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Clinical outcome of third molars in adults followed during 18 years.

PURPOSE: The aim of the present study was to follow the clinical changes in third molar status during an 18-year period in patients aged 20 to 38 years. PATIENTS AND METHODS: The series consisted of 118 subjects (37 men and 81 women). In the beginning of the study, the mean age was 20.2 years (SD, +/-0.6 year), and at the end, it was 38.6 years (SD, +/-0.6 year). Panoramic radiographs were taken at baseline and at age 38. All of the subjects were clinically examined at baseline and at the end of the study. A portion of the subjects (n = 69) were also examined at age 32. RESULTS: Most of the initially unerupted third molars were removed during the follow-up period (73%, maxilla and mandible together). More than half of the initially partially erupted third molars were removed during the follow-up period (64%, maxilla and mandible together). The percentage of erupted third molars found in the mouth at age 38 increased significantly depending on the initial status. Of the initially unerupted, partially erupted, or erupted third molars, 10%, 33%, and 50%, respectively, were erupted at age 38 (maxilla and mandible together). Changes in the status of third molars continued from age 32 to age 38, although to a lesser extent (8%). The 3 third molars with advanced eruption were all maxillary teeth in men. CONCLUSION: Third molars undergo continuous clinical change on a reduced scale at least up to the age of 38 years.

Adult↗

True oligodontia with microdontia in monozygous twins: implications for reappraisal of Butler's Field Theory.

Oligodontia, which may be defined as the congenital absence of six or more teeth apart from third molars, affects less than 0.5% of the population and may occur in isolation or as part of a syndrome. This paper aims to clarify the role of genetic factors in this condition by reporting a case of a pair of identical twins and their mother who display similar patterns of oligodontia without medical problems. Each twin has 13 missing permanent teeth and their mother 16 missing teeth, but the patterns of agenesis do not conform with Butler's Field Theory according to which the distal teeth in each class are most likely to be absent. Unerupted third molars are present in both twins and all three family members display maxillary lateral incisors. Dental crown size profile patterns were computed for all three individuals and highlight a marked reduction in mesiodistal and buccolingual dimensions of the remaining teeth in each. In addition, erupted teeth showed simplified crown morphology. Oligodontia should not be viewed in isolation, but rather considered as one manifestation of a variety of dental changes in genetically susceptible individuals.

Adult↗

Caries prevention by CO2 laser treatment: dependency on the number of pulses used.

The aim of this study was to assess the caries-preventive potential of various carbon dioxide laser conditions and to explore the effect of the number of laser pulses used. The authors irradiated unerupted human molars at two wavelengths--10.6 or 9.6 micrometers--and at 1, 5, 25 or 100 pulses. All teeth were then subjected to pH cycling simulating the conditions for caries progression. Pulsed CO2 laser-preventive treatment inhibited caries-like lesion progression by up to 87 percent. This effect was dependent on the number of pulses used, but there was no correlation between caries resistance and enamel surface morphological changes.

Acetates↗

Effect of biteblocks and repelling magnets on root formation of unerupted premolars in Macaca monkeys.

The effect of repelling magnets on the root formation of unerupted teeth was studied in monkeys. Four controls, four monkeys with acrylic biteblocks and four monkeys with repelling samarium magnets embedded in biteblocks were observed for 12 weeks. After the monkeys were killed the teeth were examined histologically and the root formation evaluated. A clear influence on both the predentine formation and the Hertwig's root sheath was observed. The results clearly indicate the need for more long-term studies on the tissue reactions produced by repelling magnets.

Animals↗

Enamel dysplasia with odontogenic fibroma-like hamartomas: review of the literature and report of a case.

This article reports on a case presenting with a rare syndrome characterized by enamel dysplasia and multiple unerupted teeth with large solid fibrous pericoronal lesions manifesting with odontogenic fibroma-like features. Our case shows in addition to these findings an anterior open bite malocclusion and gingival overgrowths. These overgrowths exhibit the microscopic features of the multiple pericoronal odontogenic fibroma-like lesions that appear to be the hallmark of this syndrome. This unusual case brings the total number documented in the literature to 5, all of which were reported from South Africa.

Black People↗

Transport distraction osteogenesis following marginal resection of the mandible.

We performed sliding transport distraction osteogenesis (STDO) of an alveolar segment containing an unerupted third molar in the mandible of a 22-year-old man with a benign cementoblastoma. Marginal mandibulectomy including the tumour and the right mandibular second premolar and first and second molars was done. STDO was performed to horizontally reconstruct the alveolar ridge and to restore occlusion with the use of the third molar. After forward horizontal distraction of the alveolar segment, the third molar spontaneously erupted and was gradually moved to the position previously occupied by the second molar.

Adult↗

[Surgical-orthodontic correction of unerupted upper canine teeth and motivation for the procedure from the patient's viewpoint].

The surgical correction of the retention of upper canines is made easier by the direct bonding method, furthermore it increases the chances of successful treatment. At the same time at teen-age the treatment is usually missing, since the persistent milk-teeth in the place of impacted canines are ensuring the aesthetic effect. The late treatment is motivated by aesthetic aspects also by loosing the milk-canines. Thus the indication of the treatment is a cure only from the orthodontist's aspect, from the patient's view it's only the aesthetics.

Adolescent↗

Organic structures of developmental origin in human surface enamel.

The aim of this study was to examine the distribution of organic material in mature enamel surfaces immediately prior to eruption. Thirty-six samples of buccal or lingual enamel from unerupted third molars were prepared for transmission electron microscopy by a method involving demineralization of the enamel after embedding in Epon. The results showed that at time of eruption human surface enamel is a highly porous structure containing large amounts of developmental protein which appear as a variety of triangular, funnel-shaped, or invaginated configurations extending into the enamel. The implications of this finding may be of importance to the understanding of early caries lesion formation in the enamel since organic structures may modify the diffusion of ions in and out of the tissue.

Crystallography↗

Modified apically repositioned flap in the treatment of unerupted maxillary central incisors.

The successful management of labially unerupted maxillary central incisors requires a coordinated surgical, orthodontic and general practitioner approach. The key to achieving maximal eruption of these teeth is their surgical exposure, central to which is the philosophy that the surgeon must provide a functional width of attached gingiva on the labial surface. This case describes the incorporation of palatal mucosa into an apically repositioned flap, resulting in the successful establishment of an attached gingival margin, where routine flap design would have seriously compromised the eventual outcome.

Child↗

Identification and quantification of alpha-amino adipic acid in bovine dentine phosphoprotein.

A unique phosphoprotein, which contains an uncommon amino acid, alpha-amino adipic acid (alpha-AAA), was isolated from unerupted bovine teeth by extensive EDTA demineralization. The alpha-AAA in the protein hydrolysates was identified based on the elution time on an amino acid analyzer using the sodium and lithium citrate buffer in a dual column system, and its identity was confirmed by comparisons of its DNS derivative with that of authentic alpha-AAA. This result suggests that the lysine residues in the phosphoprotein may be deaminated by an amine oxidase into allysine and further oxidized to alpha-AAA.

2-Aminoadipic Acid↗

Imaging of unerupted and displaced teeth by cross-sectional CT scans.

Thirty-six impacted and displaced teeth in 29 patients were examined radiographically by using orthopantomography (OPG) and computed tomography (CT). CT scans were obtained by using both a conventional program and a dental CT software program. The radiographic images obtained were compared for visualization of the internal position, inclination of unerupted teeth, and diagnosis of contact and doubtful or clearly visible resorption of adjacent roots. Both CT methods were superior to OPG. As far as the internal position and inclination of the impacted teeth, direct contact, and clearly visible resorption are concerned, the conventional CT program yielded the same information as the dental CT program. However, the exact proportional cross-sectional views obtained by dental CT yielded significantly (P < 0.01) better information about doubtful root resorption in adjacent teeth than did conventional CT.

Adolescent↗

Alveolar bone grafting: a review of 115 patients.

The results of alveolar bone grafting carried out at The Hospital for Sick Children, Great Ormond Street, London, UK, between January 1982 and January 1989 were assessed. Cancellous bone from the iliac crest was grafted to alveolar cleft defects in 115 patients (63 male and 52 female). Eighty-seven unilateral (58 left and 29 right) and 28 bilateral clefts were operated on. The mean age at the time of operation was 11.5 years, with a range of 8.08-18.75 years. The cleft canine had erupted prior to bone grafting in 58.4 per cent. At the time of this study the cleft had erupted in 96.35 per cent and was unerupted in 3.65 per cent of sites. Radiographs were taken at regular intervals and assessed according to previously reported criteria. Eighty-six per cent were clinically successful (Type I and II). In Type III 10.95 per cent had less than three-quarters of the normal interdental septal height and 2.18 per cent failed (Type IV). In addition, 3.6 per cent of sites showed cervical root resorption affecting the adjacent incisor and 1.4 per cent internal resorption of the cleft canine.

Adolescent↗

Prevalence of pre-eruptive intracoronal dentin defects from panoramic radiographs.

PURPOSE: This investigation stemmed from preliminary clinical observations from a school dental clinic, which suggested that a proportion of clinically undetected, radiolucent lesions on radiographs may originate as pre-eruptive intracoronal dentin defects. This study investigated the prevalence of such defects in orthopantomograms from a group of children and young adults. METHODS: A total of 1281 orthopantomograms with 11,767 unerupted permanent teeth were examined. RESULTS: The prevalence of intracoronal dentin defects was 3% by subjects, and 0.5% by teeth; the highest prevalence being noted in the maxillary and mandibular first permanent molars. Most of the lesions occurred singly, and nearly half had extended to greater than two-thirds the width of dentin thickness. Ectopic positioning was significantly associated with this lesion. CONCLUSIONS: Pre-eruptive intracoronal dentin defects occur at a significant prevalence rate. Increased awareness of this entity may improve diagnosis and allow early treatment.

Chi-Square Distribution↗

The role of magnets in the management of unerupted teeth in children and adolescents.

This case report describes the use of magnets in the management of teeth that fail to erupt. Eight children aged between 10 and 15 years were treated. Magnetic traction was applied to two premolars and six molars. Seven teeth (one premolar and six molars) erupted successfully (mean treatment time with magnetic traction: 7.5 months). One premolar failed to erupt; serial radiographic assessment over a 9-month period revealed no evidence of movement and so the magnetic fixture was removed. Histological evaluation of tissue samples taken from around the fixture revealed no evidence of abnormal pathology.

Adolescent↗

The occlusal fissure of unerupted third molars as an experimental caries model in man.

The aim of the present investigation was to establish an experimental model for the study of fissure caries development under conditions as similar as possible to the in vivo situation. Twenty-one blocks (2 X 2 X 3 mm) constituting part of the occlusal fissure were made from unerupted human third molars, and implanted for 60 or 90 d in mandibular molars of students. One milliliter of a 50% sucrose solution was applied to the fissures twice a day. After removal, sections were examined microradiographically in polarized light and in the electron microscope. As a control, the morphology and enamel structure of fissures from 10 unerupted third molars were studied. After 90 d a subsurface, radiolucent caries-like lesion was observed in two specimens only. When examined in air in polarized light, however, all sections exhibited caries-like lesions symmetrically located around the fissures. The 60-d material showed similar lesions, but not as frequently as the 90-d specimens. In the experimental material processed for electron microscopy revealed that the fissure plaque mainly consisted of cocci and small rods. Most often the bacteria were separated from the enamel surface by a pellicle.

Dental Caries↗

A new scale to assess radiographic success of secondary alveolar bone grafts.

OBJECTIVES: To propose a new scale for evaluating the position of the bone graft within the cleft and assess its inter- and intraobserver reliability. DESIGN: Sixty-six patients (70 cleft sites) over a 14-year period were assessed, 90% of patients retrospectively and 10% prospectively. The radiographs were reviewed by two clinicians in controlled conditions twice, with 1 week between assessments. Both clinicians were blind to patient identity. OUTCOME MEASURES: A new scale subdividing the position of the bone into one of six categories was used. The radiographs were also assessed using the Bergland scale. RESULTS: Using the Bergland scale, 62.9% of the cleft sites were type I, 21.4% type II, 4.3% type III, and 5.7% type IV. It was not possible to assess 5.7% of the clefts with this scale because the canine was unerupted. Using the Chelsea alveolar bone graft scale, 58% were category A, 20% B, 7% C, 3% D, 3% E, and 9% F. CONCLUSIONS: The above scale can be used to determine accurately the position of bone within the cleft site. It can be used in the mixed dentition prior to eruption of the canine. It demonstrated moderate to substantial inter- and intraobserver reliability and offers several advantages, compared with other scales.

Adolescent↗

Effect of erupting third molars on dental caries and gingival health in Finnish students.

The purpose of this study was to assess how the eruptive status of third molars relates to gingival and dental health and, in particular, to the status of the adjacent second molar. One hundred and twenty-three young adults were followed up over a 6-year period, from age 20 to age 26. The status of the second and third molars, and DMF, DMFS, DS, MS, and FS indices, periodontal condition, and salivary acidogenic bacterial counts were assessed. The 6-year DFS increase in relation to second molars was greatest in sextants with unerupted third molars. The percentage of erupting third molars that became carious or had been filled during the study period was 30%. Most new caries lesions or filled surfaces were on mesial surfaces of second molars and occlusal surfaces of third molars. The periodontal condition was best in mandibular sextants in which the third molar was missing. It is concluded that the most favourable situation for upper second molars is if the neighbouring third molar is missing by age 20.

Adult↗

Cleidocranial dysplasia: diagnostic criteria and combined treatment.

Cleidocranial dysplasia (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and serious, complex dental abnormalities. There are many difficulties in the early diagnosis of CCD because a majority of the craniofacial abnormalities becomes obvious only during adolescence. In the present case, a hypoplastic midface, a relative prognathia of the mandible, and close approximation of the shoulders in the anterior plane were the conspicuous extraoral findings. Prolonged exfoliation of the primary dentition, unerupted supernumerary teeth, and the irregularly and partially erupted secondary dentition produced occlusional anomalies. The presence of the second permanent molars together with the primary dentition and wide spacing in the lower incisor area were typical dental signs. Gradual extraction of the supernumerary teeth and over-retained primary teeth was the first step of oral surgery. This was followed by a surgical exposure of the unerupted teeth by thinning of the cortical bone. Orthodontic treatment was aimed at parallel growth of the jaws. Removable appliances were used to expand the narrow maxillary and mandibular arches, and a Delaire mask compensated for the lack of sagittal growth of the upper jaw. Temporary functional rehabilitation was solved by partial denture. When the jaws have been fully developed, implant insertions and bridges are the therapeutic measures. The reported case and the literature data support the importance of the early diagnosis and interdisciplinary treatment of CCD.

Adolescent↗