Maxillary Distomolar Associated with Dentigerous Cyst: An Unusual Entity

Supernumerary teeth may be encountered as an incidental finding on a radiograph. When impacted, they may be associated with clinical signs related to different problems such as failure of eruption, teeth displacement, root resorption or cystic lesions. They may occur in primary and permanent dentition, in both the maxilla and mandible and can be single or multiple in patients with syndromes. Mesiodens is the most commonly impacted tooth and appears between the central maxillary incisors in pediatric ages. Supernumerary teeth distal to the third molar are rare, usually impacted and referred to as a distomolar. A 46-year-old male consulted with the main complaint of pain on the left side of the maxilla. A panoramic radiograph revealed a right impacted maxillary fourth molar located posterior to the third molar associated with a pericoronal radiolucency. The supernumerary tooth was removed surgically under local anesthesia and the pericoronal lesion enucleated. Histopathological examination was consistent with the diagnosis of a dentigerous cyst associated with an impacted distomolar. Healing was uneventful, and the patients remained asymptomatic. The occurrence of a maxillary distomolar is rare and even rarer the association with a dentigerous cyst.

Eruption Treatment of Impacted Teeth Following Surgical Obstruction Removal

Supernumerary teeth and odontomas are obstacles for spontaneous tooth eruption and may result in impaction. The aim of the study is to present a conservative treatment approach for impacted teeth following surgical obstruction removal by reviewing three treatment modalities: surgery only, which involves the surgical removal of the obstruction and the spontaneous eruption; surgery with immediate traction, which includes surgery combined with immediate active orthodontic brace cementation and traction; and surgery with delayed traction, which combines a surgical procedure of obstacle removal and orthodontic brace cementation with follow-up for the spontaneous eruption. The first two modalities require orthodontic traction either by an additional surgical procedure for orthodontic brace cementation, or combined with the surgical obstacle removal. With the third approach, clinical follow-up is performed via connected ligature wire elongation applied during the surgical procedure for the spontaneous emergence of the impacted tooth. Active orthodontic traction is only employed if the tooth fails to erupt. The visual follow-up via wire elongation serves as a reference during the emergence of the impacted teeth and reduces the need for radiographic examination. The surgical-orthodontic approach saves both further surgery and orthodontics (spontaneous eruption) or further surgery (in failure to erupt).

Management of Impacted Teeth in Orthodontics

Introduction and Purpose: Treatment of impacted teeth in orthodontics is crucially important, as clinician is supposed to manage such cases in his/her daily practice. However, impaction cases can be so complicated especially when other factors interfere within their treatments such as anatomical locations of the impacted teeth, surgical considerations and Orthodontic Traction difficulties. The management of impacted teeth in orthodontic practice varies widely from extraction of the impacted tooth to forced orthodontic eruption. Orthodontic eruption varies between closed or open techniques that must be determined for each case, per se. Materials and Methods: One hundred fifty one impacted teeth cases were followed up, classified by their techniques as to register the results statistically. The approaches for handling the impacted teeth were open forced eruption “as window or APF Apically Positioned Flap”, closed forced eruption, negligence and extraction when indicated. Bonding with Light Cure orthodontic composite was used for all cases of forced eruption. The used Device had been Mini LED, Acteron, Li-ION 3.7V, 2500mAh. Time of Exposure 20 Second. The traction attachments had been either Titanium Button and Chain (Watted) Dentaurum, or conventional Buttons (with ligature wires or elastics). This research discusses the prognosis of impacted teeth, the approaches of the orthodontic forced eruption and when to expose, extract or even “neglect”! The article does not recommend one treatment plan for all cases, in contrary; it urges the reader to search more for innovative solutions whenever such cases come across. Results and Conclusion: It is recommended that the decision regarding orthodontic forced eruption (closed or open), or extraction be based on evaluation of each independent case. In spite of the result of this research that 126 cases of the 151 screened cases had been treated successfully by orthodontic forced eruption, but complications such ankylosis, resorption, eruption failure and periodontal pockets need to be taken into account. Another complication can often be encountered that is bonding failures, especially in closed force eruption. However, the new bonding materials and the improved techniques have helped to overcome such a problem. Finally, the more precise the location and position of the impacted tooth is known, the easier the procedure becomes.

Odontogenic Cysts and Tumors of Maxilla and Maxillary Sinus (A Clinicopathological Analysis)

Background: Knowledge about the prevalence and distribution of pathologies in a particular location is important when a differential diagnosis is being formulated. The aim of this study was to describe the prevalence and the clinicopathological features of odontogenic cysts and tumors affecting the maxilla and to discuss the unusual presentation of those lesions within maxillary sinus. Materials and Methods: A multicenter retrospective analysis was performed on pathology archives of patients who were diagnosed with maxillary odontogenic cysts and tumors from 2010 to 2020. Data were collected with respect to age, gender and location. Result: A total of 384 cases was identified, 320 (83.3%) cases were diagnosed as odontogenic cysts and 64 (16.6%) as odontogenic tumors. The mean age was 30.5 years with a standard deviation of 16.2 years. Male patients were more commonly affected (n=220, 57.3%). Radicular cyst was the most common cyst (n=205, 64.1%), while the most common tumor was odontoma (n=14, 21.9%) and dentigerous cyst was the most common lesion to present within the maxillary sinus. Conclusion: This study indicates that there are some geographic similarities and differences in regard to distribution of odontogenic cysts and tumors in maxilla and it raises awareness of their presentation within maxillary sinus especially if there is an association with an ectopic or adjacent impacted tooth.

Impact of the Mesioangular Mandibular on the Peridontal Health of Adjacent Tooth by the Third Molar

Objective: The purpose of this study is to assess the impact of mesioangular mandibular 3rd molar impaction on the periodontal health of neighbouring teeth in patients. Study Design: Dental College HITEC-IMS Taxilla/Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Jan 2021-Aug 2021 Place and Duration: Methods: Total of ninety patients of both genders was presented in this study. After receiving informed written consent, detailed demographic information about the recruited cases was collected, including age, gender, body mass index, symptoms, and complications. All of the patients experienced mesioangular third molar impactions on their mandibular teeth. A total of 90 IMTMs were evaluated using panoramic radiographs to determine their impaction depth, relationship with the ramus, and angulation, as well as their association with 2nd molar distal caries and root resorption, pathological states, and proximity to the mandibular canal. The position of the impacted third molar was determined using the Pell and Gregory categorization system. The odds ratio (OR) and 95 percent confidence interval (CI) of IMTM's position on the associated problems are shown in the table below (credible interval for Bayesian models). P-values with two-tailed confidence intervals of less than 0.05 were considered statistically significant. SPSS 27.0 version was used to analyze complete data. Results: There were 55 (61.1%) males and 35 (38.9%) females with mean BMI 24.61±5.22 kg/m2. Most of patients 41 (45.6%) were aged between 20-35 years. Mean attachment level was 2.99±4.74 and probing depth was 3.78±4.61. Caries, pain, and swelling were the most often reported symptoms, according to our research. The most common diseases were distal second molar root caries, which accounted for 30 (33.3%) of all cases, and pocket development, which accounted for 21 (23.3%). According to histological findings, periapical inflammation was the most common finding in 46 (51.1%) of the cases, followed by dental follicle in 24 (26.7%), cyst in 16 (17.8%), and other malignancies in 4 (4.4%) cases. Conclusion: According to the findings of this study, the impacted mandibular third molar was most closely associated with distal second molar root caries and the formation of a pocket between the impacted tooth and the second molar tooth in the lower jaw. Most common pathology linked with the impacted molar was distal second molar root caries and the formation of a pocket between the affected tooth and the second molar. Keywords: Mesioangular, Impacted mandibular third molar, Pathology, Complication

The Correlation between Impacted Third Molar and Blood Group

Background. Blood type is among the most important genetical characteristics of any individual and is shown to be correlated with the development of a variety of illnesses including dental diseases. Finding the association of ABO and Rh blood groups and impacted tooth is important in order to predict which population is more vulnerable to grow impacted third molars that could lead to making better intervention. The present investigation tried to take a small step in that regard, by evaluating the correlation between ABO and Rh blood groups and the most commonly impacted tooth, bony impacted third molars among Iranian individuals. Methods. The investigation was done retrospectively on patients who were referred to the Department of Oral Radiology, Shiraz University of Medical Science, Shiraz, Iran. The patients were classified according to their blood groups, and 40 patients were randomly selected for each blood type. Therefore, the impaction of their third molars was evaluated, and statistical analyses were done in order to find any association. Results. A total of 320 participants contributed to the study; 136 (42%) were males and 184 (57%) were females. The mean age was 29 ± 6 years. Among all participants, 205 (64%) had no impacted third molar, 26 (8%) had one impacted third molar, 43 (13%) had 2 impacted third molars, 5 (1%) had 3 impacted third molars, and 41 (12%) had 4 impacted molars. Conclusion. According to the results of the present study, nearly one out of three individuals has at least an impacted third molar in the Iranian population, being more prevalent in individuals between 20 and 30 years old. The evaluation of the relationship between the blood group and impacted third molar revealed that blood groups have no association with the impacted third molars. However, more studies with higher and diversified participants should be done to find comprehensive results.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.