Abnormality in the Morphogenesis of Tooth Development and Relationship with Orthodontic Deformities and Treatment Approaches

In the process of odontogenesis, a disturbance in the formation of the epithelium and mesenchyme can be observed and this can be manifested by atypical forms of dental development. Such biological phenomena with altered morphology are as follows: dens invaginatus (DI), dens evaginatus (DE), talon cusps, and double teeth (DT) or connate teeth (fusion and gemination). Patients with orthodontic anomalies who also exhibit teeth with morphogenetic disorders are presented in this article. Dens evaginatus and talon cusps pose orthodontic challenges in the treatment finishing phase. These reduce the possibility of achieving maximum intercuspidation between the lower and upper front teeth as well as poor incisor guidance. Other orthodontic challenges are as follows: the risk of occlusal trauma and periodontal loading of the antagonists and the possibility of accessory cusps to play the role of the inclined plane and lead to deviations in the closure of the lower jaw. The fused teeth can cause aesthetic and occlusal disturbances in the anterior segment. Furthermore, double teeth can lead to ectopic eruption or noneruption of adjacent teeth due to their increased crown size as is the case with one of the presented patients. This is because a double tooth occupies more space in the dental arch. If not diagnosed early, impaction of the adjacent tooth, violation of the occlusal ratios (Bolton/anterior), and exacerbation of the orthodontic deformity can be observed. The modern CBCT imaging is the best diagnostic method for identifying problems related to tooth positions or tooth germs.

Ectopic Eruption of the First Permanent Molar in the Maxilla: Cephalometric Features of 13 Pediatric Patients

Ectopic eruption of the first permanent molar in the maxilla, generally characterized by the wrong axial positioning during eruption, is reported to occur in about 2–6% of children. Its incidence is surely under-estimated as it frequently remains undiagnosed and, additionally, becomes irreversible, resulting in posterior crowding in such cases. This retrospective study aims to investigate the cephalometric features of patients affected by ectopic eruption of the maxillary first molar in comparison to a control group of patients. From a total of 1935 subjects, 13 patients were enrolled in the study group, while 26 patients were randomly selected as a control group. Lateral cephalometric teleradiographs obtained at the time of diagnosis were used to measure cephalometric values between study patients and controls. The prevalence of ectopic eruption of the first maxillary permanent molar in our patients was 1.14%. The mandibular angle (SN-GoMe) was found to be significantly greater in the study group than in control. The same statistical trend was observed for the inter-maxillary angle (SnaSnp-GoMe); also, the distance Sna-Me was greater in the study group. Differences between groups were statistically significant for the following distances: Snp-Sna, Ba-S and SOR-Sna, which were found to be, overall, greater in the study group. Ectopic eruption of the first permanent molar in the maxilla seems to be associated with morphogenetic characteristics of patients, mainly with a dolichocephalic pattern.

Long term radiographic evaluation of a potentially impacted and dilacerated tooth into complete transposition

Background: Anomalies such as ectopic tooth eruption and transposition are challenging situations that may complicate the orthodontic treatment. Some of these anomalies can only be diagnosed and managed by accurate long-term radiographic examination. Delayed diagnosis could impede simple preventive orthodontic measurements and cause more costly and consuming future complicated orthodontic treatment.Case Description: We described in detail the long term follow-up of a young female patient referring with a unilateral ectopic eruption. The patient was under close observation and regular orthodontic treatment to guide a unilateral ectopic eruption into a complete transposition of an upper left canine and first premolar. The long term follow-up revealed stables results.Practical Implications: Early diagnosis and preventive measurements in patients suffering from anomalies such as ectopic eruption is crucial in order to avoid further complications such as tooth impaction and dilaceration formation and adopting the best choice of treatment.

The Piston Elastic: A Novel Device for Treating Entrapped Ectopic Permanent Molars

Ectopic eruption of the permanent molar may absorb the distal root of the primary second molar and may result in a decreased arch length or delayed eruption of the permanent tooth, requiring timely treatment. Therefore, we devised an effective and convenient method to unlock the entrapped tooth using a novel device called a “piston-elastic”. This case report aims to explain the design and clinical application of this piston-elastic and to describe successful cases. Three patients (aged 6, 13, and 16 years) with ectopically erupted maxillary and mandibular molars, respectively, were treated with a piston-elastic. It was bound to the locked molar to improve the eruption path. After a certain time period, the repulsive force pushed the surface of the adjacent tooth, improving the eruption path of the entrapped tooth. The piston-elastic is a novel device that simply and effectively changes the direction of eruption of ectopically entrapped molars. As it can be manufactured and attached to the chair side, impression acquisition on a model cast and laboratory procedures are unnecessary. Compared to existing methods, the piston-elastic can be easily produced and delivered, causes little irritation, and is inexpensive.

Impactação dentária de caninos permanentes - consequências e relação com ortopedia funcional dos maxilares

Clinical experience and knowledge of normal growth and development of children, as well as radiographic studies of the dental eruption evolution, are important to supervise the maxillary permanent canine eruption. Clinical observations of signs and symptons such as digital palpation of the permanent canine bulges above the primary canine apex, on children of about nine years old, is a very important step for the diagnosis of ectopic eruption. Dentist may find more help with the early diagnosis, to avoid complications that are not so frequent to happen, but are still a burden such as traction and adjacent root tooth resorption.

Erupção ectópica do primeiro molar permanente

Ectopic eruption of the first permanent molar means that the molar erupts at an angle usually mesial to its normal path of eruption, causing an atypical resorption in the distal root of the second deciduos molar. In some cases the permanent molar frees itself and reaches normal oclusion, in others, is needed to bring the permanent molar to oclusion. The prevalence of ectopic eruption has been reported to be about 3%.

Evaluation of the mesio-distal positioning of the maxillary first permanent molar in individuals with ectopic eruption

Objective: To evaluate the mesial-distal positioning of the maxillary first permanent molar in children who present with ectopic eruption of the maxillary first permanent molar (PFMEE). Methods: panoramic radiographs and lateral cephalometric radiographs 12 children of both genders were evaluated. The study group was composed of 12 children with PFMEE and the control group was composed of 12 children with normal occlusion with the first upper permanent molar in occlusion. After selecting the exams from both groups and performing the anatomical tracings, linear and angular measurements were performed. In the lateral cephalometric radiographs the following angles were evaluated: SNGo.GN, SN.GN, SNA, SNB, ANB, 6mx.Palatal Plane and the 6mx.PTV distance. In the panoramic radiograph the angles 6mx.Infraorbital Plane and 6mx.Occlusal Plane were evaluated. Results: PFMEE can occur in individuals regardless of their skeletal pattern. The control group showed much greater angular measurements 6mx.Palatal Plane and 6mx.Infraorbital Plane. Conclusion: There is no relationship between PFMEE and craniofacial growth pattern, there is no direct relationship with the anteroposterior relationship of the apical bases and in cases of PFMEE the mesial angulation is reduced, representing lack of space for eruption of the first permanent molars.