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Objectives: This study aimed to assess whether awake bruxism and masticatory muscle activity could be related to external root resorption (ERR) in second molars adjacent to impacted mandibular third molars., Materials and Methods: Sixty patients, with requests for a cone-beam, computed tomography, were divided into two groups: ERR (patients with ERR in the second molar, n = 30), and control group (n = 30). Awake bruxism was assessed through the Oral Behaviors Checklist (OBC) and an ecological momentary assessment (EMA). Surface electromyography (EMG) was used to assess the masseter and anterior temporal muscle function. Normality and homogeneity of variances were demonstrated. Descriptive analysis was performed, using the T-test and Chi-square test to compare the characteristics of the groups. A multiple regression model was performed., Results: The ERR group presented more non-functional oral activities related to awake bruxism than the control group, according to OBC (p = 0.027) and EMA (p = 0.035). In addition, the ERR group had higher EMG activity than the control group in rest and isotonic protocols (p < 0.05)., Conclusions: Awake bruxism and greater masticatory muscle activity seem to be related to the presence of ERR in second molars adjacent to impacted mandibular third molars., Clinical Relevance: The results of the present study can reinforce the theory that triggering ERR in the second molars adjacent to impacted mandibular third molars may be related to mechanical forces coming from the masticatory function., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The objective of this article is to establish a large sample-based prediction model for maxillary canine impaction based on linear and angular measurements on panoramic radiographs and to validate this model., Materials and Methods: All patients with at least two panoramic radiographs taken between the ages of 7 and 14 years with an interval of minimum 1 year and maximum 3 years (T1 and T2) were selected from the Department of Oral Health Sciences, University Hospital Leuven database. Linear and angular measurements were performed at T1. From 2361 records, 572 patients with unilateral or bilateral canine impaction were selected at T1. Of those, 306 patients were still untreated at T2 and were used as study sample. To construct the prediction model, logistic regression analysis was used., Results: The parameters analyzed through backward selection procedure were canine to midline angle, canine to first premolar angle, canine cusp to midline distance, canine cusp to maxillary plane distance, sector, quadratic trends for continuous predictors, and all pairwise interactions. The final model was applied to calculate the likelihood of impaction and yielded an area under the curve equal to 0.783 (95% CI [0.742-0.823]). The cut-off point was fixed on 0.342 with a sensitivity of 0.800 and a specificity of 0.598. The cross-validated area under the curve was equal to 0.750 (95% CI [0.700, 0.799])., Conclusion: The prediction model based on the above mentioned parameters measured on panoramic radiographs is a valuable tool to decide between early intervention and regular follow-up of impacted canines., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Introduction: This study aimed to identify significant factors affecting the spontaneous angular changes of impacted mandibular third molars as a result of second molar protraction. Temporary skeletal anchorage devices in the missing mandibular first molar (ML-6) or missing deciduous mandibular second molar (ML-E) with missing succedaneous premolar spaces provided traction., Methods: Forty-one mandibular third molars of 34 patients (10 male and 24 female; mean age 18.3 ± 3.7 years) that erupted after second molar protraction were included in this study. They were classified into upright (U) and tilted (T) groups. Linear and angular measurements were performed at the time of treatment initiation (T1) and of ML-6 or ML-E space closure (T2). Regression analyses were used to identify significant factors related to third molar uprighting., Results: Nolla stage (odds ratio [OR] 4.1), sex (OR 0.003 for male), third molar angulation at T1 (OR 1.1), missing tooth space (OR 0.006), rate of third molar eruption (OR 23.3), and rate of second molar protraction (OR 0.2) significantly affected third molar uprighting. Age, third molar angulation at T1, rate of third molar eruption, and rate of second molar protraction were significant factors for predicting third molar angulation at T2., Conclusions: Available space for third molar eruption before and after second molar protraction is not associated with uprighting of erupting third molars. Older patients whose third molars are in greater Nolla stage, are in a more upright position at T1, and have a greater eruption rate have a greater chance for third molar uprighting. Alternatively, an increase in second molar protraction rate results in mesial tipping of the third molars., (Copyright © 2019 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Impacted third molars (ITM) are the most commonly-impacted teeth. There is a risk for ITM to cause a number of pathological conditions, and external root resorption (ERR) of adjacent teeth is one of the most prevalent. Retaining or prophylactic extraction of ITM is a polemic topic. External root resorption of adjacent teeth is one of possible indications for prophylactic removal of ITM. The aim of this study was to assess the relationship between external root resorption (ERR) on the distal aspect of second molars' roots and positional parameters of ITM. Methods : Cone beam computed tomography scans of 109 patients (41 males, 68 females; mean age 26.4 ± 7.9 years) with 254 ITM (131 in the maxilla and 123 in the mandible) were retrospectively analyzed. Positional parameters of ITM (mesio-distal position, angulation, impaction depth, and available eruption space) were evaluated. The presence, location, and depth of ERR of adjacent second molars were assessed. Results: Analysis showed a relationship between ITM impaction depth, mesial inclination angle, and the presence of ERR. Mesial inclination angle of more than 13.6° increased the odds of ERR occurrence by 5.439 (95% CI, 2.97-9.98). ITM presence at the level of ½ of roots of the adjacent second molar or more apically increased the odds of ERR occurrence by 2.218 (95% CI, 1.215-4.048). No significant correlation was detected between the occurrence of ERR and patient age, gender, or the available eruption space in the mandible. Depth of ERR did not depend on its location. Conclusions: Incidence of ERR in second molars is significantly associated with mesial inclination and a deep position of ITM.

Background: Even though periodontal health was suggested to be not related to the traction technique, some other variables might influence the esthetic outcome of palatally displaced canines (PDC) when aligned, such as the initial position and impaction rate of the canine before treatment. The purpose of the present study was therefore to evaluate the existing correlations between periodontal health outcome of PDC after their exposure and alignment and their initial position identified according to the different rates of impaction severity., Materials and Methods: The final sample enrolled 293 PDC which satisfied inclusion and exclusion criteria. All the canines were exposed using CT by the same oral surgeon and orthodontic traction was applied using the easy cuspid device followed by fixed appliance treatment. Image analysis and periodontal status evaluation were performed for all PDCs., Results: α-Angle and d-distance showed no significant differences in the periodontal outcome of PDCs after treatment. The only tested variable showing significant differences was S, since canines with CEJ visible at the end of the treatment presented sectors with a mean score of 1.67, which was significantly different (P < 0.05) when compared to the S-sector for the canines that showed PD < 2 mm at the end of the treatment., Conclusions: Radiographic variables as α-Angle and d-distance seem to not influence the periodontal outcome of the treated impacted canine regardless of the amount of gravity. On the contrary, S-sector might play a significant role when higher rates of gravity are present suggesting the possibility in few cases for periodontal damage at the end of treatment.

Introduction: The aim of this study was to compare the root resorption (RR) of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage., Methods: This retrospective longitudinal study included 60 cone-beam computed tomography scans of patients with maxillary impacted canines: 30 scans taken before and 30 taken after orthodontic traction with nickel-titanium coil springs. Two groups were formed according to the impaction condition: 15 with unilateral maxillary impacted canines and 15 with bilateral maxillary impacted canines. Three trained orthodontists made the measurements. Demographic variables, occlusal characteristics, skeletal class, and measurements related to canine impaction were collected from the clinical history, dental models, and radiographs of each patient. RR (mm and mm 2 ) for each maxillary incisor was measured in 3 dimensions. Independent t or Mann-Whitney U tests were used, depending on data normality. Multiple linear regression analyses were used to evaluate the influence of all variables (predictors) on RR (α = 0.05)., Results: RR did not show significant differences between groups in any section (P > 0.05). No subject had RR greater than 2 mm or 5 mm 2 . The specific influence of some predictor variables varied depending on the type of maxillary incisor., Conclusions: RR of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage was similar and is not a risk to the integrity of the maxillary incisor root., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to assess the eruption of impacted teeth in cleft lip and/or palate (CLP) after alveolar bone graft., Materials and Methods: Research was carried out through a cross-sectional study at the Craniofacial Rehabilitation Center of the University General Hospital of the University of Cuiabá, Mato Grosso, Brazil. Variables related to cleft, cleft side, gender, age, laterality of cleft, impacted teeth, and orthodontic traction were analyzed., Results: Forty-two patients treated at the institution from 2004 to 2011 had their charts retrospectively reviewed. They were 54.7% male and 45.2% female. The group aged 9 to 11 years was most affected, representing 59.5% of cases. A unilateral cleft was the most prevalent craniofacial anomaly (85.7%). A total of 57 impacted teeth were observed. Maxillary canines were the most commonly impacted teeth (97.6%) and the most frequently identified in patients with a transforamen incisor cleft (TIC) (76.3%). Orthodontic traction was required for both impacted maxillary canines and impacted lateral incisors (64.3 and 35.7% respectively). The orthodontic traction was required only in patients with a TIC (p = 0.0101)., Conclusion: The canine teeth were the most commonly impacted teeth, found mainly in patients with a TIC. After placement of the alveolar bone graft in patients with a preforamen incisor cleft (PIC), all impacted teeth erupted spontaneously., Clinical Significance: An impacted tooth can have negative consequences on a patient's quality of life. Thus, a survey evaluating the incidence and prognosis of impacted teeth after an alveolar bone graft for CLP was important.

Objective: Canine impaction is a dental anomaly involving intraosseous displacement of the unerupted tooth. This situation is of significant importance causing orthodontic, surgical and interceptive problems. Trauma in the incisor area is a possible cause of the displacement of the tooth bud of the permanent canine resulting in the deviated eruption path. The aim of this article is to present two clinical cases with diagnosis of maxillary canine displacement and impaction in the incisor region after a traumatic injury during childhood, discussing treatment possibilities and outcomes achieved after orthodontic treatment., Materials and Methods: In this article ectopic maxillary canines migration in the central incisor area after a traumatic injury to the anterior upper teeth are described. The path of eruption of the canine can cause severe central incisor root resorption. Treatment strategy established for the case reports described involves orthodontic space opening, extraction of the central incisor, uncovering the impacted canine and orthodontic traction of the tooth in place of central incisor. Modification of crown morphology and color were essential to obtain an aesthetic and function outcome., Results: The patients finished treatment with normal and stable occlusion, an adequate width of attached gingiva and good aesthetic results., Conclusion: Authors suggest that might have been a possible connection between the trauma of primary dentition causing the displacement of the tooth bud of permanent canine and the deviated path of eruption. For the growing patients with a combination of dental trauma and ectopic eruption, maxillary canine to replace a central incisor was a viable option, offering excellent aesthetic results without recourse to prosthetic replacement.

Food impaction after impacted mandibular third molar extraction is a serious problem that should not be ignored. Incomplete suturing of the distal incision in the conventional method is the main cause of food impaction and delayed wound healing. The present study introduces a novel suture and drainage technology that requires hermetic suturing of the distal incision and rubber drainage for buccal drainage. 76 patients with horizontally/mesially impacted third molars (bilateral) were enrolled in this prospective study. An impacted tooth on one side of each patient was extracted by occlusal drainage using the conventional method, whereas the other side tooth was extracted by buccal drainage using the novel method. The differences in wound healing, facial swelling, bleeding and dry socket between the two sides of each patient were compared postoperatively, and the trends for patient selection of the surgical method were also compared. The results indicated that buccal drainage had obvious advantages in wound healing and reduced the risk of postoperative bleeding, and most patients preferred this technique; there were no significant differences in postoperative facial swelling or pain. Thus, buccal drainage can solve the problem of long-term food impaction induced by traditional incision postoperatively and is worthy of clinical promotion.

A 22-year-old woman came with a unilateral missing mandibular first molar and buccal crossbite. The open space was closed by protraction of the mandibular left second molar and uprighting and protraction of the horizontally impacted third molar using temporary skeletal anchorage devices, and her buccal crossbite was corrected with modified palatal and lingual appliances. The total active treatment time was 36 months. Posttreatment records after 9 months showed excellent results with a stable occlusion., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the relationship between dental follicle width and maxillary impacted canines' descriptive and resorptive features with three-dimensional (3D) cone-beam computed tomography (CBCT)., Methods: The study comprised 102 patients with cone-beam computed tomography 3D images and a total of 140 impacted canines. The association between maxillary impacted canine dental follicle width and the variables of gender, impaction side (right and left), localization of impacted canine (buccal, central, and palatal), and resorption of the adjacent laterals was compared. Measurements were analyzed with Student's t -test, Kruskal-Wallis test, and Mann-Whitney U statistical test., Results: According to gender, no statistically significant differences were found in the follicle size of the maxillary impacted canine between males and females ( p > 0.05). Widths of the follicles were determined for the right and left impaction sides, and no statistically significant relation was found ( p > 0.05). There were statistically significant differences between root resorption degrees of lateral incisors and maxillary impacted canine follicle width ( p < 0.05). Statistically significant higher follicle width values were present in degree 2 (mild) resorption than in degree 1 (no) and degree 3 (moderate) resorption samples ( p < 0.05)., Conclusions: No significant correlation was found between follicle width and the variables of gender, impaction side, and localization of maxillary impacted canines. Our study could not confirm that increased dental follicle width of the maxillary impacted canines exhibited more resorption risk for the adjacent lateral incisors.

The aim of the present study was to investigate the influences of the presence and position of a lower third molar (M3) on the fragility of mandibular angle and condyle, using finite element analysis. From computed tomographic scans of a human mandible with normally erupted M3, two additional virtual models were generated: a mandibular model with partially impacted M3 and a model without M3. Two cases of impact were considered: a frontal and a lateral blow. The results are based on the chromatic analysis of the distributed von Mises and principal stresses, and calculation of their failure indices. In the frontal blow, the angle region showed the highest stress in the case with partially impacted M3, and the condylar region in the case without M3. Compressive stresses were dominant but caused no failure. Tensile stresses were recorded in the retromolar areas, but caused failure only in the case with partially impacted M3. In the lateral blow, the stress concentrated at the point of impact, in the ipsilateral and contralateral angle and condylar regions. The highest stresses were recorded in the case with partially impacted M3. Tensile stresses caused the failure on the ipsilateral side, whereas compressive stresses on the contralateral side., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess the null hypothesis that there is no difference in the rate of dental development and the occurrence of selected developmental anomalies related to shape, number, structure, and position of teeth between subjects with impacted mandibular canines and those with normally erupted canines., Materials and Methods: Pretreatment records of 42 subjects diagnosed with mandibular canines impaction (impaction group: IG) were compared with those of 84 subjects serving as a control reference sample (control group: CG). Independent t-tests were used to compare mean dental ages between the groups. Intergroup differences in distribution of subjects based on the rate of dental development and occurrence of selected dental anomalies were assessed using χ(2) tests. Odds of late, normal, and early developers and various categories of developmental anomalies between the IG and the CG were evaluated in terms of odds ratios., Results: Mean dental age for the IG was lower than that for the CG in general. Specifically, this was true for girls (P < .05). Differences in the distribution of the subjects based on the rate of dental development and occurrence of positional anomalies also reached statistical significance (P < .05). The IG showed a higher frequency of late developers and positional anomalies compared with controls (odds ratios 3.00 and 2.82, respectively; P < .05)., Conclusions: The null hypothesis was rejected. We identified close association of female subjects in the IG with retarded dental development compared with the female orthodontic patients. Increased frequency of positional developmental anomalies was also remarkable in the IG.

Background: Goal of the research was to study occurrence frequency of impacted teeth, to develop rational methods of diagnostics and treatment of denotalveolar and facial anomalies caused by impacted teeth., Patients and Methods: From 1989 for 2013 period of time 7172 patients with dentoalveolar anomalies, referred to our clinic for the orthodontic help were surveyed., Results: At 899 (12.53 +/- 0.39%) patients it is revealed 1405 impacted teeth, from them on the maxilla--623, on mandible--752 teeth. The most widespread impacted teeth on the maxilla were canines, on the mandible--the second premolars and the third molars. Treatment of impacted teeth by stimulation of their eruption by low-frequency ultrasound with a frequency of fluctuations of 26.5 kHz, intensity of 1 W/cm, with an amplitude of 40-60 microns and wave of 0.012 m long, daily or within 1 days, with period of 3-10 seconds with the course of treatment averaging 1-5 procedures, until a tooth eruption is carried out., Conclusion: The way of stimulation developed by us for late erupted impacted permanent teeth on the basis of application physiologic for an organism low-frequency ultrasound promotes increase of efficiency and reduction of treatment terms of dentoalveolar and facial anomalies. The received positive results allow to recommend this method for adoption in orthodontic practice.

Objective: To compare the root development and the growth rate of the mandibular third molar (M3 inf) in individuals where the M3 inf erupted vs individuals exhibiting M3 inf impaction., Materials and Methods: Serial standardized intraoral radiographs (Eggen technique) were taken annually of the mandibular third molar region from 132 subjects (71 male and 61 female) from 15 to 20 years of age. Based on the films, 264 lower third molars were classified into an eruption and an impaction group. Root development was recorded according to a quantitative method described by Haavikko (1970), and the eruption status was analyzed using logistic regression., Results: In total, 155 (59%) of the M3 inf erupted, and 109 (41%) were impacted at age 20. In 44 (33%) patients both M3 inf were impacted, in 21 (16%) patients one tooth was erupted and the contralateral tooth impacted, and in 67 (51%) patients both M3 inf were erupted. The more mature a tooth was at age 15, the higher was the probability of eruption (odds ratio: 3.89, P < .001). The growth rate of the root development stage was statistically significantly associated with the probability of eruption (odds ratio: 10.50, P  =  .041)., Conclusions: Delayed mandibular third molar root development is associated with impaction. Radiographs taken at age 15 may predict the risk of impaction and thereby guide decision making for the orthodontist or the oral and maxillofacial surgeon.

Delayed tooth eruption can affect the accuracy of orthodontic diagnosis and treatment planning and could delay overall treatment. A girl, aged 7 years 4 months, who had unilateral delayed eruption of several teeth was successfully treated. The evaluation of delayed tooth eruption should be considered by the orthodontist because the role of these teeth can affect the overall treatment of malocclusion. In patients with delayed tooth eruption, careful and accurate diagnosis and treatment planning will allow the orthodontist to start treatment at the proper stage and might reduce the overall orthodontic treatment time., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

One of the main criteria used in dental age diagnostics in living adolescents and young adults is assessment of the mineralisation stage of the third molars. In the case of Europid populations, it has been established that impaction status has an influence on the rate of mineralisation of the third molars. In view of this, a study was undertaken to determine whether the chronological process of wisdom tooth mineralisation is dependent upon impaction status in black Africans too. Orthopantomograms (553) of 437 male and 116 female black South Africans with verified birth dates in the age group between 10 and 26 years were studied. Mineralisation stage and impaction status were determined for all third molars. Statistical measures were calculated for the mandibular wisdom teeth at stages F, G and H and for the maxillary wisdom teeth at stage H in the male gender for both impacted and non-impacted third molars. It was ascertained that the minimum age in persons with impacted third molars, depending on the wisdom tooth observed, was 0.19-2.57 years higher than in those with non-impacted wisdom teeth. Test persons with impacted mandibular wisdom teeth at stage F or G were on average between 0.32 and 1.88 years older than those with non-impacted mandibular wisdom teeth. The 50 % probability values of impacted wisdom teeth at stage H were 1.85-3.31 years higher than those in non-impacted wisdom teeth. The conclusion was drawn that in male black Africans, impacted mandibular wisdom teeth mineralise more slowly than non-impacted lower third molars. The presence of impacted mandibular wisdom teeth in mineralisation stage H in male black Africans does not, however, furnish proof of completion of the 18(th) year of life beyond reasonable doubt.

Objectives: To propose a treatment protocol for the management of impacted second molars., Materials and Methods: Patients were randomly divided into two equal groups (20 patients in each). The patients in the first group underwent a surgical removal of the mucosa covering retained teeth; the second group was the control group and patients were not treated but only observed. The total number of retained teeth considered were 66 (34 in the first group and 32 in the control group). A Chi squared test has been performed to compare the prevalence of eruption in the two groups. We compared the frequency of eruption for the treatment compared to the control group by calculating the risk ratio (RR) and 95% confidence interval (95% CI)., Results: Eruption occurred in 32 teeth after surgical removal of the mucosa while in the control group only 3 teeth erupted in the considered period. The difference between the two groups showed statistically significant. Among the non erupted teeth, 20 were positioned with a mesial inclination and 12 were positioned vertically., Conclusions: The results show that the removal of the mucosa covering teeth allows in several cases second molars to erupt. It's a conservative method which doesn't exclude the possibility of a successive different therapy. Therefore it must be considered among the treatment options during treatment planning., (Copyright © 2011 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.)

The modern version of the Dental Impaction Pain Model (DIPM) was developed in the mid-1970s. Since that time, several hundred studies have been conducted by numerous investigators. Today it is arguably the most utilized of all the acute pain models. Its popularity is due to the success rate of the studies, fast subject entry, and cost effectiveness. The surgical procedure is extremely standardized, and the surgery requires either minimal or no use of CNS depressant anesthetics. The methodology is similar to that utilized in other acute pain models; however, the DIPM is much more versatile than most other models. The model can be easily adapted to perform multiple-dose studies, pharmacokinetics/pharmacodynamics (PK/PD) correlations, preemptive interventions, and sleep-pain studies. A few investigators have even developed microdialysis techniques, wherein they insert probes into extraction sockets to collect exudates for measuring biochemical mediators of pain or drug levels at the site of injury. In many instances, an accomplished site can complete a study of several hundred subjects in approximately 3 months. There are studies in the literature that have incorporated up to six treatment arms in one study and clearly separated the drugs from each other. The exquisite assay sensitivity is due to the homogeneity of the study population, the predictable level and appropriate intensity of the postsurgical pain, and the minimizing of variability by using only one or two study centers. The DIPM has been employed to evaluate NSAIDs (both nonselective and selective Cox inhibitors), opioids and combination analgesics, as well as some investigational drugs with unique mechanisms of action. The model is particularly useful for proof-of-concept studies that require dose-ranging and profiling the time-effect curve for efficacy including onset, peak effect, and duration of analgesic activity.

Background: Small upper lateral incisors in patients with palatally impacted canines may contribute to inter-arch tooth size discrepancies., Aim: To compare the Bolton ratios in female patients with and without unilateral palatally impacted canines., Methods: The pretreatment dental casts of 30 female patients with unilateral palatally impacted canines (Impaction group) and 30 female patients without palatally impacted canines (Control group) were used. The latter were matched for age and incisor malocclusion with the Impaction group. The anterior and overall Bolton ratios were calculated for each group., Results: Although the total width of the upper anterior teeth in the impaction group was significantly smaller than the total width of the upper anterior teeth in the Control group (p = 0.029), there was no significant difference between the mesio-distal widths of the lower anterior teeth in the two groups. Furthermore, there were no significant group differences in either the mean anterior Bolton ratio (p = 0.156) or the overall Bolton ratio (p = 0.652)., Conclusion: Females patients with palatally impacted canines may not have more inter-arch tooth size discrepancies than female patients without palatally impacted canines.

Purpose: The aim of the study was to assess changes in the angular position and eruption status of third molars in students of an Asian Indian population during a 4-year follow-up period., Patients and Methods: The series consisted of 43 students (11 males, 32 females). Standardized panoramic radiographs were taken at baseline (mean age, 19.1 +/- 0.7 years) and at the end of study (mean age 23.1 +/- 0.7 years). Angulation and degree of impaction of third molars were determined by their sagittal relationship to the adjacent second molar and eruption to the occlusal plane. Root formation was also assessed., Results: During the 4-year follow-up period, 11 of 72 of the mandibular teeth (15%) and 17 of 74 of the maxillary teeth (23%) changed their sagittal inclination. Thirty-one of 118 impacted teeth (26%; level B + C) achieved level A eruption more so in the mandible, ie, 15 of 52 (29%), than in the maxilla, ie, 16 of 66 (24%). In the mandible, 9 of 24 impacted vertical teeth (37.5%), 3 of 6 distoangular teeth (50%), and 3 of 22 mesioangular impacted teeth (13.6%) erupted to the occlusal plane. In the maxilla, 9 of 36 impacted vertical teeth (25%) and 7 of 27 distoangular teeth (26%) erupted to the occlusal plane during the follow-up. The number of teeth with complete root formation increased in mandible from 61% to 93% and in maxilla from 62% to 94.5%., Conclusions: Unpredictable changes in the position and angulation of teeth continued to occur even after the age of 19 years, more so in vertical and distoangular teeth than in mesioangular teeth.

Dental emergencies can significantly affect the mission of the deployed unit. As many as 22% of all emergency department visits at a deployed Expeditionary Medical Support facility can be attributed to dental problems and many of these problems are caused by impacted third molar teeth. Currently, there is no reliable method of predicting when asymptomatic, partially erupted third molar teeth will become painful. Therefore, it is imperative that Air Force dental providers carefully consider the consequences of giving patients a clean bill of health when asymptomatic, partially erupted third molar teeth are present in the oral cavity. Recommendations for future study are presented.

The ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor that occurs predominantly in children and is generally associated with unerupted teeth. The choice of treatment for this entity is conservative surgery with enucleation and its prognosis is excellent. However, preserving the associated impacted teeth may make complete removal of the lesion difficult and may explain some cases of recurrence. A case of AFO in a 6-year-old girl treated with enucleation and preservation of an impacted lower left first permanent molar is reported. After two years of follow-up, there were no signs of recurrence and complete spontaneous eruption of the preserved tooth was observed. The present report indicates that the degree of involvement of the impacted tooth by AFO is a fundamental aspect to be considered during radiological analysis and surgical assessment. We concluded that preservation of the impacted permanent teeth associated with this tumor should always be considered and carried out with caution, since they are clearly not included in the surgical cavity.

Introduction: The purpose of this study was to determine whether a clinically significant association exists between maxillary skeletal width and palatal canine impaction, also known as palatally displaced canine (PDC)., Methods: Seventy-nine patients with PDC were matched for age, sex, and malocclusion to 79 controls. Maxillary and mandibular skeletal widths and nasal cavity widths were measured on posteroanterior cephalograms; maxillary and mandibular intermolar widths were measured on dental casts; and maxillary interalveolar arch widths at 3 levels (canine, premolar, and first molar) were measured on occlusograms., Results: Only maxillary alveolar arch width at the canine level was significantly different between the 2 groups. However, further analysis showed that the presence of erupted deciduous or permanent canines, rather than their absence in the canine area (whether due to extraction, exfoliation, impaction, or not yet having erupted), was strongly associated with maxillary intercanine alveolar arch width., Conclusions: The additional finding in this study that the eruptive status of canines significantly affects maxillary alveolar arch width in this area suggests that maxillary intercanine alveolar arch width as measured in this or other studies is not a good predictor of PDC.

Aims: Delayed eruption of teeth may be caused by the presence of one or more supernumerary teeth. The purpose of this study was to evaluate findings, predisposing factors and differentiate different techniques used that affect the outcome following removal of supernumerary teeth. A comprehensive literature review was also undertaken., Methods: A longitudinal retrospective study was carried out at the Royal Liverpool Children's Hospital. A total of 120 patients were identified from the general anesthesia records that had supernumeraries extracted. Only 43 cases had delayed eruption of teeth caused by supernumeraries. The pre and post extraction record data collected were the gender, radiographic assessment, position of the supernumerary, age at time of referral and extraction of the supernumerary, age at time of eruption of the impacted tooth and the orthodontic and surgical management., Results: The mean age of referral was 9.1 years with a male to female ratio of 4.4:1. There was a greater predilection for supernumeraries to be on the left side and be positioned palatally. Tuberculate type supernumeraries were the most frequent followed by the conical type. Spontaneous eruption of the impacted tooth occurred in 49% of cases. Eruption of the impacted tooth within eighteen months following removal of the supernumerary was observed in 91% of cases. The chronological age and space availability were the two factors that were critical in determining if eruption was spontaneous following removal of the supernumerary., Conclusions: The findings of this study reiterates the fact that given early referral, sufficient space and time, the majority of teeth prevented from erupting by a supernumerary tooth would erupt spontaneously following removal of the supernumerary alone. Randomized multi-centre prospective studies are suggested.

Objectives: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice., Methods: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals., Results: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients., Conclusions: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Intraosseous migration of impacted teeth across the midline to the opposite side of the jaw is a rare dental anomaly of unknown etiology. Transmigration of an impacted mandibular canine through the symphysis to the contralateral side of the arch has been documented. Transmigration of an impacted maxillary canine across the midpalatal suture to the opposite side of the maxilla has not been previously observed and is reported here for the first time.

Purpose: Most mandibular fractures occur because of blunt trauma. In some cases, the mandible can be weakened by the presence of an unerupted or impacted tooth. The fate of this tooth in the fracture line and its effects on bone healing remain an important outcome event., Materials and Methods: In this study, we analyzed the records of 117 patients with a total of 121 fractures having an unerupted tooth remaining in the fracture line who were treated and followed by the Dental Faculty of Ankara University between 1986 and 1996. All were open fractures, and none of the patients had a history of an acute inflammatory episode related to the unerupted tooth before the injury. Intermaxillary fixation was used in all cases., Results: Three of the patients subsequently required open reduction with internal fixation. The unerupted tooth was not extracted in any patient. The fixation was maintained for an average of 45 days and followed up for 3 months. No complications were encountered., Conclusion: According to these results, we suggest that asymptomatic impacted teeth in the fracture line of uncomplicated mandible fractures do not cause delayed healing when treated with closed reduction.

Intrabony migration of impacted teeth is a rare dental anomaly, which occurs only in the permanent dentition of the lower jaw. The teeth involved in this phenomenon are the mandibular lateral incisor, canine, and second premolar. Migration of the lateral incisor is usually in a distal direction, resulting in transposition with the canine. Migration of the canine is most frequently in a mesial direction, resulting in transmigration across the mandibular symphysis to the opposite side of the dental arch. The second premolar most often migrates distally, sometimes past the gonial angle and as far as the coronoid process. Surgical and orthodontic treatment options are presented for the three intrabony migrating teeth.

The aim of this study was to investigate the eruption of teeth associated with dentigerous cysts in the mandibular premolar and maxillary canine regions in preadolescents. Fifty-eight cyst-associated teeth, including 47 mandibular premolars and 11 maxillary canines, were examined retrospectively by using normalized panoramic radiographs and histological materials. The subjects were divided into 2 groups: the erupted group, in which the teeth had erupted successfully after marsupialization, and the nonerupted group, in which the teeth had undergone orthodontic traction or cystectomy with removal of the cyst-associated tooth. Eighty-one percent of the mandibular premolars and 36% of the maxillary canines in the cysts erupted successfully about 100 days after marsupialization without traction. The eruption of a mandibular premolar was significantly related to a shallow position in the alveolar bone, shallow angulation of the tooth, and young age of the patient but not to cyst size and dental space for the eruption. The eruption of the maxillary canine was significantly related to the small size of the cyst and the patient's age. The cyst walls of the erupted group showed severe inflammatory cellular infiltration. These findings present a treatment guideline for dentigerous cysts associated with mandibular premolars and maxillary canines in preadolescents.

Two cases are presented, each with both unerupted maxillary canines so badly positioned that eruption seemed unlikely. However, over a period of approximately three years, three out of the four initially displaced canines did erupt; the improvements in position being unrelated to whether or not the associated primary canine was extracted. Three out of four primary canines were removed. These cases highlight the difficulties in predicting canine eruption for individual patients.

Primary tooth impaction is quite rare during the development of primary dentition. Various factors contribute to the impaction of a deciduous tooth, including malposition and malformation of the tooth bud, dentomaxillofacial disharmony, tumors, and cysts. This case was a 6-year-old female with complete left cleft lip/palate. A maxillary right second deciduous molar impacting at a high level approximate to the maxillary sinus was noted on the initial visit. To prevent surgical trauma to the surrounding tissue and succedaneous teeth, regular follow-up with radiographic examination was taken every 2 years. After a 7-year long-term follow-up, the impacted second primary molar in the right maxillary sinus had almost completely been resorbed with only about 10% of the original structure left. To the present, the resorption of the impacted deciduous molar seemed to have continued with no major pathological changes. Periodic radiographic examination is strongly advised until the total resorption process is completed.

The purpose of this study was to investigate the eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst in preadolescents. Premolars on the cyst and noncyst sides and size of the cyst were retrospectively examined with a total of 42 pairs of normalized panoramic radiographs in 20 patients who underwent neither extraction nor orthodontic traction of the cyst-associated mandibular second premolar after marsupialization. Sixteen premolars at the intraosseous eruption stage in a total of 9 preadolescents without cysts were also examined. The eruption speed and rate of angulation change of the cyst-associated mandibular second premolar were significantly faster than those of the premolars without cysts, and significantly correlated with the diminishing rate of the cyst size, which rapidly decreased for the first 3 months after marsupialization. In addition, the eruption speed of the cyst-associated mandibular second premolar correlated with that of the premolar on the noncyst side, and the rate of angulation change inversely correlated with the level of root formation. The results suggest that a cyst-associated permanent tooth erupts more rapidly regardless of the level of root formation and size and type of the cyst, and the abnormally tilted tooth axis improves more rapidly for the first three months after marsupialization of a dentigerous cyst in preadolescents.

The aim of this paper is to show an occlusal and functional rehabilitation of a lower canine tooth in total osseous inclusion by means of surgical and orthodontic therapy. This rehabilitation is very important for mastication and for the correct function of the temporomandibular joint.

Presented here is a case of 7 years 6 month old child with an apically impacted mesiodens in relation to the developing root of right upper central incisor. The removal of mesiodens was deferred in order to avoid disturbance in the natural development of the upper central incisor. Serial X-rays are presented and case is discussed.

The aim of this study was to investigate the differences between two groups of patients with either erupted or impacted mandibular third molars before and after orthodontic treatment. All patients were treated with Begg appliances following extraction of the four first premolars. The erupted group consisted of 14 subjects and the impacted group 13 subjects. Lateral cephalometric films, peri-apical radiographs, orthopantomographs and orthodontic casts of each subject were taken before and after treatment. Thirteen measurements were carried out on the lateral cephalometric radiographs. The results revealed slightly more vertical growth and a smaller mandibular arc angle in the erupted group at pre-treatment, and also a more upright lower third molar position and slightly greater distance between the distal point of the lower second molars and the centre of ramus (Xi) in the same group. In the course of treatment, mandibular third molars seemed less likely to erupt when the condyle grew vertically. The lesser resorption on the anterior border of the ramus might have played a part in this finding. In addition, a greater mesial inclination of the mandibular third molars might be an indication of the tendency for these teeth to be impacted in the present study.

Ectopic eruption and impaction of canines is a frequently encountered clinical problem. The incidence of impaction ranges between 1% and 3%. The cause of canine impaction can be the result of localized factor(s) or can be a polygenic multifactorial inheritance and associated with other dental anomalies. There are a number of possible sequelae to canine impactions, ranging from loss of space in the arch to resorption of the roots of the neighboring teeth. Although the management of the ectopically erupting teeth necessitates the combined expertise of a number of clinicians, the orthodontist should have the primary responsibility of coordinating these efforts to provide the patient with the optimal treatment options with the most stable and favorable outcome.

Teeth may become impacted when they fail to erupt or develop into the proper functional location. As such, impacted teeth are considered nonfunctional, abnormal, and pathological. The mandibular third molar is the most common tooth to become impacted. The cause of impacted third molars is thought to be inadequate space. Several studies indicate that a change from a coarse, attritive diet to a modern, refined diet has lead to an increased incidence of impacted teeth. Interproximal attrition allows for greater mesial migration of teeth and space for third molar teeth. Teeth that fail to attain a functional position may be pathological and should be considered for removal. The indications for removing impacted teeth can be divided into those of acute or chronic pathology. Impacted third molars are often associated with pain, infection, cyst formation, benign tumors, root resorption, bone loss, periodontal disease, and caries. The decision to surgically remove impacted third molars is often unclear. There are no absolute treatment protocols established. The dentist must consider a variety of factors and make an informed decision with the patient. Most experienced clinicians combine objective data and common sense to arrive at a logical treatment plan. The purpose of this article is to discuss factors related to impacted teeth and help the orthodontist understand the general management of impacted third molars. The decision for surgery will be assisted by an understanding of all of the risk factors associated with impacted teeth and presenting the options to the patient.

Objective: To measure changes in angular position and eruption status of mesially impacted mandibular third molars (M3) during 4-year follow-up period., Study Design: Standardized panoramic radiographs were taken at the start of the study (the average age of the subjects was 19.7 years) and 4 years later. Angulation and degree of impaction of M3 were determined by their sagittal relationships to the adjacent second molars. The impacted M3 were either partially erupted or unerupted., Results: Initial examination showed that among a total of 59 mesioangular M3, 49 (83%) had inclination between 5 and 30 degrees. The proportion of M3 that became upright (zero tilt) was 76% (13/17) with initial angulations of 5 to 10 degrees, 61% (11/18) with initial angulations of 15 to 20 degrees, and 14% (2/14) with initial angulations of 25 to 30 degrees. None of the M3 originally presented at 35 degrees or more became upright, but an average decrease of 12 degrees in angulation was registered. In total, 26 M3 of 59 (44%) became upright during the follow-up period. Initial examination of levels of eruption showed that among 59 M3, 13 (22%) were partially erupted and the rest were unerupted. Of the 46 M3 initially unerupted, 17 (37%) became fully erupted and 7(15%) erupted partially during the 4-year follow-up. Of the total sample, 25 (42%) had erupted to full occlusion during the observation period., Conclusion: A significant proportion of mesially impacted mandibular M3 had changed their angulation and became fully erupted by the time the individual reached 24 years of age. Positional changes and eruption of impacted M3 are unpredictable phenomena.

The records of a consecutive series of 72 patients who had undergone excisional exposure of one or both palatally displaced canines were reviewed. The purpose was to ascertain whether the canine(s) erupted spontaneously following surgery, whether orthodontically-assisted eruption was required or whether the procedure failed completely indicating the need for re-exposure. The results of the study suggest that the majority of canines will erupt once exposed and of those that fail to erupt completely most will still remain exposed to a sufficient extent to allow attachments to be bonded to the palatal surface.