Análisis de concordancia de tres clasificaciones de terceros molares mandibulares retenidos / Agreement analysis of three mandibular third molar retention classifications

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

Evaluation of 1211 third molars positions according to the Classification of Winter, Pell & Gregory / Evaluación de posiciones de 1211 terceros molares acorde a la Clasificación de Winter, Pell & Gregory

Panoramic radiographs are important for the evaluation and classification of the third molars position, allowing the diagnosis and planning of extraction. The objective of this study is to evaluate upper and lower third molars positions in panoramic radiographs with the classification methods proposed by Pell and Gregory (1933) and Winter (1926) and the subsequent comparison of results with other authors. Panoramic radiographs of 310 patients were analyzed, 197 female and 113 male, totaling 1,211 third molars. In relation to the upper third molars, the most prevalent positions were: angle compared to the long axis of the second molar of Distoangular form (53.23 %) and the depth of impaction as Class C (48.25 %). In the lower third molars, the most prevalent positions were: angle to the long axis of the second molar in Mesioangular classification (52.96 %), the depth of impaction was B (46.54 %) and the tooth relationship with the mandibular ramus was identified as class I (55.26 %). These results provide information that can be utilized in predicting third molar development in terms of impaction or eruption, assisting dental surgeons in making decisions regarding surgical planning and treatment.

Las radiografías panorámicas son importantes para la evaluación y clasificación de la posición de los terceros molares, lo que permite el diagnóstico y la planificación de la extracción. El objetivo de este estudio fue evaluar terceros molares superiores e inferiores y posiciones en las radiografías panorámicas con los métodos de clasificación propuestas por Pell & Gregory, y Winter y la posterior comparación de los resultados con otros autores. Se analizaron las radiografías panorámicas de 310 pacientes, 197 mujeres y 113 hombres, con un total de 1.211 terceros molares. En relación con los terceros molares superiores, las posiciones más prevalentes fueron: ángulo con respecto al eje longitudinal del segundo molar de forma distoangular (53,23 %) y la profundidad de la impactación como Clase C (48,25 %). En los terceros molares inferiores, las posiciones más prevalentes fueron: ángulo con respecto al eje longitudinal del segundo molar en la clasificación mesioangular (52,96 %), la profundidad de impactación fue de B (46,54 %) y la relación de los dientes con la rama mandibular fue identificado como Clase I (55,26 %). Estos resultados proporcionan información que puede ser utilizada para predecir el desarrollo del tercer molar en términos de compactación o erupción, ayudando a los cirujanos dentistas en la toma de decisiones respecto a la planificación y el tratamiento quirúrgico.

Retenção prolongada de dente decíduo por impactação de dente supranumerário em criança de 12 anos / Tooth prolonged retention of deciduous tooth impaction supernumerary in children under 12 years

Dente supranumerário é definido como um distúrbio de desenvolvimento caracterizado pela presença de um ou mais elementos dentários fora do número considerado normal de uma arcada. A ocorrência dos supranumerários pode ocasionar uma variedade de complicações, como por exemplo, apinhamento de dentes permanentes, erupção retardada e/ou ectópica, rotação dentária, formação de diastema, desenvolvimento de lesões císticas, reabsorção de dentes adjacentes. Na maioria das vezes o diagnóstico da presença desse elemento é realizado por exame clínico e radiográfico de rotina. O objetivo do presente trabalho foi relatar um caso clínico de retenção prolongada de um dente decíduo e erupção retardada de um dente permanente em decorrência da presença de um elemento supranumerário diagnosticado apenas aos 12 anos de idade. Após a identificação do elemento supranumerário e análise de exames radiográficos complementares,foi realizada cirurgia para remoção dos elementos decíduo e supranumerário, bem como acompanhamento por três meses do processo eruptivo do elemento impactado,um segundo pré-molar inferior direito o qual se posicionou favoravelmente na arcada dentária. Concluiu-se que a detecção em momento oportuno e a remoção de elementos supranumerários, também respeitadas à necessidade e oportunidade cirúrgica, são importantes para evitar danos futuros à oclusão dos pacientes, devendo-se dar importância ao acompanhamento e evolução clínica do caso.

Supernumerary teeth is defined as a developmental disorder characterized by the presence of one or more dental elements out of a number considered normal arch. The occurrence of supernumerary can cause a variety of complications, such as crowding of the permanent teeth,delayed and / or ectopically erupting, tooth rotation, diastema training, development of cysticlesions, resorption of adjacent teeth. In most cases the diagnosis of the presence of this elementis made by clinical examination and routine radiographic. The aim of this study was to reporta case of prolonged retention of a primary tooth eruption and delayed a permanent tooth dueto the presence of a supernumerary element diagnosed only 12 years old. After identifying the supernumerary element and analysis of complementary radiographs, it was carried out surgeryto remove the elements deciduous and supernumerary and monitoring for 3 months of the eruptive process impacted element, a premolar law that favorably-positioned in the dental arch.It was concluded that the timely detection and removal of supernumerary elements also respected the need and surgical opportunity, are important to prevent future damage to the occlusion of patients, should be given importance to the monitoring and clinical outcome.

[Prediction of maxillary canine impaction with panoramic radiographs]

The incidence of maxillary canine impaction is between 1% and 3% populations. Determining whether impaction will occur and timing the treatment modalities that are affected by impacted canine [s] are paramount for a successful out come, panoramic radiograph to identify canine impaction; not only is economical but treatment result will be more desirable. The aim of this investigation was to develop a reliable method for predictors of maxillary canine impaction on a panoramic radiograph. Sixty - four panoramic radiographs of mixed dentition patients were inspected to belong to two groups of patient with impacted and not impacted canines. 88 were found with no impaction and 40 with impacted canines. For predicting canine impaction panoramic radiographs were inspected for two indices: 1- The erupted lateral tooth were divided to fourfold zone from 4 to 1 sectors in mesiodistal dimension; therefore identified the unerupted permanent canines cusp tip location related to the erupted permanent lateral. 2-The internal angle between the long axis of the unerupted canine and a horizontal line between superior points of condyles was measured. The data were analyzed by descriptive statistics and logistic regression. All of not impacted teeth were found in sector I and II. [69.3% in sector I and 30.7% were placed in sector II]. 17.5% of impacted teeth were in sector I, 42.5% in sector II, 27.5% in sector Ill and 12.5% were placed in sector IV. Furthermore the mean angle for non impacted teeth was 74.72' and for impacted teeth was 67.12'. The location of canine cusp tip in panoramic radiograph is the most important factor in predicting probable impaction, but often, the angle of canine is not worth

Avaliação da prevalência de terceiros molares inferiores inclusos e da posição e inclinação do seu longo eixo em radiografias panorâmicas / Evaluation of prevalence of non erupted lower third molar and of the position and inclination of its long axis in panoramic radiographs

As inclusões dentárias mais freqüentes ocorrem em dentes que fazem erupção em época mais tardia, ou seja, os terceiros molares, sendo a falta de espaço a principal causa de uma inclusão. A classificação dos terceiros molares inclusos é um importante auxílio na comunicação entre profissionais, na determinação do tratamento e no planejamento cirúrgico. A amostra deste estudo foi composta por 250 radiografias panorâmicas, nas quais um total de 70 terceiros molares inclusos foi avaliado. A análise foi feita em uma clinica odontológica na cidade de São Raimundo Nonato - PI, no período de julho a novembro de 2004. A maioria dos dentes inclusos estava em posição mesioangulada, segundo a classificação de Winter (quarenta casos – 57,14 por cento). De acordo com a classificação de Pell & Gregory, os terceiros molares inclusos pertenciam, na sua maioria, às classes B e II: quarenta e cinco casos, 64,28 por cento, e cinqüenta e seis casos, 70por cento, respectivamente

Guidelines for management of impacted canines.

Though the management of impacted canine is considered a multi-disciplinary entity requiring the expertise of a number of specialists, the general practitioner needs to coordinate care and must know about the diagnosis and management of canine impaction. The management of canine impactions can be simplified by following a logical and systematic approach. The schematic treatment plan for impacted canines and the factors influencing and determining the plan are discussed in this article.

Clasificación de caninos retenidos y su aplicación clínica / Classification of impacted canines and its clinical application

Existen numerosas clasificaciones para la retención de los dientes anteriores, la mayoría son confusas, muy diferentes entre sí y no dan una idea clara de la posición y la relación de los caninos retenidos. Se sugiere una clasificación sencilla y exclusivamente para caninos retenidos, ya que es un problema muy común en la práctica ortodóntica. Hasta hoy no existe una clasificación clara para los caninos retenidos. Se describen las complicaciones que presentan en su tratamiento ortodóntico y se sugieren medidas preventivas muy sencillas para tratar de evitar estas retenciones. Se hace hincapié en el uso de la radiografía pósteroanterior de cráneo en los paciente que se sospecha potencial de retención de caninos

Dentes inclusos / Unerupted tooth

O objetivo deste trabalho é estabelecer uma rotina para exame clínico e radiográfico de dentes inclusos a fim de facilitar o diagnóstico e a escolha da técnica cirúrgica indicada