Surgical-orthodontic treatment of Class III malocclusion with agenesis of lateral incisor and unerupted canine

INTRODUCTION: Orthodontic-surgical treatment was performed in patient with skeletal Class III malocclusion due to exceeding mandibular growth. Patient also presented upper and lower dental protrusion, overjet of -3.0 mm, overbite of -1.0 mm, congenital absence of tooth #22, teeth #13 and supernumerary impaction, tooth #12 with conoid shape and partly erupted in supraversion, prolonged retention of tooth #53, tendency to vertical growth of the face and facial asymmetry. The discrepancy on the upper arch was -2.0 mm and -5.0 mm on the lower arch. METHODS: The pre-surgical orthodontic treatment was performed with extractions of the teeth #35 and #45. On the upper arch, teeth #53, #12 and supernumerary were extracted to accomplish the traction of the impacted canine. The spaces of the lower extractions were closed with mesialization of posterior segment. After aligning and leveling the teeth, extractions spaces closure and correct positioning of teeth on the bone bases, the correct intercuspation of the dental arch, with molars and canines in Angle's Class I, coincident midline, normal overjet and overbite and ideal torques, were evaluated through study models. The patient was submitted to orthognathic surgery and then the post-surgical orthodontic treatment was finished. RESULTS: The Class III malocclusion was treated establishing occlusal and facial normal standards.

INTRODUÇÃO: o presente trabalho apresenta um tratamento ortodôntico-cirúrgico realizado em paciente portadora de má oclusão de Classe III esquelética com crescimento mandibular, protrusão dentária superior e inferior, trespasse horizontal de -3,0mm, trespasse vertical de -1,0mm, ausência congênita do dente 22, dentes 13 e supranumerários inclusos, dente 12 com forma conoide e parcialmente irrompido em supraversão, retenção prolongada do dente 53, tendência ao crescimento vertical da face e assimetria facial. A discrepância na arcada superior era de -2,0mm, e na inferior era de -5,0mm. MÉTODOS: o tratamento ortodôntico pré-cirúrgico foi realizado com extrações dos dentes 35 e 45. Na arcada superior foram extraídos os dentes 53, 12 e supranumerário, para efetuar o tracionamento do canino incluso. Os espaços das extrações inferiores foram fechados com mesialização do segmento posterior. Após o alinhamento e nivelamento dos dentes, foram avaliados por meio de modelos de estudo o fechamento dos espaços das extrações e o posicionamento correto dos dentes nas bases ósseas, a intercuspidação correta das arcadas dentárias, com molares e caninos em Classe I de Angle, linhas medianas coincidentes, trespasse horizontal e trespasse vertical normais e torques ideais. A paciente foi encaminhada para realização de cirurgia ortognática e, em seguida, o tratamento ortodôntico pós-cirúrgico foi finalizado. RESULTADOS: a má oclusão de Classe III foi corrigida, estabelecendo padrões oclusais e faciais normais.

Associação entre caninos inclusos e agenesias de incisivos laterais superiores permanentes / Association between impacted maxillary permanent canines and agenesis of permanent lateral superior incisors

Objetivo: Avaliar a prevalência de pacientes de Ortodontia com caninos superiores permanentes inclusos (CSPI), e sua localização e associação com a agenesia dos incisivos laterais superiores permanentes (ILSP). Materiais e métodos: A amostra foi constituída a partir dos prontuários de 825 pacientes, sendo o Grupo Experimental (GE) composto de 27 pacientes, 14 do sexo feminino (idades entre 10,5 anos e 15,4 anos) e 13 do sexo masculino (idades entre 11 anos e 17,6 anos), com CSPI e o Grupo Controle (GC) por 27 pacientes sem CSPI, pareados com GE de mesma idade e sexo. Analisaram-se a anamnese, o exame clínico, os modelos, as fotografias, radiografias panorâmica, periapicais e oclusais, telerradiografias cefalométrica lateral e póstero-anterior, em ambiente escurecido com negastocópio e lupa testeira (aumento 4x). Resultados: Observaram-se 27 pacientes (3,27%), totalizando 31 caninos inclusos, 51,85% ocorreram no sexo feminino e 48,15% no masculino; o Teste de Diferença de duas proporções verificou maior número de agenesias de ILSP(7) no GE do que no GC (1) (p = 0,0255) e que a ocorrência de agenesias concentrou-se nos pacientes comCSPI na região palatina (p = 0,0227). Conclusão: A prevalência de caninos superiores permanentes inclusosé de 3,27%, mais frequente por palatino e há dependência entre a prevalência aumentada de agenesia deincisivos laterais superiores permanentes e a inclusão palatina de caninos superiores.

Objective: The purpose of this study was to evaluate the prevalence of included permanent maxillary canines (IPMC) in orthodontic patients, their location and association of agenesis of the permanent upper lateral incisors (PULI). Materials and methods: A sample from the medical records of 825 patients was analyzed. The experimental group (E.G.) was composed of 27 patients with IPMC, including 14 females (aged from 10.5 to 15.4 years) and 13 males (aged from 11.0 to 17.6 years). The control group (CG) was made up of 27 patients without IPMC, paired with E.G. of the same age and sex. We analyzed clinical histories and clinical examinations, models, photographs; also panoramic, periapical, occlusal and lateral radiographs, and lateral and antero-posterior cephalometric teleradiographs were examined in a darkened room with an illuminated viewbox and headband magnifier (4X magnification). Results: There were 27 patients (3.27%) with IPMC, totaling 31 included maxillary canines, 51,85% in females and 48.15% in males. The difference in proportions test found a higher number of cases of PULI agenesis (7) in the E.G. than in the CG (1) (p = 0.0255) and that the occurrence of agenesis was concentrated in patients with palatal IPMC (p = 0.0277). Conclusions: The prevalence of included permanent maxillary canines is 3.27%, more frequent in the palatine area. There is dependence between the increased prevalence of agenesis of permanent upper lateral incisors and palatal impaction of maxillary canines.

Dentigerous cyst associated with multiple mesiodens: a case report.

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete dentition the diagnosis is a surprise; as about 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. More frequently the mesiodens occurs unilaterally, but it may also be bilateral, while three or more supernumerary teeth in the median region of the palate are more rarely found. We report a rare case of dentigerous cyst in association with multiple mesiodens in a 14-year-old female patient.

Treatment of space loss caused by submerged maxillary second primary molar.

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.

Reabsorção intracoronária pré-eruptiva de dente permanente: relato de caso / Pre-eruptive intracoronal resorption of permanent tooth: case report

O objetivo deste artigo é relatar um caso de reabsorção intracoronária pré-eruptiva e alertar quanto a importância de um diagnóstico precoce através de uma correta interpretação radiográfica. Durante um exame odontológico da paciente L. T. M., foi detectada na radiografia interproximal de rotina, uma imagem radiolúcida na porção dentinária da coroa do segundo pré-molar inferior direito não irrompido, sugerindo uma reabsorção intracoronária pré-eruptiva. O dente foi tratado somente após a sua erupção em duas sessões (tratamento expectante), sendo restaurado com proteção pulpar (cimento de hidróxido de cálcio) e resina compósita