Objective This study aims to characterize the imaging features of the gubernaculum dentis in impacted or unerupted permanent teeth. It also investigates whether these features differ between individuals with eruption-related pathologies and those without associated pathological conditions. Materials and Methods A case-control design was employed, comprising 110 individuals in the study group (pathology-associated impacted/unerupted teeth) and 112 individuals in the control group (impacted/unerupted teeth without pathology). Categorical variables were analyzed using Pearson’s Chi-Square test, which is appropriate for evaluating associations between categorical variables. In instances where multiple group comparisons were necessary, the Bonferroni-corrected Z-test was applied to adjust for the increased risk of Type I error due to multiple testing, thereby maintaining the overall statistical validity. Results A statistically significant association was observed between GD status (absent, present, or enlarged) and group classification (pathology vs. control; p < 0.001). Specifically, GD absence was more prevalent in the pathology group (53.6%) compared to controls (26.1%). No significant age-related differences were detected between genders (p = 0.307). Conclusion The findings demonstrate an inverse relationship between GD presence and pathological conditions associated with impacted or unerupted teeth. This suggests that GD absence or enlargement may serve as a radiographic marker for underlying odontogenic pathologies. Further studies are warranted to elucidate the mechanistic role of GD in eruption disturbances.

Accuracy and user experience of dental diagnosis of a patient with cleidocranial dysplasia using immersive virtual reality and cone-beam computed tomography multiplanar reconstructions.

Mixed dentition analyses are used to determine possible tooth-size and arch-length discrepancies during the transition from primary to permanent dentition. Prediction methods using a probability table or linear regression equation use the sum of the mesiodistal widths of mandibular permanent incisors to predict the mesiodistal width of unerupted permanent teeth. Racial and sexual variations and sexual dimorphism in tooth size have been reported. The objective of this study is to validate Moyer's and Tanaka Johnston's mixed dentition analyses in a contemporary South Indian population.

The objective of this study is to present an uncommon case of adenomatoid odontogenic tumor (AOT) with an impacted maxillary canine, initially mimicking a follicular cyst. AOT is a rare odontogenic tumor, accounting for approximately 1% to 9% of all odontogenic tumors. It primarily occurs in the maxilla and is often associated with an unerupted permanent tooth. Follicular cysts, also known as dentigerous cysts, are benign odontogenic cysts that encase the crown of an unerupted or impacted tooth. We describe a case of AOT occurring in a 14-year-old male. Both the follicular cyst and adenomatoid odontogenic tumor (AOT) can exhibit similar clinical and radiographic presentations. It is crucial to accurately differentiate between the two to ensure appropriate treatment and prognosis.

The ulotomy consists of a linear incision of the gingival tissue that covers the incisal surface of the dental crown of an unerupted deciduous or permanent tooth, in order to allow it a free path to occupy its normal position in the dental arch. The objective of this study was to report a case of ulotomy in a six-year-old pediatric patient. This is a descriptive study. The research was carried out in the municipality of Mato Verde-MG at Faculdade Verde Norte (FAVENORTE). A six-year-old male patient attended the Pediatric Dentistry clinic at Faculdade Verde Norte – FAVENORTE, with the main complaint: “The teeth are late”. Upon clinical examination, it was observed that tooth 11 had already begun the process of eruption into the oral cavity and tooth 21 had not yet erupted into the cavity and the gums had a pale pink color and fibrous consistency in the region; due to the patient's uncooperative behavior, but clinically it was possible to observe that there was no bone layer covering the dental crown, as the imminent presence of the unerupted tooth was clear, which justified the indication of ulotomy on the upper central incisors. Ulotomy proved to be a satisfactory procedure in the reported case, but professionals must evaluate each case individually to determine an appropriate treatment plan for each clinical situation.

Imaging characteristics of gubernaculum tracts in patients with cleidocranial dysplasia: a computed tomography study

Pediatric facial fractures are rare and make up 5–15% of all facial fractures. The low incidence of facial fractures among children is due to physiological and environmental factors such as greater resilience of the pediatric skeleton, higher bone to tooth ratio, direct parental supervision and limited outdoor activity.1 In children of 5–10 years of age nasal fractures are by far the most frequent (58.6%), followed by mandibular fractures (21.5%). Orbital (9.5%), frontal (5.1%), and midfacial (3.8%) fractures are next in frequency2. Le Fort fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. In the mandible condylar fracture is the most common (38.9%) followed by angle (20.6%), parasymphysis (18.3%), body (15.3%) and symphysis (5.3%).3 Facial fractures are more common in boys, though this varies greatly from 1.1:1 to 8.5:1.4 The majority of facial fractures in children result from falls (7.8–48%) and sports-related injuries (4.4–42%).5 In primary or mixed dentition, the placement of internal fixation hardware is challenging due to the risk of injuring unerupted permanent tooth follicles. The use of resorbable plates and screws offer a potential solution to the growing pediatric facial bone as the standard titanium fixation systems carry the risk of translocation, growth restriction, and dental injury. Dental splinting or suspension wires can also be used in place of direct plating. Fortunately, mild malocclusion at this age has the potential to be improved through bony remodeling, the eruption of permanent dentition, compensation of the mastication mechanism, and posttraumatic orthodontia.6 Accordingly, the goal of treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion with minimal residual functional and esthetic impairment.

Aim: The Gubernaculum Dentis (GD) is a structure that serves as the eruption path for permanent teeth, extending from the tooth follicle to the gingiva and including the gubernacular cord. It plays a crucial role in the normal eruption process by providing a defined path for the tooth to emerge through the bone. Radiographically, GD is visible as a radiolucent area, bordered by cortical bone, around the crown of an unerupted tooth on standard X-rays. On Cone Beam Computed Tomography (CBCT) scans, it appears as a hypodense cortical path adjacent to the dental follicle of the unerupted tooth. This study aims to examine the prevalence, radiological appearance, and characteristics of GD in unerupted permanent teeth with CBCT and to investigate its characteristics according to the Demirjian dental calcification scale. Materials and methods: Radiographic images of 75 pediatric patients whose CBCT images were taken for various reasons were analysed retrospectively. The prevalence of GD in the images, types of shapes, attachment sites to the teeth, and areas of openings in the alveolar crest were evaluated. GD angle and length measurements were made on CBCT images. Teeth were classified according to Demirjian tooth development method and the relationship between GD and tooth development was examined. Results: The prevalence of GD was found as 73.5% in the 1055 unerupted teeth that were examined. While the prevalence of GD was 60% in the maxilla, it was found as 87.8% in the mandible. (p < 0.001) When the shapes of GDs were analyzed, the most common shape was flat with 54.8%, followed by rectangular with 38.7%. When the opening sites of teeth with GD were examined, the highest rate was found in palatinal and lingual with 57.8%, followed by the crest apex with 40.9%. The mean GD angle was found as 6.260, while the mean length was found as 3.93 mm. According to the Demirjian tooth calcification scale, the highest rate of GD was seen in stage C teeth with 92.7%, while the lowest rate of GD was seen in stage A teeth with 33.3% (p < 0.001). Conclusion: According to the results of this study, it was found that GD was mostly in the maxilla and flat. GD length value was found to be higher in the mandibular teeth, Demirjian scale A and especially canine teeth.

It is estimated that 4.3% of patients experience delayed eruption of permanent teeth due to local causes. Mandibular second premolars were the most frequent permanent teeth associated with delayed eruption, followed by maxillary canines, and maxillary central incisors. While rare, unerupted permanent teeth should be treated promptly to avoid potential impacts on future function, esthetics, confidence, mental health, and pronunciation. For this reason, parents often seek dental examinations and treatment for their children. Delayed tooth eruption (DTE) can also affect treatment planning and orthodontic timing. This report presents three cases of unerupted teeth. All cases were treated with a simple excision of overlying tissue to expose the crown using either a scalpel or electrocautery. Two of three lesion diagnosis was confirmed by Histopathology anatomy (HPA). In all cases, the involved teeth spontaneously erupted immediately following treatment, providing good aesthetics. However, one case experienced complications due to allergies during the wound healing process. In conclusion, proper diagnosis and treatment of DTE, including consideration of developmental disturbance factors, can help ensure normal eruption patterns and satisfactory aesthetic results.

Background: Supernumerary teeth, which are defined as any tooth or odontogenic structure formed from tooth germ in excess of the usual number for any given region of the dental arch, is a developmental anomaly encountered in pediatric clinical practice. This case report series presents the multidisciplinary treatment approach applied to three different patients with anterior maxillary supernumerary teeth. Case Series: Case 1: An 11-year-old male patient was treated with surgical and orthodontic interventions due to the delayed eruption of the supernumerary tooth in the maxillary anterior region. Case 2: It was determined that the unaesthetic appearance in the maxillary anterior region of a 10-year-old female patient was caused by supernumerary teeth. The supernumerary teeth were extracted and the unerupted teeth were treated by orthodontic intervention. Case 3: In a 9-year-old male patient, it was determined that the reason for the delayed exfoliation of the primary teeth in the maxillary anterior region was supernumerary teeth. The patient was treated with surgery and orthodontic intervention. Results: Spontaneous eruption of permanent central teeth may last for up to three years. Orthodontic treatment may be required to ensure the even alignment of the erupting teeth. The teeth can be monitored for spontaneous eruption if there is ongoing root development, although orthodontic treatment will be necessary if the root development has already been completed, as such teeth have no chance of spontaneous eruption Conclusion: Early diagnosis of delayed eruption of permanent successors is necessary to avoid many dental complications. The management of such cases should be designed by a multidisciplinary team as there is no definitive time to surgically remove unerupted supernumerary teeth.

Abstract Background Regional odontodysplasia (ROD) is a rare localised developmental disorder affecting the dental tissues. It presents with specific clinical, radiographic, and histopathological features. There have been less than 180 reported cases of ROD in the literature. Case Report A 10-year-old boy was seen in the paediatric dental department with a complaint of missing teeth and pain in the left maxilla. Examination revealed retained fragments of primary teeth and a partially erupted upper left first permanent molar (UL6) with an unusual morphology, cavitation, and associated infection. The dental development in the rest of the mouth appeared to be normal. CT scanning of the left maxilla revealed all unerupted permanent teeth were present but had a characteristic "ghost-teeth" appearance suggestive of regional odontodysplasia. The patient underwent surgical exploration of the left maxilla and removal of the UL6. The remaining unerupted teeth in the area showed no signs of infection. Although they have a poor long-term prognosis, they were left in situ in order to preserve alveolar bone whilst the patient is growing. Histological examination showed thin disorganised dental tissues with large pulp chambers, confirming the diagnosis of regional odontodysplasia. Discussion ROD presents management challenges, particularly in children. This case highlights the importance of being aware of the clinical and radiographic features of rare disorders in order to aid diagnosis and treatment planning. This case also demonstrates the importance of targeted intervention and monitoring in order to improve outcomes for placement of dental prostheses in adulthood once growth is complete.

A dentigerous cyst is a benign and asymptomatic lesion that may become extremely large and then interfere with tooth eruption. Marsupialization is known as the best treatment option for large cysts involving an unerupted permanent tooth. A 16-year-old female has been referred with the chief complaint of an unerupted tooth, extraoral and intraoral swelling, and pain. Radiographic examination demonstrated a unilocular, well-defined, and large radiolucent lesion extended from the distal of the right mandibular canine approximately to the left first mandibular molar. The mandibular left canine was also embedded within the lesion. The selected treatment plan was marsupialization, followed by performing orthodontic treatment of the unerupted mandibular canine. This clinical report presented the successful eruption of an impacted mandibular canine over a 4-years follow-up. The findings of this study revealed that the combination of marsupialization and orthodontic treatment is an effective treatment for large jaw cysts with impacted teeth.

The occurrence of balanced reciprocal translocation of chromosome 1 and 7 is one of the rare anomalies. The present case report focuses on a case of 07-year-old male patient with craniofacial anomaly due to balanced reciprocal translocation of chromosome 1 and 7 manifesting as microcephaly, microstomia, oligodontia and scrotal hypospadias with bilateral retractile testis. The patient had severe retrognathic and hyperdivergent mandible along with multiple carious and unerupted permanent teeth. After complete oral prophylaxis of the patient, the restorations of all carious teeth were carried out. Extraction of root stumps under conscious sedation has been planned in later phase. The patient will further be followed up for orthodontic correction of maxillary and mandibular arches in all three planes keeping in view of the growth status of the patient. The present case report intends to provide an overview of the clinical and radiographical features of this rare anomaly who need a prolonged interdisciplinary management and long term follow up. Further, this will add value to the existing prevalence in the available literature.

Treatment of odontogenic cyst in pediatric patients should be considered to preserve adjacent anatomical structures, especially developing permanent teeth. Decompression can prevent damage to surrounding permanent teeth and induce spontaneous eruption of permanent teeth. Removable space maintainer with rubber tube for decompression is used to maintain the patency of the cyst and space for the eruption.These are four case reports of odontogenic cyst involving maxillary canine and mandibular premolars. Due to preserving permanent teeth, all cases were treated with decompression. This case report shows that mandibular premolar spontaneously erupted into the proper position. While maxillary canine may need additional treatment intervention, such as orthodontic traction or surgical extraction.

The purpose of this work was to study the literature on research papers by domestic and foreign authors describing pre-eruption intracoronal resorption. The review discusses issues that indicate the presence of a resorption process in permanent teeth before their eruption. This lesion of the hard tissues of the teeth is rare, and the etiology of this process is not fully understood. The processes of tooth resorption can be observed outside on the root surface or inside the pulp chamber, and if a permanent tooth is involved in this process, this indicates the development of pathological resorption. Along with dental caries and periodontal disease in childhood, processes of resorption of coronal dentin tissue in unerupted permanent teeth can be observed. Some authors describe internal resorption, ectopic positioning, external resorption, and origin from developmental pits on the occlusal surface as etiological factors for preeruptive intracoronal resorption, but other authors suggest that the etiology of this lesion remains poorly understood. The main diagnostic method is an x-ray examination, in which preeruptive intracoronal resorption is accidentally detected and other research methods are additionally used. Histological examination reveals osteoclasts, multinucleated giant cells, macrophages, and serrated edges in this lesion, which may possibly enter the developing tooth from the surrounding bone or through breaks in the dental follicle or enamel epithelium. With a small lesion and if the tooth is close to eruption, periodic X-ray control is necessary, and after eruption, when occlusal access is reached, the defect is restored in order to minimize the attachment of the carious process.

Statement of the Problem: Gubernacular canal (GC) is a canal that extends from the follicle of unerupted permanent teeth to the alveolar bone crest filled with remnants of the dental lamina. This canal is thought to guide tooth eruption and be related to some pathologic conditions.Purposes: This study aimed to determine the presence of GC and its anatomical characteristics in teeth, which failed to erupt normally on cone beam computed tomography (CBCT) images.Materials and Method: This cross-sectional study evaluated CBCT images of 77 impacted permanent and supernumerary teeth obtained from 29 females and 21 males. The frequency of GC detection, its location in relation to the crown and root, the anatomical surface of the tooth from which the canal has originated, and the adjacent cortical table to which the canal opens, along with the length of the GC were studied.Results: GC was observed in 53.2% of teeth. The anatomical tooth aspect of origin was occlusal/ incisal in 41.5% and crown in 82.9% of teeth. Moreover, 51.2% of GCs opened in palatal/lingual cortex and 63.4% of canals were not located along the tooth long axis. Finally, GC was detected in 85.7% of teeth undergoing the crown formation stage.Conclusion: Although GC was introduced as an eruption pathway, this canal is also present in impacted teeth. This means that presence of this canal does not promise the normal eruption of tooth and the anatomical characteristics of GC may influence the eruption process.

Cysts of jaw present as swellings of jaws and midface. Of different varieties, dentigerous cyst is most common type of noninflammatory odontogenic cyst. Dentigerous cysts are generally associated with crowns of impacted or unerupted permanent teeth. Here we present a case of dentigerous cyst in 13‑year‑old female child, which was successfully treated with conservative therapy. Patient also reported after one and half year with protruding teeth and retained deciduous right upper canine & impacted permanent canine. This case report also presents orthodontic management of retained deciduous canine and impacted permanent canine.

66. Recurrent Facial Swelling: Primary Chronic Osteomyelitis Associated with an Unerupted Permanent Tooth in a Paediatric Patient

Conservative orthodontic and multidisciplinary approaches for patients with cleidocranial dysplasia in late adolescence or young adulthood

Objective: First report of cleidocranial dysostosis (CCD), a rare genetic disorder, in Ghana. Case report and intervention: The condition presented in a 13 year old boy with most of the classical features. He had cranial features in the form of open fontanelles, underdeveloped paranasal air sinuses and hypertelorism. Thoracic features were severelyunderdeveloped clavicles which allowed him to appose both shoulders in the midline. He had an open bite, several unerupted permanent teeth and several retained teeth most of which were discoloured which was why he was seen at the Dental department. After restoration of some of these teeth the patient was very satisfied.Conclusion: Though the definitive treatment in these patients can be sophisticated major craniofacial surgery, early restoration of malformed teeth can help ease patient’s anxiety and improve quality of life.