Arrested eruption of the permanent lower second molar.
The incidence of retention/impaction of the permanent lower second molar (M2inf) lies between 0.6/1000 and 3/1000. Therefore, the purpose of the present study was to investigate the craniofacial morphology, the frequency of dental anomalies and the inclination of the affected M2inf and the adjacent first molar in patients with arrested eruption of M2inf. The overall goal was to elucidate the aetiology of arrested tooth eruption and to present the characteristics of these patients in order to improve diagnosis and treatment planning. Radiographic material (profile radiographs and orthopantomograms) from 19 patients (nine females and 10 males; 13-19 years of age at the time of referral) were analysed. The ages of the patients when profile radiographs were taken for cephalometric analysis varied from 8 to 16 years. The study shows that this group of patients, compared with a reference group, had an increased sagittal jaw relationship (Class II). Specifically, the mandibular prognathism was less, the mandibular gonial angle smaller, the mandibular alveolar prognathism enlarged and the maxillary incisor inclination less than in the reference group. Furthermore, this group of patients had a more frequent occurrence of morphological tooth anomalies, such as root deflections, invaginations, and taurodontism. However, none of the patients with arrested eruption of M2inf had agenesis of the lower third molar. The study did not reveal an association between the degree of inclination of the M2inf and that of the first molar in the same region. The results of this investigation show that conditions such as the craniofacial morphology and deviations in the dentition are associated with arrested eruption of M2inf. Therefore, it is important to evaluate these conditions in future diagnosis and treatment planning of patients with arrested eruption of M2inf. (+info)
The physical characteristics of neodymium iron boron magnets for tooth extrusion.
Impaction and non-eruption of teeth is a common problem encountered in orthodontics and many techniques have been proposed for the management of this condition. It has been advocated that a system utilizing magnets would supply a continuous, directionally sensitive, extrusive force, through closed mucosa and thus provide not only a physiological sound basis for successful treatment, but also reduce the need for patient compliance and appliance adjustment. This ex vivo investigation examined in detail the physical characteristics of neodymium iron boron magnets employed in attraction in order to assess their usefulness in the clinical situation. Attractive force and magnetic flux density measurements were recorded for nine sets of magnet pairs with differing morphologies. The effect of spatial relationship on force was assessed by varying vertical, transverse and horizontal positions of the magnets relative to each other, and by altering the pole face angles. The data obtained suggest that magnets with larger pole face areas and longer magnetic axes provide the best performance with respect to clinical usefulness. It was possible to formulate a specific relationship between force and flux density for each magnet pair. This relationship can be used in the clinical management of unerupted teeth to predict the force between the magnets by measuring the magnetic flux density present at mucosal level. The results indicate that magnetic systems may, indeed, have a place in the treatment of unerupted teeth. (+info)
The effect of tooth position on the image of unerupted canines on panoramic radiographs.
The purpose of this study was to evaluate whether panoramic tomograms, which are routinely used in orthodontic practice, can provide adequate information to localize an impacted canine. The effect of changes in position and inclination of an impacted canine on orthopantomograms was investigated in an experimental set-up. An upper canine was removed from a human skull and replaced in a positioning system, enabling simulated positional variations in impactions. In comparison with the image of a contralateral well-aligned canine, the length of the impacted tooth always decreased or remained unchanged, whereas the tooth width increased or remained unchanged. The angulation of the image was unaffected by varying the position of the impacted canine, but altered when the inclination of the tooth in a sagittal or frontal direction was changed. If there was any transversal shift of the impacted canine on the orthopantomogram, it was always towards the mid-sagittal plane. The curvature of the tooth increased after dorsal inclination and decreased after ventral inclination (in comparison with the contralateral well-aligned canine). (+info)
A medico-legal review of some current UK guidelines in orthodontics: a personal view.
This article is a critical analysis from a medico-legal perspective of some current authoritative UK clinical guidelines in orthodontics. Two clinical guidelines have been produced by the Royal College of Surgeons of England and four by the British Orthodontic Society. Each guideline is published with the analysis immediately following it. Following recent UK case law (Bolitho v City & Hackney Health Authority, 1997) which allows the courts to choose between two bodies of responsible expert medical opinion where they feel one opinion is not 'logical', it is likely that the UK courts will increasingly turn to authoritative clinical guidelines to assist them in judging whether or not an appropriate standard of care has been achieved in medical negligence cases. It is thus important for clinicians to be aware of the recommendations of such guidelines, and if these are not followed the reasons should be discussed with the patient and recorded in the clinical case notes. This article attempts to highlight aspects of the guidelines that have medico-legal implications. (+info)
The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.
BACKGROUND: Removal of wisdom teeth is one of the most common surgical procedures performed in the UK. Little controversy surrounds the removal of impacted third molars when they are associated with pathological changes such as infection, non-restorable carious lesions, cysts, tumours, and destruction of adjacent teeth and bone. However, the justification for prophylactic removal of impacted third molars is less certain and has been debated for many years. OBJECTIVES: To provide a summary of existing evidence on prophylactic removal of impacted wisdom teeth, in terms of the incidence of surgical complications associated with prophylactic removal, and the morbidity associated with retention. METHODS: A systematic review of the research literature was undertaken. METHODS - DATA SOURCES: An existing review formed the basis of this report, and additional literature searches were undertaken, including searches of electronic databases (MEDLINE, 1984-99; EMBASE, 1984-99; Science Citation Index, Cochrane Controlled Trials Register, National Research Register; Database of Abstracts of Reviews of Effectiveness), paper sources (including Clinical Evidence), and web-based resources. Relevant organisations and professional bodies were contacted for further information. METHODS - STUDY SELECTION: Studies were selected for inclusion if they met the following criteria: (1) design - randomised controlled trials (RCTs), literature reviews, or decision analyses; (2) participants - people with unerupted or impacted third molars, or those undergoing surgical removal of third molars either as prophylaxis or due to associated pathological changes; (3) reported outcomes - either the pathological changes associated with retention of third molars, or post-operative complications following extraction. There were no language restrictions on study selection. METHODS - DATA EXTRACTION AND SYNTHESIS: Data from included studies were extracted into structured tables and individual study validity was assessed against methodological checklists. Data were summarised descriptively. Decisions relating to study selection, data extraction and validity assessment were made by two independent reviewers, and disagreements were resolved by discussion. For non-English papers, translators were recruited to assist with study selection and data extraction. RESULTS: Forty studies were included in the review: two RCTs, 34 literature reviews, and four decision analysis studies. One RCT in the UK focused on the effects of retained third molars on incisor crowding (predominantly a cosmetic problem) in patients who had previously undergone orthodontic treatment. The results of this trial suggested that the removal of third molars to prevent late incisor crowding cannot be justified. Another on-going RCT in Denmark compares the effects and costs of prophylactic removal of third molars with removal according to morbidity. So far, this trial has recruited 200 participants, and preliminary results indicate that watchful waiting may be a promising strategy. However, more data and longer follow-up of patients are needed to conclude which treatment strategy is the most cost-effective. It is also known that a trial is on-going in the USA but no results are available so far. The methodological quality of the literature reviews was generally poor, and none of the reviews was systematic. Conclusions from nine reviews on anterior crowding suggested that there was only a weak association between retention of third molars and crowding. Six out of 21 reviews with a more general scope also concluded that the prophylactic removal of third molars was unjustified. Twelve general reviews did not conclude with a clear message about the management of third molars. Three reviews suggested that prophylactic removal of third molars is appropriate, but these reviews were of poorer methodological quality than the majority of other reviews. Three out of four papers focusing on surgical management expressed (+info)
'Killer' canines: the morbidity and mortality of ebino in northern Uganda.
In northern Uganda, unerupted primary canine teeth are commonly extracted because they are believed to cause diarrhoea, vomiting, and fever. This practice, known as ebino, is performed under very crude conditions often using unclean tools. To evaluate the morbidity and mortality of complications related to ebino, we retrospectively analysed discharge records from the paediatric ward of Lacor Hospital, Gulu. In the period 1992-98, ebino-related complications, mainly sepsis and anaemia, were among the leading causes of admission (n = 740) and hospital death (n = 156, case fatality rate = 21.1%, proportional mortality rate = 3.3%). Discouraging the adoption of deeply rooted traditional practices that are potentially hazardous to health should be a public health priority in northern Uganda. This could be done by educating not only the general public, but also traditional healers and community and religious leaders, who could convey the knowledge to their people. (+info)
Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital.
This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students. (+info)
Ameloblastic fibroma of the anterior maxilla presenting as a complication of tooth eruption: a case report.
Ameloblastic fibroma is a rare mixed odontogenic tumour, which is extremely uncommon in the anterior maxillary region. A case report is presented where failure of eruption of an upper central incisor was the presenting feature. (+info)