Pericoronal Space Research Articles

Pre-eruptive intramural resorption in unerupted teeth: a cone-beam computed tomography evaluation of prevalence and related factors

ObjectivePre-eruptive intramural resorption (PEIR) is defined as an abnormal, well-circumscribed radiolucency within the coronal dentin of the tooth, which is often overlooked in plain radiographs. This study aimed to investigate the prevalence of PEIR and its related factors using cone-beam computed tomography (CBCT).MethodsCBCT images of 590 unerupted teeth were evaluated for the presence of PEIR, location of PEIR, number of lesions in the affected tooth, PEIR score, tooth angulation, tooth position, and pericoronal space. Binary logistic tests were used to analyze the association between the characteristics of PEIR and the patient’s demographic data and related factors.ResultsThe tooth prevalence of PEIR was 13.6% among unerupted teeth. However, it was noteworthy that 19.2% of the unerupted teeth with PEIR were planned to be kept. PEIR was significantly associated with transverse (p = 0.020), inverted-angulated (p = 0.035), and centrally-positioned teeth (p = 0.043). The severity of PEIR was more pronounced in teeth with distal (p = 0.019), lingual (p = 0.023), or inverted-angulated (p = 0.040) positions, and in the absence of pericoronal space (p = 0.036).ConclusionPEIR should be suspected in transverse, inverted-angulated, centrally positioned unerupted teeth, particularly in molars, with no pericoronal space. Further monitoring through CBCT is recommended in such cases.Clinical relevanceThe management of unerupted teeth does not always involve surgical removal. Instead, they could be utilized for artificial eruption or tooth transplantation. The present study emphasizes the significance of early detection of PEIR. Clinical recommendations for screening PEIR in unerupted teeth are also proposed, which can be applied to routine plain radiographs.

Correlation of Pericoronal Radiolucency Around Impacted Mandibular Third Molars Using CBCT with Histopathological Diagnosis: A Prospective Study

Purpose: This study aimed to correlate the pericoronal width surrounding impacted mandibular third molars with their histopathological findings. Materials and Methods: The present study included patients who were advised for extraction of impacted mandibular third molars with the pericoronal radiolucency radiographically. The CBCT scans were compared with histopathologic findings of the follicles. Results: Out of 70 patients evaluated histopathologically, 24 patients showed mild inflammatory changes, whereas 34 patients revealed cystic changes suggestive of a dentigerous cyst, followed by 12 patients showing evidence of calcifications in the pericoronal follicles. The dentigerous cyst was more likely to occur if the bucco-lingual width of the pericoronal radiolucency was 14.00-16.00mm, and calcifications were found to be most likely present if the buccolingual width was 12.00-14.00mm, both of which were statistically significant. Conclusion: CBCT can be a reliable tool in the evaluation of pericoronal follicular space, and the values in different dimensions can be an accurate predictor radiologically for the diagnosis of pathologies when compared to 2D imaging.

Histopathological features assessment of suspected pathologic pericoronal tissue of embbeded teeth

ObjectiveThis study aims to evaluate the incidence of the histopathological status of suspected pathologic pericoronal tissues of asymptomatic embedded teeth. Materials & methodsA total number of 298 specimens from 274 patients without any significant symptomatic signs and symptoms were collected. Radiological and histopathological examinations were done for the participants and the results were recorded. Sizes of the dental follicles in the radiograph were reassessed and grouped as less than 2.5 mm and 2.5 mm and above. The widest region of dental follicular space was measured by tracing the tooth contours and pericoronal space on tracing paper with caliper scale. Findings of histological diagnosis were analyzed for associations with sex, age and size of the dental follicle. ResultsBiopsy results of follicular tissues showed pathological lesions such as dentigerous cyst, odontogenic keratocyst, chronic nonspecific inflammatory tissue and ameloblastoma. 48 % showed histologic changes suggestive of normal follicle and 52 % were suggestive of pathological entities. Most pathologies were encountered in the third decade and there was an increase incidence of pathological entities as the age of the patient increased at a statistical significance level of 0.01 (P = .001). There was the male predominance of incidence of pathological changes but there was no statistical significance between the follicle size group and the histologic results of the dental follicles. ConclusionThis study showed that the incidence of the histopathological status of suspected pathologic pericoronal tissues of asymptomatic embedded teeth increased following the increase age. Therefore, the suggestion of asymptomatic embedded tooth should be removal consideration.

GUBERNACULUM DENTIS IN A TRANSMIGRATING CANINE: CASE REPORT AND LITERATURE REVIEW

Background Gubernaculum dentis (GD) is an anatomic structure, described in the literature as an eruption pathway from the dental follicle to the gingiva for permanent teeth.1 This is the first reported case of a GD associated with a transmigrating canine.2 Clinical and Radiologic Findings A 60-year-old female of Indian origin presented for evaluation for implant placement to replace a clinically missing lower canine tooth. Her medical history was unremarkable. Cone beam computed tomography (CBCT) of the mandible was performed, and the image demonstrated the presence of a corticated tract of low density, contiguous with the dental follicle of the horizontally displaced and impacted mandibular left canine. The tract extended from the pericoronal space around the impacted tooth toward the alveolar crest. The structure measured 2 cm long and 2 mm wide. Differential or Definitive Interpretation On the basis of the clinical and radiographic findings, this structure was diagnosed as GD and had to be differentiated from bone trabeculae, medullary spaces, neurovascular bundles, or sinus tracts. Because this is considered a normal anatomic structure, no biopsy was indicated.1 Discussion Histologically, GD consists of a fibrous band running in the bony channel that connects the pericoronal follicular tissue of the successional tooth with the overlying gingiva. Typically, GD opens on the alveolar bone crest behind the deciduous teeth. Radiographically, GD appears as a corticated tract of low density, contiguous with the dental follicle of an unerupted tooth on CBCT.3 It would be difficult to visualize the very thin and round radiolucent structures with a diameter of only 1 to 3 mm on 2-dimensional radiographs. In addition, the structure lies in the spongy bone of the maxilla and the mandible. Therefore, GD has not received adequate attention in dental fields, including oral and maxillofacial radiology.

Histopathologic evaluation of follicular tissues associated with impacted lower third molars

Context:Previous studies have reported that the dental follicular tissues associated with impacted lower third molars (ILTMs) may undergo cystic degeneration and/or neoplastic transformation. This is especially likely when the pericoronal space is >2.5 mm on intraoral radiographs and >3 mm on panoramic radiographs and to examine dental follicular tissue for pathological changes in patients with ILTMs and pericoronal radiolucencies of <2.5 mm.Aim:Histopathological evaluation of follicular tissues associated with ILTMs.Materials and Methods:The morphology of the hematoxylin and eosin-stained follicular tissues of 146 such impactions were studied.Results:On microscopy, no cystic structures with fibrous walls were identified. 85 cases (58%) showed fibrous or myxomatous connective tissue and no epithelial elements. 61 cases (42%) showed epithelial elements in addition to fibrocollagenous tissue. Of these, 16 cases exhibited epithelium, of which 13 cases showed reduced enamel epithelium and three cases showed squamous metaplasia/non-keratinized stratified squamous epithelium.Conclusions:All asymptomatic unerupted third molars with pericoronal radiolucency of <2.5 mm should be retained since they do not exhibit cyst formation microscopically.

Incidence of cystic changes in impacted lower third molar

To assess the incidence of cystic changes in the impacted lower third molar (ILTM) in which the pericoronal (follicular) space is less than 2.5 mm as measured from the radiograph. The relationship between the cystic changes and patient's age, sex, and angular position and contact of ILTM with adjacent tooth was also evaluated. Follicular space less than 2.5 mm as measured from the panoramic radiograph was included in the study. A total of 73 tissue samples collected during the extraction ILTM were examined histopathologically. Then the data were analyzed for associations with age, sex, angular position, and contact of the ILTM with an adjacent tooth. There were 37 male and 36 female patients, age ranging from 17 to 35 years (mean 23.95 years). Out of 73 specimens, 17 (23.3%) showed cystic changes; among them 16 (22.1%) showed dentigerous cysts and 1 (1.2%) showed odontogenic keratocysts. Most of the cystic changes occurred in the 26-30 year age range. The cystic changes showed male predominance but could not gain statistical significance. The relationship between cystic changes and angular position was statistically significant (P < 0.05). Higher probability was found in distoangular positioned ILTM. The relationship between cystic changes and communication of ILTM with the second molar was not statistically significant. Incidence of cystic changes in ILTM justifies extraction of the impacted tooth associated with symptoms. The decision to extract or not to extract impacted third molar should be individualized, rather than generalized.

Apicotomy as Treatment for Failure of Orthodontic Traction

Objective. The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique. Case Report. A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test. Conclusion. Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.

A study on dentigerous cystic changes with radiographically normal impacted mandibular third molars.

Dentigerous cyst develops in the follicular tissue surrounding the impacted lower third molar. A study was carried out to know the incidence of Association of Dentigerous cyst with radiographically normal impacted lower third molars and to draw the attention of the Oral Surgeons towards the prophylactic removal of impacted third molars. A prospective study was done on 30 patients with impacted lower third molars which were indicated for extraction. The follicle tissue surrounding the impacted tooth was subjected for histopathologic investigations. Only those teeth with a radiographic finding of pericoronal space of less than 2.5mm were considered. Two Oral Pathologists reviewed the slides for any changes suggestive of cystic pathology. Pathologic changes suggestive of Dentigerous cyst was found in 7 of the 30 follicular tissue sent for histopathologic testing. It was found to be statistically significant (P<0.001). This study shows statistically high incidence of Dentigerous cyst association with radiographically normal impacted lower third molar teeth. Hence the Oral and Maxillofacial surgeons should consider histopathologic evaluation and radiographic diagnosis in the management of impacted lower third molars. Prophylactic extractions of normal impacted lower third molars should be considered as a treatment option.

Interleukin-1 beta, interleukin-6 and TGF-beta in follicular tissue of impacted third molars

The clinical evaluation and management of impacted third molars remain challenging. The aim of the present study was to investigate possible associations between follicular tissue cytokines and radiographic manifestations of impacted third molar. The population included 72 patients who underwent surgical extraction of impacted third molars. All these patients underwent a preliminary panoramic radiograph. Levels of interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and transforming growth factor beta (TGF-β) in tissue extracts were determined using ELISA. There were no significant differences between bony and tissue impaction as regards IL-1β, IL-6 and TGF-β levels. Moreover, the same results were obtained as far as the amount of pericoronal space and the presence or absence of a history of pericoronitis are concerned. These results suggest that radiographic findings or a history of pericoronitis are not associated with levels of expression of pro-inflammatory cytokines in patients undergoing surgical removal of impacted third molars. However, further studies are needed to address the possibility of variability during disease progression.

Conservative treatment of unicystic ameloblastoma

Ameloblastomas are benign asymptomatic intraosseous lesions that affect the bones of the maxillomandibular complex, interfering both in function and facial esthetic appearance. A 14-year-4-month-old girl was referred by her clinician complaining her anterior teeth were crooked and inclined forward. The lower left mandibular tooth presented with increased pericoronal space compatible with dentigerous cyst. The aim of this report is to relate a case of unicystic ameloblastoma with conservative treatment and with indication for orthodontic treatment. The conservative therapy was performed and the lesion had been completely removed. The need for radiographic and clinical follow-up for up to 10 years, initially performed every 6 months during the first 2 years and afterwards annually, in addition to the risk of late recurrence were explained for patient and her guardian. The histopathologic exam of the surgical tissue provided the final diagnosis of ameloblastoma, as the lesion had not presented in its classical form and in atypical locations, as in this case involving a tooth that had not yet erupted.

Correlation of the Radiographic and Morphological Features of the Dental Follicle of Third Molars with Incomplete Root Formation

The objective of this study was to determine the correlation of the radiographic and morphological features of the dental follicle of unerupted third molars with incomplete root formation. A cross-sectional study was carried out with 56 patients (105 teeth) aged 13 to 24 years. Panoramic radiography was used to determine the stage of root formation to locate and measure pericoronal radiolucency. The width of the dental follicle ranged from 0.0 to 4.0 mm, the distal face being the one most frequently involved, and stage 7 of root formation showing the highest incidence. An inactive enamel reduced epithelium and inactive epithelium remnant also showed a high incidence. Dense connective tissue showed a high incidence, chronic inflammation was infrequent and calcification was a common finding. There was a significant association between the progression of the rhizogenesis and the transformation of the enamel reduced epithelium into a stratified squamous epithelium. No significant association was found between rhizogenesis and the other morphological findings or between the latter and the width of the pericoronal space. It was concluded that there was no clinically significant correlation between the radiographic and morphological features. Every asymptomatic unerupted third molar should be followed up and the follicular tissue analyzed.

Paradental Cyst: Report of Two Cases

The paradental cyst is an odontogenic lesion of inflammatory origin that has few clinical signs and symptoms apart from recurring acute episodes. A well-defined radiolucency associated with the roots or distal to the crown may be seen radiographically. The purpose of this article is to report on different aspects of two cases involving paradental cysts. In the first case, the patient complained about recurring pericoronitis. A semilunar-shaped radiolucency on the distal aspect of the mandibular third molar was noted on the periapical radiograph. In the second case, the patient's main complaint was chronic trauma of the overlying mucosa. Radiographs revealed an enlarged pericoronal space. In both cases, the mandibular third molar was extracted due to a lack of space. Lesional samples were sent for histopathologic analysis. In the first case, the drainage of cystic fluid and a regular concavity were found during tooth removal. In the second case, a nodular lesion was found adhering to the disto-buccal surface of the tooth arising from the distal wall of a periodontal pocket. The histopathologic analysis revealed a hyperplastic stratified squamous epithelium with arcading lining a fibrous capsule with inflammatory infiltrate, resulting in a final diagnosis of a paradental cyst. The presence of a paradental cyst should be considered when recurrent inflammatory periodontal processes are associated with partially erupted vital teeth, even when characteristic radiographic findings are absent. Definitive diagnosis requires a clinicopathologic correlation incorporating surgical, radiographic, and histologic findings.

A contribution to the diagnosis of the small dentigerous cyst or the paradental cyst.

The aim of this study was to verify the relationship between the radiographically measured width of the pericoronal space (PS) and the microscopic features of the follicle in order to contribute to the diagnosis of small dentigerous cysts and paradental cysts. One hundred and thirty unerupted teeth (UT) and thirty-five partially erupted teeth (PET) were radiographed and extracted. The radiographic analysis consisted of measuring the width of the PS. The results of the radiographic analysis were compared with those of the histopathologic examination of the dental follicle. The width of the PS ranged from 0.1 to 5.6 mm. The most frequently observed lining of the follicles was a reduced enamel epithelium (REE) (68.4%) in UT and a hyperplastic stratified squamous epithelium (HSSE) (68.5%) in PET. Inflammation was present in 36.1% of the UT and in 82.8% of the PET. There was a statistically significant association between the presence of stratified squamous epithelium (SSE) and PS enlargement for UT (p < 0.05). There was a tendency of association between inflammation and PS enlargements in PET and, possibly, in UT, despite the absence of statistical significance. Surgically, we did not detect bone cavitation or luminal cystic contents in pericoronal spaces smaller than 5.6 mm. We suggest that the first radiographic diagnosis for a PS enlargement, in most of the routine clinical cases, should be of "inflammation of the follicle". The hypothesis of "dentigerous cyst" or "paradental cyst" is suggested as a second diagnosis. The final differential diagnosis between a small dentigerous or a paradental cyst and a pericoronal follicle depends on clinical and/or surgical findings, such as the presence of bone cavitation and cystic content.

Periodontopathic bacteria and salivary microbes before and after extraction of partly erupted third molars.

This study examines the effect of extraction of third molars on suspected periodontopathogenic microbes, salivary acidogenic bacteria, and yeasts. The subjects were 39 healthy conscripts aged 20.2 yr, with symptom-free, partly erupted mandibular third molars. Microbial samples were taken from the mandibular third molar pericoronal space and from the adjacent gingival pocket of the second molar. The samples were stained by Gram's and Giemsa's methods and studied under a light microscope. Stimulated saliva was collected for assessing mutans streptococci, lactobacilli, and yeast counts by chair-side kits. All partly erupted third molars were extracted from 20 test subjects; 19 control subjects were left untreated. Microbial samplings were repeated 2 and 5 months postoperatively. Results showed that at base line the total number of Gram-negative bacteria, Gram-negative rods, and spirochetes was significantly higher at the third molar than at the second molar sites. The extraction of the third molars caused a significant decrease in the percentage of these bacteria at the second molar sites. High counts of salivary mutans streptococci (CFU > or = 10(6)) and lactobacilli (CFU > or = 10(5)) were also significantly less frequent after the operations. Yeast counts were not affected by the extractions. Thus, partly erupted third molars may harbor a periodontally pathogenic microflora and increase the number of salivary acidogenic microbes.

Effect of extraction of partly erupted third molars on subgingival microorganisms

This study was made to investigate the effect of extraction of third molars on subgingival microbes in 39 generally and gingivally healthy men with an average age of 20.2 years (SD 0.9). Microbial samples were taken from the pericoronal space of symptom-free partly erupted lower third molars and from the adjacent gingival pockets of the second molars. The samples were cultivated anaerobically. All partly erupted third molars were extracted from 20 subjects. A control group of 19 subjects was left untreated. Microbe sampling was repeated 2 and 5 months postoperatively with highly significant results. It was shown that at baseline the number of black-pigmented gram-negative bacteria and Fusobacterium species was more frequent in third molar than in second molar sites. The total bacterial count decreased significantly at the second molar sites after extraction of the third molars when compared with the control group. Before the extractions, black-pigmented gram-negative bacteria were detected in 45% of the test subjects and Actinobacillus actinomycetemcomitans in 20%. The respective postoperative figures were 30% for black-pigmented gram-negative bacteria and 10% for Actinobacillus actinomycetemcomitans. Capnocytophaga species were not affected by the extractions. The findings suggest that erupting third molars may harbor harmful bacteria that can be reduced by eradicating the foci.

Anterior maxillary supernumerary teeth: a clinical and radiographic study.

Clinical records and radiographs of 90 patients with 113 anterior maxillary supernumerary teeth (mesiodens) have been evaluated. Although uncommon, mesiodentes are the most frequent supernumerary teeth and may disturb the eruption and/or position of the adjacent permanent incisors. Clinical and radiographic examination may disclose the number, direction and location of mesiodentes and their effects on neighbouring teeth. In the present study the majority of the supernumerary teeth lay palatal to the central incisors. Complete or partial eruption of a mesiodens was rare, hence the importance of radiographs to locate supernumerary teeth in the premaxilla. Pathological findings included the formation of dentigerous cysts in three patients and complete ossification of the pericoronal space with resorption of the crown of the mesiodentes in eight cases. Retention and malposition of the adjacent permanent incisors occurred in 39 and 24 cases, respectively.

Suspected periodontopathogens in erupting third molar sites of periodontally healthy individuals

Abstract 29 periodontally healthy subjects (11 female and 18 male) with a mean age of 24 years (range 19 to 38 years) and with partially erupted lower third molars participated in this study. 18 subjects demonstrated no signs or symptoms of acute inflammation and were without pain (group A). 5 subjects showed redness of the pericoronal tissues and experienced pain upon palpation (group B). 6 subjects suffered from acute pain and exhibited formation of pus (group C). Microbiological samples were taken from the lateral aspect of the pericoronal space using the paperpoint-method. Continuous anaerobic techniques were utilized for microbiological processing. The samples were cultivated on ETSA and on selective media and were studied by darkfield microscopy. Gram-negative anaerobic rods accounted for 27% (group A), 34% (group B) and 39% (group C) of all organisms growing on ETSA. Bacteraides intermedius was detected in 61% (group A), 80% (group B) and 83% (group C) of the samples. B. gingivalis was found in 1 sample of group A only. Fusobacterium sp. was detected in 56% (group A), 80% (group B) and 33% (group C) of the samples. Capnocytophaga were seen in 67% (group A), 20% (group B) and 50% of the samples. Actinobacillus actinomycetemcomitans was found in 44% (group A), 40% (group B) and 17% (group C). 72% of the group A and 100% of the group B and C samples contained spirochetes. In all of those positive samples, small spirochetes were present, but only 78% contained medium and only 48% large spirochetes. These results demonstrate that organisms which are thought to be important in the etiology of periodontitis are present in young adults without periodontal disease if suitable ecological conditions such as pocket-like structures of partially erupted teeth are provided.

Suspected periodontopathogens in erupting third molar sites of periodontally healthy individuals

29 periodontally healthy subjects (11 female and 18 male) with a mean age of 24 years (range 19 to 38 years) and with partially erupted lower third molars participated in this study. 18 subjects demonstrated no signs or symptoms of acute inflammation and were without pain (group A). 5 subjects showed redness of the pericoronal tissues and experienced pain upon palpation (group B). 6 subjects suffered from acute pain and exhibited formation of pus (group C). Microbiological samples were taken from the lateral aspect of the pericoronal space using the paperpoint-method. Continuous anaerobic techniques were utilized for microbiological processing. The samples were cultivated on ETSA and on selective media and were studied by darkfield microscopy. Gram-negative anaerobic rods accounted for 27% (group A), 34% (group B) and 39% (group C) of all organisms growing on ETSA. Bacteroides intermedius was detected in 61% (group A), 80% (group B) and 83% (group C) of the samples. B. gingivalis was found in 1 sample of group A only. Fusobacterium sp. was detected in 56% (group A), 80% (group B) and 33% (group C) of the samples. Capnocytophaga were seen in 67% (group A), 20% (group B) and 50% of the samples. Actinobacillus actinomycetemcomitans was found in 44% (group A), 40% (group B) and 17% (group C). 72% of the group A and 100% of the group B and C samples contained spirochetes. In all of those positive samples, small spirochetes were present, but only 78% contained medium and only 48% large spirochetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathological changes related to long-term impaction of third molars: A radiographic study

Pathological changes related to impacted 3 rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM ( p<0.001). Other pathologic changes observed were resorption of the 2 nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.

A scanning electron microscopic study on the microflora of chronic pericoronitis of lower third molars

In nine cases of chronic pericoronitis of lower third molars, the affected teeth were carefully removed with the follicles in situ and prepared for scanning electron microscopic (SEM) study. The study disclosed great heterogeneity in the distribution and density of microorganisms on hard as well as soft tissues surrounding the pericoronal pouch. Common features were presence of discrete microenvironments with clusters of bacteria, a decrease in the number of organisms toward the bottom of the pericoronal pouch, and the high proportion of spirochetes, which tended to increase in an apical direction. The study showed leukocytic activity in all areas, and phagocytosis apparently took place on the tissue surfaces within the pericoronal space.