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Relationship between fractures of the mandibular angle and the presence and state of eruption of the lower third molar.

OBJECTIVES: This study attempted to relate the incidence of fractures at the mandibular angle with the presence and state of eruption of lower third molars. STUDY DESIGN: The records and radiographs of 200 patients with mandibular fractures were examined. The presence and degree of impaction of lower third molars were assessed for each patient and related to the occurrence of fractures of the mandibular angle. Data were analyzed by chi-square statistic and the Student's t test. RESULTS: The incidence of angle fractures was found to be significantly greater when unerupted lower third molars were present (p < 0.001). Bilateral unerupted third molar teeth predisposed to a fracture at the angle significantly more than unilateral unerupted third molars (p < 0.01). Furthermore, the amount of bony space occupied by an unerupted third molar tooth directly related to the weakness of that area of bone (p < 0.001). CONCLUSIONS: This study provides clinical evidence to suggest that unerupted third molar teeth weaken the mandibular angle both quantitatively and qualitatively.

Adolescent↗

Case 11, Part 2. Angiokeratoma corporis diffusum (Fabry's disease).

A case of Fabry's disease is reported. The patient had multiple supernumerary, impacted, and unerupted teeth and other developmental abnormalities of the facial skeleton. The patient tolerated surgical removal of impacted and unerupted teeth without complications. However, this did not relieve the facial pain. The expected prognosis of this patient will be a continued vascular and renal degeneration with death probable before the age of 50 years if the disease is untreated. Currently, the patient is being considered as a possible candidate for renal transplantation.

Diagnosis, Differential↗

Fluoride concentrations in unerupted fluorotic human enamel.

Unerupted fluorotic human enamel was obtained from teeth surgically removed from patients with dental fluorosis. Fluoride was measured in samples produced by serial acid etching from the surface to the interior of blocks of buccal and lingual enamel. The severity of fluorosis, according to the TF index, was determined from the macroscopic and microradiographic appearance of the specimens. The shape of the fluoride profiles was not affected by the degree of severity of fluorosis, but the fluoride concentrations increased with increasing severity of lesions. Fluoride concentrations were similar to those previously recorded in erupted fluorotic enamel and were not related to the length of time the teeth had been present in the jaws. It was concluded that the fluoride content of erupted fluorotic enamel represents fluoride acquired during tooth formation and that further uptake prior to eruption may be negligible.

Acid Etching, Dental↗

Lesions resembling caries in unerupted teeth.

Two cases are presented documenting the recognition and treatment of defects in the coronal portion of unerupted mandibular second permanent molars. The teeth were surgically exposed and the lesions treated as deep pit and fissure caries. Small, vital pulp exposures were encountered in both cases. Calcium hydroxide was placed and restoration with amalgam followed. Normal root formation and eruption occurred for 24 and 6 months, respectively. A firm diagnosis of caries, external resorption, or internal resorption could not be made because of the lack of histologic study.

Child↗

The effect of different lower third molar conditions on the re-crowding of lower anterior teeth in the absence of tight interproximal contacts one-year post orthodontic treatment: a pilot study.

The role of lower third molars in lower incisor crowding is a debatable topic. Some believe the presence or eruption of lower third molars is associated with the crowding of mandibular incisors, others negate such association. Thirty-two newly debonded orthodontic patients, with ages ranging from 14-19 years, were randomly selected. No retainers were used for the lower dental arch. Removal of tight interproximal contacts of the lower anterior teeth was created and maintained by periodic abrasive stripping every 2-3 months, if needed. The cases were followed up for one year. Orthopantomographs (OPGs) and study casts were taken at debonding (post-treatment) and at the end of the one year follow up (post retention). Statistical analysis of the lower third molar conditions--erupted, unerupted, or missing with or without sufficient space for their eruption--versus re-crowding of lower incisors was evaluated using Fisher's Exact Test. The results of this pilot study revealed there was no significant correlation between the different conditions of the lower third molars versus lower anterior re-crowding in the absence of tight interproximal incisal contacts; however, a larger sample size is needed to verify such findings.

Adolescent↗

Diagnosis and prevention of maxillary cuspid impaction.

Early diagnoses and prevention of maxillary cuspid impactions can save much time when treating patients orthodontically. Effective recognition and interception requires initial diagnosis at the dental age of about eight years. When a cuspid bulge is absent, diagnosis with oriented lateral and frontal radiographs is advocated and has been shown to aid in the positive recognition of lingually positioned unerupted maxillary cuspids at risk for impaction. Recommended treatment is early removal of maxillary deciduous cuspids and perhaps deciduous first premolars. Lateral and frontal radiographs should be taken at six-month intervals to follow the intra-bony eruptive movement of the permanent cuspids until they have entered the oral cavity. Failure to diagnose and intercept the potentially impacted cuspid often leads to serious malpositions that require extensive mechanical therapy for proper alignment and good function.

Child↗

Factors influencing the selection of panoramic radiography in general dental practice.

OBJECTIVES: To identify factors influencing dentists' decisions to take panoramic radiographs and to determine dentists' perceptions of the value of panoramic radiographs in the diagnosis of common dental pathologies. METHODS: Questionnaire of dentists with access to panoramic radiography equipment in 22 randomly selected Family Health Service Authorities in England and Wales. Dentists were asked to score 17 factors for their influence upon panoramic use, compare the relative diagnostic value of panoramic and intraoral radiographs for diagnosis of common dental pathologies and state their principal reasons for taking panoramic radiographs. RESULTS: The response rate to the questionnaire was 73.3%. The factors most likely to influence dentists to take a panoramic radiograph were 'planning oral surgery', 'facial trauma', 'periodontal disease', 'heavily restored dentition' and 'patient first attendance'. Dentists' opinions on the diagnostic usefulness of panoramic radiographs were in broad agreement with those in the scientific literature. The main reasons for taking panoramic radiographs were as a 'general screen' and as a 'view for unerupted or impacted teeth'. CONCLUSIONS: There are areas where dentists' prescription of panoramic radiographs is in disagreement with recent guidelines. Successful implementation of these guidelines would be likely to lead to a substantial reduction in the numbers of panoramic radiographs taken by GDPs.

Adult↗

Prediction of the size of unerupted canines and premolars in a Saudi Arab population.

The estimation of the size of unerupted permanent teeth is an essential aspect in treatment planning in the mixed dentition. The commonly used prediction methods of Moyers and Tanaka and Johnston are based on data from a sample of children of Northern European descent. The accuracy of these methods when applied to a different population is questionable. When we applied the Moyers probability tables to a limited sample of a Saudi Arab population, we found that the 35% level was a more accurate determinant than the commonly used 75% confidence level. Likewise, the prediction equations of Tanaka and Johnston overestimated the size of buccal segments in this population. The data illustrate the limitations of these methods when applied to a sample population of other than European descent. From this data, two linear regression equations were developed for tooth size prediction in Saudi Arab children.

Adolescent↗

Patterns of crowding of permanent mandibular incisors before eruption.

Observation of the radiographs taken of 37 mandibles from children ten months to seven years of age showed that the unerupted, permanent mandibular central incisors were rotated in 45 of 74 jaw halves (60.8%). The type of rotation in which the mesial aspect is directed lingually was most commonly seen (44.6%). The next most common observation was of jaw halves without any rotation of the central incisor (39.2%). The type of rotation in which the central incisor's distal aspect is turned lingually was the least common observation (16.2%). The rotation seemed symmetric in 25 jaws (67.6%).

Child↗

Cleidocranial dysostosis: report of a case.

This case of cleidocranial dysostosis showed nearly 40 accessory teeth and the unerupted teeth on radiological examinations. Other diagnostic procedures found hypoplasia in maxillary and zygomatic bones, deep palate, open fontanel and open sutures, the collapse of sagittal suture, and aplasia of the clavicle. There were some abnormalities of the fingers. Under general anesthesia eleven supernumerary teeth in the mandible and eight in the maxilla were surgically extracted. Upper and lower removable acrylic appliances were fabricated.

Child↗

A device to predict lower third molar eruption.

This study was designed to create a transparent device to be superimposed on a panoramic tomogram taken of a patient at age 20 years to make predictions of future eruption or impaction of lower third molars. The device was developed from data on 40 lower third molars initially retained at age 20 years; one half of these remained impacted, and the other half of them erupted by age 26 years. Tracings were made from panoramic tomograms taken at age 20 years. The critical point for prediction in the overlay was the intersection of a horizontal reference line and the anterior border of the ascending ramus. To estimate this critical separation line, Bayes' Decision Theory was used. The sum of false negatives and false positives was least at a distance of 14.5 mm from the distal surface of the second molar. Mesial from this point, the probability of impaction was 76%; distal from this point, the probability of eruption was 72%. Tested against 35 initially unerupted lower third molars, the predictions made by the device and the actual clinical findings were in conformity in relation to 97% of the test teeth. It could thus be concluded that the method was simple to use and may prove a good addition for predicting lower third molar development.

Adult↗

Alkali-soluble and insoluble fluoride in erupted and unerupted sound enamel of human third molars in vivo.

The amounts of firmly and loosely bound fluoride were determined in sound enamel of unerupted and erupted teeth which had been exposed in vivo for 1-16 yr to brushing at least once a day, and occasionally to mouth rinsing and the application of sealers. Enamel was sampled by an acid-etch procedure, and the fluoride levels were measured with an adapted fluoride ion-selective electrode. Unerupted enamel was etched significantly (p less than 0.05) deeper than erupted enamel up to a depth of at least 8 microns. Significant differences (p less than 0.05) were found between the mean enamel fluoride concentrations of unwashed and alkali-washed, erupted teeth up to a depth of at least 3 microns and also between unwashed or washed, erupted versus unwashed or washed, unerupted teeth. At a depth of 3 microns, the fluoride treatments of enamel had increased the total amount of fluoride by approx. 78% of which approx. 53% was loosely bound fluoride (like CaF2) and 47% firmly bound (like fluorapatite). No increase in sound enamel fluoride as a result of topical treatments over a period of up to 16 yr could be found at a level deeper than 20 microns.

Acid Etching, Dental↗

Use of nickel titanium closed-coil springs to align unerupted teeth: a case report.

We describe a case in which a patient with a class II division I incisor relationship on a skeletal II base was transferred midway through a treatment that consisted of aligning the upper and lower arches with fixed appliance orthodontics in preparation for a mandibular advancement osteotomy. The lower second molars had previously been extracted; the lower third molars were left unerupted and some distance from the lower first molars. To provide a good occlusion at the end of treatment, it was decided to expose and approximate the lower third molars to the distal aspect of the lower first molars with the use of nickel titanium closed-coil springs; this was to be done before the osteotomy.

Adult↗

Positional changes and eruption of impacted mandibular third molars in young adults. A radiographic 4-year follow-up study.

OBJECTIVE: To measure changes in angular position and eruption status of mesially impacted mandibular third molars (M3) during 4-year follow-up period. STUDY DESIGN: Standardized panoramic radiographs were taken at the start of the study (the average age of the subjects was 19.7 years) and 4 years later. Angulation and degree of impaction of M3 were determined by their sagittal relationships to the adjacent second molars. The impacted M3 were either partially erupted or unerupted. RESULTS: Initial examination showed that among a total of 59 mesioangular M3, 49 (83%) had inclination between 5 and 30 degrees. The proportion of M3 that became upright (zero tilt) was 76% (13/17) with initial angulations of 5 to 10 degrees, 61% (11/18) with initial angulations of 15 to 20 degrees, and 14% (2/14) with initial angulations of 25 to 30 degrees. None of the M3 originally presented at 35 degrees or more became upright, but an average decrease of 12 degrees in angulation was registered. In total, 26 M3 of 59 (44%) became upright during the follow-up period. Initial examination of levels of eruption showed that among 59 M3, 13 (22%) were partially erupted and the rest were unerupted. Of the 46 M3 initially unerupted, 17 (37%) became fully erupted and 7(15%) erupted partially during the 4-year follow-up. Of the total sample, 25 (42%) had erupted to full occlusion during the observation period. CONCLUSION: A significant proportion of mesially impacted mandibular M3 had changed their angulation and became fully erupted by the time the individual reached 24 years of age. Positional changes and eruption of impacted M3 are unpredictable phenomena.

Adolescent↗

Perception of the need for removal of impacted third molars by general dentists and oral and maxillofacial surgeons.

This prospective study investigated the influence of professional training and method of payment on how dental practitioners planned extraction of impacted third molars. The subjects were four groups of dental practitioners in metropolitan Chicago: 1) general dentists in traditional fee-for-service practice; 2) general dentists who were members of a preferred provider organization; 3) general dentists who were members of an Independent Practice Association model of a capitation system; and 4) oral and maxillofacial surgeons, all of whom were in fee-for-service practice. A carefully selected and trained professional actress, in good health, with four unerupted, impacted, and asymptomatic third molars, brought her recently taken full mouth periapical and panoramic radiographs to randomly selected dentists for a consultation. The number of planned extractions (no treatment was ever done) was compared. Data showed that oral and maxillofacial surgeons suggested significantly more extractions than capitation dentists and the average of all general dentists, combined.

Adult↗

Surgical repositioning of unerupted anterior teeth.

The result of surgical repositioning of 12 unerupted anterior teeth was studied. The unerupted teeth were gently exposed, gradually repositioned by shifting them bodily toward the occlusal plane without disturbing the periodontal ligament, and splinted for 3 wk. Root canal therapy was performed at the end of the second week following repositioning. Obturation was done at the end of the third week just before splint removal. Clinical and radiographic examination (follow-up period: 6 months to 3.5 yr) revealed no root resorption with satisfactory apical healing and healthy supporting tissues.

Adolescent↗

Application of analysis of crowding and spacing of the teeth.

Spacing or crowding of the teeth is measured and analyzed to assist in decisions regarding the maintenance of teeth in their existing positions or their movement to improved positions. Numerical guides always should incorporate a gray zone in which decisions cannot be made without additional information. In the stage of mixed dentition, estimates of the size of unerupted teeth are more accurate than estimates of future spacing or crowding because the perimeter of the arch does not diminish the same amount in all cases. Instead, it appears to be related to the amount of crowding in the mixed dentition. Determination of the amount of crowding or spacing must always be accompanied by consideration of molar, canine, and incisor relationships. In addition, the effect of the dentition on lip posture should also be evaluated.

Child↗

Mesiodentes in twins: a case report and a review of the literature.

This report describes 7-year-old Afro-Caribbean monozygotic twin boys who both presented with bilateral unerupted mesiodentes palatal to the central incisors. There have been two previous similar reports. From this case and previous reports it was concluded that mesiodentes in monozygotic twins are likely to be concordant with respect to the number of supernumerary teeth. Unilateral mesiodens usually have been mirror imaged in each twin. Minor discordance between monozygotic twins is common with respect to the shape (conical, incisiform or tuberculate) and orientation (inverted or normal) of individual mesiodens within and between each twin.

Child↗