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PubMed1998

Transmigration of mandibular canines: report of six cases and review of the literature.

Six young adults were found to have transmigrated mandibular canines. One patient presented with two transmigrated canines. Of the seven impacted teeth, the left mandibular canines was involved in five instances and the right two. In all patients, the primary canine was present in the dental arch. A supernumerary tooth was disclosed on the panoramic radiograph of two patients. Five patients underwent surgical removal of the transmigrated tooth from an intraoral approach. One patient experienced transient postoperative paresthesia in the zone innervated by the mental nerve. When the transmigrated canine is accessible, and especially if it is symptomatic, removal of unerupted tooth is recommended. Otherwise, it should be left alone and kept under observation.

Adolescent↗

PubMedDate not supplied

Mixed odontogenic tumors: an analysis of 23 new cases.

The ameloblastic fibroma, ameloblastic fibrodentinoma, and ameloblastic fibro-odontoma are mixed odontogenic tumors that are considered to arise from both epithelial and mesenchymal elements of the tooth germ. This article presents the clinical and histopathologic characteristics of 23 new cases. The patients' ages ranged from 3 to 19 years (median 9). Most tumors were asymptomatic and were associated with an unerupted tooth or teeth. All patients were treated with simple enucleation of the tumor. We found that histologically these lesions comprise a spectrum. Some were probably benign odontogenic tumors (neoplasms) and others were odontomas undergoing maturation (hamartomas); however, in any given case we were, on histologic grounds, unable to differentiate the two. The majority, if not all, of our cases were nonaggressive with little or no tendency to recur, whereas some reported cases have exhibited local aggressiveness and recurrence, suggestive of neoplasia. In our opinion, it is clinically important to distinguish the mixed odontogenic tumors from ameloblastoma since the mixed tumors, found mostly in children, are relatively benign when compared to ameloblastoma, which is found in all age groups (usually adults). The usually innocuous behavior of these lesions does not justify aggressive treatment initially, and simple enucleation should be appropriate in most cases.

Adolescent↗

PubMed1998

Gross periostitis ossificans in mandibular osteomyelitis. Review of the English literature and radiographic variation.

OBJECTIVE: The purpose of this study was to describe a radiographic variety of gross periostitis ossificans in mandibular osteomyelitis and to determine what types of gross periostitis ossificans are related to a specific form of mandibular osteomyelitis without demonstrable causes. STUDY DESIGN: We reviewed 20 cases of gross periostitis ossificans in patients with mandibular osteomyelitis that had been reported with illustrations in the English literature, and we reviewed our own 14 cases of gross periostitis ossificans, previously reported. The radiographic features of the 34 cases of gross periostitis ossificans were classified according to the status of original contour and the appearance of gross periostitis ossificans. Histopathologic features were studied in 12 cases. RESULTS: The 34 cases of gross periostitis ossificans could be classified radiographically into 4 types. Type A, showing an "onion-skin" appearance, was caused by a carious tooth or followed extraction of a tooth. Type B and type C showed a consolidation form; in the 36.8% (7/19) of these cases in which no infectious source could be identified, it was suspected that the condition was caused by a developing unerupted tooth or a dental follicle. Type D was seen in the most chronic stage. Biopsy specimens of 12 cases commonly showed proliferation of newly formed bone, loose interstitial fibrous tissue, and a low-grade inflammatory cell infiltration. CONCLUSION: Gross periostitis ossificans of type B or type C may be a specific form of mandibular osteomyelitis without demonstrable cause.

Adolescent↗

PubMed1983

Management of the nonerupted maxillary anterior tooth.

The noneruption of maxillary anterior teeth, particularly the canine, is a common problem. The cause of the noneruption is multifactorial but almost always involves a lack of space. The literature presents an active and a passive form of orthodontic treatment and has recently stressed the periodontal management of these teeth. Two cases are presented. In both cases the orthodontic techniques of regaining space and providing traction on the unerupted tooth are described. A free gingival graft is used in one case and an apically repositioned flap in the other to achieve a healthy periodontium. The advantages and disadvantages of the techniques used as well as their rationale are discussed.

Adolescent↗

PubMedDate not supplied

Prosthetic treatment of oligodontia with a tooth-supported overdenture--a case report.

An unusual case of oligodontia is reported in a 20 year old Nigerian male. It is unusual because of the isolated occurrence of the oligodontia which is unassociated with a family history or any other clinical features suggestive of specific syndromes or severe systemic abnormality. The patient presented with conically or peg shaped anterior and malformed posterior teeth in both the maxilla and mandible. Full mouth periapical radiographs revealed stunted roots, widening of the periodontal space and an unerupted tooth in the right mandibular premolar region. Tooth-supported upper and lower removable partial overdenture were fabricated for him. This modality of treatment is a better choice which helps not only to preserve the alveolar ridge height and improve aesthetics, but also preserves the proprioceptive mechanisms associated with the periodontal membrane of natural teeth.

Adult↗

PubMed2006

Follicular adenomatoid odontogenic tumor: immunohistochemical study.

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion that affects young patients, with female predominance, mainly in second decade, showing a radiolucent unilocular image associated with an unerupted tooth, usually a canine. In spite of previous and confusing denominations, such as adenoameloblastoma or adenomatoid ameloblastic tumor, AOT is a benign tumor with a very low rate of recurrence, that show a peculiar morphological picture (basaloid appearance with glandular-like structures, calcifying areas, and amiloid-like material) that allow its histopathological recognition. We present a clinicopathological analysis of a case of follicular AOT affecting the mandible in a 9 years-old female patient associated with unerupted lower left canine. Immunohistochemical study showed some data previously unrecognised. All cellular types that composed AOT showed nuclear positivity for p63 indicating a basal characterization in the different cellular components. According to its benign character and low potential for recurrence, AOT revealed a scant proliferative activity (2-3% nuclei showed Ki-67 positivity) limited to some epithelial nodules (AE1-3 +) of fusiform appearance. Absence of reactivity for hormonal receptors (RE and RPg) excluded a possible hormonodependence in AOT that could explain the observed female predominance.

Adenoma↗

PubMed2002

Apparently new osteodysplastic and primordial short stature with severe microdontia, opalescent teeth, and rootless molars in two siblings.

A Thai man and his sister affected with a newly recognized syndrome of proportionate primordial short stature are reported. The patients had severe intrauterine and postnatal growth retardation, prominent nose and nasal bridge, small pinnae, large sella turcica, areas of hypo- and hyperpigmentation of skin, dry and thin scalp hair, and long and straight clavicles. Ivory epiphyses and cone-shaped epiphyses of the hands were found when they were young, but most of them disappeared as they grew up. Scaphoid and trapezium had angular appearance. The second toes were unusually long. Distal symphalangism of toes and barchymesophalangy of fingers were noted. The findings that appear to distinguish this syndrome from the previously reported syndromes are long second toes, opalescent and rootless teeth, severe microdontia, severely hypoplastic alveolar process, and unerupted tooth. The mode of inheritance is suspected to be autosomal recessive.

Abnormalities, Multiple↗

PubMed1976

Calcifying epithelial odontogenic tumor (Pindborg tumor) case report.

A 36-year-old woman was examined and treated for a rare odontogenic tumor in the mandible, the calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor. The tumor extended from the left mandibular molar region to the right premolar area and had almost completely destroyed the bone in the anterior mandibular region. An orthopantomogram showed a multiloculated radiolucent lesion, with an unerupted tooth in the center surrounded by a radiopaque area. In addition, finely granular calcification was visible here and there in the tumor area. In the histologic examination the tumor tissue could be identified as calcifying epithelial odontogenic tumor. Under electron microscopy the fibrillar structure at the basal cell level suggested the presence of amyloid. The tumor was removed by enucleation with a collar of surrounding tissue. No signs of recurrence have been noted at follow-up examinations.

Adult↗

PubMed1982

The follicular primordial cyst - odontogenic keratocyst.

Primordial cysts are often associated with unerupted teeth. Superimposition may result in a 'dentigerous cyst' appearance radiographically. There is usually no direct connection between the cyst lining and the follicle of the unerupted tooth. These have been termed envelopmental primordial cysts. In some instances, however, the primordial cyst actually surrounds the crown and the cyst lining is attached to the neck of the tooth in a true dentigerous relationship. We have called these lesions follicular primordial cysts. That portion of the lining immediately adjacent to the neck of the tooth consists of reduced enamel epithelium whereas the rest of the cyst is lined by typical primordial cyst epithelium. We believe that the follicular primordial cyst is extrafollicular in origin and suggest that it arises following eruption of a tooth into the cyst cavity in exactly the same manner as it would erupt into the oral cavity.

Dentigerous Cyst↗

PubMed1987

Intramural calcifying epithelial odontogenic tumor.

The calcifying epithelial odontogenic tumor (CEOT) is a rare lesion of the jaws. It accounts for about 1% of all odontogenic tumors. The CEOT occurs primarily in the molar-premolar region of the mandible, and 52% of cases are associated with an unerupted tooth. This report describes an unusual case in a 37-year-old woman. The tumor arose in the molar area of the right mandible, appeared radiographically as a radiolucent lesion, and was thought to be a dentigerous cyst in association with an impacted first molar. The lesion was enucleated. Microscopic examination showed it to be a dental sac, within which were the 3 elements of a typical CEOT: squamoid cells with eosinophilic cytoplasm, the homogeneous eosinophilic substance, and calcium salt deposits in the form of Liesegang rings.

Adult↗

PubMed2001

Desmoplastic ameloblastoma (including "hybrid" lesion of ameloblastoma). Biological profile based on 100 cases from the literature and own files.

The profile of the desmoplastic ameloblastoma (DA) is presented, based on a survey of 100 cases. DA is a benign, locally invasive variant of the intraosseous, infiltrative ameloblastoma (IA). Radiologically, the DA shows ill-defined borders with a soap bubble appearance. The finding of a mixed radiolucency-radiopacity in 52% of the cases often leads to a preoperative diagnosis of a fibro-osseous lesion. Association with an unerupted tooth is not a typical finding. The DA accounts for 4-13% of all ameloblastomas. The over-all average age is 42.9 years, higher for males (45.9 years) than for females (39.7 years). Thus, the DA occurs at a slightly higher age than the intraosseous ameloblastoma (37.4 years). The male/female ratio is 1:1. The maxilla/mandible ratio is 1/0.9 as opposed to 1/5.4 for the IA. Seven maxillary tumours involved an entire quadrant and 15 maxillary and mandibular tumours crossed the midline of the jaws. Pathogenetically, it seems that the DA is derived from the same sources as the IA, and extra-osseous sources do not seem to play a role. Histologically, the DA reveals the following morphological characteristics: the odontogenic epithelium occurs as irregular, stellate or follicular islands and cords, the center often appearing hypercellular with spindle-shaped or squamatoid cells. Peripheral columnar or cuboidal cells rarely reveal an ameloblast-like appearance. Thus, there are only vague tendencies to mimic a follicular ameloblastoma with acanthomatous features. The most striking feature separating the DA from IA is to be found in the tumour stroma: in DA there is extensive stromal desmoplasia with an abundance of thick collagen fibres that seem to compress the epithelial islands. Nine cases of so-called "hybrid lesion of ameloblastoma" where areas of IA coexist with areas of DA are surveyed in addition to the 100 cases of DA. No conclusions can be drawn about the biological profile of this variant due to the insufficient number of cases.

Adult↗

PubMed2000

Calcifying epithelial odontogenic tumour: biological profile based on 181 cases from the literature.

The present profile of the calcifying epithelial odontogenic tumour (CEOT) is based on a literature survey of 181 published tumour cases. The CEOT is a benign, though occasional locally invasive, slow-growing neoplasm occurring as intraosseous (94%) and extraosseous (6%) variants. The intraosseous type appears radiographically as an irregular, uni- or multilocular radiolucent area containing radiopaque masses which increases in size and opacity with time. Some 60% of intraosseous CEOT are associated with an unerupted tooth (or odontoma). CEOT shows a relative frequency of 1-2%. The extraosseous variant is diagnosed slightly earlier (mean age 34.4 years) than the intraosseous type (mean age 38.9 years). Both variants have an almost 1:1 gender ratio. The intraosseous CEOT shows a maxilla:mandible site ratio of 1:2 and are mainly located in the premolar/molar region. The present authors present evidence that the CEOT originates from the complex system of dental laminae or remnants thereof. Histologically, the CEOT is characterized by the occurrence of sheets, nests and masses of polyhedral, eosinophilic epithelial cells which may show cellular abnormalities including giant cell formation and nuclear pleomorphism. Some cells increase in size and produce a homogeneous, eosinophilic, 'amyloid-like' substance which may become calcified and which may be liberated as the cells break down. The true nature of the amyloid-like material is still unresolved. Histological variants including CEOT with cementum-like components, clear-cell CEOT (15 cases reported so far), CEOT-containing Langerhans' cells, combined epithelial odontogenic tumour (CEOT/AOT) and CEOT with myoepithelial cells are discussed in detail. In view of the relatively indolent biological behaviour of the CEOT, mutilating procedures, such as wide resection or hemisection of the mandible, seem unwarranted. Enucleation with a margin of macroscopically normal tissue is, therefore, the recommended treatment for CEOT involving the mandible. Maxillary CEOT should, however, be treated more aggressively, as they tend to grow more rapidly and do not usually remain well confined. Generally, recurrences are rare. Five years is considered the absolute minimum follow-up period. The survey has revealed only one well-documented case of a mandibular CEOT in a 75-year-old man showing features of malignancy.

Age Factors↗

PubMed1995

Management of the orthodontic patient 'at risk' from infective endocarditis.

There are no clear guidelines for the application of current antibiotic prophylactic regimes to orthodontic patients at risk from infective endocarditis. In order to ascertain current practice, a survey on various aspects of the management of orthodontic patients at risk from infective endocarditis was undertaken. Questionnaires were sent to all 1038 members of the British Society for the Study of Orthodontics and the British Association of Orthodontists. A total of 518 replies were received, 480 (46%) of which were completed in full and analysed. Eight cases of infective endocarditis associated with orthodontic treatment over a 44-year period were reported. The majority of respondents underestimated the number of at risk patients likely to be encountered over a 5-year period. Most orthodontists routinely contact the medical practitioner (62%) or hospital consultant (65%) for advice on the prescription of prophylactic antibiotics. Only 58 (12%) claimed to have refused orthodontic treatment for at risk patients. The majority of respondents advise the use of antibiotic prophylaxis for band placement and removal and manipulation of an unerupted tooth. A high standard of oral hygiene must be established prior to orthodontic treatment for at risk patients. Antibiotic prophylaxis in orthodontics should be used for procedures which cause gingival trauma eg band placement and removal. The daily use of a chlorhexidine mouthwash during treatment and prior to appliance adjustment is recommended.

Adolescent↗

PubMed1997

Clinical and radiological features of odontogenic myxoma of the jaws.

OBJECTIVES: To analyse critically the clinical and radiological features of odontogenic myxoma. METHODS: The clinical features of 164 cases of odontogenic myxoma (two new and 162 from the literature) and the radiological features of 96 cases (two new and 94 from the literature) were analysed. RESULTS: Most of the tumors (75%) were diagnosed in the 2nd to 4th decades. The male to female ratio was 1:1.5. Tumors were located in the mandible in two-thirds and in the maxilla one-third of cases. A multilocular appearance was observed in 55% and unilocular in 36%; 9% were not loculated. There was a statistically significant correlation (P < 0.000) between the size of the lesion and its locularity with the larger lesions more likely to be multilocular. Only 5% of the tumors were associated with an unerupted tooth. CONCLUSIONS: Odontogenic myxoma has a variable clinical and radiological appearance and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups.

Adolescent↗

PubMed1967

Odontogenic tumour of lip.

There have been nine cases of ;calcifying epithelial odontogenic tumour' described so far. The histological pattern is quite distinctive, and one feature is the presence of abundant intracytoplasmic and stromal material which (Vickers, Dahlin, and Gorlin, 1965) has been shown to react histochemically as amyloid. The tumour is generally believed to be epithelial in origin, arising from the reduced enamel organ of an unerupted tooth with which all the tumours so far recorded are associated. Another case is described, this time arising in the soft tissue of the lip and remote from a tooth. This tumour showed features which suggest that it is of odontoblastic origin and therefore not epithelial. Evidence is also produced to show that the ;amyloid-like' material is not degenerative but probably dentine being actively produced by the tumour cells themselves.

Amyloid↗

PubMed1995

Transcription and translation of CSF-1 in the dental follicle.

The dental follicle, a loose connective tissue sac which surrounds the unerupted tooth, is required for eruption to occur. Injection of colony-stimulating factor-1 (CSF-1) will accelerate molar eruption in rats, as well as stimulate tooth eruption in osteopetrotic rats. Utilizing in situ hybridization and reverse- transcription polymerase chain-reaction techniques, we show here that CSF-1 mRNA is present in vivo in the dental follicle of the first mandibular molar of the rat. Analysis of the molars from day 0 through day 10 post-natally demonstrates that the maximal expression of CSF-1 mRNA is at day 3 post-natally. Immunostaining also reveals that the CSF-1 mRNA is translated, with immunostaining for the CSF-1 itself, being heavy in early post-natal days and absent by day 9 postnatally. In view of the fact that there is a maximal influx of mononuclear cells (monocytes) into the dental follicle at day 3 post-natally--an influx which increases the numbers of osteoclasts needed to form a tooth eruption pathway--it is probable that the maximal expression of CSF-1 mRNA by day 3 post-natally contributes to this monocyte influx. Thus, this study establishes a relationship among a molecule (CSF-1), cell (monocyte), and tissue (dental follicle) that appear to play a major role in tooth eruption.

Animals↗

PubMed1984

An unusual lateral incisor.

The conditions of hypodontia, hyperodontia and connation (fusion or gemination) have been outlined. A case has been reported in which there has been failure of development of a normal maxillary lateral incisor on one side, with an unerupted tooth in this region which exhibited characteristics of a supernumerary tooth; a diagnosis of hypo-hyperodontia is suggested. This has occurred in a patient in whom the deciduous incisors in the same quadrant were connate.

Anodontia↗

PubMed2005

Ameloblastic fibroma at the University of Nairobi Dental Hospital.

OBJECTIVE: To document the occurrence of cases of ameloblastic fibroma. DESIGN: A retrospective study. SETTING: The Division of Oral Pathology and Oral Medicine histopathology laboratory at the Faculty of Dental Sciences, University of Nairobi, January 1991 to December 2000. RESULTS: Seven complete records of histopathologically confirmed cases of ameloblastic fibroma were identified. There were four male and three female cases with an age range of 10 to 22 years (mean=14 years). Remarkably, six of the cases had lesions in the molar regions of the mandible with a single case with a maxillary molar area lesion. One of the cases had the neoplasm associated with an unerupted tooth. From the clinical notes all the patients were managed by meticulous enucleation and curettage of the lesions. After follow up periods ranging from several months to eight years no recurrences had been recorded. CONCLUSION: Evidently ameloblastic fibroma is an uncommon neoplasm as noted in the earlier literature. Although the lesions can be quite extensive at the time of diagnosis, the recurrence rate appears to be relatively low if the neoplasms are meticulously extirpated.

Adolescent↗