontogenic tumor which shows locally aggressive behavior and accounts for less than 1% of all odontogenic tumors. The most frequent location is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla. Since histopathology remains the main method for definitive diagnosis, this lesion presents an enigma to a clinician when lesions occur in atypical locations. The authors report a case of CEOT in the maxillary anterior region associated with an impacted supernumerary tooth (mesiodens).

Unusual occurrence of missing central incisor: a case report

An unerupted maxillary central incisor is an uncommon finding in general dental practice. A thorough patient history and radiological examinations can reveal surprising findings. This article presents a case involving a dilacerated and impacted maxillary central incisor, examines its probable etiology, and discusses the condition in terms of pertinent literature.

[Primary failure of eruption: diagnostics, treatment, casus and review of literature]

Primary failure of eruption is a rare eruption disorder of above all, the permanent second and sometimes the first molars. It is characterized by infra occlusion of the molars resulting in a severe lateral open bite. Primary failure of eruption is a disorders which affects all molars distal to the most mesial involved tooth. Diagnosis is possible both clinically and with radiographs. A panoramic radiograph combined with clinical findings of impaction or infra occlusion can confirm the suspicion of primary failure of eruption. Primary failure of eruption cannot be treated as other eruption disturbances are. The teeth do not respond to orthodontic force. Exposure of the molar and orthodontic traction of a molar affected by primary failure of eruption is discouraged. Observation and extraction, in case the primary failure of eruption poses a risk to the healthy dentition, are the only two treatment options for young patients. Additional treatment of this eruption disorder should be carried out at an adult age and consists of prosthetic closure of the open bite.

Diagnosis and localization of impacted maxillary canines: comparison of methods

OBJECTIVES

Numerous clinical signs may be indicative of a canine impaction; however, studies determining the efficiency of visual inspection and digital palpation in localizing an impacted maxillary canine are sparse. Of the radiographic techniques, no studies have compared the accuracy of the horizontal and the vertical parallax techniques to determine the location of an impacted canine. Hence, the objectives of this study were to evaluate the efficiency of visual inspection and digital palpation, and to compare the accuracy of the horizontal and vertical parallax techniques in determining the location of an impacted maxillary canine.

METHODS

The study sample comprised the records of 522 patients who had attended a dental hospital. The location of an impacted maxillary canine was determined radiographically using the vertical and the horizontal parallax principles. The findings were then confirmed from the surgical records in those cases that had undergone surgical intervention of the impacted canine.

RESULTS

The position of the impacted canine was determined successfully by visual inspection and digital palpation in 85.3 and 85.2% of the cases respectively.

CONCLUSIONS

The vertical parallax technique demonstrated a higher degree of accuracy (97.7%) and a greater degree of diagnostic capability (98.2%) when compared with the horizontal parallax technique (92.6 and 78.0% respectively).

Audit of the Health Service Executive orthodontic referral pathway between 2009 and 2011 in the Dublin Mid-Leinster region

An audit was undertaken in 2009 to determine the success of the new national orthodontic referral protocol introduced to the Health Service Executive (HSE) in 2007 and operated in the Dublin Mid-Leinster HSE region. It was repeated in 2011 to determine if the HSE austerity measures have had a bearing on the orthodontic service performance in the Dublin Mid-Leinster HSE region. The audit also measured the success of referring practitioners in identifying the correct Index of Orthodontic Treatment Need (IOTN) classification of the patient. In the 2011 audit, the figures were broken down to identify the occlusal variables that caused dental practitioners most difficulties in identification. The audit demonstrates a good referral to assessment timeframe in 2009 (85-80% compliance for IOTN 5 and 4 within three to six months, respectively), which deteriorates significantly in 2011 (26-4% for IOTN 5 and 4 within three to six months, respectively). The ability of dentists to identify the correct IOTN classification was better in 2009 (60% correct) compared to 2011 (51% correct), but both figures fell below the audit standard of 75% of referrals with correct IOTN classifications. The IOTN occlusal dental health components most readily identified by referring practitioners and meeting audit standards were 5a (overjet >9mm), 5i (impacted teeth) and 5h (extensive hypodontia). The remaining occlusal dental health components in the HSE IOTN fell below the audit standard. The audit clearly identifies a requirement for a continued educational effort to maintain the HSE IOTN skill base in primary care, and a need for additional resources to manage the demand for orthodontic assessments.

Management of bilateral severely impacted mandibular second molars: a case report

Impaction of the mandibular second molar is relatively rare but when it occurs it may cause a clinical problem for orthodontist and oral surgeon. There are various treatment options to manage this condition depending on the degree of second molar inclination, the position of third molars, and the desired type of tooth movement. Here, a case of orthodontic uprighting of bilateral horizontal impaction of the lower second molars in a 17-years-old Thai female patient is presented. Correction of the impactions involved removal of the overlying third molars and use of full edgewise appliances with open NiTi-coil spring and super-elastic NiTi archwire.

[Failure in the orthodontic treatment of impacted maxillary canines]

Maxillary canine impaction occurs in 1-3% of most Western populations and its orthodontic treatment is often difficult. Failure to resolve the impaction is not uncommon and may lead to malpractice lawsuits. The information in the literature about the reasons for non-resolution of this condition is sparse and unsubstantiated. This encourages the dispensing of inappropriate treatment that may result in severe tooth, soft and hard tissue damage as well as a prolonged treatment period. This review describes the epidemiology, pathogenesis and the wide range of reasons that may lead to failure to resolve the canine impaction. It shows that a lack of appreciation of anchorage demands and inaccurate positional diagnosis of the 3-D location and orientation of impacted teeth are the major reasons for failure. In addition, the review shows that invasive cervical root resorption (ICRR) is a frequently undiagnosed or unrecognized cause of failure of orthodontic resolution of impacted canines, and should be distinguished from replacement resorption (ankylosis). Corrective measures which may lead to successful treatment are further recommended. Special emphasis is placed on the crucial role of cone beam computerized tomography in the accurate radiographic diagnosis and early detection of pathology of impacted tooth and damage to adjacent anchor teeth. The importance of teamwork in achieving the best treatment outcome is stressed.

[Becker's nevus and hemimaxillary hypoplasia: coincidence or syndrome?]

INTRODUCTION

Becker's nevus is a dermatological disease sometimes associated with a malformation such as hemifacial bone dysplasia.

OBSERVATION

A 11-year-old male patient presented with a delayed growth of the left maxillary and dental impactions. At 15 years of age, Becker's nevus appeared on the upper torso, both shoulders and cheeks. Le Fort I segmented osteotomy with an iliac bone graft was complicated because of maxillary dysplasia.

DISCUSSION

The chronology of our patient's cutaneous and maxillary abnormalities was similar to previously reported cases. Conversely, the Becker's nevus-bone dysplasia association has been reported only twice. It may not be a coincidence and could belong to a Becker's nevus syndrome.

Impacted maxillary canines: diagnosis and management

Canine impaction is a relatively frequent clinical presentation in dentistry, with challenges that should be resolved. A good understanding by the clinician of the situation and treatment options can have a significant impact on the treatment outcome. Therefore, clinicians should be competent to perform the proper investigation, provide a correct diagnosis, develop an optimum treatment plan, and render appropriate treatment for each individual patient so each patient realizes the best outcome possible.

Complications of misdiagnosis of maxillary canine ectopic eruption

Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption.

[Predictive factors of third molar eruption]

INTRODUCTION

We studied the prognosis of upper and lower third molar evolution.

PATIENTS AND METHODS

Seventy-eight patients were included after a clinical examination, dental casts, panoramic and lateral cephalometric radiographs on inclusion (T1) and two years after (T2). Five parameters were studied: retromolar space (RMS) between the third molar (M3) and the anterior ridge of the ramus; RMS/M3 crown diameter ratio, distances (PTV-M(1)) and (X(i)-Mi(2)); and third molar angle with occlusal plane.

RESULTS

They were noted at T1 and T2. The gain of retromolar space from T1 to T2 reached 1.2 to 2.2mm without extraction, 2 to 2.7mm with PM extraction, and 4.5 to 6.8mm with M1 extraction. The "RMS/M3 diameter" ratio increased in the maxilla from 0.6 to 0.8 and from 0.5 to 0.8 in the mandible (P=0.01) between T1 and T2. PTV-M1 increased significantly from 17.1 to 19.9mm (P<0.001), and Xi-M2i increased significantly from 18.5 to 22.4mm (P<0.001) between T1 and T2.

DISCUSSION

The extraction of premolars has little influence on the variation of the retromolar space; conversely first molar extraction increases that space. Prognosis techniques for the evolution of third molars are helpful when considering avulsion.

Cemento-osseous dysplasia-like lesion and complex odontoma associated with an impacted third molar

We present a case of a 36-year-old female with a benign fibro-osseous lesion consistent with cemento-osseous dysplasia (COD) that was located coronally to the crown of an impacted mandibular third molar tooth and was associated with a complex odontoma. The pathogenesis of this unusual association is discussed and the odontogenic origin of COD is suggested.

[Pediatric mandibular ameloblastic fibro-odontoma]

INTRODUCTION

Ameloblastic fibro-odontoma (AFO) is a very rare mixed odontogenic tumor (2% of all odontogenic tumors). It is considered as a non-extensive non-aggressive tumor but recurrence and malignant transformation remain possible. We report a voluminous AFO in a child.

CASE REPORT

A 7-year-old boy presented with a right mandibular and facial swelling. The panoramic radiograph and CT scan revealed a voluminous unilocular radiolucent lesion (10 cm) with an impacted tooth that involved the ramus area and the angle of the right mandible. Enucleation and curettage was performed with a good outcome. There was no recurrence at ten months.

DISCUSSION

This case is exceptional because of the young patient's age, the large tumor diameter, and the good outcome after ten months. This tumor occurs more often in the posterior region of the mandible and is frequently seen in the first two decades of life. The diagnosis is made on radio-clinical data and may be confirmed by histology. A surgical treatment with complete tumor removal is recommended to prevent recurrence.

SEITO - Stockholm Eastman Index of Treatment Outcome

To obtain high quality in orthodontics; it is important to evaluate the treatment. There are many indices for evaluation of treatment outcome however all of them compare treatment outcome with ideal occlusion. Therefore Stockholm Eastman Index of Treatment Outcome (SEITO) was invented. This index relates the treatment outcome to the treatment goal. SEITO is a morphological index based on criteria from the records including study casts, and/or intra oral photos.

METHOD

The outcome of treatment is related to the treatment goal as stated in the records. Pre-treatment goals are divided into subgroups; overjet, vertical relation anterior/lateral), anterior cross bite, transverse relations, impacted teeth and space crowding/ spacing. Each subgroup is scored; the points are 0, 1, 3 or 5 depending on the severity of the malocclusion. The points for each subgroup are added to give a total sum of treatment goal points. Each post-treatment subgroup above is evaluated. If the treatment goal is fulfilled, the treatment outcome points are equal to the treatment goal points. If not - there is a reduction in the outcome points. Finally the outcome points are expressed as a percentage of the treatment goal points and form a measure of the success of treatment.

CONCLUSION

SEITO index is a simple and quick way to obtain a picture of the quality of treatment outcome, and the only orthodontic index that relates the treatment outcome to the treatment goal.

Non-syndromic multiple supernumerary teeth in a family unit with a normal karyotype: case report

Introduction. Hyperdontia is an odontostomatologic anomaly characterized by an excess in tooth number. It seems to occur more often in patients with hereditary factors concerning this anomaly: this case represents a rare form of hyperdontia, with bilateral multiple supernumerary teeth, with evident penetrance of the phenotype in the family unit engaged in the present study. The karyotype determination excludes a pathogenesis on chromosomal basis.Case report. A 30 years old patient came to our observation with five impacted teeth (1.8, 2.8, 3.8, 4.7 and 4.8), as well as with the presence of an impacted supernumerary tooth (distomolar 4.9). The patient was suggested to allow us to perform a radiologic screening to his two sisters aged 17 and 13 years.The X-ray photography showed that the elder sister had nine impacted teeth; these were 1.8 - 1.9 - 2.8 - 2.9 - 2.10 - 3.8 - 3.9 - 4.8 - 4.9; while the youngest sister had four impacted teeth, that is 1.8 - 1.9 - 2.8 - 2.9.Conclusions. The value of the present case report can be used as a paradigm for the assessment of the hereditary factors predisposing the onset of hyperdontia, and for the consequent management by oral surgeon of family units in which the odontostomatologic anomaly was detected without any syndromic forms.

[Means of localization of impacted canines: new update]

Canine impaction is a phenomenon enough current in dental practice. It can have more or less complex consequences. The management of impacted canine requires accurate knowledge of its exact position in three-dimensional space. Indeed, authors report very different locations (palatal position between 50 and 85%). At our disposal clinical means and conventional and digital radiological investigations each have their own advantages and disadvantages. With the multitude of ways of localization, practitioners must be able to prescribe the most "targeted" investigation ever. This is prerequisite for any successful orthodontic therapy and/or surgery. This work intends to review different clinical and radiographic investigations available and discuss their relevance in terms of location accuracy of the impacted canine.

Analysis of impacted and retained teeth operated at Department of Oral Surgery, School of Dental Medicine, Zagreb

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8- (38.64%), -8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses -8 and 8- are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000.

Impact of guideline implementation on patient care: a cluster RCT

In Western European countries, dentists use standardized procedures, rather than individualized risk assessment, for routine oral examinations. The predictive hypothesis was that guideline implementation strategies based on multifaceted interventions would be more effective in patient care than the dissemination of guidelines only. A cluster-randomized trial was conducted, with groups of general dental practitioners (GDPs) as the unit of randomization. Patients were clustered within practices and prospectively enrolled in the trial. Patient data were collected from registration forms. The primary outcome measure was guideline-adherent recall assignment, and a secondary outcome measure was guideline-adherent bitewing frequency. The interventions consisted of online training, guideline dissemination, and educational sessions. For low-risk patients, guideline-adherent recall increased in the intervention group (+8%), which differed from the control group (-6.1%) (p = 0.01). Guideline-adherent bitewings showed mixed results. We conclude that multifaceted intervention had a moderate but relevant effect on the performance of GDPs, which is consistent with other findings in primary care.

Central incisor impacted by an odontoma

AIM

The aim of this report is to present a clinical case of impaction of a maxillary left central incisor in a mixed dentition caused by the presence of an odontoma as well as a review of the pertinent dental literature.

BACKGROUND

Knowledge of the normal tooth eruption patterns is essential for the identification and appropriate treatment of deviations in eruption that may endanger physiologic development. A delay in time between the exfoliation of a deciduous tooth and the eruption of its permanent successor may be related to a disorder known as dental retention. This occurs when tooth eruption does not occur within a normal time frame, the tooth is not present in the dental arch, and there is no potential for eruption due to the presence of a completely formed root or when the homologous tooth has been erupted for at least six months with complete root formation.

REPORT

A 10-year-old boy in the mixed dentition stage presented with an impacted maxillary left central incisor due to the presence of an odontoma. Treatment included the surgical removal of the lesion and the follow up of the spontaneous eruption while a partial fixed appliance was used to recover the space of the missing tooth. Since spontaneous eruption failed to occur within the expected time frame, surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption.

SUMMARY

The incisor was integrated to the dental arch without any root or periodontal sequelae. The treatment was considered a success, since both health and aesthetics of the smile were recovered. The importance of the clinical and radiographic diagnosis of the retention of a permanent tooth associated with a pathological entity should be emphasized. The participation of a multidisciplinary team to accomplish the appropriate treatment of such patients is extremely relevant because of the esthetic and functional ramifications of a missing anterior tooth as well as the psychological well-being of the individual.

[Orthodontics in general practice 4. Impaction of maxillary front teeth]

Eruption failures in the maxillary frontal region occur during the mixed dentition period. Dislocation and impaction of central incisors are diagnosed during or at the end of the early mixed dentition stage. These failures can be caused by crowding, premature loss of deciduous teeth, trauma or supernumerary teeth. Occasionally, a preventive orthodontic treatment is desirable to release the obstructed eruption path of a canine. Sometimes, a surgical intervention may be indicated to expose an obstructed central incisor and to remove supernumerary teeth. Retention and impaction of canines are generally discovered late in or after the late mixed dentition stage. In the agenesis of the lateral incisors or peg-shaped teeth, there is frequently impaction of the canines. General dental practitioners must be alert for possible deviations in the pattern of change in dentition right from the early mixed dentition period. Conventional two-dimensional radiographs can sometimes unjustifiably suggest a bad prognosis of an impacted tooth. Cone-beam CT scanning, which gives a three-dimensional image, can provide important additional diagnostic information.

Various root abnormalities. Report of three cases

Disturbances during morphodifferentiation of tooth germs are rare in the permanent dentition. Reasons for abnormalities are: trauma (fighting, falling, any sport activity) occurring during the eruption; mechanical blockage of the path of eruption by neoplasms; cysts; supernumerary teeth; therapeutic irradiation of the area; and orthodontic treatment. Abnormalities are classified as dilaceration, extra root formation, double root formation, concrescence, rizomegali and hypercementozis. In this article, three different root abnormalities are presented.