Tratamento de dentes inclusos em proximidade a cavidade nasal e seio maxilar: relato de caso / Treatment of teeth included with proximity to the nasal cavity and maxillary sinus: case report

Durante a formação dentária, distúrbios de desenvolvimento podem acontecer, causando anomalias de número, forma, tamanho, estrutura e posição, além de apresentarem anormalidade no padrão sequencial de irrupção. Uma boa anamnese, associada a palpação e exames de imagens são indispensáveis para um diagnóstico precoce e favorável destas alterações. Os exames de imagem determinarão a relação espacial destes dentes com as estruturas nobres adjacentes. O objetivo deste trabalho é relatar a presença de supranumerário unilateral e impactação bilateral de caninos permanentes, ambas anomalias com proximidade da cavidade nasal e seio maxilar, ressaltando a importância do diagnóstico preciso através de exames clínico e de imagens, que direcionam o planejamento terapêutico específico para cada caso, bem como a associação multidisciplinar para obtenção de um resultado satisfatório do quadro e melhora da qualidade de vida do paciente(AU)

During dental formation, developmental disorders can occur, causing anomalies of number, shape, size and position, in addition to presenting abnormality in the sequential pattern of irruption. Anamnesis associated with palpation are indispensable for an early diagnosis of these alterations. Imaging exams will determine the spatial relationship between these teeth and the adjacent noble structures. The aim of this study was to report the presence of unilateral supernumerary and bilaterally impacted canines, both anomalies with proximity of nasal cavity and maxillary sinus, emphasizing the importance of accurate diagnosis through clinical and imaging exams, that direct the specific therapeutic planning for each case, as well as the multidisciplinary association to obtain satisfactory results and improve the life quality of patients(AU)

Mirror image: an unusual case of prolonged tooth retention in twins

Introduction: Studies of twins are important because environmental and genetic factors seem to be related to the phenotypic alterations. Objective: This paper presents a unique case of monozygotic twins with mirror image of a retained primary central incisor. Case report: Twin male brothers, 9-years-old, presented prolonged retention of the primary central upper incisor. The over-retained teeth in one twin were a mirror image of those in the other twin. The first twin presented a prolonged retention of the tooth 51 whereas the other twin presented a prolonged retention of tooth 61. After radiographic exams the over-retained teeth were extracted. Conclusion: Twins may show similarity in pattern of dental anomalies supporting the influence of genetic factors. In identical twins the location of diagnosed anomalies can be mirror imaged. This fact should lead the professional to examine the pair of twins in order to diagnose any dental anomaly that may be present.

Introdução: Estudos feitos em gêmeos são importantes porque fatores ambientais e genéticos parecem estar relacionados às alterações fenotípicas. Objetivo: Este artigo apresenta um caso raro de gêmeos monozigóticos apresentando imagem em espelho de retenção prolongada de incisivos centrais decíduos superiores homólogos. Relato do caso: Os irmãos gêmeos, com 9 anos de idade, não apresentavam história de trauma orofacial ou doença comum da infância. Após exames clínicos e radiográficos foram identificados a retenção do dente 51 no gêmeo 1 e do dente 61 no gêmeo 2. Em ambos os pacientes, os dentes 11 e o 21 estavam em erupção. O tratamento proposto foi a exodontia dos dentes decíduos com anestesia local e acompanhamento. Conclusão: Gêmeos podem apresentar semelhança no padrão de anomalias dentárias devido à influência de fatores genéticos. Adicionalmente, em gêmeos monozigóticos, a localização das anomalias diagnosticadas pode se apresentar invertidas ou imagem em espelho. Esse fato deve estimular o profissional a examinar o par de gêmeos para diagnosticar qualquer anomalia dentária que possa estar presente. O diagnóstico precoce e tratamento adequados devem ser realizados para evitar danos funcionais e estéticos em pacientes com retenções dentárias.

Intervenção cirúrgica de um canino incluso em sínfise mandibular: relato de caso / Surgical intervention of an unerupted canine in mandibular sinfisis: case report

Objetivo: relatar um caso de exodontia do dente 43, incluso, na região do mento, com o auxílio de um exame complementar eficaz e de baixo custo: radiografia lateral de mandíbula utilizando filme oclusal. Relato de caso: paciente do gênero masculino, 26 anos de idade, melanoderma e normossistêmico, buscou tratamento ortodôntico por motivos de apinhamento dental anterior e presença do dente 83 (canino inferior decíduo) não esfoliado. Para um planejamento cirúrgico correto, foi realizada a radiografia lateral do mento com filme oclusal, em que se constatou que o dente 43 encontrava-se por vestibular em relação aos dentes anteriores inferiores. Assim, o paciente foi submetido à cirurgia sob anestesia local, para exodontia do dente 43. Considerações finais: o tratamento para transmigração de caninos inferiores deve incluir minuciosos planejamentos clínico e radiográfico. O tratamento sugerido para a grande maioria dos casos é a remoção cirúrgica, devido à possibilidade de falhas dos outros meios de tratamento, ocasionando complicações posteriores. (AU)

Objective: this paper aims to describe and discuss a surgical removal of canine included in the chin region with the aid of an effective and low-cost complementary exam: lateral radiographic of the mandible using the occlusal film. Case report: a male patient, 26 years old, without systemic diseases sought orthodontic treatment due to anterior crowding and presence of an unerupted tooth 83. In order to perform a correct surgical planning, the lateral radiograph of the occlusal film was performed, where it was found that the tooth 43 was in vestibular position in relation to the lower anterior teeth. Thus, the patient underwent surgery under local anesthesia for tooth extraction. Final considerations: the treatment for transmigration of lower canines should include careful clinical and radiographic planning. The suggested treatment for the vast majority of cases is surgical removal due to the possibility of failure of the other means of treatment, causing subsequent complications. (AU)

Tomografia computadorizada multidetectores de baixa dose de radiação para avaliação de canino incluso / Low-dose multidetector computed tomography for impacted canine evaluation

Objetivo: avaliar caninos inclusos em tomografias computadorizadas multidetectores (TCMD) realizadas no Hospital Universitário de Santa Maria. Materiais e mé¬todo: foi realizado um estudo observacional transversal com imagens de um banco de dados de TCMD de baixa dose de radiação, solicitadas por indicações clínicas odontológicas. Os exames em formato digital imaging and communications in medicine foram avaliados por um examinador treinado, no software Weasis Medical Viewer. A avaliação dos exames compreendeu a observação das seguintes características: impactação do canino (uni ou bilateral), localização do canino (maxila ou mandíbula), localização da coroa do canino (vesti¬bular ou lingual/palatal), eixo de erupção, espessura do folículo pericoronário, presença de lesões associadas, presença de reabsorção nos dentes adjacentes e presença de agenesias dentárias ou de supranumerários. Os resultados foram avaliados de maneira descritiva, por meio de prevalência dos achados. Resultados: foram encontrados 21 caninos inclusos em 837 tomografias avaliadas (1,9%). Foi observado um predomínio de indivíduos do sexo feminino (71,4%), e a retenção do canino foi mais frequente na maxila (71,4%) e com impactação unilateral (61,9%). Quatro caninos apre¬sentaram folículo pericoronário, com espessura maior que 2 mm; 19% dos exames apresentaram reabsorção radicular externa em algum incisivo lateral. Apenas um canino apresentava lesão associada, sugerindo esclero-se óssea. Além dos caninos inclusos, foi possível avaliar alterações relacionadas às demais regiões e estruturas dentomaxilofaciais. Conclusão: apesar da amostra limitada de imagens, o presente estudo demonstrou a aplicabilidade clínica da TCMD com protocolo de baixa dose de radiação, para a avaliação dos caninos inclusos e características relacionadas a esses dentes, bem como de dentes e regiões adjacentes. (AU)

Objective: to evaluate impacted canines by tomographic exams performed at the University Hospital of Santa Maria. Materials and method: a cross-sectional observational study was performed with selected images from a database of low dose computed tomography (CT) scans requested by several dental indications. The DICOM files were evaluated by a trained examiner, using Weasis Medical Viewer software. The evaluation of each exam included the following characteristics: canine impaction (uni or bilateral), location of the canine (maxilla or mandible), location of the canine crown (buccal or lingual / palatal), shaft of canine eruption, thickness of the pericoronal follicle, presence of associated lesions, presence of external root resorption in adjacent teeth and presence of dental agenesis or supernumerary tooth. The results were evaluated in a descriptive way, through prevalence of the findings. Results: a total of 21 impacted canines were found in 837 CT scans evaluated (1,9%). A predominance of female patients was observed (71,4%); canine impaction was more frequent in the maxilla (71,4%), and unilateral (61,9%). In 19% of the exams, external root resorption occurred in some lateral incisor. Four dental elements presented pericoronal follicles thicker than 2 mm. In the evaluated sample, only one canine presented an associated lesion, suggesting bone sclerosis. Beyond the canine-related, other dental and maxillofacial changes were also evaluated. Conclusion: in spite of the limited sample, the present study demonstrated the clinical applicability of low dose CT for the evaluation of impacted canines, and characteristics related to these teeth, as well as to the adjacent teeth and regions. (AU)

Quiste dentígero en tercer molar mandibular en posición invertida / Dentigerous cyst in an inverted mandibular third molar

Introducción: la erupción es un proceso complejo y, debido a esto pueden aparecer fallas en él. Objetivo: presentar un caso clínico de un quiste dentígero en un tercer molar mandibular invertido. Caso clínico: paciente masculino de 36 años de edad, quien refiere haber asistido a una clínica estomatológica por molestias en la región mandibular derecha y que al realizársele una ortopantomografía, se detecta la presencia del 48 retenido, por lo que es remitido. Al examen físico bucal se detecta ausencia clínica del 48 con expansión de la tabla vertibular en la zona. Al observarse la ortopantomografía se aprecia en la zona de molares derechos reabsorción radicular en el 47, con 48 en posición invertida y una imagen radiolúcida de límites bien definidos en relación con la corona del 48. Se realiza, bajo anestesia local, la exéresis del 47, 48 y la lesión responsable de la imagen radiolúcida mandibular mediante curetaje. Se indica el estudio histopatológico de la lesión, que indica la presencia de un quiste dentígero. El paciente mostró buena evolución posoperatoria. Conclusiones: lo inusual de la presencia de un quiste dentígero, como complicación de la retención dentaria, en un tercer molar mandibular invertido, permitió valerse de los beneficios de estudios imaginológicos digitales y del método clínico para crear un plan de tratamiento que desencadenó en la exéresis exitosa, sin complicaciones transoperatorias, de los dientes y la lesión asociada(AU)

Introduction: tooth eruption is a complex process and due to this complexity flaws may appear in it. Objective: present a clinical case of a dentigerous cyst in an inverted mandibular third molar. Clinical case: a male 36-year-old patient reports having visited a dental clinic for discomfort in the right mandibular region. Orthopantomography was indicated which revealed that tooth 48 was retained; the patient was therefore referred. Clinical oral examination detected the absence of tooth 48 and an expanded vestibular table in the area. The orthopantomograph showed root resorption of tooth 47 in the area of the right molars, with 48 in an inverted position and a radiolucent image of clear-cut boundaries in relation to the crown of 48. Exeresis of 47 and 48 was performed under local anesthesia, and the lesion responsible for the mandibular radiolucent image was removed by curettage. Histopathological examination of the lesion was indicated, revealing the presence of a dentigerous cyst. Postoperative evolution was satisfactory. Conclusions: the infrequent presence of a dentigerous cyst as a complication of dental retention in an inverted mandibular third molar prompted the use of the benefits offered by digital imaging studies and the clinical method to develop a treatment plan leading to successful exeresis of the teeth involved and the associated lesion, without any perioperative complications(AU)

No erupción de segundos molares mandibulares permanentes en radiografía panorámica / Unerupted mandibular permanent second molars in radiographic analysis

RESUMEN: La no erupción de segundos molares es relativamente baja, pero ha ido en aumento en los últimos años. Se relaciona con un tratamiento multidisciplinario largo, costoso y complejo, por lo cual es de suma importancia enfocarse en el diagnóstico precoz y tratamiento temprano. El objetivo de este estudio es poder hacer una comparación de medidas radiográficas entre un grupo de pacientes con segundo molar mandibular permanente no erupcionado o sin posibilidades de erupcionar y un grupo control. Método: Se realizó una revisión manual consecutiva de las 16.835 fichas sobre las cuales se aplicaron criterios de inclusión y exclusión. Los datos se obtuvieron de radiografías panorámicas de las cuales se obtuvieron medidas lineales y angulares que fueron comparados entre dos grupos de estudio. Se desarrolló un modelo predictivo mediante análisis discriminante. Resultados: El 1,5% de los pacientes tuvieron segundos molares no erupcionados. Los promedios de las variables relevantes fueron: Ángulo del segundo molar 33,7°; distancia desde distal del primer molar al borde anterior de la rama mandibular 15mm; invasión distal del primer molar por el segundo molar 2,1mm; inclinación mesial de segundo molar con respecto al plano oclusal 128° y al plano mandibular 63°. El puntaje crítico discriminante fue de 36,7. Conclusión: La presencia de segundos molares incluidos es baja. Se encontró diferencias estadísticamente significativas entre casos y controles en todas las variables. El modelo predictivo puede identificar molares sin probabilidad de erupción natural. Es necesario contar con nuevos estudios con muestras poblacionales para establecer cuáles serían los valores de normalidad para poder diagnosticar en forma precoz esta condición.

ABSTRACT: No eruption of seconds is relatively low, has been increasing in recent years. It relates to long, costly and complex multidisciplinary treatment, so it is important to focus on early diagnosis and early treatment. The aim of this study is to make a comparison of radiographic measurements among a group of patients with mandibular second permanent molar eruption and no possibility of a control group. Method: A consecutive manual review of 16,835 sheets on which inclusion and exclusion criteria were applied. The data were obtained from panoramic radiographs of which linear and angular measurements were compared between two study groups were obtained. A predictive model was developed using discriminant analysis. Results: 1.5% of patients had unerupted second molars. The averages of the relevant variables were: Angle of the second molar 33.7 °; distance from distal of the first molar to the anterior border of the ramus 15 mm; invasion distal of the first molar the second molar 2.1mm; second molar mesial inclination relative to the occlusal plane 128 ° and 63 ° mandibular plane. The critical discriminant score was 36.7. Conclusion: Statistically significant differences between cases and controls was found in all variables. The predictive model can identify likely molars with or without natural eruption. It is necessary to have further studies with population samples to establish what would be the normal values to diagnose this condition at an early stage.

Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle

ABSTRACT Fragile X syndrome (FXS) is a disorder linked to the chromosome X long arm (Xq27.3), which is identified by a constriction named fragile site. It determines various changes, such as behavioral or emotional problems, learning difficulties, and intellectual disabilities. Craniofacial abnormalities such as elongated and narrow face, prominent forehead, broad nose, large and prominent ear pavilions, strabismus, and myopia are frequent characteristics. Regarding the oral aspects, deep and high-arched palate, mandibular prognathism, and malocclusion are also observed. Objective: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. Material and Methods: The patients were in the range of 6–17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. Results: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (p<0.05). In this group, supernumerary deciduous teeth (2.83%), giroversion of permanent teeth (2.31%), and partial anodontia (1.82%) were the most frequent dental anomalies. In addition, an increase was observed in the mandibular angle size in the FXS group (p<0.05). Conclusion: We conclude that knowledge of dental radiographic changes is of great importance for dental surgeons to plan the treatment of these individuals.

Radiographic analysis and prevalence of impacted maxillary canine teeth in children between 8 and 16 years / Análisis radiográfico y prevalencia de caninos maxilares retenidos en niños entre 8 y 16 años

The objective of this study was to determine the prevalence of impacted maxillary canines and analyze variables associated with its retention in panoramic radiographs. Manual and Retrospective observational study of 16,835 records. A sample of 1,353 panoramic radiographs was obtained. The variables measured were canine angle, distance from the canine apex to occlusal plane, vertical and horizontal canine location. For reliable measurement an intra class Fleiss and Cohen correlation coefficient was used (0.997). Prevalence was 2.3%. 31 subjects had one or both retained canines. Average age 10.77±2.45, 61.3% were women. 64.5% presented unilateral retaining of which the largest percentage was left. A total of 41 retained canines were observed. Distance to occlusal plane 19 mm on average. In relation to the vertical location the highest percentage (48.7%) was found in the apical third. Regarding the horizontal location the highest percentage (77.6%) was found in sectors 1, 2 and 3. When analyzing the canine angle it was found that 83% measured 31 degrees or more. Radicular resorption was observed in 2 lateral incisors. The prevalence found is similar to that reported in the international literature. It occurred more frequently in women and left unilateral both not statistically significant.

El objetivo de este trabajo fue determinar la prevalencia de dientes caninos maxilares retenidos y analizar variables asociadas a su retención, en radiografías panorámicas. Se realizó un estudio observacional retrospectivo y manual de 16.835 fichas. Se obtuvo una muestra de 1.353 radiografías panorámicas. Las variables medidas fueron ángulo del canino, distancia de la cúspide del canino al plano oclusal, localización vertical y horizontal del canino. Para la fiabilidad de las mediciones se usó el coeficiente de correlación intraclase de Fleiss & Cohen (0,997). La prevalencia fue 2,3%. Treinta y un sujetos presentaron 1 o ambos caninos retenidos. La edad promedio fue 10,77±2,45, y el 61,3% fueron mujeres. El 64,5% presentó retención unilateral, principalmente del lado izquierdo. Se observó un total de 41 caninos retenidos. La distancia al plano oclusal en promedio fue 19 mm. En relación a la localización vertical, el mayor porcentaje (48,7%) se encontró en el tercio apical. Respecto a la localización horizontal, el mayor porcentaje (77,6%) se encontró en los sectores 1, 2 y 3. Al analizar el ángulo canino, se encontró que 83% midió 31 o más. Se observó reabsorción radicular de dos incisivos laterales. La prevalencia encontrada es similar a la reportada en la literatura internacional. La retención se presentó con mayor frecuencia en mujeres y de manera unilateral en el lado izquierdo, pero en ambos casos no es significativa.

Transmigration of the Mandibular Canine: A Report of Two Rare Cases.

When the tooth, instead of erupting in its normal position, remains impacted and crosses midline and is seen on the opposite side of the jaw, it is termed as Transmigration; e.g., right side tooth is seen on the left side and vice-versa. This phenomenon occurs without any pathology intervening cause. Canines are commonly seen unerupted and remain impacted, but rarely seen crossing the midline and migrating to the opposite side. They are usually symptomless. Here, we present two such rare cases of transmigration of the mandibular canine, one from the right side to the left side and appearing piercing the lower border of the mandible and producing a hard bulge on the left side of the lower jaw, but without any pain. The other case is of transmigration of mandibular left canine toward the right side well below the inferior alveolar canal beyond mental foramen facing toward posterior region of the mandible and causing pain symptoms in the jaw due to its close proximity to inferior alveolar canal. It is very essential to have panoramic radiograph to detect such abnormalities at an early stage to plan treatment and avoid future complications. Cone beam computed tomography images also play an important role.

A color contrast aided density imaging technique to differentiate between dental hard tissues and its relevance.

Aim: Radiographic interpretation of a disease requires knowledge about normal structures. The calcifying jaw diseases can range from radiolucent areas to varying degrees of calcification. Therefore, it is vital to differentiate radiographically between various hard tissues. Materials and Methods: We have illustrated the use of computed tomography scan to quantify the calcified structures as dentin and enamel in a case of ameloblastic fibro-odontoma. Results: The enamel, dentin and cementum showed different values. Conclusion: The "Dentascan" can be used to distinguish the hard tissues in a variety of calcifying diseases of jaws.

Primary and secondary impaction of four primary molar teeth in a single patient / Retención primaria y secundaria de los cuatro primeros molares en un paciente

The lack of eruption of a primary tooth can be considered rare. In primary impaction, the primary tooth not only has never appeared in the oral cavity, but also is always covered by a more or less thick layer of bone. Secondary impaction, which is relatively more common, denotes teeth that at one time erupted into the mouth, but subsequently clinically appear to have receded from this position. The purpose of this paper is to present a case of primary and secondary impaction of four primary molar teeth in a single patient(AU)

La falta de erupción de un diente temporal puede ser considerada una situación rara. En la retención primaria, no sólo el diente temporal nunca ha aparecido en la cavidad bucal, sino que también está cubierto por una capa más o menos gruesa del hueso. La retención secundaria, que es relativamente más común, se refiere a los dientes que inició su erupción en la boca, pero clínicamente quedan atrapados en esta posición. El propósito de este trabajo es presentar un caso de retención primaria y secundaria de cuatro molares primarios en un paciente(AU)

Localization of impacted permanent maxillary canine using single panoramic radiograph.

Background and Objectives : The objective in localization is selection of a suitable technique which has minimal radiation dose, cost and maximum details. Panoramic radiograph, being a screening radiograph, can satisfy the above needs. Taking this into consideration, the present study was done to evaluate the reliability of panoramic radiograph in localization of impacted permanent maxillary canines by applying the criteria suggested by Chaushu et al. and by comparing it with Clark's rule. Materials and Methods : The study comprised of 114 subjects in the age group of 13-30 years of both the genders with 150 impacted canines visiting Department of Oral Medicine and Radiology during the study period. The study subjects were examined for clinically missing canine, and then confirmed with intra-oral peri-apical radiograph (IOPAR). Panoramic radiographs (for application of Chaushu et al. criteria) and IOPAR's (for application of Clark's rule) of the subjects were made and interpreted for parameters pertaining to the impacted canines. The data obtained was tabulated and subjected to statistical analysis using the statistical package for social sciences (SPSS) software. Results : Determination of the bucco-palatal position from panoramic radiographs, by applying Chaushu, et al. criteria, showed that localization in bucco-palatal position was possible for 96 of the 102 impacted canines placed in the middle and coronal zones. The remaining six impacted canines, three each in the middle and coronal zones, could not be localized as they showed overlapping in their range. By excluding them, the overall agreement worked out to be 94.11%. Localization was not possible for 48 impacted canines that lied in the apical zone. Conclusion : A single panoramic radiograph can serve as a reliable indicator for determining the bucco-palatal position of the impacted canines when they lie in the middle and coronal zones. When they lie in the apical zone it is recommended to explore their presence with other conventional or advanced imaging modalities.

Canine ectopia: report of two cases.

Transmigration of mandibular canine is a rare elusive phenomenon described in dental literature. The eruption of such transmigrated canines is even rarer. Two rare cases one of midline mandibular canine and the other of transmigrated mandibular canine across the midline and erupted distal to the opposite lateral incisor are presented. The transmigrated canine maintained its nerve supply from the original site. It is suggested that on routine evaluation of orthopantomograms when the dentist finds an excessive mesial inclination of the unerupted mandibular canine at 8-9 years associated with proclination of lower anteriors. increased axial inclination of the unerupted canine and an enlarged symphyseal cross section area of the chin, it is best to keep such a patient under routine evaluation.

Supplemental premolars in a 13 year old child--a case report.

A case of 13 old year is presented with supernumerary maxillary premolars one on either side. Radiograph revealed presence of five more supernumerary teeth unerupted in both maxilla and mandible. The implications of early diagnosis and management to prevent further complications are discussed.

Chondroectodermal dysplasia: a case report.

Chondroectodermal Dysplasia is a disease complex consisting of bilateral manual polydactyly, chondrodysplasia of long bones resulting in acromelic dwarfism, hydroitic ectodermal dysplasia affecting principally the nails, teeth and hair and congenital heart malformations. It is necessary to identify this disease at its early stage in order to render prompt treatment. The oral manifestations are characteristic for this particular disease so that a dental surgeon can identify this condition and refer the case to a cardiologist and orthopedician for corrective surgeries. In this article, a case of a 2 1/2-year old child with chondro-ectodermal dysplasia is presented along with radiographic investigations and treatment plan.