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Eruption of mandibular second molars usually occurs around the age of 12. Incomplete eruption of second molars in such young patients can lead to loss of the molars, due to caries, root resorption or periodontal pathology. When a pathology of this kind develops, the treatment option for a mesially impacted molar is often to extract the tooth. If tooth eruption is, however, monitored closely by the dentist and/or orthodontist, early treatment can be considered in order to preserve the tooth. Partially impacted second molars can be placed in a functional anatomical position by surgical uprighting and repositioning. As long as certain conditions are met, this results in sound functionality with preservation of the full dentition. In cases of incomplete eruption, this treatment option should therefore be considered by dentists and orthodontists before extracting the second molars.Mandibulaire tweede molaren breken normaliter door rond 12-jarige leeftijd. Gestoorde doorbraak van tweede molaren bij deze jonge patiënten kan leiden tot verlies van de gebitselementen door het ontstaan van cariës, wortelresorptie of parodontale pathologie. Indien dergelijke pathologie zich heeft ontwikkeld, betreft de behandeling van een mesiaal geïmpacteerde molaar vaak verwijdering. Indien de eruptie echter goed gemonitord wordt door de tandarts en/of orthodontist, dan kan een vroegtijdige behandeling overwogen worden met als doel het gebitselement te behouden. Partieel geïmpacteerde tweede molaren kunnen door middel van chirurgische oprichting en repositie in een functionele anatomische positie geplaatst worden. Mits aan enkele voorwaarden is voldaan, resulteert dit in een goede functie met behoud van de volledige dentitie. In het geval van onvolledige eruptie dient deze behandeloptie daarom door behandelaars overwogen te worden vóórdat tweede molaren verwijderd worden.

In a fifteen-year-old girl, bilaterally impacted permanent maxillary canines were established. A difficult palatinal placement and an apical deviation were found in both teeth. Surgical exposure of the canines, followed by orthodontic traction was not desirable. Both remaining primary canines showed signs of resorption. Autogenous transplantation of the maxillary canines was the treatment chosen.Bij een 15-jarig meisje werden bilateraal geïmpacteerde blijvende cuspidaten in de bovenkaak vastgesteld. Van beide gebitselementen was sprake van een moeilijk palatinale ligging en apicale deviatie. Chirurgische vrijlegging van de cuspidaten, gevolgd door een orthodontische extrusie, was niet gewenst. Beide nog aanwezige melkcuspidaten vertoonden tekenen van wortelresorptie. Er werd gekozen voor een bilaterale autologe cuspidaattransplantatie.

Various incision techniques to remove impacted third molars in the mandible have been described, for example, the flap incision, the envelope incision, the distal incision and the modified envelope incision. The aim of this study was to record the incision techniques used by oral and maxillofacial surgeons in the Netherlands for the removal of impacted third molars in the mandible. All members of the Dutch Association of Oral and Maxillofacial Surgery (NVMKA) received a questionnaire. In this questionnaire, the surgeons specified their standard incision technique for the removal of, respectively, mesially impacted, upright, or distally impacted mandibular third molars. Of the 323 questionnaires sent, 172 were returned (53,3% response rate). The flap incision and the distal incision were the most frequently used incisions by oral and maxillofacial surgeons (including residents) in the Netherlands. The academic centre seems to have a lasting impact on the preferred way of removing an impacted third molar. It also seems that an oral and maxillofacial surgeon more frequently removes a third molar in the mandible from a sitting position than a resident.In de literatuur zijn verschillende incisietechnieken beschreven om geïmpacteerde derde molaren in de onderkaak te verwijderen, bijvoorbeeld de flapincisie, de envelopincisie, de distale incisie en de gemodificeerde envelopincisie. Het doel van het onderzoek was het in kaart brengen van de door mka-chirurgen gebruikte incisie­technieken in Nederland bij verwijdering van geïmpacteerde derde molaren in de onderkaak. Alle leden van de Nederlandse Vereniging van Mondzieken, Kaak- en Aangezichtschirurgie (NVMKA) werd een enquête gestuurd. Er kon worden aangeven welke incisietechniek standaard werd gebruikt bij het verwijderen van respectievelijk een mesiaal, rechtstandige of een distaal geïmpacteerde derde molaar in de onderkaak. Van de 323 verzonden enquêtes werden er 172 geretourneerd (53,3% respons). De flapincisie en de distale incisie waren de meest gebruikte incisies door mka-chirurgen (in opleiding) in Nederland. Het academisch opleidingscentrum lijkt een blijvende impact te hebben op de manier van verwijdering van de derde molaar. Tevens lijkt een mka-chirurg de behandeling vaker in zittende positie uit te voeren dan een mka-chirurg in opleiding.

Eruption disturbances of teeth are not unusual; many variations are encountered and eruption disturbances can negatively influence the development of the tooth and jaw system. Causes of eruption disturbances can be categorized into general and local factors. The clinical spectrum of eruption disturbances involves syndromic and non-syndromic problems for both kinds of factors, varying from delayed eruption to primary failure of eruption. The following types of eruption disturbances should be distinguished: impaction, primary retention, secondary retention and primary failure of eruption. Early detection of eruption disturbances and timely and appropriate treatment of the various eruption disturbances play an important role in preventing the negative effects of eruption disturbances on the development of the dentition and the craniofacial skeleton.

Primary failure of eruption is a rare eruption disorder of above all, the permanent second and sometimes the first molars. It is characterized by infra occlusion of the molars resulting in a severe lateral open bite. Primary failure of eruption is a disorders which affects all molars distal to the most mesial involved tooth. Diagnosis is possible both clinically and with radiographs. A panoramic radiograph combined with clinical findings of impaction or infra occlusion can confirm the suspicion of primary failure of eruption. Primary failure of eruption cannot be treated as other eruption disturbances are. The teeth do not respond to orthodontic force. Exposure of the molar and orthodontic traction of a molar affected by primary failure of eruption is discouraged. Observation and extraction, in case the primary failure of eruption poses a risk to the healthy dentition, are the only two treatment options for young patients. Additional treatment of this eruption disorder should be carried out at an adult age and consists of prosthetic closure of the open bite.

A 12-year-old boy was referred by his orthodontist due to the dysmorphic condition of the impacted teeth 18 and 28. Because teeth 17 and 27 were close related to the third molars, the decision was made to remove the impacted teeth under general anaesthesia. During luxation of tooth 28, it was accidentally displaced deeper into the socket. The tooth could still not be localized after the use of radiographs, an antrostomy, and surgical exploration. It was decided to leave the 28 in its place and to perform cone beam computertomography. This showed that tooth 28 was displaced into the infratemporal fossa. Since the patient was free of symptoms, a period of watchful waiting was initiated. A control visit and cone beam computertomography 9 months postoperatively revealed no signs or symptoms or changes in the position of the displaced tooth. It was therefore decided to leave the third molar in its displaced position. Displacement of a maxillary third molar into the infratemporal fossa is considered a rare complication.

The impaction of permanent maxillary canines occurs frequently. In recent decades, research has led to 2 methods of treatment: the modified window technique and the closed eruption technique. Although these methods have been described in detail, it is still not clear which method is most effective. In a study involving 73 orthodontic patients with an impacted, palatally displaced permanent maxillary canine, this cuspid was exposed by means of a gingival flap and an orthodontic bracket was immediately fixed on the exposed canine, after which the gingival flap was repositioned using sutures. The patients were clinically and radiographically examined 3 months after the orthodontic treatment. In a control group consisting of 93 orthodontic patients, there were no cases of impacted permanent maxillary cuspids. The overall success rate for the treatment in the study group was 63%. Problems in adjacent teeth were correlated significantly with older age among the patients. There was a significant difference in the number of pockets around the teeth adjacent to the canines in the study group and in the control group.

A mesiodens is often diagnosed coincidentally during a radiological examination. However, a mesiodens may also be diagnosed in relation to a clinically identified central diastema and an eruption disturbance, or a rotation of a central incisor. In this study of a group of 162 children and adolescents varying in age from 4 to 18 years, with a mesiodens, the frequency of position abnormalities, diastemas, and eruption disturbances of the maxillary frontal teeth was registered retrospectively. One or more of these complications was diagnosed in 72% of the patients. Usually, removal of the mesiodens in children and adolescents results in spontaneous recovery of the complications. Early diagnosis and early treatment are therefore important.

An eruption disturbance of a central maxillary incisor can be caused by the intrusion of a deciduous incisor. Depending on the age of the individual when trauma occurred, this may lead to a so-called dilaceration. Surgical exposure and ligation if needed, followed by orthodontic extrusion, will generally be successful. In one case, the central upper incisor appeared to be dislodged and exposure, ligation and orthodontic extrusion resulted in an excellent aesthetic result.

Eruption failures in the maxillary frontal region occur during the mixed dentition period. Dislocation and impaction of central incisors are diagnosed during or at the end of the early mixed dentition stage. These failures can be caused by crowding, premature loss of deciduous teeth, trauma or supernumerary teeth. Occasionally, a preventive orthodontic treatment is desirable to release the obstructed eruption path of a canine. Sometimes, a surgical intervention may be indicated to expose an obstructed central incisor and to remove supernumerary teeth. Retention and impaction of canines are generally discovered late in or after the late mixed dentition stage. In the agenesis of the lateral incisors or peg-shaped teeth, there is frequently impaction of the canines. General dental practitioners must be alert for possible deviations in the pattern of change in dentition right from the early mixed dentition period. Conventional two-dimensional radiographs can sometimes unjustifiably suggest a bad prognosis of an impacted tooth. Cone-beam CT scanning, which gives a three-dimensional image, can provide important additional diagnostic information.

Since the introduction of composites and bonding in orthodontics, the possibilities of aligning impacted teeth into the dental arch after a surgical intervention, have remarkably increased. There are 4 important treatment techniques. The closed-eruption technique includes bracket-bonding to and ligating of the exposed tooth, followed by repositioning of the mucosal flap. The disadvantage of the method is the uncontrollable orthodontic force on the non-visible tooth during orthodontic extrusion. The open-eruption technique aims at keeping the exposed tooth visible, followed by spontaneous eruption. However, the exposure appears often as a radical exposure with unfavourable gingival consequences. The open-eruption technique with apical positioned mucosal flap is designed to expose teeth highly buccally impacted. The mucosal graft may cause a typical thick, stretched and not aesthetically acceptable gum after orthodontic treatment, even in case of using a split-thickness graft. The modified window technique is an open-eruption technique with minimal exposure, resulting in immediate eruption. If orthodontic treatment is required, the tooth is no longer impacted. The success rates of the 4 techniques vary from 75 until 99%. Study of the literature reveals insufficient scientific evidence in favour of 1 treatment technique. However, independent of the surgical technique applied, general practitioners play a crucial role in diagnostics of eruption failures and timely referral to an orthodontist.

Patients suffering from familial adenomatosis polyposis develop multiple pre-malignant gastrointestinal polyps and are at high risk of developing colon cancer. In addition extra-intestinal manifestations are observed frequently. The combination of extra-intestinal manifestations and familial adenomatosis polyposis is named Gardner's syndrome. An early diagnosis of this disease is important because it could mean a better prognosis for the patient. This review describes the oral and maxillofacial symptoms of FAP, and its potential implications for dental treatment.

A 22-year-old male patient was referred by his dentist to a department of Oral and Maxillofacial Surgery because of recurrent swelling of the oral mucosa of unknown origin in region 17. One year before, molar 17, although clinically sound but showing an apical radiolucency, was endodontically treated. Eight months ago, molar 17 was removed because of recurrent complaints. Clinical examination revealed a fistula with purulent drainage in region 17. Radiographic examination revealed the cause, viz. a follicular cyst originating from the right wisdom tooth located in the maxillary sinus. Thus, the persisting complaints in region 17 were not related to molar 17, but related to a chronically inflamed follicular cyst originating from an impacted third molar.

Eruption disturbances of teeth should not be considered as a curiosity. Acquaintance with these phenomena should form a substantial component of the dentist's, orthodontist's and oral and maxillofacial surgeon's basic expertise. Early detection of these disturbances followed by treatment in due time, can minimise progressive negative effects, such as the development of severe malocclusion. Treatment modalities are described.

In contrast to removal of other teeth and roottips, a third molar is mostly removed for preventive reasons. There is still debate about the correct indications for removal of third molars. As soon as the decision to remove a third molar surgically is made, the dentist has to decide between performing the surgical procedure himself or referring the patient to an oral and maxillofacial surgeon. Level of difficulty of the treatment and experience, available time, availability for postoperative care, and personal interest of the dentist are issues influencing this decision. This article describes systematically the indications, for instance using preoperative radiodiagnostics, the factors determining the technical surgical plan, as well as the practical surgical procedures.

The records of 68 adult patients, referred to a Department of Oral and Maxillofacial Surgery for extraction of one or more teeth, have been studied with regard to the complexity of the treatment and the postoperative course. In 11 patients surgical removal had to be performed, while in the remaining 57 patients treatment consisted of simple extractions. Forty-six patients of these 57 patients returned a questionnaire about postoperative problems and use of analgesics. These patients were divided into two groups, one consisting of 17 healthy patients without any medical disorder and/or use of drugs, and a second consisting of 29 medically compromised patients. The postoperative course did not differ between both groups. Four patients (1 healthy, 3 medically compromised) experienced postoperative complaints during more than 6 days. Remarkably, the number of patients who experienced pain but did not use analgesics was considerably higher in the healthy group (29%) compared with the medically compromised group (7%). On the other hand, medically compromised patients more often experienced pain in spite of the use of analgesics (52%) than healthy patients (41%). No differences in wound healing after simple tooth extractions were observed between healthy and medically compromised patients.

Two developing supernumerary bicuspids were noticed accidentally in the mandible of a 12 years old girl when evaluating an impacted 35 on a radiograph. The development of these teeth was followed, but at a later stage they were removed. In a 17 years old man multiple complete developed bicuspids were seen on a radiograph. The backgrounds and treatment concerning supernumerary bicuspids in the mandible are discussed.

62 patients with clefts of the alveolus who had received alveolar bone grafts (iliac crest) at ages 8.6 to 12.8 years (mean 10.1 years) were studied. The eruption of 73 canines from 11 bilateral and 51 unilateral cleft patients could be evaluated. The postoperative observation period ranged from 2 to 16 years (mean 9 years). Spontaneous eruption occurred for 77% of the canines, 20% required surgical uncovering either bony or/and soft tissue. One canine had to be removed and one canine is still impacted.

A disturbance in the normal eruption pattern of one or both of the maxillary canines is found in 1% to 2% of the teenagers aged ten to thirteen years. Frequently, dentists refer these patients to orthodontists who, in turn, seek the assistance of an oral and maxillofacial surgeon to retrieve the impacted canine, either by exposure alone or by exposure and attachment of a bracket and ligature for orthodontic extrusion. A common request in this procedure is the extraction of the persistent upper deciduous canine and/or, in case of an Angle Class II molar relationship, extraction of the upper first premolar. It has been shown, however, that on average 15% of these exposed or ligated maxillary canines fail to erupt. Therefore, one should be reluctant to extract the deciduous canine or the permanent first premolar before it is clear that the impacted maxillary canine will indeed erupt after surgical exposure and/or placing of a bracket and ligature for orthodontic extrusion.

Third molars are often removed in order to prevent complications and various other problems associated with impacted third molars and their removal. Abortion of mandibular third molars is a procedure carried out at an early age in those subjects where there is insufficient room for the eruption of the third molars. On the other hand one can also decide to remove the second molars and to annexate orthodontically the third molars in the arch.

Prevention of impaction depends in many cases on the knowledge of variations in eruption sequences. However, in case of impaction, spontaneous eruption can be stimulated by exposing the tooth with the modified window-technique. Frequent communications between dentist, orthodontist and oral surgeon are required to determine the right time of intervention.

The clinical, radiographical and histological aspects of secondary retention in permanent molars were studied in a group of 53 patients with 81 secondarily retained permanent molars. First molars turned out to be affected most frequently. The mean infraocclusion at the patients' first visit was 4.3 mm. After six months, infraocclusion had increased in adolescents. It seemed to be stable in adults. Tilting of adjacent teeth was observed in 39 cases of secondary retention. A solid, clear percussion sound and a partial absence of the periodontal ligament space on radiographs was only noted in less than 20% of the affected molars, while histological examination of 38 removed molars revealed that local areas of ankylosis were present in all cases. During a follow-up period of four years, six new cases of secondary retention were observed in the same population.

Treatment goal of the maxillary impacted cuspid should include health periodontal end results. This clinical and radiographic study reveals in 75% of the cases a satisfying periodontal condition.

Delayed eruption of impacted canines in more or less guaranteed by using the modified window technique. A decision for futher treatment can be made afterwards. If orthodontic treatment is required, fixed appliance is recommended for uneventful orthodontic positioning of these teeth.

A review of the treatment of the impacted upper cuspid is presented. A description of a modified exposure technique is given. Up to the present day more than 400 impacted cuspids have been treated with this technique.

Attention is paid to the normal and disturbed eruption of the upper cuspid. Genetic factors seem to play the most important role in impaction or delayed eruption. The dentist needs to be aware of the diagnostic and roentgenological features of this phenomenon.

Impacted upper cuspids may give rise to problems, such as the formation of cysts and the resorption of adjacent teeth. Early diagnosis (before the age of 12) is important. Proper timing of extraction of the deciduous cuspid may lead to spontaneous correction. When the position of the cuspid is unclear, orthopantomography and a lateral skull film may be helpful. Palatally impacted cuspids should be exposed surgically and moved into position by orthodontic treatment. Labially impacted cuspids are exposed by relocation of an attached gingival flap. The experience of the authors with the treatment of 81 patients are reported.