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Background: Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress., Aim: To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB)., Design: A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021., Results: Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%)., Conclusion: Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption., (© 2023 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

Objective: Primary failure of eruption is characterized by a nonsyndromic defect in tooth eruption in the absence of mechanical obstruction. It is correlated to rare heterozygous variants in the parathyroid hormone receptor 1 gene. The management of primary failure of eruption is complex because many therapies are ineffective. The present study aimed to compare the clinical outcomes of our patients with the findings reported in the literature, and to propose a treatment guideline based on the literature and our experience., Methods: Retrospective study of patients affected by primary dental eruption failure in the department and analyse of the results and compare with those of the litterature., Results: Twelve patients belonging to 5 families (9 males, 3 females; 13-52 y old) diagnosed and treated in the maxillofacial surgery and stomatology department of the Lille University Hospital were included. All patients showed posterior tooth involvement, and most patients showed bilateral defects. None of the affected teeth had coronal alveolar bone, whereas 6 patients showed root resorption in the affected teeth. Genetic analyses, performed on 11 patients, identified a parathyroid hormone receptor 1 disease-causing variant in 7 of them (63%). Multidisciplinary treatment was required to rehabilitate these patients. Orthodontic interventions, even at an early age, are difficult in affected teeth, which are often blocked or have internal resorption. Moreover, retention of these affected teeth during growth leads to dentoskeletal malocclusions, requiring difficult surgical management in the long term. Therefore, early extraction of these teeth is frequently recommended once the diagnosis has been confirmed. An implant-borne prosthetic rehabilitation can then be achieved at the end of growth after correction of the jaw discrepancy. In case of a late diagnosis, other surgical or noninvasive techniques may be used depending on the clinical situation. Distraction osteogenesis or segmental osteotomy could be discussed for patients with mild phenotypes., Conclusions: Early diagnosis of primary eruption defects is crucial to offer appropriate management as early as possible, and so to avoid late complicated treatments., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background: Forced eruption of an impacted tooth usually requires surgical and orthodontic interventions to successfully bring the tooth into the dental arch. The clinical time required for a forced eruption is difficult to predict before treatment begins and success rates are affected by several factors before and after an eruption. This study was conducted to identify factors that affect the success of forced eruption, the duration of orthodontic treatment of impacted teeth, and the reasons for re-operation and forced eruption failure in a various teeth and cases., Methods: In this retrospective study, the records regarding the forced eruption of 468 teeth in 371 patients from June 2006 to May 2020 at the Advanced General Dentistry Department of Yonsei University Dental Hospital were initially examined. The records of 214 teeth in 178 patients who completed orthodontic treatment were included in the analysis. Data on patient demographics, tooth characteristics, orthodontic treatment duration, re-operations, and failures were collected from electronic medical records., Results: There was a significant difference in age between the success and failure forced eruption. Factors significantly affecting treatment duration were apex formation, position, rotation, and re-operation. Re-operation had a 96% success rate. The average orthodontic treatment duration was 29.99 ± 16.93 months, but the average orthodontic treatment duration for teeth that undergone re-operation was 20.36 ± 11.05 months, which was approximately 9 months shorter. Additionally, there was an interaction effect between rotation and re-operation on the duration of orthodontic treatment. The causes for failure of forced eruption in 6 cases were ankyloses (3 cases), incomplete alignment with the normal dental arch (2 cases), and a significant deviation in the impacted tooth's location (1 case)., Conclusions: To increase the success rate of forced eruption, age should be considered as a priority, and in order to predict the treatment period, the apex formation status, position in the arch, and rotation should be considered in addition to age. When determining re-operation, considering factors such as ankylosis, root curvature, and apex formation can help in the success of orthodontic treatment., (© 2024. The Author(s).)

Objective: Unerupted permanent teeth are amongst the most commonly occurring dental anomalies in adults and present unique treatment challenges. The aim of this retrospective study was to (1) identify the prevalence of adult patients with unerupted teeth attending a multidisciplinary clinic and (2) to identify predictors (age, gender, incisor and skeletal classification) which influence the patients treatment decision., Material and Methods: Consecutive adult patients with unerupted permanent teeth attending the Joint Orthodontic-Restorative clinic were identified. Study variables were collected using a prespecified data collection form. Descriptive statistics were employed; Fisher's exact test was used to detect associations between variables and treatment decision outcome. Ordinal logistic regression derived multinomial regression relative risk ratios (RRR) and 95% confidence intervals (CI) were calculated for the effect of age, gender, incisor and skeletal classification on treatment decision/outcome., Results: Sixty-six patients with impacted teeth were identified from a sample of 483. The prevalence of adults with unerupted teeth was 13.7%. The mean age was 30.7 years (SD 11.2). The majority of the sample had a Class I incisor relationship (54.6%) or Class I skeletal base relationship (54.6%), and the most common distribution of impacted teeth was a single unerupted upper right canine (34.9%). Orthodontic treatment (non-extraction or extraction basis incorporating the alignment or removal of impacted teeth) and restorative treatment only were equally favoured. Factors including age, gender, incisor and skeletal classification did not appear to influence or predict the final treatment decision., Conclusions: In this sample, adults presenting with impacted teeth favoured certain treatment modalities: orthodontic treatment only and restorative treatment only. Factors such as age, gender, incisor and skeletal classification did not influence the outcome., (Copyright © 2020 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Dentigerous cysts are common odontogenic cysts associated with unerupted teeth. We describe a previously unreported case of a multidisciplinary approach using surgical, orthodontic, and implant treatment to establish the occlusion for a patient with a maxillary dentigerous cyst., Case Presentation: An 18-year-old Japanese woman visited our hospital with a chief complaint of gingival swelling in her anterior maxillary region, midline diastema, and tooth crowding. Her main symptom was this gingival swelling. A panoramic radiograph revealed a radiolucent area, 30 mm in diameter, round in shape, and with well-demarcated margins including the maxillary canine. Computed tomography revealed a cystic cavity filled with homogeneous fluid of the same density as water, and a distolingually inclined canine. Our clinical diagnosis was maxillary dentigerous cyst with an unerupted distolingually inclined canine. The selected treatment was marsupialization of the dentigerous cyst, followed by orthodontic traction of the unerupted canine, and simultaneous orthodontic treatment of the midline diastema and tooth crowding. The orthodontic traction failed because the canine did not erupt completely, and the canine was extracted. The treatment plan was then changed to implant treatment after the tooth crowding and midline diastema had been improved. Because the alveolar ridge width was inadequate, the implant was placed after a two-stage implant treatment; therefore, a satisfactory occlusion could be achieved. Our patient did not experience any complications, and the cyst has not recurred. A radiograph taken 7 years after marsupialization of the dentigerous cyst revealed that the cystic cavity had been replaced by new bone., Conclusions: In general, orthodontic traction of an unerupted tooth after marsupialization should be the best option. However, if orthodontic traction fails, a multidisciplinary approach involving implant treatment may be necessary. We describe a case in which a multidisciplinary approach involving surgical, orthodontic, and implant treatment was used to establish a satisfactory occlusion for a patient with a dentigerous cyst.

Treatments without tooth extractions have become more popular over the last two decades. In this context, expansion of the maxillary arch is an interesting treatment option for cases in which space is required and other factors not favoring extractions (such as the facial profile) are present. According to several authors, this posterior expansion can be obtained using a system comprising self-ligating brackets and superelastic nickel-titanium arches. The present article aims to report a case of a young patient with Class II, Division 2 malocclusion, with impacted upper canines and significant arch length-tooth discrepancy., Methods: The case was treated by means of a passive self-ligating appliance in association with Class II elastics and coil spring for distalizing the molars. This treatment alternative was effective for correcting Class II and obtaining space to correct tooth positioning., Competing Interests: There are no conflicts of interest

Introduction:: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch., Objective:: To report a clinical case that took advantage of an unerupted third molar., Case History:: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction., Results:: After 12 months, the third molar reached the proper position., Conclusion:: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

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. 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. 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. Of the primary teeth reported as unerupted, second deciduous molars are the teeth most frequently involved, followed by primary central incisors. At present almost no coverage is seen about the impaction of the first deciduous molar. In this case, a 4-year-old boy who presented with an impacted left maxillary first deciduous molar came to the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. This tooth, located higher to the left maxillary first premolar, was well near to the maxillary sinus. The family and medical histories were noncontributory and his physical findings were within normal limits. The mother was reported as having experienced no illness or other complications and taken no medications during pregnancy. His clinical extraoral examination was noncontributory. His clinical intra-oral examination revealed that the maxillary left first primary molar was not present. No enlargement of the area was apparent visually or on palpation. The remaining primary dentition was well aligned and in good condition. His oral hygiene was good, although there were incipient occlusal carious lesions in the mandibular second primary molars. There was no history or evidence of dental trauma. A diagnosis of a left maxillary first deciduous molar was made on the basis of the clinical and radiographic evidence. Numerous local etiologic factors have been described for impacted teeth. These include anomalous teeth, malposition, fusion with adjacent or supernumerary teeth, odontoma, dentigerous cysts, tumors, underdevelopment of the jaws, keratinized epithelial lining, hereditary conditions, and trauma. In this case, the reason for impaction was not clear. After the comprehensive clinical evaluation, treatment consisted of placement of a space maintainer, the periodic examination was indicated for the follow-up, so that early interventions, such as subsequent surgical intervention and orthodontic traction could be recommended timely to manage orofacial disfigurement and to avoid consequent problems with resultant proper functioning and good periodontal health.

Tooth impaction is defined as any tooth that fails to erupt into a normal functional position and remains unerupted in the jaw beyond the time of its normal eruption. Primary impaction of primary teeth is rare. Furthermore, a combination of eruption failure of primary second molars and horizontally impacted permanent first molars has not yet been reported. The purpose of this study was to present the treatment of two cases of primary impaction of primary second molars combined with horizontally impacted permanent first molars. The impacted primary second molars were extracted, and orthodontic traction was performed to induce normal eruption of the permanent first molars. We then regained space for the eruption of the second premolar and applied a space maintainer to secure the space and induce successful eruption of succedaneous teeth and normal function of permanent first molars in their positions.

Background: The aim of this case report was to describe the surgical-orthodontic treatment of an unerupted mandibular canine tooth in a 9-year-old girl., Case Presentation: A 9-year-old white girl presented with an unerupted right mandibular canine tooth. Combined surgical-orthodontic treatment was performed to correct dental impaction and to achieve good aesthetic and functional results., Conclusion: Orthodontic treatment achieved all of the required objectives.

Posterior open bite can cause problems with occlusion. It arises from systemic or local factors such as physical or functional interference, ankylosis, and failure of eruption. Primary failure of eruption (PFE) is a rare condition that is difficult to differentiate from ankylosis and requires complex treatment strategies. Here we report a 12-year-old girl who was referred to our hospital by her dentist for re-evaluation of eruption failure of the left maxillary secondary premolar and first and second molars with congenitally missing maxillary lateral teeth. The maxillary first molar was extracted for a therapeutic diagnosis. The left maxillary secondary premolar and second molar reacted well to subsequent orthodontic treatment. Auto-transplantation of the mandibular premolar to the maxil-lary arch was carried out to achieve optimal overjet, overbite, and occlusion. The active treatment period spanned 4 years and 1 month. Assessment of the patient's medical and dental history, prior trauma, and clinical conditions resulted in a therapeutic diagnosis of PFE. Satisfactory orthodontic treatment results were achieved.

Proper localization of supernumerary teeth is very important for the diagnosis, treatment planning, and prior to any surgical intervention. Traditionally, supernumerary teeth were diagnosed and located using two-dimensional (2D) radiographic methods such as panoramic views, cephalometric imaging, and also intraoral (also often occlusal) radiographs. With the introduction of cone beam computed tomography (CBCT) in dental medicine, this three-dimensional (3D) imaging technique is now more and more used for the exact localisation of supernumerary teeth and the diagnosis of root resorption of adjacent teeth. Treatment planning depends on various factors such as the time of diagnosis, the age of the patient, the position of the supernumerary tooth and possible complications. In the present second part of this review article on supernumerary teeth in the maxilla and mandible, the diagnostic workflow and current treatment concepts will be presented and critically discussed.

Aim: To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment., Methods: Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded., Results: Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545)., Conclusions: The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

Background: Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required., Review: The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed., Recommendations: (1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption., Conclusion: Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Introduction: The retrieval of unerupted teeth in pedodontics is always significant to preserve the trophism of adjacent tissues, establish the correct space, provide adequate function and maintain good esthetics for the patient. The treatment plan is based on radiographic examinations and measurements, and on an accurate clinical evaluation; it aims to achieve the best treatment possible depending on the complexity of the specific case.In the most difficult clinical cases it is very important to have an early diagnosis, which is essential to plan the treatment and achieve success. In these cases, the pediatrician is in a strategic position to give an early diagnosis through a child's medical history and by counting the child's teeth., Case Presentation: This article presents two different difficult clinical cases of impacted teeth diagnosed during pediatric age, with a radiological analysis, and successfully treated with orthodontic devices designed for these specific cases. Clinical case 1 describes a 13-year-old Italian girl; clinical case 2 describes a 9-year-old Italian girl. The use of these devices achieved the desired treatment goals. The problems associated with impacted teeth and the biomechanical interventions used for these patients are discussed., Conclusions: An early and careful diagnosis followed by an accurate treatment plan for the individual cases can lead to retrieval of the impacted teeth without affecting other anatomic structures and adjacent teeth. In these cases, the pediatrician is in a strategic position to give an early diagnosis through a child's medical history and by counting the child's teeth.

This case report describes the multidisciplinary treatment of a male with a dilacerated maxillary left central incisor and transposition of the ipsilateral maxillary canine and lateral incisor. The initial treatment plan involved removal of the dilacerated incisor with mechanical eruption and alignment of the ectopic left canine, aiming to substitute the lateral incisor for the missing central incisor. However, the plan was modified to include eruption of the canine in the central incisor region in response to progressive ectopic development and mesial transmigration of the maxillary left canine. Although substitution of a maxillary canine for a central incisor is comparatively rare, the canines offer a relatively favorable template to simulate a central incisor. For this growing patient with a combination of dental trauma and developmental anomalies, maxillary canine-central incisor replacement was a viable option, offering excellent esthetic results without recourse to prosthetic replacement., (Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Pre-eruptive intra-coronal resorption (PIER) is a defect located in the dentin of an unerupted tooth, just beneath the dentin-enamel junction, with a prevalence of 0.5-2% of the teeth. The depth of the lesion is variable and may also reach the pulp. In the past, these lesions were confused with caries, and were therefore called "hidden" or "pre-eruptive caries". These defects are usually detected incidentally in routine dental radiographs. It has been proven that in the pre-eruptive stage the lesions contain soft tissue and inflammatory cells. The present report describes the clinical management of a case of PEIR on a mandibular first permanent molar and discusses the alternatives for treatment.

Primary failure of eruption is a rare eruption disorder of above all, the permanent second and sometimes the first molars. It is characterized by infra occlusion of the molars resulting in a severe lateral open bite. Primary failure of eruption is a disorders which affects all molars distal to the most mesial involved tooth. Diagnosis is possible both clinically and with radiographs. A panoramic radiograph combined with clinical findings of impaction or infra occlusion can confirm the suspicion of primary failure of eruption. Primary failure of eruption cannot be treated as other eruption disturbances are. The teeth do not respond to orthodontic force. Exposure of the molar and orthodontic traction of a molar affected by primary failure of eruption is discouraged. Observation and extraction, in case the primary failure of eruption poses a risk to the healthy dentition, are the only two treatment options for young patients. Additional treatment of this eruption disorder should be carried out at an adult age and consists of prosthetic closure of the open bite.

Delayed tooth eruption can affect the accuracy of orthodontic diagnosis and treatment planning and could delay overall treatment. A girl, aged 7 years 4 months, who had unilateral delayed eruption of several teeth was successfully treated. The evaluation of delayed tooth eruption should be considered by the orthodontist because the role of these teeth can affect the overall treatment of malocclusion. In patients with delayed tooth eruption, careful and accurate diagnosis and treatment planning will allow the orthodontist to start treatment at the proper stage and might reduce the overall orthodontic treatment time., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objectives: The aim of this study was to assess the effect of blood contamination on the shear bond strength and failure site of three different orthodontic self-ligating brackets., Study Design: 240 bovine permanent mandibular incisors were randomly divided into 12 groups of 20 specimens each. Orthodontic self-ligating brackets were tested under four different enamel surface conditions: a) dry, b) blood contamination before priming, c) blood contamination after priming, d) blood contamination before and after priming. Brackets were bonded to the teeth and subsequently tested using a Instron universal testing machine. Shear bond strength values and adhesive failure rate were recorded. Statistical analysis was performed using ANOVA and Tukey tests (strength values), and Chi squared test (ARI Scores)., Results: Non-contaminated enamel surfaces showed highest bond strengths for all self ligating brackets. Under blood-contamination shear bond strengths lowered for all brackets tested. Groups contaminated before and after primer application showed the lowest shear bond strength. Significant differences in debond locations were found among the groups under the various enamel surface conditions., Conclusions: Blood contamination of enamel during the bonding procedure lowers bond strength values of self ligating brackets, expecially when contamination occur in different times of the bonding procedure.

This case report presents treatment of two patients with the usual characteristics of Cleidocranial Dysostosis. A multidisciplinary approach using the disciplines of prosthodontics, orthodontics, and oral surgery was effected. Exfoliation of the patient's deciduous teeth and failure of permanent anterior tooth eruption led to emotional, social, and self-esteem issues in both patients. Due to the psychosocial issues confronting these two patients, esthetics was addressed prior to active intervention with orthodontics and after some surgical intervention. The use of two interim overdenture prostheses with magnetic retention is described., (© 2011 by The American College of Prosthodontists.)

Mesiodens is the most common type of supernumerary tooth found in the premaxilla. It might be discovered by the orthodontist by chance on a radiograph or as the cause of an unerupted maxillary central incisor. The genetic transmission of supernumerary and impacted teeth is poorly understood. The occurrence of identical unerupted maxillary central incisors and mesiodentes in monozygotic twins suggests that genetic factors might influence the etiology of this problem. In this case report, we discuss the treatment of unerupted maxillary permanent incisors caused by mesiodentes in monozygotic twins., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: Dentinogenesis imperfecta is one of the most common hereditary disorders of dentine formation. Opalescent teeth composed of irregularly formed and undemineralised dentine that obliterates pulp chambers and root canals characterize it. Complete-coverage crowns are usually the preferred restoration for patients with this condition., Case Report: A 9 year-old girl presented with dentinogenesis imperfecta, congenitally missing maxillary lateral incisors and maxillary right permanent second molar retention., Treatment: The treatment comprised an initial approach to allow the correct eruption of the retained second molar. The use of low-fusion metal ceramic restorations comprised a second stage to improve the aesthetic appearance and decrease the risk of overload on teeth with limited value., Follow-Up: The patient has been recalled regularly and at the last visit, 10 years after initial prosthetic treatment, no problems or signs of complications have occurred. The patient is now aged 25 years and is still satisfied with the prosthetic rehabilitation., Conclusion: This case illustrates the need for appropriate and timely restorative treatment to prevent deterioration of the dentition. This case will also demonstrate that low-fusion metal ceramic restoration is a viable esthetic treatment option for today's patients.

This paper describes the clinical orthodontic treatment of two cases that were successfully entered for the 2008 intercollegiate MOrth cases prize. The first case describes the management of a 12-year-old female with an increased overjet treated using a Dynamax functional appliance followed by fixed appliances. The second case involves the management of a class II division I malocclusion complicated by an unerupted maxillary central incisor and a mandibular first molar of poor prognosis.

An ankylosed tooth and adjacent alveolar process can lead to the development of an open bite, an unesthetic smile line, and abnormal function in mastication. Intraoral alveolar bone distraction osteogenesis is an option for treating an ankylosed tooth. The purpose of this clinical report was to show the treatment of a growing patient with an ankylosed maxillary central incisor. A simple tooth-borne intraoral distractor was made with an expansion screw and 0.9-mm stainless steel wire, which enabled it to move easily. Intraoral alveolar bone distraction osteogenesis will give the best results in patients with favorable root length and severely resorbed alveolar bone in the vertical dimension., (Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Eruption disturbance of a permanent tooth is challenging to clinicians. Eruption failure of a posterior tooth causes lateral open bite that severely interrupts function. This case report describes the treatment of nonerupting permanent molars by segmental repositioning followed by orthodontic fine adjustment. Two nonerupting permanent molars at different eruption stages were repositioned with a one- or two-step single-tooth segmental osteotomy technique. Final location of the repositioned tooth-alveolar bone segment was adjusted via orthodontic means.

Background: Primary failure of tooth eruption (PFE) is a rare condition affecting any or all posterior quadrants. Unilateral involvement of maxillary and mandibular quadrants causes a dramatic posterior open bite that requires complex management strategies., Case Report: An 8 year-old boy attended the Dublin Dental School and Hospital regarding infra-occlusion of his right maxillary and mandibular primary molars. Both right first permanent molars had also failed to erupt. All permanent teeth were present radiographically. Facial appearance and soft tissues were normal and oral function was not affected. The patient had no significant medical history and his siblings had no similar dental abnormalities., Treatment: The infra-occluded right first and second primary molars were extracted, and the right first permanent molars were surgically exposed., Follow Up: Eruption of the premolars and molars was monitored over the next 2 years. The premolars showed signs of eruption and continued root development. Exfoliation of the remaining primary teeth proceeded as usual. The right first permanent molars did not erupt and were subsequently extracted. Continued eruption of the canines and premolars reduced the inter-arch separation. A removable tongue shield appliance was suggested but declined by the patient. At age 13 years, orthodontic extrusion was used to further reduce the inter-dental distance between the canine and premolars. The reduction was from 5 mm to 1.5 mm between the right first premolars and from 10 mm to 5 mm between the right second premolars. Extrusion of the canine teeth was also attempted to improve the smile line. The canine extruded 1 mm to give a 2 mm overlap. There were no changes in centric occlusion and the midline was unaffected. In the 2 years since orthodontic treatment, the spaces have reopened slightly to 3 mm between first premolars and 6 mm between second premolars. The patient is now aged 16 years and is aware that an improved aesthetic smile line may be achieved by use of onlay restorations., Conclusion: In this unique case, a profound unilateral posterior open bite occurred due to primary failure of eruption of the maxillary and mandibular teeth on the affected side. Orthodontic therapy was used to modify the position of the permanent canines and premolars to reduce the posterior open bite.

This case report describes the treatment of a patient with an unerupted maxillary left central incisor, class III malocclusion with crossbite of the maxillary posterior teeth and lateral open bite. Treatment consisted of rapid maxillary expansion followed by anterior space opening, maxillary protraction and traction of the unerupted teeth with a light force system. Favorable results were obtained in terms of correcting incisor position and class III malocclusion. The results achieved remained stable throughout a 4-year retention period.

Trauma to primary teeth can result in a wide range of disturbances to the underlying permanent teeth, such as dilaceration. Root dilacerations occur more commonly than crown dilacerations. This paper is a report of an 11-year-old girl with a missing maxillary left anterior tooth. Past history revealed premature loss of primary maxillary anterior teeth due to trauma. Radiographic examination revealed crown dilaceration of permanent maxillary left central incisor. An interdisciplinary approach in the management of this child is presented herewith.

Delayed eruption of a permanent tooth may be a significant concern for children in the mixed dentition stage and their parents. This report describes the orthodontic management of a case in which an unerupted tooth was guided into occlusion during the mixed dentition stage, rather than waiting until the permanent dentition stage to perform comprehensive treatment. The article includes a description of the treatment mechanics for this process, which can be readily accomplished by general dentists.

Extrusion of teeth may be necessary in cases of delayed eruption, primary retention, traumatically intruded teeth, or subgingivally fractured teeth. Removable appliances are advantageous, as anchorage is not as tooth-dependant as in the case of fixed appliances. They are cost-effective, operator friendly, and a valuable treatment option to consider in cases where extrusion of anterior teeth in the transitional dentition is necessary. The purpose of this paper was to describe a simple, cost-effective technique using a removable appliance for extrusion of incisors in the transitional dentition.

Purpose: Demineralization of a thin layer of bone over a root prominence after corticotomy surgery can optimize the response to applied orthodontic forces. This physiologic response is consistent with the regional acceleratory phenomenon process. When combined with alveolar augmentation, one is no longer strictly at the mercy of the original alveolar volume and osseous dehiscences, and fenestrations can be corrected over vital root surfaces. This is substantiated with computerized tomographic and histologic evaluations. Two case reports are presented that demonstrate the usefulness of the accelerated osteogenic orthodontics technique in de-crowding and space closing for the correction of dental malocclusions., Materials and Methods: Orthodontics is combined with full-thickness flap reflection, selective alveolar decortication, ostectomy, and bone grafting to accomplish complete orthodontic treatment., Results: Rapid tooth movement was demonstrated in both cases and stability up to 8 years of retention., Conclusion: The accelerated osteogenic orthodontics technique provides for efficient and stable orthodontic tooth movement. Frequently, the teeth can be moved further in one third to one fourth the time required for traditional orthodontics alone. This is a physiologically based treatment consistent with a regional acceleratory phenomenon and maintaining an adequate blood supply is essential.

Ankylosis of a tooth is a pathologic condition commonly manifested by infraocclusion and vertical alveolar bone defect of the involved tooth. Extraction is often indicated in patients with severe tipping of adjacent teeth and serious infraocclusion, rather than attempting orthodontic repositioning. However, the residual alveolar bone defect after extraction must be restored adequately to establish sound dentition with a healthy periodontium. The bone-forming potential of sound periodontal ligament cells of the adjacent teeth can be used to restore the bone defect, through precisely controlled mesial movement of the root of the tilted molar. In this case report, a successful mesial root movement of the mandibular second molar is shown by the combined use of a conventional uprighting spring and orthodontic miniscrew implants in the mandibular premolar area. Adequate occlusion and periodontal health were restored in a 15-year-old girl with the typical sequela of an ankylosed molar.

Unlabelled: This case report describes a novel approach to bridge design using fibre-reinforced composite materials., Clinical Relevance: By thinking 'outside the box' clinicians may be able to use modern materials in unusual clinical situations.

Background: Many reports have indicated the treatment for permanent teeth with disturbed eruption due to the presence of supernumerary teeth. However, successful treatment for an unerupted maxillary incisor with severe rotation and another maxillary incisor with disturbed eruption by a supernumerary tooth is quite rare., Case Report: We treated a 7-year-old Japanese male with an unerupted and severely rotated maxillary right incisor, along with a maxillary left incisor due to interference with eruption by an inverted supernumerary tooth. Orthodontic treatment using surgical exposure, traction and guidance of the rotated right incisor, and maxillary expansion following extraction of the supernumerary tooth were performed., Follow-Up: At 27 months following extraction of the supernumerary tooth, and comprehensive orthodontic treatment led the malposititioned central incisors to a functional position and stable occlusion.

Multiple unerupted teeth with no obvious etiology is a rare dental anomaly. Various local and systemic factors have been implicated in the failure of eruption of multiple permanent teeth. But the localization of the genetic defect in the phenotype of failure of eruption is largely unknown at present. Our aims in this article were to consolidate and organize the available information regarding the molecular biology of tooth eruption and to corroborate the current evidence with the report of 2 adult cases of failure of eruption of multiple permanent teeth without a known cause.

Odontogenic tumor is a rare condition in dental medicine that mostly proceeds unrecognized until the occurrence of clinical symptoms such as delayed eruption, or is incidentally detected on routine x-ray examination. The exact cause is not known, however, previous dental trauma and infection have been postulated as the potential factors in the development of odontogenic tumor. The earliest possible operative extirpation of the tumorous growth is recommended to eliminate permanent tooth impaction and to enable normal growth of the teeth. In some cases, corticotomy, including complete removal of the bony coat of the tooth, may be needed to additionally facilitate and precipitate its eruption. Orthodontic therapy is also of great importance in correct alignment of the teeth 'n the dental arch as well as in the management of other anomalies that may be associated with odontogenic tumor. A patient with compound odontoma is presented, along with the course of combined surgical-orthodontic therapy. The patient reported previous intrusion trauma that had occurred at the age of 4 years, which may have been the potential factor in the development of odontoma. In this case, there was a massive odontogenic tumor which had compromised the growth of permanent teeth, and the growth impulse was almost at the end since the patient was 11 years old and the apexes of the upper incisors were partially closed. The first operation included complete removal of the tumorous mass that had interrupted spontaneous eruption of the upper permanent incisors. It did not result in immediate spontaneous tooth eruption, so an additional operation was needed. The objective of the second operative procedure was complete removal of the covering bone over the unerupted upper permanent incisors in order to eliminate the physical barrier to tooth growth and eruption. The objective of fixed orthodontic therapy was full eruption of the partially erupted upper incisors. After 16 months, the upper incisors were regularly located in the dental arch. In this case, orthodontic therapy had another objective, i.e. to ensure rotation of the first upper premolar, to provide space for the upper permanent canine eruption and to establish regular intercuspidation after upper second premolar hypodontia. In colclusion, combined operative and orthodontic therapy can be recommended irrespective of the stage of the impacted tooth development because any treatment to precipitate tooth eruption has favorable effects. Impacted teeth should always be provided all treatment options for faster eruption, as demonstrated in our case where a good clinical result was achieved within 2.5 years. The role of regular clinical and x-ray controls for assessment of the impacted tooth eruption should also be emphasized.

Infraocclusion of primary molar teeth is a relatively common clinical finding and decision-making concerning the successful management of such cases can present a challenge to the general dental practitioner. This paper reviews the epidemiology, aetiology, diagnosis, treatment rationale and includes flow charts for easy reference to the various treatment options for infraoccluded primary molar teeth.

This study consisted of two parts: the first part describes the aetiology behind primary retention of first permanent mandibular molars by comparing the affected molar region with the contralateral region, and the second the follow-up of the retained molars. The material comprised dental pantomograms from 29 patients (17 males and 12 females; aged 6 years 2 months to 12 years 5 months) which were sent by Danish public dental clinics to the Department of Orthodontics at Copenhagen Dental School for treatment guidance (Part 1). Questionnaires were later sent to the dentists for follow-up information regarding the affected teeth (Part 2). Part 1-aetiological evaluation: From each radiograph, the number and location of the molars, maturity of individual molars, and deviations from normal morphology were recorded. The findings showed that, in an affected region, disruption of normal dental development and eruption had occurred, causing a delay in dental maturity as well as arrested eruption of the first molar. Part 2-follow-up of eruption: Completed questionnaires and radiographs were returned for 25 subjects. In 10, eruption had occurred, six after surgical removal of mucosa covering the retained first molar. In eight patients the molar had been removed while in seven the observation time from first diagnosis was too short to evaluate eruption. The results indicate that retained first permanent mandibular molars have the ability to erupt and suggest that a unilaterally retained first permanent mandibular molar may represent a temporary delay in eruption rather than permanent failure.

Developmental disturbances of unerupted permanent tooth result from trauma to primary tooth as there is a close proximity between the root of the primary tooth and its permanent successor. The damage to the unerupted permanent tooth occurs by the transmission of traumatic forces to the permanent tooth germ. In the present case, however, a developmental disturbance on the permanent maxillary central incisor resulting from a direct effect of the inversely intruded primary maxillary central incisor is presented. The intruded tooth was extracted under general anesthesia. Upon eruption of the permanent central incisor, a localized crown malformation along with enamel hypoplasia which was not classified as a developmental disturbance before was observed. The damaged sites were restored with a light-cured composite resin.

Patients with cleidocranial dysplasia (CCD) commonly present with significant dental problems, such as retention of multiple deciduous teeth, impaction or delay in eruption of permanent teeth and, often, the presence of supernumerary teeth. Several approaches have been described for the management of such patients. We report 2 cases illustrating the shift in the management paradigm from edentulation and prosthetic replacement to orthodontically assisted forced eruption and fixed appliance orthodontic treatment combined with orthognathic surgery.

The aim of this study was to produce a treatment difficulty index (TDI) for unerupted maxillary canines. Thirty treated cases, each with an unerupted unilateral maxillary canine, were graded by 14 consultant orthodontists in terms of perceived alignment difficulty, and the four main factors which had contributed to each grade were listed in order of importance. The relationship between the grade and the contributory factors was then examined using regression analysis, and weightings were derived. These were applied to each factor, in order to derive a difficulty score total for each case. Linear regression analysis of difficulty scores against consultant grades produced an R2 value of 54.7 per cent using the original equation and an R2 of 52.3 per cent using values rounded to the nearest half. Both indicated a moderate level of agreement between allocated difficulty grade and calculated difficulty scores. The index provides a useful treatment planning aid for the management of impacted maxillary canines.