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The incidence of unerupted permanent teeth and related clinical cases.

The impacted or mal-erupted tooth and its associated pathosis provide great diagnostic challenges to the dentist. The frequency of occurrence of impaction was found to be over 10,000 in 5,000 Army recruits. The type and position of impaction are summarized in tables. The incidence of impactions was higher than previously reported and may reflect some sampling bias. The incidence of impacted second and fourth molars is higher than expected. Impactions or mal-eruptions were seen to involve every permanent tooth except the mandibular incisors and first molars. Impactions can occur because of malpositioning of the tooth bud or obstruction in the path of eruption. However, the exact mechanism is still unknown. Six unusual cases of impacted permanent teeth are described to illustrate the importance of panoramic radiographs in the discovery of some anomalously located impactions.

Adolescent↗

Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal.

AIM: This was to assess the predictability of eruption of delayed permanent incisors after supernumerary removal and creation of adequate space, in relation to: root maturity, degree of vertical impaction, and degree of angulation of impaction. METHODS: The dental records of children with supernumerary teeth delaying the eruption of permanent incisors were analysed. The type of a supernumerary tooth, its location and position were recorded, along with the stage of root maturation, angulation and vertical distance of impaction of the permanent incisor. At the initial surgery, the unerupted supernumerary tooth and any retained primary incisors were removed. The unerupted permanent incisor was not exposed. If necessary, the maxillary primary canines were removed to create sufficient space for eruption of the delayed permanent tooth. A secondary surgical procedure was planned after 18 months if there was no significant progress of the permanent tooth towards eruption. STATISTICS: All data were entered onto a Microsoft Excel spread sheet and analysed using Fisher's Exact Tests throughout due to the small numbers. RESULTS: Sixty-six supernumerary teeth were removed, 22 from boys and 44 from girls with ages ranging from 6 to 10 years 6 months at the time of surgery. Primary canines were extracted in 59.1% of cases. Spontaneous eruption occurred in 89.4% of delayed permanent teeth. The mean time to eruption was 9.2 months (median = 7 months). There was no statistically significant association between tooth eruption and root maturity or the degree of vertical impaction. There was an association between eruption and the degree of the angle of impaction of the permanent incisor (p<0.05). CONCLUSION: The majority of delayed permanent teeth erupt spontaneously if sufficient space is available or created at the time of removal of the unerupted supernumerary. The angulation of impaction of the permanent incisor is associated with a delay in eruption.

Child↗

Unerupted premolars--an alternative approach.

These two cases illustrate variations of an alternative technique for moving unerupted teeth into the mouth. Previously described techniques may damage the tooth or the periodontium and the regular adjustments required can be uncomfortable and are unpleasant for the patient and the operator. The method described provides a stress free alternative which is readily acceptable to patients. Adjustments are rarely needed, but if required they usually involve repositioning a magnet in the removable appliance, a procedure carried out simply by the operator or technician using cold cure acrylic.

Adolescent↗

Fluoride distribution in the enamel of the mesio-lingual cusps of pairs of erupted and unerupted third molars of man with a low fluoride background.

The enamel fluoride concentrations at different depths were determined at 5 different sites on the mesio-lingual cusps of 16 pairs of erupted and unerupted third molars. Six successive acid etchings were done on each of the 5 sites. The 16 subjects (18 to 33 years) were living continuously since birth in a low fluoride area (F less than 0.10 ppm). They did not take any systemic fluoride since birth nor did they practise any other anti-caries fluoride program than brushing their teeth once or twice a day with fluoride-containing dentrifrices with about 1,000 ppm fluoride. The fluoride level in the etch solution was measured with the use of an adapted fluoride selective electrode. Statistically significant differences (p less than 0.05) were found in the mean etch depth between the erupted and unerupted molars, to a depth of approximately 5 micron. The mean enamel fluoride concentrations of the erupted and unerupted molars also differed significantly to a depth of approximately 5 micron. There was no influence of fluoride from the oral environment on enamel levels of approximately 10 micron and deeper. Over an exposure period of 1 to 16 years, sixty percent more enamel fluoride (at a depth of approximately 2 micron) was found in the erupted enamel relative to the unerupted enamel (with a low background fluoride) as a result of tooth brushing with fluoride-containing dentifrices. More enamel fluoride was found near the incisal edge than near the cervical margin of 14 of the 16 subjects independently of the age of the subjects.

Acid Etching, Dental↗

Pulp canal obliteration in an unerupted permanent incisor following trauma to its primary predecessor: a case report.

Trauma to a primary tooth may result in damage to the underlying developing permanent tooth bud because of the close proximity between the root of the primary tooth and its permanent successor. We report an unusual case where injury to the primary dentition resulted in pulp canal obliteration (PCO) of a permanent maxillary central incisor prior to its eruption. The other permanent maxillary central incisor was diagnosed as malformed because of trauma to the primary dentition at an earlier age. The occurrences of PCO or crown malformation dose not routinely disrupt the eruption of those teeth. Periodic assessment is required to determine the need for endodontic intervention.

Child↗