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Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR. The patient's chief complaint was recorded as "spontaneous pain" in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of "Symptomatic Irreversible Pulpitis" and "Normal Apical Tissue," respectively. The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of "granulation tissue with acute and chronic inflammation". No caries were detected. Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Pre-eruptive intracoronal radiolucency (PEIR) poses a challenge to paediatric dentists as it cannot be clinically detected., Aim: To estimate the prevalence and coexisting factors of PEIR in permanent teeth of children and adolescents in western Tamil Nadu, India., Design: This cross-sectional study assessed 5012 digital panoramic radiographs of children and adolescents below 14 years of age obtained from private digital imaging centers, dental clinics, and dental colleges located in five districts of western Tamil Nadu. The prevalence and PEIR and its coexisting factors were assessed by two independent calibrated investigators. Data were analyzed using the chi-square test., Results: The subject prevalence and tooth prevalence of PEIR were estimated to be 3.2% and 0.4%, respectively. Maxillary canines and mandibular premolars were commonly involved. Majority of the lesions were limited to less than one-third of dentin thickness (74%) and distal aspect of the crown (45.1%). Ectopic positioning (9.3%) and dental caries in the preceding primary tooth (9.9%) were the most common coexisting factors., Conclusion: Pre-Eruptive Intracoronal Radiolucency defects were commonly seen in maxillary canines, mandibular premolars, and distal aspect of the crown involving less than one-third dentin thickness. Ectopic positioning and caries in primary teeth were commonly seen along with the PEIR defects., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

This study examined the prevalence, characteristic features, and complications associated with the occurrence of unerupted permanent incisors among children and adolescents attending a university dental teaching hospital. A retrospective review was performed of the clinical records of children and adolescents who attended the Prince Philip Dental Hospital, Hong Kong between 2005 and 2014. All patients who had at least one unerupted permanent incisor tooth were included. A total of 266 subjects with 320 unerupted permanent incisors were identified. The prevalence of unerupted permanent incisors among children and adolescents was 2.0%. Permanent maxillary central incisors (70.6%) were the most commonly affected teeth. The most common cause for unerupted incisors were dilacerations (n = 83, 36.7%) for maxillary central incisors; developmental dental anomalies (n = 22; 30.6%) together with unfavorable root development (n = 22; 30.6%) for maxillary laterals incisors; and abnormal tooth/tissue ratio (n = 11, 50.0%) for mandibular incisors. A majority of unerupted incisors presented with complications the most common being ectopic/displacement/rotation of the unerupted incisors (46.6%), loss of space (36.9%) and midline shift (27.5%). In conclusion, the causes were distinct for different manifestations of unerupted permanent incisors. As the majority of unerupted incisors presented with complications, a systematic and organized method of history taking as well as clinical and radiographic examinations is mandatory in the diagnosis of unerupted permanent incisors., Competing Interests: The authors have declared that no competing interests exist.

Aim: The aim of the present study was to determine the prevalence, location, size, and tooth type of pre-eruptive intracoronal radiolucencies (PEIR) from panoramic radiographs in Thai patients., Methods: A retrospective study of PEIR was conducted on 1599 panoramic radiographs of 629 Thai males and 970 Thai females with an age range of 4-20 years (average age: 14.0 ± 4.0 years). Each radiograph was reviewed by two calibrated examiners. The age and sex of the patients, location, size, and tooth type of the lesions were recorded. The SPSS program was used for statistical analysis., Results: The PEIR were found in 0.32% of tooth samples (29/9060) and 1.63% of patients (26/1599). There was no statistical difference in the presence of PEIR between both sexes. The mandibular second molars were the most affected teeth. The lesions were mostly located at the central part of the crown. The lesion sizes were mostly limited to less than one-third of dentinal thickness., Conclusions: The present study showed that the prevalence of PEIR in Thai samples is 1.63%. This could raise dentists' awareness in reviewing unerupted teeth in panoramic radiographs. Early detection of the lesions should aid in proper treatment planning of affected teeth to prevent complications from carious invasion after tooth eruption., (© 2017 John Wiley & Sons Australia, Ltd.)

The relationship between maxillary lateral incisor anodontia and the palatal displacement of unerupted maxillary canines cannot be considered as a multiple tooth abnormality with defined genetic etiology in order to be regarded as a "syndrome". Neither were the involved genes identified and located in the human genome, nor was it presumed on which chromosome the responsible gene would be located. The palatal maxillary canine displacement in cases of partial anodontia of the maxillary lateral incisor is potentially associated with environmental changes caused by its absence in its place of formation and eruption, which would characterize an epigenetic etiology. The lack of the maxillary lateral incisor in the canine region means removing one of the reference guides for the eruptive trajectory of the maxillary canine, which would therefore, not erupt and /or impact on the palate. Consequently, and in sequence, it would lead to malocclusion, maxillary atresia, transposition, prolonged retention of the deciduous canine and resorption in the neighboring teeth. Thus, we can say that we are dealing with a set of anomalies and multiple sequential changes known as sequential development anomalies or, simply, sequence. Once the epigenetics and sequential condition is accepted for this clinical picture, it could be called "Maxillary Lateral Incisor Partial Anodontia Sequence."

Enlarged follicles associated with multiple unerupted teeth always comprise an area of considerable interest for oral and maxillofacial surgeons. The condition of multiple calcifying hyperplastic dental follicles is extremely rare and is characterized by multiple unerupted teeth with abundant calcifications and odontogenic epithelial rests in the enlarged dental follicles. We report an interesting case of multiple calcifying hyperplastic dental follicles in a 16-year-old healthy male patient., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: The determination of tooth size to arch length discrepancy in mixed dentition requires an accurate prediction of mesiodistal width of unerupted permanent teeth. Presently available methods use only the mesiodistal width of mandibular incisors. Melgaco (2007) introduced a new method of estimating width of unerupted canine and premolars by using mesiodistal width of incisors and first permanent molar., Aim: The aim of this study is to determine linear regression equation for estimating the widths of mandibular permanent canines and premolars using mesiodistal width of mandibular incisors and first molars in the Himachal population., Materials and Methods: Dental casts of 250 subjects were selected from the Himachal population who had fully erupted mandibular permanent incisors, canine, premolar, and first molar. Actual mesiodistal width of all fully erupted teeth were measured with digital vernier caliper and the values obtained were subjected to statistical and regression analysis., Results: High values of correlation (0.957) were found while considering Melgaco's method., Conclusion: From this study, it can be evaluated that Melgaco's method gives better prediction of unerupted permanent canines and premolars, and the equation Y = 13.48 + 0.614X can be suggested for the present population.

Objectives: Enamel fluorosis is a hypomineralization caused by chronic exposure to high levels of fluoride during tooth development. Previous research on the relationship between enamel fluoride content and fluorosis severity has been equivocal. The current study aimed at comparing visually and histologically assessed fluorosis severity with enamel fluoride content., Methods: Extracted teeth (n=112) were visually examined using the Thylstrup and Fejerskov Index for fluorosis. Eruption status of each tooth was noted. Teeth were cut into 100 μm slices to assess histological changes with polarized light microscopy. Teeth were categorized as sound, mild, moderate, or severe fluorosis, visually and histologically. They were cut into squares (2 × 2 mm) for the determination of fluoride content (microbiopsy) at depths of 30, 60 and 90 μm from the external surface., Results: Erupted teeth with severe fluorosis had significantly greater mean fluoride content at 30, 60 and 90 μm than sound teeth. Unerupted teeth with mild, moderate and severe fluorosis had significantly greater mean fluoride content than sound teeth at 30 μm; unerupted teeth with mild and severe fluorosis had significantly greater mean fluoride content than sound teeth at 60 μm, while only unerupted teeth severe fluorosis had significantly greater mean fluoride content than sound teeth at 90 μm., Conclusions: Both erupted and unerupted severely fluorosed teeth presented higher mean enamel fluoride content than sound teeth., Clinical Significance: Data on fluoride content in enamel will further our understanding of its biological characteristics which play a role in the management of hard tissue diseases and conditions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To elucidate the mesiodistal inclination of the unerupted mandibular second premolar (MnP2) in cases of mandibular incisor (MnIc) agenesis and unilateral MnP2 agenesis., Materials and Methods: Twenty-two cases of unilateral MnP2 agenesis (MnP2 agenesis group) and a control group (control group A) of 22 cases without permanent tooth agenesis excluding third molars were selected. Thirty-six cases of MnIc agenesis (MnIc agenesis group) and another control group (control group B) of 36 subjects were also selected. Mesiodistal inclination of the unerupted MnP2 on the panoramic X-rays was measured according to the distal angle and premolar-molar angle using the methods of Shalish et al. and Baccetti et al., respectively. Differences in mean values of the angular measurements between agenesis groups and corresponding controls were investigated (unpaired t-test)., Results: In the MnP2 agenesis group, the mean distal angle decreased 12.3° and the mean premolar-molar angle increased 13.3° for the MnP2 compared with control group A (both P < .001). In the MnIc agenesis group, no significant differences in the means of those angles for the MnP2 were found when compared with control group B., Conclusion: In Japanese orthodontic patients, there is a relationship between unilateral MnP2 agenesis and the mesiodistal angulation of the unerupted MnP2. However, no significant relationship was observed between MnIc agenesis (which relationship is often seen in Asian populations) and the position of the unerupted MnP2. These results suggest that different genetic factors are involved in MnP2 agenesis and MnIc agenesis.

Aim: This paper describes a case of an eruption hematoma in a 20-month-old boy and the impact of this hematoma on the quality of life (QoL) related to oral health of this infant and his family., Background: Eruption hematoma is a soft benign cyst that contains blood and overlie a tooth that are about to erupt. Oral health conditions can affect the QoL and bring psychological impacts., Case Report: The proposed treatment was based on oral hygiene instruction, normal diet and massage on the lesion area. A weekly follow-up visits up to the spontaneous regression at the 6 weeks of the lesion was conducted. The impact on QoL was assessed though the Brazilian version of the early childhood Oral Health Impact Scale (B-ECOHIS) questionnaire before and after 2 months of the hematoma regression., Conclusion: The presence of eruption hematoma impacted, physically and emotionally, the QoL related to oral health of the child and his family, and this impact decreased when the eruption hematoma disappeared., Clinical Significance: It is important the knowledge of the dentists about eruption cyst/hematoma to make the correct decisions to improve the QoL of their patients and families.

Cases of congenitally missing and delayed eruption of the maxillary first molar are rare. However, in recent years, we have experienced cases of suspected delayed eruption of or congenitally missing first molars. The purpose of this study was to analyze the formation of delayed erupted maxillary first molars (M1) (>2 standard deviations), which play important roles in occlusion, and normal eruption of the maxillary first molars (U6). The frequency of M1 among patients born between 1974 and 1994 in one institution with a clear total patient number and personal oral histories was 1.55 % [80 % bilateral eruption in 8 of 806 male patients (0.99 %) and 23 of 1195 female patients (1.92 %)]. To evaluate the formation and eruption of M1 according to Moorrees's tooth formation stages, panoramic X-ray films were obtained every year for 73 patients with M1 from 3 institutions (20 male and 53 female patients, total 131 M1s) without systematic histories or genetic disorders. The development/growth curve of M1 was fitted to both the logistic curve and U6 curve. The M1 development/growth curve was started behind with U6 curve; however, the straight part of the M1 curve exhibited steep inclination compared with the straight part of the U6 curve. The curve of the eruption pathway of M1 also exhibited a sigmoid S shape. These results indicate that the development and migration speed of M1 are faster than that of U6, excluding the delayed start point. These results may help orthodontists in treatment planning for patients with M1.

Background: The purpose of the study was to correlate the provisional diagnosis of pericoronal radiolucencies associated with impacted, embedded, or unerupted teeth with the histopathologic diagnosis, and also to emphasize the importance of early detection for better diagnosis and management., Methods: This is a retrospective study involving 18 cases of pericoronal radiolucencies associated with unerupted, embedded, or impacted teeth whose data during 1-year period were retrieved, and were reviewed for clinical, radiological, and histopathologic data. Also, comparison and correlation of clinico-histopathologic diagnosis was made., Results: Of the 18 cases, 11 were provisionally diagnosed as dentigerous cyst and the remaining were diagnosed as ameloblastoma, odontogenic keratocyst, adenomatoid odontogenic tumor, and calcifying epithelial odontogenic cyst. Histopathologic diagnosis of the 18 cases showed varied results, with only 10% correlating with the provisional diagnosis., Conclusion: Although many pathological processes may present radiographically as pericoronal radiolucencies associated with unerupted teeth, the most common is the dentigerous cyst. Hence, it is crucial for the clinician to fully investigate all teeth that fail to erupt at the expected time, and promptly initiate appropriate assessment and management of suspected cystic lesions.

For the last 70 years, the phenomenon of pre-eruptive intracoronal resorption (PIR) has been described in the literature, including a number of case reports illustrating the challenges clinicians face in diagnosing and managing these resorptive defects. Pre-eruptively affected teeth can be difficult to access and posteruptively they are difficult to diagnose because the defects resemble caries. Many times, these defects are not detected until after eruption, when the majority are diagnosed as dental decay and teeth are often subjected to surgical tooth restoration. The purposes of this paper are to report a case of nonprogressive PIR that was detected early, treated with a preventive glass ionomer sealant, and monitored for 44 months, and to propose an alternative approach to management of nonprogressive defects that may help preserve tooth structure.

The purpose of this paper was to describe a rare case of idiopathic coronal resorption of an unerupted permanent mandibular second molar, which was detected as a chance finding on an orthopantomogram taken to assess dental eruption on a young patient about to start orthodontic treatment. The affected tooth was removed and underwent histopathological investigation. This case report provides a discussion of the possible etiologies for this radiographic appearance, as well as the diagnosis and management of such lesions. Failure to identify such lesions can potentiate a guarded prognosis. Further research is required in this field to investigate the etiology and pathological process, albeit this is limited by the rarity if these lesions.

Aim: This study evaluated and improved a protocol for obtaining standard caries-affected dentin (CAD) by Streptococcus mutans biofilm demineralization process., Materials and Methods: Forty-eight human molars were divided in six experimental groups, according to: period of cariogenic challenge (7, 14 or 21 days) and type of dentin (erupted or unerupted teeth). After complete cariogenic challenge sound and CAD dentin were evaluated by: visual inspection (VI), digital radiography (DR), optical coherence tomography (OCT) and laser fluorescence (LF)., Results: Visual inspection confirmed the formation of CAD based on tissue yellowing and loss of surface gloss. Digital radiography detected the presence of radiolucent images, suggesting caries. Three calibrated examiners viewed all images obtained by VI and DR and were able to distinguish healthy from CAD. Fisher's exact statistical test (p < 0.05) confirmed no difference between groups by VI (G1/G4: p = 0.6; G2/G5: p = 1; G3/G6: p = 1) or DR (G1/G4: p = 1; G2/G5: p = 1; G3/G6: p = 1). Both LF values and demineralization depth, as determined by OCT, were subjected to ANOVA (p < 0.05). For LF, a statistically significant difference was observed for the type of substrate (p = 0.001). For OCT, no statistically significant differences in the type of substrate (p = 0.163), length of cariogenic challenge (p = 0.512) or interaction between factors (p = 0.148) were observed. Scanning electron micrographs confirmed the presence of CAD; a more uniform demineralization surface was observed in the dentin of unerupted teeth., Conclusion: This protocol suggests that standard CAD can be obtained in 7 days of cariogenic challenge using unerupted teeth. Clinical significance: With the new perspective on the clinical treatment of caries lesions, bonding is increasingly performed to demineralize CAD, which is susceptible to remineralization. A useful protocol to standardize the production of CAD, by microbiological cariogenic challenge, would be an important contribution to laboratorial test in the field of operative dentistry.

There is a resurgence of interest in coronectomy, but its appropriate application in the management of third molar teeth has yet to be defined. Dentigerous cysts associated with unerupted teeth are most commonly associated with mandibular third molars. In this case series we evaluate outcome after coronectomy of teeth with associated dentigerous cysts in cases where the inferior dental nerve was thought to be at risk, or there was an increased risk of mandibular fracture. We retrospectively studied 21 consecutive patients treated by coronectomy for dentigerous cysts at the Oral Surgery Department at Guy's Hospital. The most commonly affected teeth were mandibular third molars (20/21). One patient had permanent injury to the inferior dental nerve, but no mandibular fracture or recurrence of cyst was reported. One patient required secondary retrieval of the retained root because of eruption. Coronectomy of unerupted teeth associated with dentigerous cysts is an effective treatment when there is high risk of injury to the inferior dental nerve injury or potential for mandibular fracture. Further work with larger numbers and longer follow-up is required to discover the long-term outcome of the electively retained root., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Cases have been reported in the literature in which extraoral sinus tracts of dental origin have been diagnosed and successfully treated. Similarly, the presence of an intracoronal radiolucency in unerupted permanent teeth has been found in the dental literature. The association of one with the other, however, is a rare occurrence. The purpose of this case report was to describe the treatment of a 7-year-old child who presented with an extraoral draining sinus originating from a carious, developing tooth bud of the unerupted permanent mandibular left second molar. After a thorough clinical and radiographic examination, a conclusive diagnosis was determined and surgical treatment was performed. The patient responded well, and the cutaneous lesion healed uneventfully.

Ghost cell differentiation within an ameloblastic fibroma is extremely rare. The ghost cells found in an ameloblastic fibroma in previously reported cases were all associated with a typical calcifying odontogenic cyst. Here, we report a case of an ameloblastic fibroma with focal ghost cells and calcifications in some neoplastic epithelial islands, but without other histologic manifestations consistent with a calcifying odontogenic cyst. The patient was a 13-year-old Chinese boy who presented with a bony-hard swelling in the posterior mandibular region over a 6-month period. Radiographs showed a well-defined multilocular radiolucency associated with an unerupted tooth. The lesion was mostly cystic-solid and comprised of odontogenic epithelial strands, islands and myxoid ectomesenchymal component microscopically. Small groups of ghost cells and calcification were noted in the epithelial islands.

Background: The dentigerous cyst is usually defined as a cystic cavity that surrounds the crown of an unerupted tooth on the cementoenamel junction. The present article reports a case of an uncommon dentigerous cyst, highlighting its clinical, radiographic and surgical characteristics and discussing the aspects related to its development in infancy., Case Report: A 03-year-old boy patient presented with an extensive radiolucid area involving the crown of the right maxillary lateral incisor. A surgical excision was performed. Anatomopathological examination revealed a cystic tissue with a fibrous wall surrounded by nonkeratinized stratified squamous oral epithelium, without atypia., Conclusion: It is possible that the dentigerous cyst grows in the dental germ in any stage of development and not only in the follicle of a tooth with calcified crown attached to the cementoenamel junction.

Objectives: The aim of this study was to investigate the relationship between podoplanin expression and proliferative activity of ameloblastomas and remnants of the odontogenic epithelium from dental follicles (DF) of unerupted teeth., Subjects and Methods: Thirty-three paraffin-embedded ameloblastomas and thirty-two DF obtained of unerupted teeth were analyzed by immunohistochemistry using anti-human podoplanin and anti-Ki-67 antibodies. Podoplanin expression in odontogenic epithelial cells was evaluated using a scoring method, and the Ki-67 labeling index was determined by the percentage of positive odontogenic cells., Results: All ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands. Membranous expression of podoplanin in ameloblastomas was stronger than in the remnants of odontogenic epithelium (P = 0.001). Statistically significant difference was observed between the cytoplasmic and membranous expression of podoplanin in the remnants of odontogenic epithelium (P = 0.001). The index of epithelial odontogenic proliferative activity, verified by Ki-67 expression, was higher in ameloblastomas vs remnants of odontogenic epithelium (P < 0.001). No statistically significant correlation was identified between podoplanin and the cellular odontogenic proliferative activity in meloblastomas and DF (P > 0.05)., Conclusions: These results provide evidence that there is no connection between podoplanin immunostaining and odontogenic cellular proliferative activity and suggest a role for membranous podoplanin expression in the local invasion of ameloblastomas., (© 2012 John Wiley & Sons A/S.)

Aim: Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity [Massler et al., 1941]. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage [Andreasen et al., 1997]. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001]., Case Report: This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

Introduction: In this prospective longitudinal study, we compared the prevalence of mandibular second molar eruption difficulties in patients treated with appliances to maintain mandibular arch perimeter. Other independent variables (age, molar angulation, space-width ratio, treatment time, and sex) were tested for their value as predictors of eruption difficulty., Methods: Three hundred one patients and subjects were divided into 4 groups: patients treated with a Schwarz appliance, patients treated with a mandibular lingual holding arch, patients treated with a combination of both appliances, and subjects who received no treatment (controls). Logistic regression analysis was used to determine the statistical significance of the possible predictors of eruption difficulty. Panoramic radiographs were analyzed at 2 times--before and after treatment. The radiograph before treatment was evaluated for the angulation of the mandibular second molars and space available for these unerupted teeth. The radiograph after treatment was used to determine the incidence of mandibular second molar eruption difficulty., Results: All 3 treatment groups had higher incidences of mandibular second molar eruption difficulty when compared with the controls; the increased prevalence was significant for the protocols incorporating the Schwarz appliance. Initial molar angulation, space-width ratio, age, and sex of the patient were not significant predictors of disturbances in the eruption pattern of the mandibular second molars., Conclusions: Orthodontic appliances intended to maintain mandibular arch perimeter in the mixed dentition increase the probability of eruption disturbances of the mandibular second molars. Clinicians should monitor these patients carefully to prevent impaction of the second molars., (Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Crown dilaceration of permanent teeth occurs due to the non-axial displacement of the already formed hard tissue portion of the developing crown at an angle to their longitudinal axis due to trauma to the primary predecessors. This is a rare condition, representing only 3% of the total of injuries to developing teeth and usually occurs in permanent maxillary incisors because of the close proximity of their tooth germs to the primary incisors, which are more susceptible to trauma. This alteration frequently results from the intrusion of a primary tooth when the child is around 2 years of age, at which time half of the crown of the permanent successor is already formed. Teeth with dilacerated crowns may either erupt with buccal or lingual displacement or remain impacted. The treatment may involve endodontic, orthodontic, restorative and prosthetic procedures. This paper reports the restorative treatment proposed to reestablish the esthetics and function of the affected teeth in three cases of crown dilaceration in permanent maxillary incisors after trauma to their primary predecessors.

Ekman-Westborg and Julin is a trait that shows multiple macrodontia and multituberculism affecting only the teeth with no other anomalies (E-WJ). The aim of this report is to present a case which appears to manifest all the clinical signs of the E-WJ trait including odontoma formation. A 18-year-old girl with gingival inflammation particularly in the maxillary insicor area was referred to the authors' department. Panoramic, periapical and cephalometric radiographs were examined and complex odontoma associated with unerupted maxillary permanent lateral incisors was revealed. Intraoral examination revealed anterior crossbite, Angle Class III type malocclusion with mandibulary prominence and macrodontia of teeth 37, 12, 11 and 21. The patient was accepted as a new sporadic case of E-WJ. More case reports are needed to elucidate the causes and pathogenesis of this condition., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Odontodysplasia is a rare, non-hereditary developmental anomaly affecting dental tissues derived from both the mesoderm and ectoderm which results in a bizarre clinical and radiographic appearance. Regional odontodysplasia describes the segmental and localized nature of the condition. Odontodysplasia occurring in a single tooth is a rare occurrence. A case of Solitary odontodysplasia in an eleven year and half old male whose chief complaint was the absence of eruption of permanent maxillary right central incisor teeth is presented. Clinical, radiographic and histological findings of a single tooth, odontodysplasia are described in this case report.

Epidermoid carcinoma and mucoepidermoid carcinoma that arise centrally within the jaws are often associated with dental cysts. Central mucoepidermoid carcinoma of the jaws is rare, and usually presents in the fourth to eighth decades; we know of only 7 cases that have been described in children younger than 16. Here we describe a central mucoepidermoid carcinoma in an 8-year-old girl that arose from a dentigerous cyst associated with an unerupted mandibular molar., (Copyright © 2010 British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Amelogenins are highly conserved proteins secreted by ameloblasts in the dental organ of developing teeth. These proteins regulate dental enamel thickness and structure in humans and mice. Mice that express an amelogenin transgene with a P70T mutation (TgP70T) develop abnormal epithelial proliferation in an amelogenin null (KO) background. Some of these cellular masses have the appearance of proliferating stratum intermedium, which is the layer adjacent to the ameloblasts in unerupted teeth. As Notch proteins are thought to constitute the developmental switch that separates ameloblasts from stratum intermedium, these signaling proteins were evaluated in normal and proliferating tissues., Methods: Mandibles were dissected for histology and immunohistochemistry using Notch1 antibodies. Molar teeth were dissected for western blotting and RT-PCR for evaluation of Notch levels through imaging and statistical analyses., Results: Notch1 was immunolocalized to ameloblasts of TgP70TKO mice, KO ameloblasts stained, but less strongly, and wild-type teeth had minimal staining. Cells within the proliferating epithelial cell masses were positive for Notch1 and had an appearance reminiscent of calcifying epithelial odontogenic tumor with amyloid-like deposits. Notch1 protein and mRNA were elevated in molar teeth from TgP70TKO mice., Conclusion: Expression of TgP70T leads to abnormal structures in mandibles and maxillae of mice with the KO genetic background and these mice have elevated levels of Notch 1 in developing molars. As cells within the masses also express transgenic amelogenins, development of the abnormal proliferations suggests communication between amelogenin producing cells and the proliferating cells, dependent on the presence of the mutated amelogenin protein., (© 2010 John Wiley & Sons A/S.)

Aim: To measure the arch length of sides containing palatally displaced canines and to compare them with those of contralateral sides with normally positioned canines., Methods: The study sample consisted of 36 children 10 to 12 years of age with unerupted permanent maxillary canines who presented with palatally displaced canines, unilaterally, with respect to the maxillary lateral incisors. The palatal displacement was evaluated using the horizontal tube shift method with periapical radiographs, after the canine cusp tips were found to overlap their adjacent lateral incisors on panoramic radiographs. Arch length was measured on either side from a uniform point on the mesiolingual surface of the permanent first molar to a point on the dental arch that coincided with an anterior extension of the midpalatal raphae. The side that contained the palatally displaced canine was considered experimental, while the contralateral side was the control. The mean, standard deviation, range, and 95% confidence interval values were calculated, and the Student t test was carried out to obtain the P values for the arch lengths., Results: The mean arch length value from the experimental sides was 31.38 ± 1.98 mm (95% CI 29.30 to 33.45). The mean value from the control sides was 32.86 ± 2.28 mm (95% CI 30.48 to 35.24)., Conclusion: There is a significantly high possibility of finding palatally displaced canines with respect to maxillary lateral incisors on sides with lesser arch lengths compared to the contralateral sides., (© 2011 BY QUINTESSENCE PUBLISHING CO, INC.)

The continuous growth of rodent incisors requires the presence of stem cells capable of generating ameloblasts and odontoblasts. While epithelial stem cells giving rise to ameloblasts have been well-characterized, cells giving rise to the odontoblasts in incisors have not been fully characterized. The goal of this study was to gain insight into the potential population in dental pulps of unerupted and erupted incisors that give rise to odontoblasts. We show that pulps from unerupted incisors contain a significant mesenchymal-stem-cell (MSC)-like population (cells expressing CD90+/CD45-, CD117+/CD45-, Sca-1+/CD45-) and few CD45+ cells. Our in vitro studies showed that these cells displayed extensive osteo-dentinogenic potential, but were unable to differentiate into chondrocytes and adipocytes. Dental pulps from erupted incisors displayed increased percentages of CD45+ and decreased percentages of cells expressing markers of an MSC-like population. Despite these differences, pulps from erupted incisors also displayed extensive osteo-dentinogenic potential and inability to differentiate into chondrocytes and adipocytes. These results provide evidence that continuous generation of odontoblasts and dentin on the labial and lingual sides of unerupted and erupted incisors is supported by a progenitor population and not multipotent MSCs in the dental pulp.

Introduction: The aim of this study was to evaluate the significance of association between distally displaced premolars (DDP) and palatally displaced canines (PDC) in the pattern of associated phenotypes of dental developmental disturbance., Methods: A sample of 2811 subjects (mean age, 9 years 7 months +/- 1 year 3 months) was divided randomly into 2 groups. The first group of 500 subjects was the control group. The reference prevalence rates for the examined parameters were calculated for this group: DDP (measured with the distal angle theta and the premolar-molar angle gamma); PDC; and other dental anomalies, specifically, aplasia of the third molars, aplasia of the contralateral mandibular second premolar, aplasia of the maxillary lateral incisors, and small maxillary lateral incisors. Of the remaining 2311 subjects, the first 100 with a diagnosis of DDP of at least 1 mandibular second premolar comprised experimental group 1 (DDP group). In addition to sex distribution, the same variables that were examined in the control group were analyzed. In the subgroup with the concurrent DDP and PDC (experimental group 2, or DDP-PDC group), the presence of other dental anomalies was investigated. The prevalence rate for PDC in experimental group 1 was compared with that in the control group. The same was done for the prevalence rates for the 4 other dental anomalies in the PDC-DDP group (experimental group 2) vs the prevalence rates for these anomalies in the control group. All comparisons were performed with chi-square tests with the Yates correction (P <0.05), as were the comparisons between the sexes in experimental groups 1 and 2. The values for theta and gamma angles in experimental group 1 were compared with the values for these angles in experimental group 2, as well as with those in the control group. These statistical comparisons were made with analysis of variance (ANOVA) with the Bonferroni post-hoc test (P <0.05)., Results: The prevalence rate for PDC in experimental group 1 (28%) was significantly greater than in the control group (4.2%) (P <0.01). Significantly greater prevalence rates for aplasia of the second premolars, aplasia of the maxillary lateral incisors, and small maxillary lateral incisors were found in the PDC-DDP group (experimental group 2) compared with the control group. Significant sex differences (P <0.01) were found in both experimental groups., Conclusions: A significant relationship between distal displacement of unerupted mandibular second premolars and PDC was found. Because DDP is diagnosed earlier than PDC, it can be a developmental risk indicator for displaced maxillary permanent canines., (2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Aim: To compare the dimensions of lateral incisor crowns adjacent to unerupted palatally displaced and nondisplaced permanent maxillary canines., Methods: The sample consisted of 36 children between 10 and 12 years of age with unerupted maxillary canines. Each presented with a unilaterally palatally displaced (with respect to the lateral incisor) canine. The lateral incisor next to the palatally displaced canine was considered the experimental tooth; the tooth on the contralateral side was considered the control tooth. Measurements were crown width (mesiodistal), thickness (labiopalatal), taper (convergence of the crown toward the incisal edge), taper type, and crown length., Results: No association was found between the experimental and control lateral incisors for crown width and thickness. However, a significant correlation was found for crown taper (P=.048) and length (P=.01). The experimental lateral incisors had a higher mean crown taper (0.54 mm) than the controls (0.24 mm). The mean crown length was smaller for the experimental lateral incisors (6.74 mm) than the control ones (7.55 mm)., Conclusion: There is a significantly greater possibility of finding lateral incisors with greater crown taper and shorter length next to palatally displaced canines. However, there is no significant difference in crown width or thickness., (© 2010 BY QUINTESSENCE PUBLISHING CO, INC.)

Dentigerous cysts are usually encountered in the practice of pediatric dentistry. The treatment modalities range from marsupialization to enucleation of the lesion and are based on the involvement of the lesion with the adjacent structures. However, loss of a permanent tooth in the management of a dentigerous cyst can be devastating to a child who has already a congenitally missing tooth. The first case describes the technique of marsupialization in which we extracted the grossly carious deciduous 1st molar and created a window through the extracted socket to decompress the lesion. In this case the 2nd premolars were congenitally missing on both sides of the mandible for which we had not gone for enucleation of the dentigerous cyst along with the developing 1st premolar. The second case is a developmental type of a big dentigerous cyst where marsupialization was followed by enucleation of the cystic lining but without removal of the affected tooth. Both the teeth erupted in the oral cavity.

The present study was undertaken to analyze the status of formation of the upper first molar in individuals suspected as having delayed eruption of the upper first molar. The subjects of this study were 51 patients presenting to orthodontic specialists with delayed eruption of the upper first molars. The 95 teeth of these 51 patients were observed. The investigation of the tooth development status included evaluation of the tooth development stage on panoramic radiographs according to the method of Moorrees et al. The upper first molars that showed delayed development were at the stage of initial cleft formation, reflecting a delay by 2.09 years in boys and 2.84 years in girls. In most cases, the delayed eruption was bilateral, and the development stage of the subject teeth did not differ between right and left sides. The plot of the developmental stage of the subject teeth (Y-axis) against the calendar age of the subjects (X-axis) showing delayed upper first molar development was fitted to the logistic curve. The tooth development was at the stage of initial cleft formation was delayed 2.5 years or more, according to these curves.

MIH was defined by Weerheijm (2001) as "hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors". The prevalence of MIH varies between 2.8% and 25%, dependent upon the study. At their sixth congress in 2003, The European Association of pediatric dentistry defined criteria for diagnosis of the phenomena. It included the presence of demarcated opacity, posteruptive enamel breakdown, atypical restoration, extracted molar due to MIH and unerupted teeth. According to the teeth involved and to the time of the crown formation, researches focused on environmental and systemic conditions as possible reasons for MIH.The etiologies were divided into five groups: Exposure to environmental contaminants, pre/peri and neonatal problems, exposure to fluoride, common childhood illnesses and medically compromised children. The clinical implications include highly sensitive teeth, difficulty to achieve adequate anesthesia, behavioral problems and anxiety, rapid progression of caries and the esthetic implications. A six step approach to management was described suggested: risk identification, early diagnosis, remineralization and desensitization, prevention of caries and posteruption breakdown, restorations and extractions and finally maintenance. Restoring an affected molar can vary from adhesive intra coronal restorations (resin composite is the material of choice) to extra coronal restorations (e.g. preformed metal crown). Esthetic solutions to affected incisors may include microabrasion (that shows little improvement) and resin composite or porcelain veneer. The key for a successful treatment is early diagnosis, intense follow up and usage of remineralizating agents as soon as the teeth erupt. There is still need for further research to clarify the etiological factors and improve the durability of restoration in affected teeth.

Forty-four patients with malignant diseases for which they received peripheral stem cell transplant therapy (PSCT) were retrospectively studied regarding local and systemic infection originating from around partially erupted third molars (PEMs). Twenty-two patients had one or more PEMs, while 22 patients had none. Data were retrieved from medical and dental records. Systemic and local signs of infection and treatment were assessed. We recorded the number of transplanted CD34(+) blood stem cells, days with white blood cell counts < 0.5 x 10(9) l(-1), days until engraftment, maximum level of C-reactive protein (CRP), days with fever, positive blood cultures, days taking antibiotics, days drinking < 0.5 l, days of total parenteral nutrition, days receiving intravenously administered analgesics, and number of admission days. No statistically significant difference was detected between patients with PEMs and those without PEMs regarding any of the studied parameters. Of patients with PEMs, 36% (8 of 22) developed local infections around PEMs during the PSCT period. The study indicates that PEMs pose no significant risk of causing systemic infection in patients receiving PSCT for malignant diseases but increase the risk of developing a local infection, justifying close supervision and early treatment in cases of local infection during PSCT treatment.

Aim: The purpose of this article is to focus on aetiology and appropriate treatment techniques concerning anklyosis of primary molars., Literature: The dental literature is reviewed in detail concerning aetiology, frequency of occurrence, diagnosis and longevity of ankylosed primary molars without successors. Treatment concepts are discussed. Long term implications of treatment decisions made in the mixed dentition are emphasised. Areas of treatment that are unsupported by evidence are identified as potential research topics., Conclusion: When the underlying premolar is present and the infra-occlusion is not progressive, then observation is appropriate. Only when there is severe disruption to the occlusion and/or the underlying premolar, extraction and space management may be appropriate. When the ankylosed primary molar has no underlying premolar, orthodontic input is needed to determine if extraction and space closure, extraction and transplantation or extraction and prosthetic replacement is the best plan.

Background: Regional odontodysplasia, also described as ghost teeth, has been described on a number of occasions, in some cases generalized odontodysplasia affecting both the primary and the permanent dentition. However, generalised odontodysplasia is a very rare finding, involving large pulps and short roots of the whole dentition and in the cases previously reported the teeth finally erupt. In the case reported on herein this has not happened., Case Report: A female patient, now aged 22-years-old, cared for in the TAKO-centre (Oslo) since she was 5 years old, presented with a continuing problem of absence of permanent teeth due to total lack of eruption. All her permanent teeth were either retained intra-alveolar or had been extracted following previous periods of pain and infections. There was no enamel on any of the permanent teeth and the dentine was softer than normal. In addition, there appeared to be very little potential for eruption. Hence, tooth development was affected in all aspects. Her skeletal height was much shorter than expected taking her tall parents into consideration. After all possible assessments, no specific diagnosis for the condition of this young woman has been determined., Treatment: Before the present series of dental care the patient was wearing full dentures in both jaws. In the autumn of 2007, implants were placed in her maxilla and an implant supported fixed prosthesis in porcelain was installed the following spring. Similarly, implants were placed in her mandible, partly in retained teeth, in the autumn of 2008, and an implant supported fixed prosthesis was inserted during the spring of 2009., Follow-Up: after prosthetic treatment a dental hygienist has seen the patient regularly. No problems or signs of infections have occurred to date., Conclusion: This case report concerns a rare and apparently un-named syndrome affecting both primary and permanent teeth. This paper has been written with an aim of gathering the views as to the aetiology of her problem, hopefully finally to provide a definitive diagnosis.

Objective: The clinical appearance of patients with cleidocranial dysplasia (CCD), which is caused by mutations in the RUNX2 gene, is characterized by anomalies of the clavicles, thorax, spine, pelvis and extremities and by disturbances of the skull and tooth development. Of orthodontic relevance are multiple supernumerary teeth associated with delayed tooth eruption. The present investigation is based on the hypothesis that an altered phenotypic expression of periodontal ligament (PDL) cells from CCD patients and a reduced ability of those cells to support the differentiation of bone-resorbing osteoclasts might contribute to delayed tooth eruption., Materials and Methods: To test this hypothesis, PDL cells from healthy donors and from two patients with clinically and molecular biologically diagnosed CCD were characterized for the basal and induced mRNA expression of osteoblast marker genes. The physiological relevance of the findings for the differentiation of osteoclasts was examined in an osteoclast assay, as well as in a co-culture model of PDL cells and osteoclast precursors., Results: Both CCD patients displayed missense mutations of the RUNX2 gene. The in vitro experiments revealed an unaltered expression of RUNX2 mRNA, however especially in CCD patient 2 there was a reduced basal expression of mRNA for the key regulatory gene for bone remodeling RANKL. Furthermore, compared to the control cells from healthy donors, these factors were less inducible by stimulation of the cultures with 1alpha,25(OH)(2)D(3). In the osteoclast assays as well as in the co-culture experiments, PDL cells from the CCD patients showed a reduced capacity to induce the differentiation of active osteoclasts., Conclusions: These data indicate that PDL cells from CCD patients express a less distinctive osteoblastic phenotype resulting in an impaired ability to support osteoclastogenesis which might, in part, account for the delayed tooth eruption that can be observed clinically.

Unlabelled: INTRODUCTION Root resorption can occur as a physiologic or a pathologic process, and it is an unwanted side effect of orthodontic treatment. No baseline studies have assessed this phenomenon in the absence of force variables such as mastication, parafunction, and soft-tissue pressure. In this study, we investigated the incidence and quantitative value of root resorption on unerupted third molars with normal development using microcomputed tomography., Methods: Nine unerupted, nonimpacted maxillary third molars were collected from 6 patients (ages, 19.47 plus /minus 1.89 years). The teeth were examined with microcomputed tomography and compared with teeth from other studies. (The other teeth had been treated with buccally directed light [25 g] or heavy [225 g] forces applied for 28 days, or light [25 g] or heavy [225 g] intrusion forces for 28 days.), Results: Imaging and volumetric analyses showed resorption craters in many locations and with various magnitudes. Analysis of variance was completed by position (P = 0.04), surface (P = 0.07), height (P = 0.045), left or right side of the mouth (P = 0.85), and subject (P = 0.70). The midroot region on the mesial surfaces of the third molars, near the root structure of adjacent erupted second molars, had the greatest statistical significance. When compared with crater volumes of fully erupted first premolars, we found that the unerupted third molar sample had a slightly greater cube root volume per tooth than the erupted first premolars not subjected to orthodontic force and a similar cube root volume per tooth as did first premolars subjected to light (25 g) buccal and intrusive orthodontic forces., Conclusions: Root resorption as a consequence of orthodontic treatment might be added to a baseline level of root resorption. The elevated results suggest that resorption might occur as part of hard-tissue remodeling and turnover, eruption, or transmission of masticatory forces through the dentition to the alveolar bone.

Introduction Distal caries in lower second molars has been associated with mesioangular third molars. Caries detection and restoration can be difficult. If caries progresses, root canal treatment or extraction of the second molar can be necessary.Aims To identify the prevalence of caries in lower third molars and the distal aspect of corresponding lower second molars in patients referred for lower third molar assessment.Methods Analysis of OPG X-rays for 420 consecutive patients (776 third molars) referred to three maxillofacial centres over a five month period.Results Thirty-four percent of third molars were mesioangular. There was radiographic evidence of distal second molar caries in 42% of these. When unerupted mesioangular third molars were excluded this increased to 54%. There was no difference in age or dental health of these patients compared to the whole group. There was no angulation of the mesioangular third molar for which distal caries in the second molar was more likely.Conclusion Distal caries in lower second molars related to a mesioangular third molar is a common finding in oral and maxillofacial patients in secondary care, especially if the third molar is fully or partially erupted. If such a third molar is left in situ, close monitoring and regular bitewing radiographs are recommended.

The aim of this study was to determine the prevalence of sequelae in the permanent anterior teeth following trauma in their predecessors, and also to verify the existence of association between the sequelae in the permanent teeth and the type of injury in their predecessors according to the age group at the time of injury. This study was performed based on data from the records of 169 boys and 138 girls who received assistance at the dental clinic of the State University of Rio de Janeiro from March 1996 to December 2004. The sample was collected from 753 traumatized deciduous teeth of children aged 0-10 years. The number of boys and girls with dental trauma corresponded to 55.0% and 45.0%, respectively. The more affected age period was between 1 and 4 years (75.3%). The most common type of traumatic injury was the intrusion (29.3%), followed by avulsion (14.1%). Concerning permanent dentition, the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors. It was not possible to find an association between the type of injury in primary teeth and sequelae in their successors in the studied age groups (P

Purpose: This study evaluated the relationship between the status and position of mandibular third molars and angle fractures., Materials and Methods: In a total of 2,033 patients with a mandibular fracture, 532 (26%) had angle fractures, and 1,466 (72%) had retained their lower third molars. The most frequent cause for mandibular fracture was road traffic accident (64%), followed by assault (19%)., Results: Of 341 patients with an unerupted third molar, mandibular angle fracture was evident in 249 patients (73%). Only 62 patients (9.4%) with a completely erupted third molar had angle fractures, whereas 83 patients (17.6%) with partially erupted third molars had angle fractures., Conclusions: Our study confirmed an increased risk of angle fractures in the presence of a lower third molar, as well as a variable risk for angle fracture, depending on the third molar's position.

Aim: The purpose of this study is to evaluate the developmental disturbances in permanent teeth as a result of luxation injuries in the primary teeth predecessors., Materials and Methods: A total of 5330 records, corresponding to 10 years attendance at the Emergency Center of Baby Clinic, Londrina State University, Brazil, were analyzed. Three hundred and eighty nine children were involved in this study, totaling 620 traumatized primary teeth. Clinical and radiographic examinations were carried out in the permanent successor teeth., Results: In total, 623 permanent teeth were examined and developmental disturbances were detected in 126 teeth (20.2%). The white or yellow-brown discoloration of enamel was the clinical disturbance most observed (78.0%) and the crown alteration most detected through radiographic analysis was hypoplasia (86.0%). Root alterations were rare; root dilaceration was observed in only one case. The age of the children when their primary teeth received damage varied between 6 and 36 months (P = 0.000325). Intrusive luxation and avulsion were related with most of the cases of sequelae in the successor permanent teeth (P = 0.000001)., Conclusion: The results of the present investigation emphasize the special attention required for children who suffered dental trauma at an early age, especially in cases of intrusive luxation and avulsion.

Pulp necrosis is a commonly observed sequela in traumatized primary teeth and is one of the possible etiologic factors for the development of dentigerous teeth. This article reports the case of a dentigerous cyst associated with the germ of a permanent maxillary central incisor that developed secondary to trauma to the predecessor primary incisor. The therapeutic approach included endodontic treatment of the primary tooth and marsupialization of the lesion. After 36 months of follow up, the permanent incisor presented with normal physiologic conditions, absence of dental anomalies and erupted in its correct position in the oral cavity. In conclusion, with proper case selection, marsupialization might be a good treatment option for conservative management of dentigerous cysts.