Tratamento de odontoma composto e cisto dentígero: relato de caso / Treatment of compound odontoma and dentigeral cyst: case report

Introdução: o odontoma é considerado como um frequente tumor odontogênico benigno, podendo ser classificado em tipo composto ou tipo complexo. O cisto dentígero é o mais comum entre os cistos odontogênicos de desenvolvimento, onde envolve a coroa da unidade dentária no nível da junção amelocementária. Há poucos estudos na literatura do encontro das duas lesões, acometendo o mesmo local na cavidade oral. O diagnóstico pode ser constituído por exame clínico e de imagem. Objetivo: apresentar um caso clínico de odontoma composto e cisto dentígero em região de parassínfise mandibular esquerda abordando as caraterísticas clínicas destas duas lesões e as adequadas formas de tratamento. Relato de caso: paciente do sexo masculino, 16 anos de idade, compareceu ao ambulatório do Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), portando encaminhamento de ortodontista, solicitando exodontia da unidade dentária 33 inclusa associada a um odontoma. Ao realizar exames físicos e imaginológicos detectou-se a hipótese diagnóstica de odontoma composto associado a unidade dentária, envolto em folículo pericoronário ou cisto dentígero. Foi realizada biópsia excisional das duas lesões e exodontia da unidade. A análise histopatológica confirmou o diagnóstico para odontoma composto associado a cisto dentígero na unidade 33. Ao acompanhamento de 03 meses, paciente apresentou neoformação óssea da região de parassínfise mandibular, mediante a análise de novos exames imaginológicos. Discussão: há poucos estudos na literatura da associação entre as duas lesões, porém relatos afirmam que o odontoma pode ser encontrado associado aos cistos odontogênicos. Por conta da falta de maiores estudos dessa associação, há escassez de recomendações terapêuticas de acordo com faixa etária e extensão do acometimento das lesões. Considerações finais: lesões comumente assintomáticas, tem o diagnóstico constituído por exame clínico e avaliação de exames de imagem(AU)

Introduction: odontoma is considered a frequent benign odontogenic tumor and can be classified as a compound or complex type. The dentigerous cyst is the most common among developmental odontogenic cysts, where it involves the crown of the dental unit at the level of the cementoenamel junction. There are few studies in the literature on the meeting of the two lesions, affecting the same site in the oral cavity. The diagnosis can be made by clinical and imaging examination. Objective: to present a clinical case of compound odontoma and dentigerous cyst in the left mandibular parasymphysis region, addressing the clinical characteristics of these two lesions and the appropriate forms of treatment. Case report: male patient, 16 years old, attended the outpatient clinic of the Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), having been referred by an orthodontist, requesting extraction of the included dental unit 33 associated with an odontoma. Upon physical and imaging examinations, the diagnostic hypothesis of a compound odontoma associated with a dental unit, surrounded by a pericoronal follicle or dentigerous cyst, was detected. Excisional biopsy of the two lesions and extraction of the unit were performed. The histopathological analysis confirmed the diagnosis of compound odontoma associated with dentigerous cyst in unit 33. At the 03-month follow-up, the patient presented bone neoformation in the mandibular parasymphysis region, through the analysis of new imaging exams. Discussion: there are few studies in the literature on the association between the two lesions, but reports state that odontoma can be found associated with odontogenic cysts. Due to the lack of further studies on this association, there is a lack of therapeutic recommendations according to age group and extent of lesion involvement. Final considerations: commonly asymptomatic lesions, the diagnosis consists of clinical examination and evaluation of imaging tests(AU)

Decoloración coronaria inducida por la utilización de Biodentine y MTA blanco en procedimientos de regeneración pulpar: estudio ex vivo / Coronal discoloration induced by the use of Biodentine and white MTA in pulp regeneration procedures: an ex-vivo study

Se comparó el grado de decoloración de la corona clínica en piezas dentarias anteriores humanas ex-traídas, sometidas a procedimientos de regeneración endodóntica, utilizando MTA blanco o sustituto bioac-tivo de la dentina (Biodentine) como barrera cervical, en presencia de coágulo sanguíneo como andamio. En total se prepararon 24 piezas dentarias anterio-res superiores humanas que fueron divididas en dos grupos control (GC) y dos grupos experimentales (GE). Cada uno incluía 6 piezas dentarias. En los GE se colo-có sangre humana fresca en el interior del conducto, y se confeccionó una barrera de Biodentine (GE3) o MTA (GE4). En los GC se colocó una torunda de algo-dón estéril saturada con solución fisiológica estéril, y se confeccionó una barrera de Biodentine (GC1) o MTA (GC2). El color se evaluó de acuerdo con el espa-cio de color CIE L* a* b* utilizando imágenes fotográfi-cas digitales estandarizadas en dos puntos de tiempo: día 0 (T0) y día 35 (T35). La descripción de los datos in-cluyó mediana (Md), primer cuartil (Q1), tercer cuartil (Q3), media y desviación estándar (DE). Se emplea-ron las pruebas de los rangos con signo de Wilcoxon (RSW) y ANOVA de una vía; p < 0,05 fue considerado significativo. Cuando se comparó ∆E se observaron diferencias significativas entre GC1 y el resto de los materiales (p < 0,05). ∆E fue menor en GC1 (media ± DE; 2,1 ± 1,6) que en los grupos restantes que no pre-sentaron diferencias significativas entre sí. En base a estos resultados, la estabilización del coágulo san-guíneo, como así la limpieza de la cavidad previa a la colocación del Biodentine y el uso de barreras cervi-cales, es imprescindible para evitar la coloración de la corona clínica (AU)

Discoloration remains an unfavorable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. Objective: Compare the degree of discoloration of extracted human teeth after regenerative endodontic procedures, using MTA or Biodentine as a cervical barrier with a blood clot as a scaffold. In total 24 human upper anterior teeth were prepared and divided into two control groups (CG) and two experimental groups (EG). In the EG, fresh human blood was placed inside the root and a Biodentine (GE3) or MTA (GE4) barrier was made in. A sterile cotton swab saturated with sterile physiological solution was placed in the GCs and a Biodentine (GC1) or MTA (GC2) barrier was made in. The color was evaluated according to the CIE L* a* b* color space using standardized digital photographic images at two time points: day 0 (T0) and day 35 (T35). The description of the data included median (Md), first quartile (Q1), third quartile (Q3), means, and standard deviation (SD). Wilcoxon signed rank tests (RSW) and one-way ANOVA were used. p < 0.05 was considered significant. When ∆E was compared, significant differences were observed between GC1 and the rest of the materials (p < 0.05). ∆E was lower in CG1 (mean ± SD; 2.1 ± 1.6) than in the remaining groups, which did not present significant differences between them. There was no significant difference between tooth discolorations with materials in the presence of blood. However, in the absence of blood, Biodentine exhibited less tooth discoloration than MTA (AU)

Multiple Talon Cusps: A Rare Case Report.

Talon cusp is a very rare developmental anomaly, arising as a cusp like elevation on the lingual aspect of maxillary or mandibular anterior teeth, usually projects from the cemento-enamel junction or cingulum. It can involve single tooth, either primary or permanent dentition, usually unilateral in occurrence and seen bilaterally in 1/5th of the cases. It can result in a host of clinical problems like occlusal interference, irritation of the tongue, pulpal necrosis, caries, TMJ disorders and periodontal problems. The prevalence of multiple, bilateral talon cusp occurrence is rare, we report a case of Multiple Talon cusps involving all maxillary anterior teeth.

Facial talon cusp on mandibular incisor: A rare case report with review of literature.

Talon cusp is a relatively rare developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. It is characterized by cusp‑like projections from the cingulum area, or cemento‑enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition, usually observed on the lingual surface of the affected tooth. The cusp may or may not contain an extension of the pulp. The etiology remains unknown. The incidence is 0.04‑8%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors. The anomaly has been reported to be rare especially when it occurs on mandibular teeth. This article reports a case of talon cusp on permanent mandibular central incisor that too on facial aspect which makes it a rare entity.

Non‑syndromic multiple talon cusps in siblings.

Talon’s cusp is an anomalous structure that projects palatally from the cingulum areas of maxillary or mandibular anterior teeth. This dental anomaly may pose several pathological, functional and esthetic problems. Talon cusps usually affect a single tooth, but may rarely affect an entire sextant. Such multiple talon cusps may not always occur in association with a syndrome. Furthermore, they may exhibit a genetic pattern of inheritance. This article emphasizes rare occurrence of such nonsyndromic multiple talon cusps in two siblings.

Rare case of bilateral gemination in deciduous teeth / Un caso infrecuente de geminación bilateral en dientes temporales

Gemination in bilateral mandibular primary teeth is a rare anomaly. This kind of anomaly features two crowns totally or partially separated, but only one root and one root canal. At intraoral clinical examination of children we found different anatomy of mandibular primary canines with two partially separated crowns. The radiographic exams showed geminated teeth. After 3-years of follow-up, the cone beam computed tomography showed the absence of the mandibular permanent lateral incisors and the aspect of normality of the permanent canines germs. Although the gemination in primary teeth itself is considered as a harmless anomaly, its presence could indicate the occurrence of some dental anomaly in the permanent dentition. To the best of our knowledge, this is the only case of bilateral mandibular geminated deciduous teeth after 3 years of follow-up. Therefore, we highlight the importance of the early diagnosis and follow-up of this anomaly until the eruption of the permanent dentition.

La geminación dientes temporales mandibulares bilateralmente es una anomalía poco frecuente. Este tipo de anomalía presenta dos coronas total o parcialmente separadas, pero solo una raíz y un canal radicular. Al examen clínico intraoral de los niños encontramos la variación anatómica de los caninos temporales mandibulares con dos coronas parcialmente separadas. Los exámenes radiográficos mostraron los dientes geminados. Después de 3 años de seguimiento, la tomografía computarizada Cone-Beam mostró la agenesia de los incisivos laterales permanentes mandibulares y el aspecto de normalidad de los gérmenes de los caninos permanentes. Aunque la geminación en dientes primarios se considera como una anomalía no patológica, su presencia puede indicar la presencia de alguna anomalía dental en la dentición permanente. Según nuestro nuestro conocimiento, este es el único caso de dientes temporales geminados mandibulares bilateralmente tras 3 años de seguimiento. Se destaca la importancia del diagnóstico precoz y el seguimiento de esta anomalía hasta la erupción de la dentición permanente.

Permanent mandibular incisor with multiple anomalies - report of a rare clinical case

Permanent mandibular central incisor is rarely affected by tooth shape anomalies of crown and root. Co-occurrence of multiple anomalies in a permanent mandibular central incisor is extremely rare. This paper reports an unusual concurrent combination of multiple dental anomalies affecting both the crown and root of a permanent mandibular left central incisor - talon cusp, dens invaginatus, short root anomaly and macrodontia -, which has not previously been reported together. Case management is described and implications are discussed. The dentist should be aware of these rare entities in order to provide an accurate diagnosis and management for which detailed examination of the tooth both clinically and radiographically is very important.

O incisivo central inferior permanente raramente é afetado por anomalias de forma envolvendo a coroa e a raiz. A co-ocorrência de múltiplas anomalias em um incisivo central inferior permanente é extremamente rara. Este artigo relata uma combinação concomitante incomum de múltiplas anomalias dentais afetando tanto a coroa quanto a raiz de um incisivo central inferior permanente - cúspide em garra (talon cusp), dens invaginatus, anomalia de raiz curta e macrodontia - que ainda não havia sido descrita na literatura. A condução do caso é descrita e suas implicações são discutidas. É importante que o dentista esteja familiarizado com essas entidades raras a fim de proporcionar diagnóstico e tratamento precisos, para os quais exames clínicos e radiográficos detalhados são extremamente importantes.

A rare case of multiple talon cusps in three siblings

Talon cusp is an uncommon anomaly, whose etiology may be disturbances in the morphodifferentiation stage. Dens in dente is also a rare anomaly that is challenging in clinic as it may cause pulp necrosis or periapical lesions due to the communication with the oral cavity. This article reports multiple talon cusps on permanent maxillary and mandibular incisors and molars in 3 siblings. A 9-year-old boy presented with structures like nodules, shaped as cylindrical cones with a sharp point or a raindrop with deep developmental fissures on the palatal aspect of the maxillary central incisors, lingual aspect of the mandibular central incisors and labial aspect of both mandibular first molars. The buccal surface of the maxillary right central incisor was also affected. Some of them exhibited dens in dente. His 15-year-old sister had prominent talon cusps on the palatal surface of maxillary central incisors and buccal surface of the mandibular first molars and mandibular left second molar. His 7-year-old brother had only one trace talon on the maxillary left central incisor. No syndrome was identified in the patients. In conclusion, genetic inheritance may be a causative factor in talon cusp.

Cúspide em garra (talon cusp) é uma anomalia incomum, cuja etiologia pode estar relacionada a distúrbios no estágio de morfo-diferenciação. Dens in dente é também uma anomalia rara que impõe desafios na prática clínica, uma vez que pode causar necrose pulpar ou lesões periapicais devido à comunicação com a cavidade oral. Este artigo relata múltiplos casos de cúspide em garra em incisivos e molares superiores e inferiores permanentes em 3 irmãos. Um menino de 9 anos apresentou-se com estruturas nodulares em formato de cone cilíndrico com uma ponta aguda ou de "gota de chuva", com fissuras de desenvolvimento profundas na face palatina dos incisivos centrais superiores, e face lingual dos incisivos centrais e vestibular de ambos os primeiros molares inferiores. A face vestibular do incisivo central superior esquerdo também foi afetada. Alguns dentes apresentavam dens in dente. Sua irmã de 15 anos apresentava cúspides em garra proeminentes na face palatina dos incisivos centrais superiores e face lingual dos primeiros molares inferiores e segundo molar inferior esquerdo. Seu irmão de 7 anos apresentava apenas uma cúspide em garra vestigial no incisivo central superior esquerdo. Nenhuma síndrome foi identificada nos pacientes. Conclui-se que a herança genética pode ser um fator causativo da cúspide em garra.

Multiple dental anomalies and aggressive periodontitis: A coincidence or an association.

Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis mostly characterized by an early age of clinical manifestation and a distinctive tendency for cases to aggregate in families. Abnormal dental morphology and position have been associated with severe periodontal diseases. The purpose of this paper is to report a case of multiple dental anomalies associated with AgP. This paper reports a case of unusual association of multiple dental anomalies to AgP. Clinical findings and history led to the diagnosis of localized AgP, and radiologically. It was associated with multiple dental anomalies, especially supernumerary roots. Thus, the present case represents a very interesting demonstration of AgP association with supernumerary roots and the nature of this association merits further investigations.

Esthetic and endosurgical management of Turner's hypoplasia; a sequlae of trauma to developing tooth germ.

Turner's hypoplasia usually manifests as a portion of missing or diminished enamel, generally affecting one or more permanent teeth in the oral cavity. A case report of 8 year old girl who met with trauma at 2 years of age leading to primary incisors being knocked out, reported after 6 years with complaint of pain and discharge in her anterior malformed teeth is discussed in this article. The permanent incisors erupted with dilacerated crown, root malformations and missing enamel. Further, patient developed sinus, lateral root pathology, tooth mobility and malocclusion in relation to affected teeth which were managed by esthetic, functional, endodontic and surgical procedure. Root canal treatment along with palatal contouring and esthetic restoration by light cure composite was performed on the tooth with crown dilaceration and sinus, where as surgical management was considered for the tooth with root malformation.

Talon's cusp: report of four unusual cases.

Talon cusp is a developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. The etiology remains unknown. The incidence is 0.04-10%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports four cases of talon cusp. The first and the second cases describe bilateral involvement of talon cusp on palatal surfaces of maxillary primary centrals; in the third case talon tubercle occurs on palatal surfaces of both maxillary permanent lateral incisors and the maxillary left central incisor and in the last case a talon cusp in the lingual surface of mandibular permanent lateral incisor.

Influencia del surco palato-gingival sobre la anatomía radicular y canalicular / The influence of palato-gingival groove on radicular and canal anatomy

El surco palato-gingival es una anomalía de desarrollo que produce cambios morfológicos y estructurales en la cara palatina de la corona y raíz de incisivos permanentes superiores. La magnitud de la lesión es muy variada y en ciertos casos provoca importantes deformaciones en la raíz y cavidad pulpar, con graves complicaciones pulpares y periodontales que pueden ocasionar la pérdida del diente. Ante esta situación anatómica un tanto compleja, y no siempre de fácil diagnóstico, nos propusimos como objetivo estudiar con una visión endodóntica, la influencia que esta anomalía tiene sobre la macroy microestructura radicular y, en consecuencia, sobre la cavidad pulpar. En cortes transversales de raíces que presentaban esta patología, se observó que los defectos podían ser muy variados y que en los casos donde la lesión era muy acentuada, se producían importantes cambios, que evidenciaban un intento de bifurcación tanto enl a raíz como en el conducto.

Recontorno cosmético em dentes anteriores superiores: relato de caso clínico / Anterior superior teeth cosmetic remodelling: a clinical case

Na atual sociedade, a valorização da estética trouxe para a Odontologia a busca por materiais e técnicas que melhorem a aparência do sorriso, a qual é vista como fundamental na manutenção da saúde física e mental do indivíduo. Este trabalho teve como objetivo relatar um caso clínico em que o paciente apresentava incisivos centrais superiores, desproporcionalidade dos caninos no sentido mésio-distal, além de grande trenspasse vertical, gerando uma mordida profunda acentuada. O caso, apesar de outras alternativas possíveis, foi solucionado apenas com recursos de Dentística, através da utilização de ceroplastia e de resinas compostas fotopolimerizáveis, realizando-se a remodelação cosmética, alcançando-se previsibilidade na resolução estética do problema.

An unusual case of talon cusp on a geminated tooth

Talon cusp is a developmental anomaly seen on the lingual surface of anterior teeth. Gemination is an anomaly caused by a single tooth germ that attempted to divide during its development. These developmental anomalies may cause clinical problems including esthetic impairment, pain, caries and tooth crowding. This paper presents an unusual case of gemination accompanied by talon cusp in permanent dentition. The clinical and radiographic findings are described.

Cúspide em garra (talon cusp) é uma anomalia de desenvolvimento que occore na face lingual de dentes anteriores. Geminação é uma anomalia causada quando um germe dental tenta se dividir durante a fase de desnvolvimento. Estas anomalias de desenvolvimento podem causar problemas clínicos tais como comprometimento estético, dor, cárie e apinhamento dental. Este artigo relata um caso incomum de geminação acompanhado de cúspide em garra (talon cusp) na dentição permemente. Os achados clínicos e radiográficos são descritos.

Management of two unusual cases of dens invaginatus and talon cusp associated with other dental anomalies.

The management of two unusual cases of dens invaginatus and talon cusp is presented. The first concerns talon cusp in maxillary primary and permanent lateral incisors, a supplemental tooth with dens invaginatus hampering eruption of the permanent incisors. The other present with bizarre crown morphology of a lateral incisor with talon cusp, dens invaginatus and a palatal accessory cusp-like structure. Early diagnosis and management are important to avoid complications.

Labial talon cusp on permanent central incisor: a case report.

Talon cusp is a supernumerary crown structure, a developmental disturbance in the shape of teeth that causes various diagnostic, functional and esthetic problems. Some synonyms for talon cusp are dens evaginatus of anterior teeth, interstitial cusp, tuberculated tooth, odontoma of the axial core type, evaginated odontoma, enamel pearl, supernumerary cusp etc. The lingual location on incisors, which frequently affects occlusion, is pathognomonic of the talon cusp. This report describes a rare odontogenic, isolated anomaly rather than an integral part of any disorder, a case of talon shaped cusp projecting from the labial surface of a maxillary permanent central incisor.

Talon cusp: an overview with case reports of 3 clinical variants.

Talon cusp is a dental anomaly, which is present as an accessory cusp and is seen both in the deciduous and permanent dentition. It may occur unilaterally or bilaterally and has been reported mostly in maxillary teeth, with a few cases occurring in the mandible. Talon cusp is usually asymptomatic; however, there are many clinical problems associated with it. Talon cusp is clinically manifested in three forms: talon, semi-talon and trace talon. In this article, we present four case reports of talon cusp with an overview of different clinical variants of talon cusp, classification, etiopathogenesis, associated syndromes, clinical problems, and treatment modalities.

Effect of mechanical trauma on the tooth germ of rat molar--a scanning electron microscope study.

OBJECTIVE: Clinical and histopathological evaluation of mechanical trauma on the development of maxillary first molar with Scanning Electron Microscope. DESIGN: Experimental study with four newborn Wistar rats. Trauma induced on 1st, 3rd, 7th and 10th postnatal days with dental K file. Right first molar region of the maxilla was the experimental side and the left side as control. Animals were sacrificed on the 42nd Postnatal day when the teeth came into functional occlusion. Teeth were evaluated clinically and SEM study of the crown was performed. RESULTS: Marked disfigurement of cusps, roughened defective, enamel, crown dilacerations and enamel hypoplasia were observed. Damage was less severe to the tooth subjected to trauma on the 10th postnatal day.