Age estimation through the development of third molars in a case of multiple dismemberment / Estimación de la edad mediante el desarrollo de terceros molares en un caso de desmembramiento múltiple

El crimen organizado se ha convertido en un flagelo a nivel internacional conformado por grupos al margen de la ley que realizan todo tipo de actividades que involucran desde tráfico de personas, secuestros, extorsiones, narcotráfico y muchos otros delitos. Producto de este fenómeno, la desaparición y ejecución de personas es cada día más frecuente, en muchos casos los cuerpos son quemados o desmembrados para impedir o hacer más difícil la identificación. La odontología forense se ha convertido en una disciplina transcendental en la identificación de cadáveres y restos óseos, además de contar con múltiples métodos para estimar la edad aproximada de una persona. Se presenta el caso de un descuartizamiento múltiple de tres individuos masculinos donde era indispensable identificar si alguno correspondía a una persona menor de 18 años.

Organized crime has become an international scourge made up of outlaw groups that carry out all kinds of activities ranging from human trafficking, kidnapping, extortion, drug trafficking and many more. As a result of this phenomenon, the disappearance and execution of people is becoming more frequent every day, in many cases the bodies are burned or dismembered to prevent or make identification more difficult. Forensic odontology has become a transcendental discipline in the identification of corpses and skeletal remains, in addition to having multiple methods to estimate the approximate age of a person. The case of a multiple dismemberment of three male individuals is presented, where it was essential to identify a person under 18 years of age.

Quiste dentígero: correlación de examen imagenológico con diagnóstico de certeza / Dentigerous cyst: corelation between the imaging examination and diagnostic certainty

Se presenta un caso clínico de quiste dentígero, asociado a un tercer molar inferior izquierdo retenido, que concurre a la Cátedra de Diagnóstico por Imáge- nes de la Facultad de Odontología de la Universidad de Buenos Aires. El paciente, de 53 años de edad, es de sexo femenino. Se utiliza la tomografía de haz cónico para diagnosticar presuntivamente dicha patolo- gía. Posteriormente, se realiza biopsia para obtener una muestra y ser enviada para realizar los estudios anatomopatológicos, que corroboran el presuntivo diagnóstico. Basado en lo expuesto, se analiza al quis- te dentígero según ubicación, sexo, edad y maxilar; habiendo realizado una revisión de la literatura (AU)

A clinical case of a dentigerous cyst associated with a retained lower left third molar is presented. The 53-year-old patient is female. Cone beam tomography is used to presumptively diagnose said pathology. Subsequently, a biopsy is performed to obtain a sample and be sent to perform pathological studies that corroborate the presumptive diagnosis. Based on the above, the dentigerous cyst is analyzed according to location, sex, age and maxilla; having carried out a review of the literature (AU)

Avaliação das alterações moleculares dos folículos dentários em relação à idade cronológica / Evaluation of molecular changes in dental follicles in relation to chronological age

O Folículo dental (FD) é um tecido de origem ectomesenquimal. Aproximadamente 57% dos adultos apresentam terceiro molar mandibular impactado, sendo esse elemento dentário com maior prevalência de impactação dental. Há maior incidência de alterações patológicas em indivíduos mais velhos em comparação com indivíduos mais jovens. Porém os mecanismos envolvidos na formação de cistos e tumores relacionados aos FDs não estão bem elucidados, e, por isso, alguns autores defendem a extração profilática dos terceiros molares inclusos. Durante o envelhecimento cronológico, padrões epigenéticos mudam, e um padrão de hipometilação global do DNA pode ser encontrado concomitantemente com hipermetilação de vários genes supressores tumorais. A metilação do DNA é um dos mecanismos que regula as vias de sinalização celular, como a da MAPK/ERK, que atuam no controle da proliferação e diferenciação. Alguns pesquisadores descobriram um aumento na atividade do ERK 1/2 durante o processo de envelhecimento, o que poderia contribuir para a ocorrência de doenças, e a sua desregulação está envolvida na indução e na progressão de doenças como câncer e doenças autoimunes. Portanto, o presente estudo teve por objetivo avaliar se os FDs de indivíduos jovens e indivíduos mais velhos apresentam diferença no perfil de metilação global do DNA, e avaliar o padrão de imunoexpressão da forma fosforilada ERK1/2 (pERK1/2) nos FDs. A metilação global do DNA (percentual de 5mC) e a hidroximetilação (5hmC) foram avaliadas por ELISA em 59 amostras. Testamos a correlação entre o conteúdo de 5mC e 5hmC e a correlação de cada um com a idade dos pacientes. Examinamos a imunorreatividade do pERK 1/2 para avaliar a ativação das vias MAPK/ERK em 46 amostras de FD. As amostras apresentaram variação entre 13 e 31 anos de idade. Os resultados mostraram uma relação inversamente proporcional entre o conteúdo de 5hmC e idade até os 19 anos, portanto o percentual de 5hmC nos FDs tende a diminuir linearmente com o envelhecimento. O estudo imuno-histoquímico mostrou um padrão variável de imunoexpressão de pERK1/2 com 46% (21/46) das amostras exibindo menos de 10% de células positivas, enquanto 24% (11/46) das amostrasapresentaram imunopositividade entre 10 e 50% e 30% (14/46) das amostras mais de 50% das células de FD. Não foi observado diferença nas idades entre esses grupos. Em conclusão, nossos resultados sugerem que a hidroximetilação global do DNA possui alteração no seu padrão durante o envelhecimento e que a via de sinalização celular MAPK/ERK está ativa nos FDs.

The dental follicle (DF) is a tissue of ectomesenquimal origin. Approximately 57 % of young adults have impacted third molars, which is the most prevalent impacted tooth. The incidence of pathological changes is greater among older individuals than younger individuals. However, the mechanisms behind the formation of cysts and tumors related to DFs have not been fully clarified and, therefore, some researchers defend the prophylactic extraction of third molars. During chronological aging, epigenetic patterns change and a global DNA hypomethylation pattern can be found concomitantly with hypermethylation of several tumor suppressor genes. DNA methylation is one of the regulators of cell signaling pathways, such as the MAPK/ERK pathway. Some researchers have found an increase in ERK1/2 activity during the aging process, which may contribute to the occurrence of disease, and its dysregulation is involved in the induction and progression of diseases such as cancer and autoimmune diseases. Thus, the aim of the present study was to evaluate whether DFs in young and older individuals differ in terms of global methylation and hydroxymethylation and to evaluate the immunoexpression pattern of phosphorylated ERK1/2. Global DNA methylation (5mC content) and hydroxymethylation (5hmC) were evaluated by ELISA in 59 DF samples We tested the correlation between 5mC and 5hmC content, and the correlation of each with patients' age. We examined ERK1/2 immunoreactivity for the evaluation of the activation of the MAPK pathways in 46 DF samples. Age of patients of the 59 samples of DFs raged from 13 to 31 years. An inversely proportional relation was found between the 5hmC content and age up to 19 years, therefore, the percentage of 5hmC in the DFs tends linearly decrease with aging. The immunohistochemical study showed a variable pattern of immunoexpression of pERK 1/2 with 46% (21/46) of the samples showing less than 10% of positive cells, while 24% (11/46) of the samples showed immunopositivity between 10 and 50% and 30% (14/46) of the samples greater than 50% of the DF cells. There was no difference in age among these groups. In conclusion, our results suggest that the global hydroxymethylation of DNA changes in its pattern during aging and that the MAPK/ERK cell signaling pathway is active in DFs.

Tercer molar heterotópico en el reborde orbitario: Reporte de un caso y revisión de literatura / Heterotopic third molar in the orbital rim: Report of a case and literature review

Los terceros molares heterotópicos son órganos dentarios que se encuentran en un sitio anatómico fuera de lo habitual, pueden ser supernumerarios, deciduos o un diente permanente, el cual ha sido reportado en diferentes posiciones, incluyendo la región coronoidea, cavidad nasal, seno maxilar, región orbitaria, palatina, cóndilo mandibular. La etiología de la erupción heterotópica/ectópica es desconocida, aunque hay varias teorías como la discrepancia óseo-dentaria por la evolución. Los órganos dentarios heterotópicos/ectópicos son comunes en la mandíbula y en el género femenino y pueden ocurrir en ambas denticiones. Algunos terceros molares heterotópicos/ectópicos son asintomáticos durante el periodo de vida y son usualmente detectados en hallazgos clínicos y radiográficos de manera incidental. Existen casos documentados desde 1887 hasta la actualidad cuya localización es en el reborde orbitario. En el presente artículo se expone un caso clínico de una extracción quirúrgica de un tercer molar superior heterotópico en el reborde orbitario descrita bajo el protocolo de las retenciones dentales. Dicho caso fue establecido en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE en la Ciudad de México, con el que se obtuvieron resultados favorables, fue el primer reporte de la literatura en México. Se realizó una revisión aleatoria de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library y se desarrolló el reporte de caso clínico de una paciente con un tercer molar superior heterotópico ubicado en el piso de órbita derecho (AU)

Heterotopic third molars are dental organs that are in an anatomical site out of the ordinary, can be supernumerary, deciduous or a permanent tooth, which has been reported in different positions, including the coronoid region, nasal cavity, maxillary sinus, orbital region, palatal, mandibular condyle. The etiology of the heterotopic/ectopic eruption is unknown, although there are several theories such as bone-dental discrepancy due to evolution. The heterotopic/ectopic teeth are common in the jaw and in the female gender and can occur in both dentitions. Some heterotopic/ectopic third molars are asymptomatic during the lifetime and are usually found incidentally in clinical and radiographic findings. There are documented cases from 1887 to the present that its location is in the orbital rim. In the present article we present a clinical case of a surgical extraction of a third upper molar heterotopic in the orbital rim and that is described under the dental retention protocol established in the Regional Hospital «General Ignacio Zaragoza¼ of the ISSSTE in the City of Mexico, with which they obtain favorable results, first report of the literature in Mexico. A randomized review of the literature was made on pages such as PubMed, ScienceDirect and Springer, Cochrane Library and the clinical case report of a patient with a heterotopic upper third molar located on the floor of the right orbit was developed (AU)

Incidence of Lower Anterior Third Molars on Dental Crowding. A New Approach / Incidencia de Terceros Molares Inferiores en el Apiñamiento Dental. Un Nuevo Enfoque

ABSTRACT: This paper main objective is to estimate the level of association between lower anterior crowding and the presence of lower third molars on study models and panoramic dental radiographs of patients treated by the Orthodontics Postgraduate Students at the Dentistry Faculty at the University of Cartagena (Cartagena de Indias, Colombia) and also other dental and radiographs care centers in Cartagena de Indias. It was made using a cross-sectional study at the Dentistry Faculty at the University of Cartagena and others dental care centers in the city. There were 366 study models and panoramic dental radiographs selected by strict inclusion/exclusion criteria for patients. An instrument that includes age, gender, presence or absence of third molars, position of third molars according to Winter's classification, stage of formation of the third molars according to Nolla's classification, and crowding magnitude according to Harfin's classification was used. Data were analyzed based on frequency distributions and proportions; inferential analysis was performed through proportional odds model using the software package IBM SPSS Statistics v23. It was found that the patients with Nolla 6 from the right side are more likely to have mild-moderate crowding magnitude than patients with Nolla 10 on that same side. In conclusion, this research provides as main result the implication of the eruption of the lower third molars and particularly those erupting in mesioangular and horizontal positions in the anterior crowding (AA).

RESUMEN: El objetivo de este trabajo fue estimar el nivel de asociación entre el apiñamiento dentario anteroinferior y la presencia de terceros molares inferiores en modelos de estudio y radiografías panorámicas de los pacientes atendidos por estudiantes del posgrado de ortodoncia de laFacultad de Odontología de Cartagena de Indias, Colombia y también otros centros dentales y de radiografías en Cartagena de Indias. Se realizó un estudio transversal en la Facultad de Odontología de la Universidad de Cartagena y otros centros de atención odontológica de la ciudad. Se utilizaron 366 modelos de estudio y radiografías dentales panorámicas seleccionadas por estrictos criterios de inclusión / exclusión para los pacientes. Se utilizó un instrumento que incluía edad, sexo, presencia o ausencia de terceros molares, posición de los terceros molares de acuerdo con la clasificación de Winter, etapa de formación de los terceros molares de acuerdo con la clasificación de Nolla y magnitud de apiñamiento según la clasificación de Harfin. Los datos se analizaron en base a las distribuciones y proporciones de frecuencia; el análisis inferencial se realizó a través del modelo de probabilidades proporcional utilizando el software IBM SPSS Statistics v23. Se encontró que los pacientes con Nolla 6 en el lado derecho son más propensos a tener una magnitud de apiñamiento de leve a moderada en comparación a los pacientes con Nolla 10 en ese mismo lado. En conclusión, esta investigación proporciona como resultado principal la implicación de la erupción de los terceros molares inferiores y particularmente aquellos que erupcionan en posiciones mesioangulares y horizontales en el apiñamiento dentario anterior (AA).

Terceiro molar intrassinusal: relato de caso / Intra-sinusal third molar: case report

Ectopic tooth eruption into an area other than the oral cavity is rare. Nasal septum, mandibular condyle, coronoid process and infratemporal fossa space have been reported as frequent locations for ectopic tooth eruption. Ectopic teeth located within the maxillary sinus may be asymptomatic, found only in routine examinations. Headache, sinusitis and nasal obstruction are some of the associated symptoms. The differential diagnosis includes foreign bodies (rhinolith), infections (syphilis and tuberculosis), benign lesions (hemangioma, osteoma, calcified polyp) and malign lesions (osteosarcoma). Upper third molars located within the maxillary sinus may be associated with the development of mucocele or dentigerous cyst. The aim of this paper was to describe the case of a 24-year old female patient with an ectopic right upper third molar in the maxillary sinus. A hyperdense area was observed with sinus obliteration, consistent with mucous material.

Erupção ectópica dos dentes em outras regiões além da cavidade oral é rara. O desenvolvimento ectópico desses dentes tem sido relatado no septo nasal, côndilo mandibular, processo coronoide e no espaço da fossa infratemporal. Dentes ectópicos localizados no seio maxilar podem ser assintomáticos, descobertos em exames radiográficos de rotina. Dentre os sintomas associados estão cefaleia, sinusite e obstrução nasal. Corpos estranhos (rinólitos), processos infecciosos (sífilis ou tuberculose), lesões benignas (hemangioma, osteoma, pólipos calcificados) e malignas (osteossarcoma) podem ser considerados no diagnóstico diferencial de dentes ectópicos. Os terceiros molares superiores, quando localizados no seio maxilar, podem estar associados ao desenvolvimento de mucocele, assim como de cistos dentígeros. Dessa forma, o objetivo deste artigo foi relatar o caso de uma paciente do gênero feminino, com 24 anos de idade, em que se observou terceiro molar superior direito com localização intrassinusal associado a uma área de hiperdensidade média, causando parcial obliteração do seio maxilar, compatível com material mucoide.

Clinico-radiographic examination of odontogenic myxoma with displacement of unerupted upper third molar: review of the literature / Examen clínico-radiográfico de un mixoma odontogénico con desplazamiento de un tercer molar no erupcionado: revisión de la literatura

Odotogenic myxoma is a benign tumor which presents in 3 percent to 6 percent of all odontogenic tumors. According to the WHO classification, multiple radiolucent areas of varying size, separated by straight or curved bony septa with poorly defined borders are the radiologic characteristics of the condition. We report the case of maxillary odontogenic myxoma in a 21 year old man. The radiological feature of the current case was interesting, due to the size of the lesion and severe displacement of the upper third molar.

El mixoma odontogénico es un tumor benigno que se presenta en el 3 por ciento a 6 por ciento de todos los tumores odontogénicos. De acuerdo a la clasificación de la OMS, las características radiológicas de esta patología presentan múltiples áreas radiolúcidas de tamaño variable, separadas por tabiques óseos rectos o curvos, con márgenes mal definidos. Presentamos un caso de mixoma odontogénico maxilar en un hombre de 21 años. La característica radiológica es interesante, debido al tamaño de la lesión y al desplazamiento severo del tercer molar superior.

Immunohistochemical Analysis of Proliferating Cell Nuclear Antigen (PCNA) in Dental Follicles of Impacted Third Molars / Análisis Imunohistoquímico de Antígeno de Proliferación Celular Nuclear (PCNA) en Folículos Dentales de los Terceros Molares Retenidos

This study investigated the immunodetection of PCNA in epithelial components of dental follicles associated with impacted third molars without radiographical and morphological signs of pathosis. A total of 105 specimens of dental follicles associated with impacted third molars with incomplete rhizogenesis (between Nolla's stage 6 and 9) were surgically removed from 56 patients. Epithelial cell proliferating was determined by using immunohistochemical labeling. Statistical analysis was performed using the Fisher exact test. Of the 105 dental follicles collected, 6 were PCNA-positive ( 6 percent). The specimens with squamous metaplasia and epithelial hyperplasia had higher rates of positivity for PCNA, as well as those with proliferative remnants of odontogenic epithelium. In conclusion, this study shows that dental follicles at this stage of development have low proliferative potential, but suggests that squamous metaplasia, hyperplasia of the epithelial lining and presence of proliferative odontogenic epithelial rests in the connective tissue may be early signs of developing lesions of odontogenic origin.

Se investigó la inmunodetección de PCNA en los componentes epiteliales de los folículos dentales asociados a terceros molares retenidos sin signos radiográficos y morfológicos de la patología. Fueron extraídos quirúrgicamente, de 56 pacientes, 105 muestras de folículos dentales asociados a terceros molares retenidos con rizogénesis incompleta (entre los estadíos de Nolla 6 y 9) La proliferación de células epiteliales se deteminó mediante inmunohistoquímica. El análisis estadístico se realizó mediante la prueba exacta de Fisher. De los 105 folículos dentales recogidos, 6 fueron PCNA-positivos ( 6 por ciento). Las muestras con metaplasia escamosa e hiperplasia epitelial tuvieron mayores tasas de positividad para PCNA, así como aquellos con restos de proliferación del epitelio odontogénico. En conclusión, este estudio mostró que los folículos dentales en esta etapa del desarrollo tienen un potencial proliferativo bajo, pero sugiere que la metaplasia escamosa, la hiperplasia del epitelio y la presencia de restos epiteliales odontogénicos, en proliferación en el tejido conectivo, pueden ser signos tempranos de lesiones en el desarrollo de origen odontogénico.

Keratocystic odontogenic tumor with impacted maxillary third molar involving the right maxillary antrum:An unusual case report.

The odontogenic keratocyst (OKC), first described by Phillipsen in 1956, has metamorphosized as a keratocystic odontogenic tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. KCOT is a benign intraosseous neoplasm of the jaw and its occurrence in maxilla is unusual and its appearance in maxillary antrum along with maxillary impacted third molar is very uncommon. This article reports a case of KCOT associated with impacted maxillary third molar in right maxillary antrum and describes its rare site of occurrence.

Impacted mandibular third molars: pattern of presentation and postoperative complications

The purpose of this prospective study was to evaluate the occurrence, characteristics and postoperative complications of impacted mandibular third molars in 260 patients from Oct 2008 to July 2010. Clinical and radiographic examinations were carried out. Data regarding the age, gender, angulations type, depth and width of impactions and postoperative complications were evaluated and analyzed. The age ranged from 17 to 59 years with high frequency occurring in 3rd decade. The common cause for extraction was pericoronitis. Mesioangular impaction was most common [n=124, 48%] followed by vertical [n=90, 34%]. Majority of the patients presented with Class IIA [n=84, 32.3%] followed by IA [n=61, 23.5%]. Postoperative complications included persistent pain and swelling [16.5%] followed by dry socket [4.2%] and trismus [4.2%]. There was a greater risk of developing complications in horizontal and distoangular types, and in Class IIIC and IIIA impactions

Resolución intra-quirúrgica de osteotomía sagital bilateral de rama mandibular desfavorable en paciente con látero-desviación: estado del arte de casos reportados / Intra-operative resolution of unfavorable bilateral mandibular sagittal ramus osteotomy in a patient with lateral deviation

Objetivos: 1) presentar un caso clínico de fractura de rama ascendente mandibular luego de realizar laosteotomía sagital bilateral y su correspondiente resolución 2) Determinar a través de una Revisión Bibliográfica si la presencia de terceros molares incrementa o no el índice de fracturas desfavorables al momentode la osteotomía sagital de rama.Materiales y método: 1) Se presenta un caso clínico de fractura de rama ascendente mandibular luego deosteotomía sagital de rama en una mujer de 24 años, quien presenta un tercer molar normalmente erupcio-nado, la resolución de dicha complicación y controles a distancia. 2) En una búsqueda realizada en Pubmedy Medline, limitada para artículos clínicos de los últimos 20 años y con un numero mayor a 100 osteotomías, se dividió a los pacientes en 2 grupos: Grupo 1 (con tercer molar presente) n= 898 osteotomías y Grupo 2 (tercer molar ausente) n=1217 osteotomías.Se analizaron Índices de fractura durante la osteotomía con presencia o no del tercer molar, ubicación dela fractura según sea el segmento proximal o distal, según el sexo y según sean mandíbulas prognáticas oretrognáticas. Conclusiones: 1) La presencia del tercer molar al momento de la osteotomía no incrementa el índice de fracturas p: 0,98. 2) A mayor experiencia del cirujano, menor índice de fracturas. 3) En ausencia del tercermolar, la fractura del segmento proximal es más frecuente que la del distal p: 0,0089. 4) En presencia del tercermolar son más frecuentes las fracturas distales p: 0,012. 5) Son más frecuentes las fracturas en mandíbulasretrognáticas que las prognáticas.Caso clínico: 1) Se lograron los objetivos planteados en el VTQ. 2) El cóndilo izquierdo se encuentra remo-delado, en función. No se observan alteraciónes en los movimientos de apertura y cierre mandibular, ni tam-poco desviación de las líneas medias dentarias superior e inferior en apertura y cierre

Prevalencia de terceros molares incluidos en estudiantes de una escuela pública de São Luís, Maranhão, Brasil / Prevalence of third molars in students of a public school in São Luís, Maranhão, Brazil

Los terceros molares presentan características muy particulares referentes a la erupción, inclusión, y complicaciones que requieren una evaluación clínica y radiológica más detallada para definir mejor el diagnostico y tratamiento cuando necesario. El objetivo era investigar la prevalencia de los terceros molares incluidos en estudiantes de una escuela pública de la ciudad de São Luís - Maranhão. Fue realizado un estudio transversal descriptivo de las características clínicas y radiológicas de los terceros molares de 155 estudiantes desde los 18 a los 21 años de edad de ambos sexos de un Instituto Federal de Educación Tecnológica de Maranhão. Los molares presentes con rizogénesis completa fueron clasificados según su nivel de inclusión. Todos los datos fueron registrados en historias clínicas propias, tablas del EPI - INFO 2000 y sometidos al test chi-cuadrado para verificar la existencia de asociaciones entre las variables del estudio, con un nivel significativo del 5%. De una población de 155 estudiantes, se obtuvo 531 (85,6%) terceros molares presentes y 89 (14,4%) terceros molares ausentes. De aquellos presentes 462 (87%) terceros molares fueron evaluados en cuanto a su nivel de inclusión. De estos, 239 (51,7%) se encontraban en algún estadio de la fase de inclusión, siendo que 201 (84,1%) estaban parcialmente incluidos y 38 (15,9%) totalmente incluidos. Hubo asociación positiva entre dientes incluidos y terceros molares (p = 0.0015). Los molares incluidos fueron una condición frecuente en la muestra (51%), donde fueron observados terceros molares en distintas fases de inclusión

Third molars have characteristics that are very peculiar regarding the eruption, inclusion and complications. Accordingly, they often require particular clinical and radiological assessments, in order to better define diagnosis and treatment. The aim of this study was to investigate the prevalence of dental inclusions of the third molars within students from a public school in São Luís - Maranhão. We conducted a transverse, descriptive study assessing the clinical characteristics, as well as the radiographies of the third molars, from 155 students (ages from 18-21 years, both genders), from the Federal Institute of Technological Education, in Maranhão. Teeth with complete rhizogeneses were classified according to different inclusion state. Data were transferred to summary files, and then entered in a database (EPI-INFO 2000). Groups were compared using the Chi-Square test in order to assess associations among the study variables. Significance level was established in 5%. Among 155 students, 531 (85.6%) teeth were present, and 89 (14.4%) were not. Among the present, 462 (87%) third molars were assessed according to the inclusion pattern. From them, 239 (51.7%) were in any inclusion state, while (84.1%) had partial inclusion and 38 (15,9%) in total inclusion We found a positive association between dental inclusion and third molars (p=0.0015). Dental inclusion was frequent in our sample (51%), where we observed third molars in different patterns of inclusion

Tercer molar ectópico impactado en zona retromolar: reporte de caso / Ectopic and impacted third molar in retromolar zone: a case report

El desarrollo dentario resulta de una complicada interacción entre el epitelio oral y el tejido mesenquimático subyacente. La interacción anormal de tejidos en este período podría resultar en el desarrollo y erupción de un diente ectópico. Terceros molares incluidos son una de las patologías más frecuentes encontradas en cirugías oral y maxilofacial. Su evaluación generalmente es radiográfica, y los de ubicación mesioangular son los más prevalentes en la mandíbula. El presente reporte muestra un caso clínico de tercer molar incluido en la región retromolar mandibular. El diagnóstico se efectuó durante una evaluación por medio del análisis de una ortopantomografía en un paciente de sexo femenino de 51 años de edad. La pieza estaba ubicada en la zona retromolar mandibular derecha inmediatamente subcortical. Dado que se encontraba asintomática, sin signos radiográficos ni clínicos de patología, no fue indicada la exodoncia; sin embargo, es importante considerar esta variación anatómica y una posible resolución quirúrgica de ella ante la posible rehabilitación protésica del área.

Tooth develop results of several interactions between oral epithelium end underlying mesenchymatic tissue during odontogenesis. Abnormal relation of tissues could result in develop and eruption of an ectopic tooth. Impacted third molars are a frequent pathology in oral and maxillofacial surgery, it evaluation is commonly radiographic, and the most frequent position in jaw bone is mesioangular. This report wants to show an impacted third molar in mandibular retromolar region. Diagnosis was done through a orthopantomographic study during a clinical evaluation of 51 years of age female patient. Teeth was found sub cortical of right retromolar zone. Considering patient did not related or shown clinical signs of pathology, and radiograph neither had disease compatible signs, was resolved do not proceed to extraction. However, is important to consider this anatomical variation and a possible surgical resolution if a prosthetic rehabilitation of this area.

Pathosis associated with radiographically normal follicular tissues in third molar impactions: a clinicopathological study.

BACKGROUND: The follicular tissue around impacted third molars has a potential to develop pathosis. However, it is generally assumed that the absence of abnormal radiolucency indicates the presence of a normal follicle. AIMS: The aim of this study was to investigate abnormalities associated with radiographically normal follicular tissue of third molar impactions. MATERIALS AND METHODS: One hundred eighty-five impacted third molars from 170 patients with no signs of abnormal radiolucency (follicular space < 3 mm) were used for this study. Follicular tissues of the relevant teeth were collected. Specimens were fixed in 10% formalin and stained routinely with hematoxilin and eosin to be independently examined by two pathologists. A diagnosis was registered only when the results from both pathologists were in concordance. Clinical details for each patient were registered in WHO standard forms to undergo chi-square statistical analysis. RESULTS: Fifty-three per cent of the specimens had developed pathosis. The incidence of pathosis was higher in the age group of 20-30 years, in men compared to women and in the mandible compared to the maxilla. CONCLUSION: The findings of this study suggest that radiographic appearance may not be reliable in the diagnosis of pathosis in follicular tissue as a surprisingly high rate of pathosis was found in the absence of any radiographically detectable sign.

Estudio de prevalencia de patologías dentarias de desarrollo en radiografías panorámicas / A study of the prevalence o developmental oral pathologies in panoramic radiographs

El objetivo de este estudio fue determinar la prevalencia de patologías dentarias de desarrollo (erupción, forma, posición, tamaño, número) que caracterizan a la población de la Ciudad de Buenos Aires, utilizando la información que proporcionan radiografías panorámicas. Se obtuvo la prevalencia de patologías de desarrollo y el análisis de varianza con el objeto decomparar lesiones entre géneros. Se observaron radiografías panorámicas de 1000 pacientes atendidos en la Cátedra de Radiología de la Facultad de Odontología de la Universidad de Buenos Aires, derivados de clínicas de la misma.

Hallazgos clínicos y radiográficos de terceros molares con indicación de extracción: resultados preliminares / Clinical and radiographic findings of third molars with extractions indications: preliminary results

Una de las cirugías orales realizadas con más frecuencia en el mundo es la exodoncia de terceros molares (3Ms). Las indicaciones de extracción son muy variadas, siendo algunas de ellas aun controversiales. Se diseñó una completa investigación sobre el estatus de 3Ms con indicación de exodoncia. 158 3Ms correspondientes a 145 pacientes fueron evaluados. Los pacientes incluidos en el estudio acudieron voluntariamente a un centro quirúrgico privado, a un centro público de especialidades odontológicas y al centro odontológico universitario. La relación hombre:mujer fue de 0,56:1 y la edad mas frecuente de consulta fue desde los 18 a los 25 años. Casi el 70 por ciento de los pacientes fueron derivados desde centros de menor complejidad, 43 por ciento presento dolor como motivo de consulta, 23 por ciento presento pericoronitis y el 27 por ciento tuvo experiencia de caries. El dolor se asocio significativamente con la edad del paciente (p < 0,05). La mayoría de los molares se encontraba semierupcionado (35 por ciento) y con posición vertical (44 por ciento).

The most frequent oral surgeries in the world are the extractions of the third molars (3Ms). The extraction indications vary as some of them are yet controversial. A complete research program was designed on the status of 3Ms with extraction indications. One hundred fifty eight 3Ms corresponding to 145 patients were evaluated. The patients included in this investigation arrived at a private surgical centre, a public centre of odontologic specialties and at the university clinic voluntarily. The relation men: women was 0,56:1 and the average age of the consulting patient was between 18 and 25 years of age. Almost 70 percent of the patients were diverted to the minor odontologic centre, 43 percent presented pain justifying the consultation, 23 percent presented pericoronitis and 27 percent experienced caries. The pain was significantly associated with the age of the patient (p < 0,05). The majority of the molars were “semi erupted” (35 percent) and in vertical position (44 percent).

Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: a rare entity.

Ectopic eruption of teeth into a region other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin and maxillary sinus. Occasionally, a tooth may erupt in the maxillary sinus and present with local sinonasal symptoms attributed to chronic sinusitis. We present a case of an ectopic maxillary third molar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus.

Spiral CT scanning and curved tomography in localization of mandibular canal in relation to lower third molar

Accurate radiographic assessment is a must in cases of impacted lower third molars with proximity to mandibular canal to avoid the high risk of neurovascular bundle injury during surgical removal. This study was conducted as an attempt to assess the relation of horizontally impacted lower third molar to mandibular canal using curved tomography [panoramic radiography] and spiral CT scanning. Fifteen patients were comprised in this study. They were all suffering from horizontally impacted lower third molar. Images of both modalities were qualitatively and quantitatively analyzed to reveal relation of the molar to the canal. Out of our results: [1] The most common radiographic features strongly linked to intimate relation [40% of the cases] and highly predicting of contact between horizontally impacted lower third molar and canal are: superimposition of roots on canal and presence of roots just touching the superior border of the canal. [2] Majority of the investigated teeth were not in contact with the canal [60%]. The mandibular canal was most often inferior or buccal or inferiobuccaly to the roots of the horizontally impacted lower third molars. It could be concluded from this study that whenever one of the radiographic criteria predicting close proximity of molar to canal is evident on panoramic radiograph, CT should be performed to clear out the exact location of the canal. Spiral CT allows faster scanning, more resolution and a high degree of accuracy when planning removal of third molar in proximity to the canal, making it possible to formulate a more precise diagnosis and treatment plan

Occlusal caries diagnosis in permanent teeth: an in vitro study

A redução da prevalência de cáries não ocorreu uniformemente para todas as superfícies dentárias. Como as superfícies oclusais ainda são as mais susceptíveis ao desenvolvimento de lesões, novos métodos de diagnóstico ainda estão sendo avaliados. Este estudo comparou um sistema de fluorescência a laser (DIAGNOdent – DD) com o método visual de Ekstrand na detecção de cárie oclusal. Um total de 57 terceiros molares com superfícies oclusais macroscopicamente intactas foram selecionados. Dois examinadores examinaram 110 sítios por inspecção visual (IV) e DD. Após dez dias da primeira mensuração, todos os dentes foram novamente avaliados pelos mesmos métodos. A extensão de cárie foi validada por exame histológico (40 X). Os dados foram analisados quanto a sensibilidade, especificidade, reprodutibilidade intra e interexaminador e área sob a curva ROC. O teste kappa demonstrou boa reprodutibilidade intra e interexaminadores para ambos os métodos. A IV e o DD apresentaram sensibilidade semelhante para ambos os examinadores, entretanto, a IV apresentou maior especificidade que o DD. A análise geral, através da área sob a curva ROC, mostrou que a IV teve um melhor desempenho que o DD. Concluiu-se que o critério visual proposto por Ekstrand é mais confiável para o diagnóstico de cáries oclusais. O DD deve ser considerado apenas como um coadjuvante no exame de cárie em superfícies oclusais.

Estudo radiográfico e histopatológico dos tecidos pericoronários de terceiros molares não irrompidos e parcialmente irrompidos / Radiographic and histopathological study of the pericoronal tissues of unerupted and partially erupted third molar

Uma amostra aleatória de 48 pacientes (32 mulheres e 16 homens) de 16 a 26 anos, foi estudada. A partir desta amostra, 33 radiografias panorâmicas e 72 tecidos pericoronários de terceiros molares não irrompidos e parcialmente irrompidos foram obtidos. O estudo radiográfico foi dividido em 2 partes: mensuração do espaço pericoronário pelo pesquisador e análise das imagens radiográficas por dois especialistas em Radiologia Bucomaxilofacial. Os tecidos pericoronários removidos cirurgicamente foram preparados, corados e analisados por dois Patologistas Bucais. Os resultados obtidos apontaram uma variação na largura dos espaços pericoronários de 0,8 a 5,3 mm, sendo que 76 por cento dos dentes da amostra radiográfica foram diagnosticados como folículos pericoronários, segundo este critério. O teste de Kappa evidenciou uma concordância moderada entre os diagnósticos obtidos a partir da largura do espaço pericoronário e dos observadores radiográficos 1 e 2 e, um fraco nível de concordância entre os diagnósticos dos observadores radiográficos 1 e 2. Na análise histopatológica houve um predomínio de folículos pericoronários. O teste de Kappa indicou uma concordância moderada entre os diagnósticos de folículo pericoronário e de cisto dentígero realizados pelos observadores histopatológicos 1 e 2. Não foram encontrados parâmetros radiográficos e histopatológicos que isoladamente permitiram diferenciar folículos pericoronários de cistos dentígeros. Desta forma, foi considerada indispensável, a soma das características clínicas, radiográficas e histopatológicas dos tecidos pericoronários no estabelecimento do correto diagnóstico diferencial entre folículo pericoronário e cisto dentígero