Impacted Permanent Teeth Research Articles

Cleidocranial dysplasia: Spectrum of clinical and radiological findings in seven cases

Introduction: Cleidocranial dysplasia (CCD) is an autosomal dominant disorder primarily affecting bones, which undergo membranous ossification. It commonly presents with significant dental and facial problems, including the hypoplastic maxilla, retained primary teeth, unerupted permanent teeth and supernumerary teeth. It is usually diagnosed based on clinical and radiographic findings, which are pathognomic. Here, we report clinical and radiographic findings of 7 patients with CCD who reported to our Institute during 2013-2014. Results: Age of patient ranged from 13 to 55 years, out of which 5 were males and 2 were females. Characteristic clinical findings, which were present in all cases include frontal and parietal bossing, brachycephalic skull, hypertelorism, broad nasal bridge and shoulder hypermobility. Radiographic findings seen were hypoplasia/aplasia of the clavicle, open skull suture, wide, open fontanel, and the presence of impacted permanent and supernumerary teeth. In one case, there was follicular cyst associated with impacted mandibular canine. Conclusion: Successful treatment involves a multidisciplinary approach and involves timely diagnosis at an early stage of development

The study of barium concentration in deciduous teeth, impacted teeth, and facial bones of Polish residents.

The study determines the concentration of Ba in mineralized tissues of deciduous teeth, permanent impacted teeth, and facial bones. The study covers the population of children and adults (aged 6-78) living in an industrial area of Poland. Teeth were analyzed in whole, with no division into dentine and enamel. Facial bones and teeth were subjected to the following preparation: washing, drying, grinding in a porcelain mortar, sample weighing (about 0.2 g), and microwave mineralization with spectrally pure nitric acid. The aim of the study was to determinate the concentration of Ba in deciduous teeth, impacted permanent teeth, and facial bones. The concentration of barium in samples was determined over the ICP OES method. The Ba concentration in the tested bone tissues amounted to 2.2-15.5 μg/g (6.6 μg/g ± 3.9). The highest concentration of Ba was present in deciduous teeth (10.5 μg/g), followed by facial bones (5.2 μg/g), and impacted teeth (4.3 μg/g) (ANOVA Kruskal-Wallis rank test, p = 0.0002). In bone tissue and impacted teeth, Ba concentration increased with age. In deciduous teeth, the level of Ba decreased with children's age.

기저세포 모반 증후군 : 증례보고

기저세포 모반 증후군은 상염색체 우성 방식으로 유전되는 질환으로 다발성 각화낭성 치성종양, 대두증 및 두정골 융기, 골격계 기형 등을 보이는 질환이다. 다발성 각화낭성 치성 종양, 두정골 융기, 양안격리증을 가진 만 11세 환자의 하악과 상악에서 발생한 다양한 크기의 낭종에 대한 적출술과 이종골 이식술을 시행 후 교정적 견인을 시행하였다. 낭종에 의한 매복 영구치를 가진 성장중인 기저세포 모반 증후군 환자에서의 보존적인 치료를 하였기에 문헌고찰과 더불어 보고하고자 한다. The basal cell nevus syndrome is also known as the Gorlin-Goltz syndrom. It is a dominant autosomal disorder which is characterized by keratocystic odontogenic tumors in the jaw, skeletal abnormalities, and multiple basal cell nevi carcinomas. This study reports an 11-year-old boy with multiple odontogenic keratocysts in the jaw, hypertelorism, and frontal bossing. When a young patient has cystic lesions with an impacted permanent teeth, it is important to preserve the teeth. For a growing patient with impacted permanent teeth, a more conservative method is suggested, which will enable the preservation the permanent teeth in Gorlin-Goltz syndrome.

Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report

In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

Adenomatoid odontogenic tumor of maxilla in a 14-year-old child

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin, constituting only 0.1% of tumors and cysts of the jaw and 3% of all odontogenic tumors. A 14-year-old girl presented with right maxillary anterior swelling, facial asymmetry, continuously increase in size of swelling without any symptoms, and delayed eruption of permanent teeth. Orthopantomogram and computed tomography scan revealed a large unilocular radiolucency in right maxilla with permanent lateral incisor embedded within the lesion and permanent canine pushed away from its normal position. Cyst was enucleated completely under general anesthesia along impacted permanent teeth and retained deciduous teeth. Postoperative period was uneventful.

Cleidocranial dysplasia case report: remodeling of teeth as aesthetic restorative treatment.

Cleidocranial dysplasia (CCD), is an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals. It is generally characterized by orofacial manifestations, including enamel hypoplasia, retained primary teeth, and impacted permanent and supernumerary teeth. The successful treatment involving a timing intervention (orthodontic-maxillofacial surgeons-restorative) is already described. However, the restorative treatment might improve the aesthetic final result in dentistry management for patients with cleidocranial dysplasia. Objective. Therefore, this clinical report presents a conservative restorative management (enamel microabrasion, dental bleaching, and direct composite resin) for aesthetic solution for a patient with CCD. Clinical Considerations. The cosmetic remodeling is a conservative, secure, and low cost therapy that can be associated with other procedures such as enamel microabrasion and dental bleaching to achieve optimal outcome. Additionally, the Golden Proportion can be used to guide dental remodeling to improve the harmony of the smile and the facial composition. Conclusions. Thus, dentists must know and be able to treat dental aesthetic problems in cleidocranial dysplasia patients. The intention of this paper is to describe a restorative approach with the cosmetic remodeling teeth (by grinding or addicting material) associated with enamel microabrasion and dental bleaching to reestablish the form, shape, and color of smile for patients with cleidocranial dysplasia.

Cleidocranial dysplasia presenting with retained deciduous teeth and impacted permanent and supernumerary teeth

Cleidocranial dysplasia is a disease that occurs secondary to a dominant autosomal inheritance. There is no predilection for any genre or ethnic group. As there is a delay in the eruption and/or absence of permanent teeth, the patients usually report to a dental surgeon for replacement of the missing teeth. This condition is characterized by several cranial malformations and underdevelopment, absence of clavicles, and multiple impacted supernumerary and permanent teeth. The diagnosis of the condition is usually based on the presence of the above-mentioned main features and on clinical and familial evidence. Here we report a rare case of cleidocranial dysplasia in a male patient, having most of the characteristic features of this syndrome.

A Rare Co-occurrence of Amelogenesis Imperfecta and Various Non-Enamel Manifestations In Siblings-Report of two Cases

Amelogenesis Imperfecta (AI) is a hereditary enamel defect which is characterized by developmental abnormalities in the quantity and/ or quality of enamel. This condition has been associated with dental anomalies, including taurodontism, congenitally missing teeth, delayed eruption, crown resorption, pulpal calcifications and odontogenic fibromas. This paper presents two cases of AI which were associated with multiple impacted permanent teeth in both the cases; and pulpal calcifications and pericoronal odontogenic fibromas of W.H.O type additionally, in one of the cases.

Contemporary approach to diagnosis and treatment of impacted teeth

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

Yunis-Varón Syndrome Is Caused by Mutations in FIG4, Encoding a Phosphoinositide Phosphatase

Yunis-Varón syndrome (YVS) is an autosomal-recessive disorder with cleidocranial dysplasia, digital anomalies, and severe neurological involvement. Enlarged vacuoles are found in neurons, muscle, and cartilage. By whole-exome sequencing, we identified frameshift and missense mutations of FIG4 in affected individuals from three unrelated families. FIG4 encodes a phosphoinositide phosphatase required for regulation of PI(3,5)P(2) levels, and thus endosomal trafficking and autophagy. In a functional assay, both missense substitutions failed to correct the vacuolar phenotype of Fig4-null mouse fibroblasts. Homozygous Fig4-null mice exhibit features of YVS, including neurodegeneration and enlarged vacuoles in neurons. We demonstrate that Fig4-null mice also have small skeletons with reduced trabecular bone volume and cortical thickness and that cultured osteoblasts accumulate large vacuoles. Our findings demonstrate that homozygosity or compound heterozygosity for null mutations of FIG4 is responsible for YVS, the most severe known human phenotype caused by defective phosphoinositide metabolism. In contrast, in Charcot-Marie-Tooth disease type 4J (also caused by FIG4 mutations), one of the FIG4 alleles is hypomorphic and disease is limited to the peripheral nervous system. This genotype-phenotype correlation demonstrates that absence of FIG4 activity leads to central nervous system dysfunction and extensive skeletal anomalies. Our results describe a role for PI(3,5)P(2) signaling in skeletal development and maintenance.

Dental anomalies in a Portuguese population

The aim of this study was to evaluate the prevalence and pattern of agenesis, supernumerary teeth, impacted teeth and transpositions, as well as the relation between them, in a Portuguese sample. The study sample consisted of 2888 patients, observed between 2005 and 2009 at the Dentistry Clinic of the Instituto Superior de Ciências da Saúde-Norte (ISCSN, Portugal). The study included evaluation of the following parameters: agenesis of all teeth, supernumerary teeth, impacted permanent teeth and tooth transposition. The age range varied from 7 to 21 years. In order to study the absence of the third molar, subjects aged below 14 years were excluded. Statistical analysis was performed using SPSS(®). Excluding third molars, the prevalence of tooth agenesis, supernumerary teeth, impacted teeth and transpositions was 6.1%, 0.8%, 1.8% and 0.2%, respectively, for this Portuguese population. There was a significantly higher prevalence of supernumerary teeth in males than in females (P < 0.05). The mesiodens was the most frequent supernumerary tooth, the upper canine was the most frequent impacted tooth, and the upper canine and upper lateral were the two most frequently transposed teeth. There was a significantly higher prevalence of missing third molars in the impacted canine group than in the non-impacted canine group (P < 0.05). Agenesis is the most frequent dental anomaly. There are no differences between genders, except for supernumerary teeth, which are found more frequently in men. A relation between third molar agenesis and impacted canines was found.

Simultaneous Occurrence of Dens Invaginatus and Fusion

Although Dens invaginatus and fusion are well-known and well established dental anomalies, they are rarely seen in supernumerary teeth. In this article, simultaneous occurrence of Dens invaginatus and fusion between maxillary lateral incisor and a supernumerary tooth is described. Dens invaginatus is clinically significant due to the possibility of the pulpal involvement; pulpitis, necrotic pulps and chronic periapical lesions are often associated with this anomaly without clinical symptoms. Fusion has a negative impact on the aesthetics, especially when it occurs in maxillary anterior teeth. It is difficult to clinically make differential diagnosis between fused teeth and geminated teeth, especially when these anomalies take place together with hypodontia or supernumerary tooth. It has been found that sequel of such teeth may result in delayed eruption, ectopic eruption or even impaction of permanent teeth; hence proper diagnosis by clinical and radiographic methods and intervention at appropriate time is of paramount importance. The accurate knowledge of variations in morphology of tooth and pulp cavity greatly assists the dentist in planning successful treatment options.

An infected dentigerous cyst associated with an impacted permanent maxillary canine, inverted mesiodens and impacted supernumerary teeth

A dentigerous cyst is an odontogenic cyst associated with the crown of the impacted or unerupted teeth. Such cyst remain initially completely asymptomatic unless when infected and can be discovered only on routine radiographic examination. Here, such a case of dentigerous cyst, which was discovered on routine radiographic examination, is discussed here.

Orthodontic and surgical management of cleidocranial dysplasia

Cleidocranial dysplasia (CCD), an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals, is mainly caused by mutations in Runx2, a gene required for osteoblastic differentiation. It is generally characterized by hypoplastic clavicles, narrow thorax, and delayed or absent fontanel closure. Importantly, its orofacial manifestations, including midfacial hypoplasia, retained primary teeth, and impacted permanent and supernumerary teeth, severely impede the well-being of affected individuals. Successful treatment of the orofacial problems requires the combined efforts of dental specialists. However, only a few successfully treated cases have been reported because of the rarity of CCD and complexity of the treatment. This article presents the University of California, San Francisco (UCSF) treatment protocol for the dentofacial manifestations of CCD based on two treated and 17 diagnosed cases. The records of two patients with CCD who had been treated at the UCSF School of Dentistry and the treatment options reported in the literature were reviewed. The UCSF treatment protocol produced a successful case and a partially successful one (inadequate oral hygiene in the retention stage resulted in decay and loss of teeth). It provides general guidelines for successfully treating the orofacial manifestations of CCD.

Imaging in the diagnosis of a rare anomaly: Cleidocranial dysplasia

Cleidocranial dysplasia (CCD) is a rare autosomal dominant and developmental anomaly of skeleton characterized by generalized dysplasia of the bones and teeth. CCD is caused by mutation of transcription factor RuNx2, although 40% of the cases appear spontaneously with no apparent genetic cause. The disorder presents with partial or complete absence of clavicles, open anterior fontanelle, and cranial sutures, presence of multiple wormian bones, short stature, wide pubic symphysis, short middle phalanges of the 5 th finger, over retained deciduous teeth, multiple impacted permanent and supernumerary teeth and various other abnormalities. The frequency of this disorder is one/million individuals. Early diagnosis of CCD is essential for initiating the appropriate treatment approach. In confirmed cases, genetic counseling for family planning should certainly be advised. Because of its rarity, we report the classical case of CCD, with an emphasis on the importance of clinical and radiographic findings.

Submerged mandibular carious deciduous second molar along with an impacted second premolar associated with an atypical inflammatory follicular cyst: A rare case report

The author presents a case of submerged carious deciduous molar along with an inflammatory atypical follicular cyst associated with an impacted mandibular second premolar in the right mandible identified through clinical and routine radiological examination including cone beam computed tomography and histopathology. The involvement of submerged deciduous molar with dental caries by itself a rare occurrence and an impacted permanent premolar tooth associated with an infected follicular cyst is still more a rare event.

Bilaterally Symmetrical Multiple Impacted Permanent Teeth in a Nonsyndromic Patient: A Rare Finding

ABSTRACT While impaction of tooth is widespread and common, multiple impacted teeth by itself is a rare condition which often is found in association with syndromes and also rarely reported in the literature. In some cases, however, impaction of multiple teeth is not accompanied by a fixed complex of symptoms. A 51- year-old male reported to our clinic with pain and sensitivity of his maxillary right last molar and mandibular anteriors respectively. IOPA and panoramic views revealed 4 impacted teeth in mandible (bilateral cuspids and I bicuspids) and 6 impacted teeth in maxilla (bilateral cuspids, I and II bicuspids). A total of 10 permanent teeth were impacted. In our case medical and family history along with extraoral examination were not suggestive of any syndrome or metabolic disorder. The rareness is the bilateral symmetrical pattern of impaction. How to cite this article Joyce S, Mathias V, Rao BHS. Bilaterally Symmetrical Multiple Impacted Permanent Teeth in a Nonsyndromic Patient: A Rare Finding. World J Dent 2013;4(1):72-73.

Interaction between IRF6 and TGFA Genes Contribute to the Risk of Nonsyndromic Cleft Lip/Palate

Previous evidence from tooth agenesis studies suggested IRF6 and TGFA interact. Since tooth agenesis is commonly found in individuals with cleft lip/palate (CL/P), we used four large cohorts to evaluate if IRF6 and TGFA interaction contributes to CL/P. Markers within and flanking IRF6 and TGFA genes were tested using Taqman or SYBR green chemistries for case-control analyses in 1,000 Brazilian individuals. We looked for evidence of gene-gene interaction between IRF6 and TGFA by testing if markers associated with CL/P were overtransmitted together in the case-control Brazilian dataset and in the additional family datasets. Genotypes for an additional 142 case-parent trios from South America drawn from the Latin American Collaborative Study of Congenital Malformations (ECLAMC), 154 cases from Latvia, and 8,717 individuals from several cohorts were available for replication of tests for interaction. Tgfa and Irf6 expression at critical stages during palatogenesis was analyzed in wild type and Irf6 knockout mice. Markers in and near IRF6 and TGFA were associated with CL/P in the Brazilian cohort (p<10−6). IRF6 was also associated with cleft palate (CP) with impaction of permanent teeth (p<10−6). Statistical evidence of interaction between IRF6 and TGFA was found in all data sets (p = 0.013 for Brazilians; p = 0.046 for ECLAMC; p = 10−6 for Latvians, and p = 0.003 for the 8,717 individuals). Tgfa was not expressed in the palatal tissues of Irf6 knockout mice. IRF6 and TGFA contribute to subsets of CL/P with specific dental anomalies. Moreover, this potential IRF6-TGFA interaction may account for as much as 1% to 10% of CL/P cases. The Irf6-knockout model further supports the evidence of IRF6-TGFA interaction found in humans.

Intraosseous and erupted compound odontoma: A report of two cases

PurposeOdontomas, one of the most common benign odontogenic tumors of epithelial and mesenchymal origin, are actually hamartomas or developmental anomalies composed of enamel, dentin, cementum and pulp tissue. Clinically, they may be classified as intraosseous and peripheral odontomas. Very rarely, intraosseous odontomas may erupt into the oral cavity and are termed as erupted odontomas. Although most of the odontomas are asymptomatic, yet these are often associated with tooth eruption disturbances and malocclusion. Presented are two variant forms of compound odontomas, one intraosseous and the other erupted odontoma, causing impaction of permanent teeth and malocclusion in children.

Management of bilateral impacted upper canines by single tooth dento-osseous osteotomy

When it is difficult to treat impacted teeth with orthodontic traction, surgical techniques including intentional luxation, autografts and distraction osteogenesis may be performed. However, these techniques are associated with problems such as root resorption, gingival recession and pulp circulatory disorders after extrusion. Single tooth dento-osseous osteotomy is considered to be a surgical technique with minimal effect on the pulp and periodontium. We used this method to treat a patient with impacted permanent canine teeth. After concomitant single tooth dento-osseous osteotomy and orthodontic treatment, root resorption of the bilateral canines was kept to a minimum and pulp vitality was confirmed. This method may be effective in patients in whom ordinary traction is difficult.