Desplazamiento accidental del tercer molar al seno maxilar: protocolo de actuación / Accidental displacement of the third molar into the maxillary sinus: action protoco

Introducción: El desplazamiento accidental del tercer molar hacia el seno maxilar es una complicación de la cirugía bucal. La extracción de estos dientes generalmente es compleja debido a la escasa visibilidad, el espacio limitado y la ubicación espacial del diente, por lo que se requiere tener un cuidado meticuloso durante el tratamiento. Objetivo: El objetivo de este artículo ha sido el de establecer un protocolo de actuación basado tanto en el tratamiento quirúrgico como farmacológico, y el seguimiento que este tipo de complicaciones necesita según la literatura. Caso clínico: Se presenta el caso clínico de un varón de 17 años de edad, sin antecedentes médicos de interés, que fue remitido por su odontólogo para proceder a la valoración y extracción quirúrgica del tercer molar superior izquierdo que había sido desplazado al interior del seno maxilar tras el intento de exodoncia, y que producía sintomatología compatible con sinusitis aguda. La exploración radiológica descartó la afectación del resto de senos paranasales y confirmó la obstrucción casi completa del seno maxilar izquierdo. La extracción del cordal se realizó mediante ostectomía de la pared anterior del seno, pautándose tratamiento farmacológico postoperatorio y controles periódicos durante el primer año. Discusión: La terapéutica recomendada para esta complicación incluye la recuperación inmediata del diente, o la extracción posterior mientras la fibrosis se desarrolla en torno al diente desplazado, según sea necesario, tomando en cuenta la infección, el rango limitado del movimiento de la mandíbula, o malestar psicológico del paciente. El tratamiento médico y farmacológico que debe prescribirse según la literatura revisada, para facilitar el drenaje sinusal y el control de la infección. Conclusión: Para evitar este tipo de complicaciones, conviene realizar un estudio radiológico completo en los casos de cercanía del tercer molar superior en las inmediaciones del seno maxilar, y valorar la disposición e inclinación del mismo

Introduction: Accidental displacement of the third molar into the maxillary sinus is one of the complications of oral surgery. These extractions are usually complex due to some factors such as low visibility, limited space and the location of the tooth; so special care on these treatments is required. Objective: To establish an action protocol based on a surgical as well as a pharmacological treatment, and the monitoring that this kind of complications need according to the literature. Clinical case: A 17-year old man, with a noncontributory medical history, was referred to our clinic by a colleague to evaluate and perform a surgical extraction of his upper left third molar, which had been displaced into the maxillary sinus after a failed extraction, and was generating symptoms of acute sinusitis. The radiographic examination dismissed the affectation of the rest of the paranasal sinuses and confirmed the almost totally blockage of the left maxillary sinus. The extraction of this third molar took place by means of an anterior-wall ostectomy of the sinus; afterwards a pharmacological treatment was prescribed and regular control visits along the first year were planned. Discusion:The suggested treatment for this kind of complications involves the immediate recuperation of the tooth or its later extraction meanwhile the fibrosis forms around the displaced tooth, as needed. We have to take into account the infection, the limited mandibular range of movement as well as the patient's psychological discomfort. The medical and pharmacological treatment should be prescribed following the reviewed literature, in order to obtain the sinusal drainage and the infection control. Conclusion: It is convenient to carry out an exhaustive radiological examination in case of close relation between the maxillary third molar and the maxillary sinus as well as evaluate its position and inclination to avoid this kind of complications

Repositioning of a pathologically migrated tooth using autologous platelet-rich plasma: a case report with 3-year follow-up.

An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.

Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review.

Background: The incidence of impacted and transmigrant mandibular canines in the mandible is not as high as that in the maxilla; consequently, it is more difficult to find clinical guidelines derived from sound studies based on large patient samples. Objectives: The aim of this systematic review was to summarize currently available data pertaining to the incidence and aetiology of impacted and transmigrant mandibular canines and the success rates of different treatment strategies. Methods: This review was registered with PROSPERO (CRD42014006175) and was conducted using PRISMA and CRD (Centre for Reviews and Dissemination, University of York) statement. A computerized search of studies published up to February 2016 was conducted using the following databases: PubMed, Cochrane Central Register of Controlled Clinical trials, ISI Web of Knowledge, and Scopus. To identify any relevant publications not included in this list, we manually searched the references lists of the selected articles. The Newcastle-Ottawa Scale quality assessment tool was utilized to classify the included articles. Results: In total, 630 articles were identified after the removal of duplicates. A total of 13 studies published between 2001 and 2015 met all the eligibility criteria and were included for the final analysis. The sample size in these studies ranged from 14 to 112873 teeth, while their methodological quality ranged from low to medium. Conclusions: According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92 to 5.1 per cent, while that of canine transmigration ranges from 0.1 to 0.31 per cent. Various etiologies may play a role, including odontomes (up to 20 per cent) and lateral incisor anomalies (16 per cent). Surgical extraction (89 per cent in some studies) and orthodontic traction (20-32 per cent) are the most commonly used treatment strategies, with the latter showing a failure rate of 17 per cent in two studies.

Quantified diagnostic work-up casts: applications for interdisciplinary treatment planning.

Diagnostic casts that accurately replicate a patient's occlusion are essential for planning comprehensive care and interdisciplinary treatment. These casts can reveal the actual problem in the spatial relationship between the maxilla and the mandible, which may not be apparent on intraoral examination. Duplicate casts can be altered and measured to quantify the extent of the correction necessary for a predictable result. Treatment planning for interdisciplinary cases requires thorough evaluation of the entire problem and solution set as well as coordination of all procedures. Severe problems and invasive treatments require precise treatment planning. This case report illustrates these principles through multiple applications of quantified diagnostic work-up casts for a patient requiring orthognathic surgery, orthodontics, and occlusal adjustment after a mandibular subcondylar fracture.

Transmigration of mandibular canines: a rare case report and review of literature.

Transmigration of permanent mandibular canines is a very rare phenomenon and has no definite etiology. Most of them are asymptomatic, impacted, and commonly involve the left canines. The eruption of transmigrated canines is even rarer. The purpose of this paper was to review the literature on erupted transmigrated mandibular canines and report a rare case of it in a 13-year-old girl with a transmigrated permanent right canine corresponding to the least frequent Mupparapu type 5 pattern.

Dente em cavidade nasal de etiologia não traumática: apresentação rara / Tooth in nasal cavity of non-traumatic etiology: uncommon affection

Introdução: A presença de dente supranumerário ou ectópico não é fato incomum, sendo estimado ocorrer em 1% da população geral. Contudo, um dente em cavidade nasal constitui-se em evento raro, independente da etiologia. Objetivo: Relatar um caso de dente em fossa nasal cuja etiologia não foi traumática nem iatrogênica. Relato de Caso: Paciente jovem apresentou imagem radiopaca em fossa nasal quando em propedêutica odontológica. Durante investigação otorrinolaringológica, verificou-se tratar-se se dente, a despeito da inexistência de qualquer trauma. Foi realizado tratamento cirúrgico sem intercorrências. Comentários Finais: A presença de dente em fossa nasal, apesar de infrequente, deve receber atenção especial. O triângulo perigoso da face é local potencial de complicações, portanto, a abordagem deve ser cirúrgica, mesmo que o paciente esteja assintomático.

Introduction: The presence of ectopic supernumerary tooth is not an uncommon fact, and the estimate is that 1% of the population is affected. However, a tooth in nasal cavity is a rare event, independently of the etiology. Objective: To report a case of a tooth in nasal cavity whose etiology is neither traumatic and nor iatrogenic. Case report: The young patient presented with a radiopaque image in nasal cavity during dental propedeutics. Upon otorhinolaryngological exams, a tooth was identified, in spite of no existence of any trauma. Surgical treatment was carried out without complications. Final Comments: The presence of tooth in nasal cavity, in spite of being uncommon, must be given special attention. The dangerous triangle of the face is a potential place of complications, therefore, the approach must be surgical even in asymptomatic patients.

Extraoral removal of a transmigrant mandibular canine associated with a dentigerous cyst.

Although the maxillary permanent canine is frequently misplaced, misplacement of the mandibular canine is a comparatively rare event. Pre-eruptive migration of a tooth across the midline is called transmigration. This condition has not been reported for teeth other than canines. Dentigerous cysts can involve any tooth, but mandibular canines are rarely affected like premolars and molars. Odontogenic cysts associated with impacted teeth are usually removed through an intraoral approach. However, on rare occasion, an extraoral approach is required to remove these lesions. A case of transmigrant mandibular canine associated with a dentigerous cyst that required an extraoral submental approach for removal is presented.

Transmigrant maxillary canines.

OBJECTIVE: The objective of this study was to investigate the incidence and pattern of transmigrant maxillary canines. PATIENTS AND METHODS: The records of 6000 patients who were presented to our oral and maxillofacial surgery services between January 1998 and January 2007 were reviewed. Observations were made as to the right/left localization and number of transmigrant canines; sex and age of patients; retained deciduous canines; and any other associated pathology. RESULTS: A total of 12 patients presented with transmigrated maxillary canines with 6 females (age 15 to 37) and 6 males (age 17 to 57) in 6000 individuals (0.2%). All transmigrant canines were unilateral. The numbers of left and right transmigrant maxillary canines were equal. Ten individuals in 12 patients had not retained deciduous canines. None of these patients had any pathology associated with impacted canines. CONCLUSION: The canine transmigration can occur not only in the mandible but also the maxilla. Further studies are necessary to examine this rare phenomenon to allow classification of transmigrant canines in the maxillary arch. Thus, the incidence, demographic factors, and etiology of this phenomenon can be clarified. How transmigrant maxillary canines pass on the contralateral side of the mid palatal suture must be completely clarified.

Transmigrant impacted mandibular canines: a retrospective study of 15 cases.

BACKGROUND: Transmigration of mandibular canines across the midline is rare. The authors describe the clinical and radiologic characteristics of patients with transmigrant impacted mandibular canines. METHODS: The authors conducted a retrospective observational study of 14 patients with transmigrant canines. They diagnosed transmigrant canines in all of the patients on the basis of the clinical and radiological findings, and they obtained the data from the patients' case histories and panoramic radiographs. They considered a canine to be transmigrant when one-half or more of its length crossed the mandibular midline. RESULTS: There were 15 transmigrated canines in 14 patients aged 16 to 60 years. Primary canines were present in 10 cases. One case involved a pericoronal infection, two involved supernumerary teeth, one was associated with an odontoma, and in two a pericoronal radiolucency was seen that was compatible with a follicular cyst. Treatment consisted of surgical extraction for eight patients, and periodic clinical and radiologic follow-up visits for six patients. CONCLUSIONS: Radiographic examination is necessary to diagnose impacted transmigrant canines, among other anomalies. Surgical extraction is the treatment of choice for patients with transmigrant canines involving associated pathology. In some cases, the management of asymptomatic impaction can be limited to periodic clinical and follow-up visits. CLINICAL IMPLICATIONS: The absence of the permanent canine within the arch beyond the normal time of eruption suggests the presence of an impacted canine. A transmigrant canine may develop an associated pathology.

Alignment of displaced or impacted teeth with the traction chain.

To align those teeth in the dental arch that cannot erupt or are displaced, they must be surgically exposed. After the traction device is attached, the tooth is again covered with the mucoperiosteal flap to protect the tissues involved. For this reason, the loss of this traction device must be absolutely avoided in order to prevent another surgical intervention. Here at the University of Ulm, we have developed and tested an optimized traction chain for that purpose. The chain is attached to the tooth with a laser-roughened pad applying the acid-etching technique. The chain links serve as fixation elements for traction devices such as elastic ligatures or piggyback archwires. At the same time, one can determine the distance covered by the tooth by the number of the erupting chain links. We demonstrate the clinical application of this traction device in two cases.

Transmigración del canino inferior incluido. Presentación de un caso y revisión de la literatura / Transmigration of impacted lower canine. Case report and review of literature

La retención, es decir, la no erupción de un diente permanente más allá de un año después de la edad normal de erupción, es relativamente poco frecuente si exceptuamos el caso de los terceros molares y los caninos superiores. La transmigración se define como el fenómeno en el cual un diente incluido no erupcionado traspasa en más de la mitad de su longitud la línea media. Exponemos el caso clínico de una paciente de 20 años de edad, que presentaba la transmigración del canino inferior izquierdo, con un patrón de migración tipo 4 de Mupparapu. De igual forma, realizamos una revisión bibliográfica de los casos publicados de transmigración, actualizando los principales aspectos de esta patología

Retention, that is, a permanent tooth which is unerupted more than a year after the normal age of eruption, is a relatively rare event, except in the case of the third molars and the upper canines. Transmigration is defined as the phenomenon of more than half an unerupted impacted tooth crossing the midline. We report the clinical case of a twenty-year-old patient presenting transmigration of the lower left canine, with a type 4 transmigration pattern (Mupparapu). Likewise, we carried out a review of the literature of the cases that have been published on transmigration, updating the main aspects of this pathology

Transmigration of impacted lower canine. Case report and review of literature.

Retention, that is, a permanent tooth which is unerupted more than a year after the normal age of eruption, is a relatively rare event, except in the case of the third molars and the upper canines. Transmigration is defined as the phenomenon of more than half an unerupted impacted tooth crossing the midline. We report the clinical case of a twenty-year-old patient presenting transmigration of the lower left canine, with a type 4 transmigration pattern (Mupparapu). Likewise, we carried out a review of the literature of the cases that have been published on transmigration, updating the main aspects of this pathology.

Dispositivo de seguridad para controlar mejor el tercer molar impactado durante exodoncia: Una nueva técnica / Security device for a better control of impacted third molars during exodontia: a new technique

El desplazamiento accidental del tercer molar impactado es unacomplicación que ocurre de vez en cuando durante la exodoncia. La recuperaciónde estos dientes accidentalmente desplazados puede ser complejadebido a la mala visibilidad y el espacio limitado. Describimos unatécnica fácil basada en un sistema de anclaje para controlar mejor los tercerosmolares impactados durante la exodoncia

Accidental displacement of impacted third molars is acomplication that occasionally occurs during exodontia. The retrievalof these accidentally displaced third molars may be complex due topoor visibility and limited space. We describe an easy technique fora better control of impacted third molars during exodontia basedon an anchoring system

Surgical removal of a dislocated lower third molar from the condyle region: case report.

INTRODUCTION: Migration of dislocated lower third molar into the condylar region is quite rare. Attention should be taken to avoid condyle fracture. METHODS: 49-year-old patient had an ectopic lower left third molal in the condylar region, suffered from a submandibular and masseter space abscess. Removal of the molar via intraoral approach was chosen avoiding facial nerve branches and unnecessary scar formation. Coronoid process is removed, the tooth is separated and removed. The defect is filled with iliac cancellous bone. The coronoid process was fixed as a cover with a resorbable plate and screws (BIONX). RESULTS: Removal via intraoral approach is possible. Hypesthesia existed postoperatively, became normal later. CONCLUSION: Annual observation is strongly recommended. Intraoral approach is superior to the extraoral approach. Removal of the coronoid process minimizes the masticator forces. Separation of the tooth is essential. Filling the defect with cancellous bone accelerates the healing.

Transmigration of mandibular permanent canine in a Nigerian patient: presentation and management.

A rare dental anomaly--transmigration is presented in a 12-year-old female Nigerian who was referred for orthodontic assessment. A right mandibular canine was found completely located in the left side of the body of the mandible having moved ectopically and progressively from its normal developmental site through the symphysis of the mandible. The importance of the radiological diagnosis with the use of panoramic radiograph is highlighted and the management briefly discussed.

The role of orthognathic surgery in the treatment of severe dentoalveolar extrusion.

BACKGROUND: When mandibular molars are not replaced after extraction, the long-term problem of inadequate interarch space for either a fixed or removable prosthesis can occur. In the past, practitioners needed to decide whether to shorten the teeth, extract the supererupted maxillary molars to recapture space or leave the area unrestored. The authors present another option. CASE DESCRIPTION: A 61-year-old man was referred to a periodontist by his general dentist for placement of mandibular implants in the posterior sextant. Extreme supereruption of the maxillary dentoalveolar segment prevented restoration of the opposing edentulous area. An oral and maxillofacial surgeon performed a segmental osteotomy of the posterior right maxilla to gain needed interarch space. After the osteotomy was stabilized, the periodontist placed implants that were subsequently restored with a fixed prosthesis. CLINICAL IMPLICATIONS: The role of orthognathic surgery in treatment planning should not be overlooked in the comprehensive management of severe extrusion. It offers patients the opportunity to gain both function and esthetics that might otherwise be impossible.

[Unusual complication of extraction of a third molar]. / Bölcsességfog eltávolításának ritka szövödménye.

The authors summarized the technical problems of the Wisdom teeth extraction. They advised to send the patients from the basic dental service to the aMaxillofacial Surgery Departments if the position of tooth is unfavourable. They reported a complicated case of the third molar extraction.