A follow-up study of injuries to permanent and primary teeth in children.
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Ectopic eruption of teeth into regions other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin, and maxillary sinus. Occasionally, a tooth may erupt in the maxillary sinus and present with local sinonasal symptoms attributed to chronic sinusitis. We present a case of an ectopic maxillary third molar tooth that caused chronic sinusitis in the maxillary sinus.
BACKGROUND: Mucogingival interceptive therapy in patients with buccally erupting teeth is performed to prevent the ectopic permanent tooth from developing periodontal lesions. The keratinized tissue entrapped between the erupting tooth and the deciduous tooth is retained to maintain a satisfactory width of the gingiva for the permanent tooth. The aim of the present study on buccally-erupted premolars scheduled for orthodontics was to evaluate the keratinized tissue width 3 months, 2 years, and 7 years subsequent to mucogingival interceptive therapy and orthodontic treatment. METHODS: Twenty-nine patients participated. Three different surgical techniques were used according to specific indications. Eight patients were treated with double pedicle flaps (DPF), 10 patients with apically positioned flaps (APF), and 11 with free gingival grafts (FGG). RESULTS: The amount of keratinized tissue on the treated (test) sites was not significantly less than on the control (untreated) sites showing normally erupting premolars at all observation periods. All 3 surgical procedures appeared to be effective in saving the keratinized tissue for the permanent tooth. Preoperative periodontal parameters such as gingival width, probing depth, and bleeding on probing significantly influenced the outcome 3 months after surgery (P <0.01). CONCLUSIONS: Mucogingival interceptive surgery is an effective approach to conserve the keratinized buccal gingiva of ectopically erupting premolars.
Free crown tipping can be useful when teeth do not erupt in their physiologic sequence and a real intraosseous migration and eruption of a single tooth into a distant ectopic position can be observed. This article presents a case of an ectopic mandibular lateral incisor treated early, with the light-force technique and uncontrolled forces, and finished with the bidimensional edgewise appliance. A Caucasian female patient, 10 years 10 months of age, had a mandibular left lateral incisor displacement, with the lateral incisor crown positioned mesial to left second primary molar. An early treatment was planned to correct the mandibular left lateral incisor displacement and to allow proper eruption of the mandibular left canine and first premolar. A second phase of treatment, in permanent dentition, was planned for the dental Class II subdivision on the right and deep bite correction. Phase 1 treatment was completed after 10 months; phase 2 treatment was initiated in the permanent dentition and lasted 18 months. Treatment achieved the following outcomes: (1) mandibular lateral incisor in corrected position; (2) full canine and molar Class I relationship; (3) overjet and overbite within the normal limits; (4) symmetric arches; and (5) a balanced profile. The radiograph evaluation revealed good root parallelism and mandibular left lateral incisor light root resorption. The light-force technique is not only a possible alternative but the ideal appliance for treatment in the mixed dentition, when the permanent teeth should be controlled.
Ectopic eruption is a disturbance in which the tooth does not follow its usual course. Among its more important etiologic factors are macrodontism, shortened arch length, posterior positioning of the maxilla, atypical eruption angle, and genetic factors. This article reports a rare case of ectopic eruption of 4 permanent teeth, maxillary central incisors and mandibular first molars, in a child aged 7 years and 11 months, in which the treatment consisted of extracting the maxillary primary central incisors and making an orthodontic intervention on the mandibular arch. A bilateral fixed appliance containing 2 hooks with loops, 1 buccal and the other lingual, was placed on the mandibular primary first molars. The hooks were activated in a niche made of light-curing resin on the occlusal surface of the mandibular permanent molars, to bring about the distal drift of these teeth. After 6 months, complete eruption of the mandibular permanent molars occurred, and a slight displacement of the maxillary permanent central incisors toward the median line was noted. The importance of early, adequate treatment is discussed.
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The associations between tooth and eruption disturbances in four groups of children selected primarily with only one diagnosed eruption or developmental disturbance in each group was analysed. Ninety-two children were primarily diagnosed with ectopic eruption of maxillary first permanent molars, 93 children with infra-occlusion and ankylosis of primary molars, 91 children with ectopic eruption of maxillary canines, and 97 children with aplasia of premolars. Of the children studied 69-79 per cent had only a single one of the four disturbances studied. In 18-28 per cent there was one additional disturbance and in 2-3 per cent two additional disturbances. From chi square contingency tests, it was found that infra-occlusion of primary molars and aplasia of premolars exhibited a higher prevalence in both directions compared to the expected population prevalence. Ectopic eruption of maxillary canines showed a significantly higher prevalence than expected in all the other three groups. Our interpretation is that these results support the hypothesis of a common, presumably hereditary, aetiology. Thus, the four conditions studied would be different manifestations of one syndrome, each manifestation having an incomplete penetrance. With closer follow-up of the maxillary canines during the eruption period in children with some of the other three disturbances, prophylactic, or early interceptive measures may be taken and complicated orthodontic treatment be reduced or avoided.
The eruption of a canine tooth into the nasal cavity constitutes one topographic form of dental ectopy. We report a case and discuss the diagnostic aspects and diverse pathogenic theories proposed. This unusual situation should be suspected in patients with nasal obstruction and unilateral fetid purulent rhinorrhea.
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This study evaluated factors that affected pulpectomy (PE) success and its effect on the succedaneous tooth's eruption and enamel formation. Sixty-five of 250 patients with PEs met the selection criteria and yielded 81 zinc oxide-eugenol PEs (30 incisors, 51 molars) followed a mean time of 90.8 months. Overall PE success was 77.7% with no difference between molars and incisors (P = 0.53). Enamel defects were observed in 18.7% of succedaneous teeth and were related (P = 0.005) to the pre-existing infection causing excess root resorption (>1 mm preoperative root resorption = 44.4% defects) but were not related to overretention of ZOE filler (P = 1) or length of fill (P = 0.36). The PE procedure was not related to causing succedaneous tooth defects since teeth replacing PEs showed no significant increase in the incidence of defects compared with untreated contralateral controls (P = 0.99). There was a 20% incidence of succedaneous tooth anterior cross-bite or palatal eruption following incisor PEs and 21.6% ectopic eruption of premolars following primary molar PEs. Most PEs (95.9%) were lost at their normal exfoliation time or earlier, but 35.8% needed extraction due to overretention by soft tissue at the time of shedding. Pulpectomy success rates showed that the most important preoperative predictor was the amount of primary tooth root resorption. Greater than 1 mm of root resorption resulted in only a 23.1% success rate, which was significant (P = 0.001). Pulpectomies filled short or to the apex had a significantly greater success (P = 0.011) than long fills. Pulpectomies correctly done do not appear to contribute to adverse effects on succedaneous tooth formation but have a 20% chance of altering the path of permanent tooth eruption.
Unilateral complete root resorption of the permanent central incisor was experienced in a boy with deaf and dumb. Transposition of tooth germ or abnormally directed eruption of the canine caused not only an entire root but a part of enamel resorption. The patient was diagnosed clinically and radiographically as an ectopic eruption of the right maxillary upper canine and then treatments were provided to improve esthetic and functional conditions in terms of eruption guidance. It should be emphasized that the early diagnosis and the subsequent eruption guidance is essential in the patient with these kinds of eruption disorder of the mixed dentition.
Intranasal ectopic teeth are rare and ectopic eruption of teeth can occur in a variety of locations. Commonly seen in the palate and maxillary sinus, they have also been reported in the mandibular condyle, coronoid process, orbital and nasal cavities, and through the skin. With the advent of sinonasal endoscopy in the mid 1980s, and subsequent advances in surgical techniques, endoscopic management of intranasal lesions has become possible. In the current case study, we report a successful endoscopic removal of intranasal ectopic teeth located in the nasal cavity. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods of removing an intranasal ectopic tooth.
Four cases have been presented involving malpositioned premolars and molars that were brought into the arch. From the cases presented, it appears that aggressive surgical intervention to redirect ectopic premolars creates significant secondary problems. Interference with the bone surrounding the ectopic tooth may compromise the adjacent teeth and bone level. Pressure against the root of the impacted tooth may cause resorption. If the buccal or labial plate is removed, orthodontic movement will be impeded. Specific biochemical changes in bone are induced by the application of orthodontic forces. In these cases, creating space with coiled spring appliances resulted in remarkable reorientation and proper eruption of ectopic, impacted teeth. When surgical intervention is required in cases involving ectopic teeth, close collaboration between orthodontist and oral and maxillofacial surgeon is imperative to achieve successful results without negative sequelae.
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It is possible to resolve an ectopic eruption with the placement of a steel crown on the second primary molar. This article is a review of the recent literature and the presentation of three cases showing the resolution of ectopic molars using steel crowns.