Dilaceration--a surgical/orthodontic solution.
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This case report describes an unusual phenomenon related to bilaterally displaced canines, where both upper lateral incisors were absent, but where the canines produced extensive root resorption of both upper first premolars, necessitating their removal.
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A 10-year-old patient with failed eruption of the right mandibular canine associated with a retained metal plate previously placed to reduce a mandibular body fracture is presented. The incidence and site of mandibular fractures related to the developing permanent dentition and the relevance of this to popular methods of fixation employed in the reduction of fractures is discussed.
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A maxillary odontogenic myxoma in a 17-year-old male was diagnosed as a result of his presenting to an orthodontist. Histological diagnosis was obtained following enucleation, and a further wide local excision performed as definitive treatment. The origin of the tumour was most likely from the follicular remnants of a previously exposed canine tooth.
An investigation was undertaken to assess the reliability of radiographic diagnosis of abnormalities of orthodontic significance in the anterior region of the maxilla from intraoral and dental panoramic tomograph (DPT) views. DPT films of 200 patients were scrutinised by two observers on two separate occasions, who also examined intraoral radiographs of the same patients. Sixty-three of these patients were selected because they had previously been diagnosed as presenting with a defined abnormality of orthodontic relevance, such as supernumerary teeth, absent incisors, etc. The remaining cases had been assessed as depicting normal radiographic appearances. Each radiograph was allocated a unique, randomly selected code number as the only means of identification. It was not possible for the observers to match the DPT to the corresponding intraoral films, and this information was only available to the principal investigator (JWF). Both observers were asked to record the presence or otherwise of any abnormalities at each observation of each radiograph, and to record their findings. The overall level of diagnostic accuracy and reproducibility was fairly high, and in general terms the DPT views were as reliable as the intraoral films with regard to the detection of abnormalities; however, there were significant differences between the observers. It was concluded that in many instances supplementary intraoral films would not contribute any additional information compared to the DPT and that selection criteria should be defined for the former.
Much has been written on the aetiology of impacted maxillary canines, but ectopic mandibular canines, being a rarer anomaly, have attracted much less attention. This report describes a case in which the probable aetiology of the displacement of a lower canine was a mandibular fracture through the developing crypt.
The dental treatment needs of 8- and 9-year-old children registered with a GDP for at least 6 months were compared with the dental treatment needs of children from a similar social background who were neither registered nor regularly attending the Community Dental Service. The children were examined by one of the authors without prior knowledge of registration status for evidence of treatment need. Unequivocal treatment need was defined as untreated dental caries in permanent teeth, sepsis associated with deciduous teeth, instanding maxillary incisors, and untreated permanent teeth fractured into dentine; untreated caries in the deciduous teeth was also recorded. Registration status of the children was subsequently obtained from the Dental Practice Board. Sixty-three per cent of the children had been registered with a GDP for at least 6 months at the time of the survey, 6% had been registered for less than 6 months and 31% had never been registered under the new dental contract. Of the children who had been registered for more than 6 months, 18.5% had unequivocal treatment need as against 17.5% in the unregistered group; 40.4% of the registered children had decay in their deciduous teeth, as against 36.5% of the unregistered children. Comparison of the dental treatment needs of registered and unregistered children showed no significant difference between the two groups.
Five hundred pairs of dental panoramic tomographs (DPT) and maxillary anterior occlusal radiographs (AO) from patients referred to the orthodontic department of a dental teaching hospital were examined to assess the diagnostic yield from a panoramic radiograph of the premaxillary region alone and then assess the additional yield when this view was supplemented by a maxillary anterior occlusal radiograph. Of the 500 DPTs assessed, 208 (42%) lacked clarity of the premaxillary region when the labial segments were used to locate the patient in the DPT machine. An association was found between patients who had abnormal incisor relationships and poor clarity in the premaxillary region of the DPT. Overall 165 (33%) of the supplementary AO views were used to support or refute findings identified on the DPT. It was concluded that in patients referred for an orthodontic assessment, supplementary radiography of the premaxilla may be justified in the following situations: 1. unsatisfactory image quality which may frequently be the case where there are abnormal incisor relationships, 2. localisation of tooth position by vertical parallax and 3. where a reasonable expectation that pathology exists on clinical grounds.
A case is reported in which two ectopic maxillary permanent canine teeth bypassed the lateral incisors and caused extensive resorption to both maxillary central incisor teeth. Management involved positioning the canine teeth into the central incisor region and placing porcelain veneers on these teeth. The orthodontic and restorative implications of the treatment are discussed.
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