Infected Dental Follicle Secondary to Mandibular Parasymphyseal Fracture: A Case Report.

Mandibular fractures are one of the most common maxillofacial traumatic injuries. They are also reported to be associated with highest rate of post-operative infection. In mixed dentition, management of tooth buds in line of fracture present great challenge to the surgeon. Timely management and non-invasive techniques can help in alleviating complications associated with fractures in children. Such cases should be kept on long-term follow-up for evaluation of proper growth and development. This case report documents a child having a history of previous mandibular fracture and extra-oral sinus tract associated with infected dental follicle.

Treatment of sequelae in permanent dentition after severe trauma in primary dentition.

A case with a dilacerated upper right central and hypoplastic upper right lateral incisors covered with gingiva of a 10-year-old female, with a history of trauma at the age of 18 months, is presented. After clinical and radiographical evaluations, esthetic problem was solved with gingivectomy followed by composite restorations of the involved teeth.

Dentigerous cyst after distraction osteogenesis of the mandible.

Damage to the dentition or tooth follicle is often cited as a potential complication of Distraction Osteogenesis (DO). The authors describe a case of a dentigerous cyst that developed following DO of the mandible. The possible histogenic mechanisms and the management are outlined. Understanding the causes of dentigerous cysts as well as the anatomy of the neonatal mandible may help avoid such a complication in the future.

Dental follicle infection following a dog bite.

Animal bite wounds and their subsequent infection are relatively common. Incidence rates for dog bites are significantly higher among children aged 0-9 years, especially among boys. Although bite wounds may initially look innocuous, they frequently lead to serious infection with a potential for life-threatening complications. The microbiology of dog bite wounds is usually polymicrobial, typically including anaerobes, Staphylococcus aureus and Pasteurella species. A case is described of a 22-month-old boy who, subsequent to a dog bite over the left maxilla, suffered infection of the dental follicle of the primary maxillary canine with Pasteurella multocida. The infection proved difficult to treat, requiring several attempts at incision and drainage of the abscess together with systemic antibiotics, and resulted in the eventual loss of the tooth.

Radiographic evaluation of the fate of developing tooth buds on the fracture line of mandibular fractures.

PURPOSE: The goal was to suggest guidelines for the treatment of developing tooth buds located on the fracture line of mandibular fractures. PATIENTS AND METHODS: The long-term radiographic follow-up records of 28 patients with mandibular fractures involving 66 tooth buds were examined for the occurrence of abnormalities in development or eruption. The fates of the involved teeth were compared according to the fracture conditions and other factors, and the cause of the abnormalities was surveyed. RESULTS: Abnormal findings were observed in 30 of 66 developing teeth (45%); these included deficient root formation, abnormal bend of the root, nodule formation on the root, partial obliteration of the pulp cavity, impaction, growth arrest, and external resorption. No relationship was found between the presence of abnormalities and the condition of the fracture or the developmental stage of the tooth buds. However, infection, rotation of the tooth bud, and a surgical wire passing through the follicular space were associated with arrested growth and impaction. CONCLUSIONS: The tooth buds present on the fracture line should be preserved except in cases of infection, and careful attention should be paid to avoiding further injury to the tooth bud and the soft tissues of the follicle at the time of surgery.

An unusual complication of mandibular distraction.

BACKGROUND: The authors present an unusual complication of mandibular distraction in a child with the curious condition of multiple pterygium syndrome is presented. CASE REPORT: The patient was a Caucasian male with severe pterygia in his neck. As a result of his limited mouth opening and restricted upper airway leading to obstruction, he underwent lengthening of his mandible by distraction, which significantly improved his breathing. During his follow-up, it was observed that an unusually elongated permanent molar was present in an abnormal position. CONCLUSION: This case highlights the need to carefully plan the sites for osteotomy and the potential for damage to the developing permanent dentition in young children.

Unilateral primary or secondary retention of permanent teeth, and dental malformations.

The purpose of the present investigation was to describe the dentition in subjects with local primary or secondary unilateral retention of two or more permanent teeth, and to elucidate the aetiology by comparing the regions of retention with the innervation pattern of the jaws. The material comprised radiographic dental orthopantomograms (OTP) from 12 patients with an age range of 6-18 years (six females and six males). The locations of retention and the dental morphology in the affected regions were analysed. Comparison with contralateral teeth was undertaken and the innervation pattern of the affected field was considered. Varying degrees of dental root malformation were found to be associated with primary and secondary retention. More pronounced root malformations were observed in subjects with several affected teeth. A connection between unilateral retained permanent teeth and temporary or permanent disruption of the nerve supply to the affected region is suggested.

The effects of local trauma to the enamel-related periodontal tissues in the eruption of the rat incisor.

The periodontal tissues related to enamel (PTE) of the rat incisor comprise a connective tissue derived from the dental follicle and the enamel organ with its successive stages of development. Localized damage to these tissues in rat lower incisors was done surgically in three ways: with an endodontic file introduced into the labial periodontal space through either (i) its basal or (ii) its incisal extremities, or (iii) by the partial removal of the mandibular lower border, at the level of the molar teeth, together with the introduction of an endodontic file into the incisal part of that space. The lesions in the molar region of the PTE produced first a variable period of retarded eruption, and, depending upon their extent or degree were followed by a cessation of the eruptive movement and, in the majority of the operated teeth, a recovery of the normal eruption rate before the end of the experiment (17 weeks after surgery). Access to the PTE through the basal portion of the socket was erratic, but when the tissues were damaged produced similar effects. Effects on eruption of lesions produced through the alveolar crest were minimal or even absent. Localized injury to the periodontal ligament of either lower or upper incisors did not produce similar effects on tooth eruption. The dental follicle and the enamel organ of teeth of limited growth when their crown is completed are similar to the PTE in the molar region of continuously growing rodent incisors. In teeth of limited growth these tissues play an essential part in the intraosseous stage of eruption. The results here suggest that the PTE may also have a role in the supraosseous stage of eruption, which is continuous in teeth such as rat incisors due to the presence of a continuously functioning odontogenic organ.

Autotransplantation and replantation of tooth germs in monkeys. Effect of damage to the dental follicle and position of transplant in the alveolus.

The effect of damage to the follicle and of superficial positioning of tooth germs after replantation or autotransplantation was studied in green Vervet monkeys. Radiographs were taken immediately after surgery and 3, 6 and 9 months postoperatively, whereafter the animals were sacrificed. The tissue blocks were sectioned in step serial sections along a frontal plane and histologic and radiographic evaluation was made. Tooth germs whose follicle was either damaged or removed showed no sign of eruption, while tooth germs which were replanted with an intact follicle were fully erupted within 3 months. Non-operated control teeth were fully erupted within 6 months. Histologic examination revealed that roots of replanted teeth were only slightly shorter than the non-operated control teeth. Transplantation of tooth germs in different positions in relation to the alveolar crest showed that teeth placed in their original position attained an average tooth length of 12.5 mm, whereas teeth placed in a semi-erupted position achieved an average length of only 9.7 mm. A control group of non-operated incisors demonstrated an average tooth length of 13.7 mm. This study indicates that damage to the follicle at the time of replantation of tooth germs is of major importance for tooth eruption and that placing tooth germs in a semi-erupted position adversely influences later root development.