Malocclusions, pathologic tooth migration, and the need for orthodontic treatment in subjects with stage III-IV periodontitis. A cross-sectional study.

BACKGROUND: Literature is scarce on malocclusion prevalence and orthodontic treatment need (OTN) in subjects with stage III-IV periodontitis. Study aims were to assess prevalence of primary and secondary malocclusions in subjects with stage III-IV periodontitis and OTN based on pathologic tooth migration (PTM) and occlusal trauma of anterior teeth (AT). SUBJECTS AND METHODS: One hundred and twenty-one subjects with stage III-IV periodontitis were examined. A comprehensive periodontal-orthodontic examination was performed. Exclusion criteria: age <30 years, removable prosthetics, uncontrolled diabetes, pregnancy/lactation, and oncologic disease. RESULTS: Class II malocclusion was found in 49.6% (Class II div 1-20.7%, Class II div 2-9.9%, subdivision Class II-19.0%), Class I-31.4%, Class III-10.7%, no malocclusion-8.3% of subjects. PTM was observed in 74.4% of maxillary and 60.3% of mandibular AT. Spacing and extrusion were the main types of PTM of AT. Odds ratio for PTM of maxillary AT was 9.3 in cases with >30% of sites with clinical attachment loss ≥5 mm (P = 0.001). Spacing of maxillary AT was influenced by periodontitis, Class III malocclusion, and lost teeth. Tongue habit had impact on spacing of mandibular AT. Dental Health Component of Index of Orthodontic Treatment Need yielded that OTN was found in >50% and OTN due PTM, occlusal trauma and impaired function in 66.1% of subjects. CONCLUSIONS: The most prevalent malocclusion was Class II. Spacing and extrusion were prevalent types of PTM of AT. OTN was found in more than half of the subjects. The study highlights the need for preventive measures for PTM in subjects with stage III-IV periodontitis.

Chronic sinusitis of odontogenic origin due to an undiagnosed displaced root fragment in the maxillary sinus and the role of cone beam computed tomography in successful management.

Radiographic imaging is an important criteria in diagnosis, treatment planning, and follow-up of an endodontic treatment. When clinicians encounter with diagnostic difficulties and persistent symptoms, the need for advanced diagnostic aids, especially imaging methods, become imperative and essential. This paper reports a case, in which primary endodontic therapy having failed, the patient had persisting symptoms such as pain, swelling, and draining sinus along with signs and symptoms of maxillary sinusitis. Advanced diagnostic aids such as Cone Beam Computed Tomography was useful in accurate identification of the etiology, which was a fractured mesiobuccal root tip of maxillary molar. This is the first reported case, in which the fractured root tip has migrated to the maxillary sinus, during primary endodontic treatment, through the perforated antral floor causing odontogenic sinusitis. The operating microscope helped in the successful completion of endodontic retreatment along with fractured root fragment retrieval.

Effect of static magnetic field on pain level and expression of P2X3 receptors in the trigeminal ganglion in mice following experimental tooth movement.

Recent research has demonstrated that static magnetic fields (SMF) can generate an analgesic effect in different conditions. The present study explored effects of SMF on pain levels and expressions of P2X3 receptors in trigeminal ganglion (TG) in mice after experimental tooth movement (tooth movement induced by springs between teeth). Experiments were performed in male mice (body mass: 25-30 g) and divided into SMF + force group, force group, and no force group. Exposure time was over 22 h per day. Mouse Grimace Scale was used for evaluating orofacial pain levels during experimental tooth movement at 4 h and 1, 3, 7, and 14 days. Meanwhile, expression levels of P2X3 receptors in the TG were evaluated by immunohistochemistry and western blotting at same time points. We finally found that during experimental tooth movement, pain levels of mice peaked at 3 days, and then decreased. While pain levels of mice were reduced in the SMF environment at 4 h, 1 and 3 days, there was a significant difference at 1 and 3 days. Meanwhile, under the action of SMF, expression levels of P2X3 receptors in TG were significantly lower at 4 h, 3 and 7 days. These results suggest that SMF can reduce pain levels in mice, and down-regulate P2X3 receptors in TG. Bioelectromagnetics. 38:22-30, 2017. © 2016 Wiley Periodicals, Inc.

Delayed removal of maxillary third molar displaced into the infratemporal fossa / Extracción diferida del tercer molar maxilar desplazado a la fosa infratemporal

Third molar extraction is a common procedure and it is rarely associated with complications. One complication that may be associated with this procedure is displacement of the tooth into the infratemporal fossa, an anatomical structure that contains the temporalis muscle, medial and lateral pterygoid muscles, the pterygoid plexus, the maxillary artery and its branches, the mandibular nerve and its branches, and the chorda tympani. The present case report illustrates delayed surgical removal of a maxillary third molar that was displaced into the infratemporal fossa, via the intraoral access and under local anesthesia. Despite the rarity of this complication, oral and maxillofacial surgeons should be aware of its management and able to choose the optimal technique, taking into account the patient’s signs and symptoms as well as the knowledge and experience of the surgeon (AU)

La extracción del tercer molar es un procedimiento habitual que pocas veces se asocia a complicaciones. Una posible complicación asociada es el desplazamiento de la pieza dental a la fosa infratemporal, una estructura anatómica que contiene el músculo temporal, el músculo pterigoideo interno y externo, el plexo pterigoideo, la arteria maxilar y sus ramas, el nervio mandibular y sus ramas y la cuerda del tímpano (una rama del nervio facial). El caso descrito en este manuscrito ilustra la extracción quirúrgica diferida de un tercer molar maxilar que se había desplazado a la fosa infratemporal, a través de un acceso intraoral y con anestesia local. A pesar de que es una complicación excepcional, el cirujano experto en cirugía oral y maxilofacial debe conocer su tratamiento y seleccionar la técnica óptima, teniendo en cuenta los signos y síntomas manifestados por el paciente, y en función de sus conocimientos y experiencia (AU)

Integrated periodontal, orthodontic, and prosthodontic treatment in a case of severe generalized aggressive periodontitis.

OBJECTIVE: This article reports a case of severe generalized aggressive periodontitis and subsequent collapse of the occlusion in a psychiatric patient, treated by an extremely conservative orthodontic-periodontal-prosthodontic treatment. SUMMARY: A woman presented with severe anterior proclination caused by severe periodontal disease and Angle's class II molar malocclusion. The patient wanted to preserve her teeth and rejected the idea of implant treatment. This case report demonstrates that combining periodontal therapy, orthodontic treatment, and prosthodontics (through a decision-making system with a proper interdisciplinary coordination) can greatly improve function and the esthetic result. Comprehensive periodontal treatment took place before other intervention, and periodontal maintenance and follow-up throughout the treatment and after played a crucial role.

Transmigration of mandibular canines in siblings: a case report.

Transmigration is the pre-eruptive intrabony migration of a tooth across the midline. This rare phenomenon, the etiology of which is unknown, is usually seen in canines. Two cases of transmigration in the mandibular canines are reported; one shows the transposition of a mandibular canine and premolar. Familial occurence of this phenomenon and a 5-year follow-up showing a change in the inclination of the impacted tooth are outlined.

[A case of nasal foreign bodies by tooth migration]. / Un cas de corps étranger des fosses nasales par migration dentaire.

Foreign bodies are a frequent reason for ENT consultation especially in children. Although the nature of the foreign body can be variable, the discovery of a tooth in a nasal cavity is a rare occurrence. The authors report a case of foreign body inside the nasal cavity caused by tooth migration and discuss its pathologic, diagnostic and therapeutic aspects.

Patterns of third-molar agenesis and associated dental anomalies in an orthodontic population.

INTRODUCTION: The aim of this study was to investigate the frequency of dental anomalies in orthodontic patients with different patterns of third-molar agenesis, comparing them with patients without third-molar agenesis. METHODS: A sample of 374 patients with agenesis of at least 1 third molar was divided into 4 groups according to the third-molar agenesis pattern, and a control group of 98 patients without third-molar agenesis was randomly selected from the patient archives. Panoramic radiographs and cast models were used to determine the associated dental anomalies, such as hypodontia, hyperdontia, impaction, dilaceration, microdontia, ectopic eruption, transposition, and transmigration. The Pearson chi-square and Fisher exact tests were used to determine the differences in the distribution of the associated dental anomalies among the groups. RESULTS: The prevalence of agenesis of other teeth (11.2%, n = 42) was significantly greater in our study sample (groups 1-4) than in the control group (group 5) (4.1%, n = 4; P <0.05). When we compared the groups according to the various third-molar agenesis patterns, we found that agenesis of other teeth was more common in patients with agenesis of 3 and 4 third molars. In addition, the patients with agenesis of 4 third molars exhibited maxillary lateral-incisor microdontia more frequently. Another important finding was a higher prevalence of total dental anomalies in patients with agenesis of 3 and 4 third molars compared with the control group. CONCLUSIONS: Permanent tooth agenesis, microdontia of maxillary lateral incisors, and total dental anomalies are more frequently associated with agenesis of 4 third molars than with the presence of third molars.

Corrección de plano oclusal mediante implantes oseointegrados / Correcting the occlusal plane through osseointegrated implants

Se presenta en el siguiente artículo un caso donde la migración dentaria ha generado como resultado un plano oclusal descendido. Una vez que se ha decidido resolver el caso mediante terapia con implantes, se describen las maniobras que se habrán de realizarpreviamente en el tejido óseo de modo de acondicionarlo, teniendo en cuenta que de éstas dependerá el éxito del tratamiento. La ubicación tridimensional del implante utilizando el proyecto rehabilitador como base, será fundamental para restablecer lafuncionalidad y la estética, con un plano en correcta ubicación.

This paper shows a case in which tooth migration has resulted in a lowered occlusal plane. Upon deciding to solve the case using implant therapy, the techniques to be used for the preparation the bone tissue are described, taking into consideration that the success of the treatment will depend on said techniques. The three-dimensional location of the implant in the rehabilitated tissue, will be basic for the reestablishment of functionality and aesthetics, with a plane that is properly located.

Clinico-radiographic examination of odontogenic myxoma with displacement of unerupted upper third molar: review of the literature / Examen clínico-radiográfico de un mixoma odontogénico con desplazamiento de un tercer molar no erupcionado: revisión de la literatura

Odotogenic myxoma is a benign tumor which presents in 3 percent to 6 percent of all odontogenic tumors. According to the WHO classification, multiple radiolucent areas of varying size, separated by straight or curved bony septa with poorly defined borders are the radiologic characteristics of the condition. We report the case of maxillary odontogenic myxoma in a 21 year old man. The radiological feature of the current case was interesting, due to the size of the lesion and severe displacement of the upper third molar.

El mixoma odontogénico es un tumor benigno que se presenta en el 3 por ciento a 6 por ciento de todos los tumores odontogénicos. De acuerdo a la clasificación de la OMS, las características radiológicas de esta patología presentan múltiples áreas radiolúcidas de tamaño variable, separadas por tabiques óseos rectos o curvos, con márgenes mal definidos. Presentamos un caso de mixoma odontogénico maxilar en un hombre de 21 años. La característica radiológica es interesante, debido al tamaño de la lesión y al desplazamiento severo del tercer molar superior.

[Cystic lesion with a displaced tooth in the maxillary sinus]. / Zystischer Kieferhöhlenprozess mit verlagertem Zahn.

Ameloblastomas are epithelial odontogenic tumors in the mandibula or maxilla with potential local infiltrating growth; therefore, relapses can occur after incomplete resection. Among the different histological subtypes, the following are of clinical importance: The so-called unicystic ameloblastoma, radiologically presenting as a common dentigerous cyst, and the so-called extraosseous ameloblastoma. This case report describes the rare combination of a unicystic ameloblastoma with extraosseous localization in the maxillary sinus and association with a displaced tooth. This unusual constellation can cause major diagnostic problems.

Clinical evaluation of correction of pathologic migration with periodontal therapy.

OBJECTIVE: there is a paucity of clinical evidence regarding the amount and frequency of repositioning of pathologically migrated teeth after conventional periodontal treatment. The present study was carried out to find and relate these two parameters of periodontal success with severity of migration. METHOD AND MATERIALS: a total of 45 subjects with a history of recently formed diastema or noticeable increase in already existing diastema were selected. Twenty-nine patients with 76 diastema sites participated in the study (16 patients were lost to follow-up). Repositioning was assessed by measuring the sites on study models obtained at baseline, reevaluation at 6 weeks after nonsurgical periodontal therapy, and 4 months after surgery. RESULTS: after nonsurgical therapy, 65.78% of sites demonstrated some degree of repositioning, while 7.89% closed completely. Four months after surgical treatment, 32.30% of sites showed complete repositioning and 47.69% of sites showed an additional partial repositioning. This corresponds to a 79.99% rate of positive responses to therapy. When sites measuring ⋜ 1 mm were considered, 65.38% showed complete closure and 96.15% demonstrated positive response to therapy. CONCLUSION: the findings suggest that there is an inverse relationship between the severity of migration and amount (as well as frequency) of repositioning. The results emphasize the importance of early diagnosis in the successful treatment of pathologic migration to prevent more complex and time-consuming orthodontic and prosthodontic procedures.

Tratamiento quirúrgico de caninos mandibulares bilaterales transmigrados / Surgical treatment of bilateral mandibular transmigrated canine

La migración de caninos inferiores es un fenómeno poco común. Su incidencia es menor que incluidos maxilares y son frecuentemente encontrados en jóvenes. Solamente caninos, segundos premolares y terceros molares incluidos migran a lugares ectópicos en su desarrollo y dientes incluidos ectópicos son, en la mayoría de los casos, asintomáticos. La etiología es compleja y poco descrita en la literatura. Un canino es considerado un diente migrado cuando, horizontalmente, más de la mitad del diente atraviesa la línea mediana. Este artículo reporta un caso clínico, con tratamiento quirúrgico de exodoncia de caninos bilaterales incluidos, horizontalmente en la región de la sínfisis. Se observó que la exodoncia es la conducta operatoria más frecuente, presentando en este caso buenos resultados.

Migration of canine mandibles is a very uncommon phenomenon. Their incidence is less frequent than maxillary canines and present frequently in young people. Only canines, second bicuspid and third molars can migrate to ectopic areas in their development and ectopic embedded teeth are, for the most part asymptomatic. The etiology is complex and with poor information. A canine is considered a migrating tooth when it penetrates horizontally the middle line of the mandible. This paper reports a case with surgical treatment of dental extraction, including horizontal bilateral canines in the symphysis region. It was observed that dental extraction is a more frequent treatment and presented with good results in this case.

Orthodontic tooth movement into jaw regions treated with synthetic bone substitute.

INTRODUCTION: Orthodontic tooth movement is fraught with risks and complications. Root resorption is the most frequent and important outcome which may arise due to inappropriate force magnitude or tooth movement into dense or altered bone. This study was aimed to demonstrate histologic changes in tooth roots following movement into a jaw region treated with synthetic bone substitute. Another objective was to evaluate the method of experimental tooth movement using an animal model. MATERIAL AND METHODS: One mandibular premolar was extracted in each of three pigs (Sus scrofa domesticus). The extraction alveolus was filled with synthetic bone substitute material and a orthodontic appliance was attached for 90 days. The force for tooth movement was in the range of 1-2 N. Subsequently, specimens were collected using segmental osteotomy and were prepared histologically. Unmoved teeth served as controls. RESULTS: Histological analysis showed clear lacuna-like lesions in the root surface area of all specimens. The lesions were largest in the apical area, while the mid-root region was less affected. CONCLUSIONS: Due to deformations of the orthodontic tooth moving appliance, the force could not be exactly defined. Therefore, marked resorption lesions of the root surfaces cannot be unequivocally attributed to the synthetic bone substitute. However, the type of lesions on root surfaces permits the assumption that orthodontic tooth movement into areas filled with synthetic bone substitute may be associated with an increased risk of root resorption.

Una rara complicación en la extracción del tercer molar inferior incluido. Caso clínico / A rare complication during the extraction of the included inferior third molar. Case report

Presentamos una rara complicación ocurrida tras el intento deextracción del tercer molar incluido en una consulta odontológica bajo anestesialocal. El paciente requirió ingreso en el servicio de urgencias para laextracción, de forma urgente, de la pieza a través de un abordaje cervicalbajo anestesia general e intubación nasaotraqueal por desplazamiento de lapieza hacia la fosa submandibular durante el intento de extracción ambulatoria.El paciente presentó signos evidentes de inflamación en la región submandibularcon desplazamiento de la vía aérea hacia el lado opuesto. Lascomplicaciones derivadas de la cirugía del tercer molar son, en algunos casos,mortales y pueden aparecer tras un acto quirúrgico aparentemente de bajoriesgo. Estas complicaciones han sido ampliamente descritas en la literatura.Aún así consideramos importante el presentar complicaciones poco frecuentesen la cirugía del tercer molar ya que esto nos permitirá conocerlas y ofrecerla mejor solución en cada caso(AU)

We present a rare complication that appeared after anattempt to extract the included third molar with local anaesthesiaat the odontologist office. The patient was admitted to the emergencyroom to have the tooth removed cervically under general anaesthesiaand nasotracheal tubation because of its movement towards thesubmandibular fossa during the ambulatory extraction attempt.The patient showed evident signs of swelling in submandibularregion and the airway was displaced towards the opposite side.The resulting complications from the third molar surgery are, insome cases, mortal and can occur after an apparently low risksurgery. These complications have been thoroughly described inliterature. Still, we consider it important to describe infrequentcomplications of third molar surgery because it will allow us to knowmore about them and offer the best solution in every case(AU)

Dentigerous cyst associated with a displaced tooth in the maxillary sinus: an unusual cause of recurrent sinusitis in an adolescent.

We report an unusual case of a displaced maxillary molar and associated dentigerous cyst within the maxillary sinus in an adolescent presenting as recurrent sinusitis. Although a rare cause of sinusitis in children, dentigerous cysts should be included in the differential diagnosis for causes of persistent or recurrent sinusitis in this age group. This report provides further evidence for obtaining imaging studies when managing pediatric sinusitis that does not respond to standard antibiotic therapy. We discuss management options for these lesions including the differential diagnoses and need for follow-up.

Treatment of a periodontally compromised patient with mini-implant anchorage.

BACKGROUND: Advanced periodontal disease and its sequelae are characterized by severe attachment loss, tooth mobility, and migration. This pathology often leads to compromised function and esthetics. A multidisciplinary approach combining orthodontic, periodontic, and restorative treatment is necessary to provide complete rehabilitation both in terms of function and esthetics with a satisfactory long-term prognosis. METHODS: A simple and effective treatment of an adult patient with periodontally migrated teeth using mini-implants in the maxilla and mandible is described. Mini-implant placement was aided by a 3D surgical guide, which made the procedure exceedingly safe. RESULTS: Gradual intrusion of the maxillary and mandibular anterior teeth was achieved with a relatively simple orthodontic force system. A significant profile improvement was observed during the 18 months of treatment due to the retraction and intrusion of the incisors in both arches. This intrusion was accomplished without any sign of apical root resorption. The mandibular incisors were uprighted 6.5 degrees, and their maxillary counterparts were uprighted 13.4 degrees. The 2-year follow-up examination revealed a stable result with an increase in periodontal attachment as well as esthetics and function. CONCLUSION: A combined orthodontic, periodontic, and restorative treatment approach with adequate patient motivation can lead to improved masticatory function, esthetics, and periodontal conditions.