Orthodontic treatment in impacted maxillary canines. A review of the literature

The prevalence of impacted maxillary canines is 1 to 3%, with approximately 50% of impacted canines causing root resorption of adjacent teeth. If the permanent canine has not acquired its correct position, evaluation by an orthodontist is necessary to determine the most adequate treatment. Surgery and orthodontic treatment are used for the treatment of impacted canines in the maxilla affecting permanent dentition. Selection of the most adequate treatment to achieve the correct position of the canine tooth depends on the position of the canine. This article summarizes the different techniques available and describes their advantages, and cost-benefit considerations. The objective of this literature review is to describe the etiology of impacted maxillary canines and provide an update of the information on orthodontic treatments available for these patients.

Marginal Fit of Temporary Restorations Fabricated by the Conventional Chairside Method, 3D Printing, and Milling

Objectives: This study aimed to compare the marginal fit of temporary restorations fabricated by the conventional chairside method, 3D printing, and milling. Materials and Methods: In this in vitro, experimental study, 14 temporary restorations were conventionally fabricated over an implant abutment and analog that had been mounted in a phantom model at the site of canine tooth, using auto-polymerizing acrylic resin and putty index. In digital manufacturing, the original model was scanned, and the final restoration was designed. Fourteen temporary restorations were milled out of polymethyl methacrylate (PMMA) blocks, and 14 others were printed by a 3D printer. Temporary crowns were placed on the abutment, and images were obtained from specific areas under a stereomicroscope at x100 magnification to measure the amount of marginal gap. Data were analyzed using one-way ANOVA and Tukey’s test (α=0.05). Results: The mean marginal gap values for the temporary crowns in the 3D printing, milling, and chairside groups were 91.40, 75.28 and 51.23 µm, respectively. The crowns that were conventionally fabricated chairside exhibited the lowest marginal gap, and the difference in this respect was significant among the three groups (P<0.05). Conclusion: Temporary crowns fabricated by the chairside method showed significantly smaller marginal gap; however, the marginal gap of all three groups was within the clinically acceptable range.

Technical adaptations of manual and rotary instruments for preparing a giant canine tooth

Teeth with extraordinary length are a rare condition that complicates endodontic procedures due to the difficult in being reached the working length and making the adequate preparation of the root canal, once there are no endodontic instruments longer than 31 mm commercially available. This study presents a description of technical adaptations for endodontic preparation of a maxillary canine with 39.59 mm of length. The procedures adopted were based on the consultation of the literature regarding the treatment of long teeth, and included endodontic instrument adaptation and changing the reference point of the instrument. This study shows that extremely long teeth can be successfully instrumented endodontically using the described clinical techniques.

Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports

Background Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells. The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48). Case presentation Case 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion. Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion. Conclusion These cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.

Endonasal endoscopic management of different cases of dentigerous cysts and ectopic teeth

Dentigerous cyst is a type of developmental odontogenic cysts that arises from the crown impacted, embedded or unerupted teeth that standardly managed by Caldwell-luc procedure, which is found to be associated with morbidities and complications. Endonasal endoscopic removal is a minimally invasive approach aiming to prevent morbidities and complications. The aim of this article is to study the advantages of the endonasal endoscopic approach in managing different cases of dentigerous cyst and ectopic teeth. In this article, we reported three different cases (two pediatric and one adult), one presenting with unilateral dentigerous cyst with traumatic ectopic teeth in the maxillary sinus, and one presenting with bilateral dentigerous cysts and ectopic teeth in the maxillary sinuses, the third case of unilateral ectopic intranasal canine tooth. All managed by endonasal endoscopic approach, with no complications and complete recovery. The endonasal endoscopic approach is a minimally invasive surgical approach. With the use of different angled endoscopes and instruments, this approach is preserving physiological function while minimizing morbidity and preventing complications.

PALLIATIVE JAW-SPARING TREATMENT OF A NON-RESECTABLE CANINE ORAL FIBROSARCOMA USING COMBINATION OF ELECTROCHEMOTHERAPY WITH BLEOMYCIN AND IL-12 GENE ELECTROTRANSFER

A 15-year- old male castrated English setter was presented for evaluation of a rapidly growing oral mass. Patient’s history was otherwise unremarkable, except of moderate proteinuria of 5 years duration. Clinical examination findings were within normal limits, except of an ulcerated located at the left mandibular canine tooth, which was histologically confirmed as a high grade infiltrative fibrosarcoma with high mitotic index (61/10 HPF) and multifocal necrotic areas. The client declined full staging, so only hematological and biochemistry examinations of blood were performed, which were without any clinically significant alterations. Furthermore a fine needle aspiration biopsy of regional lymph nodes was performed, which revealed reactive lymphadenopathy without signs of metastases. After declining other more invasive therapeutic procedures, the clients elected treatment with combination of electrochemotherapy and IL-12 electrogene therapy. Four consecutive treatment sessions were performed, resulting not only in complete response of the primary tumor, but also in regression of untreated distant metastasis, which was diagnosed approximately one month after the initial examination. Furthermore, the percentage of circulating CD8+ cells was increased after each therapy session, indicating possible systemic induction of immune response by IL-12 gene therapy. This case shows that this type of therapy can represent an alternative type of both local and systemic treatment in selected tumor cases, where clients seek a less invasive nonsurgical treatment.Key words: dog; fibrosarcoma; electroporation; electrochemotherapy; electrogene therepy, interleukin-12 PALIATIVNO ZDRAVLJENJE NERESEKTABILNEGA FIBROSARKOMA SPODNJE ČELJUSTI PRI PSU S KOMBINACIJO ELEKTROKEMOTERAPIJE Z BLEOMICINOM IN GENSKEGA ELEKTROPRENOSA IL-12Izvleček: Petnajstleni kastrirani angleški seter je bil na našo kliniko sprejet z namenom pregleda hitro rastoče novotvorbe v ustni votlini. Pes ni imel pomembnejših sočasnih bolezni, razen zmerne proteinurije zadnjih pet let. Fizikalni pregled ni pokazal nikakršnih odstopanj z izjemo ulcerirane novotvorbe na področju levega mandibularnega grabilca. Histološka diagnoza novotvorbe je bila infiltrativni fibrosarkom visoke stopnje z visokim mitotičnim indeksom (61/10 v polju visoke povečave) in multifokalnimi nekrotičnimi področji. Skrbnik psa je zavrnil popolno določitev stadija bolezni, zato smo izvedli le osnovne hematološke in biokemijske preisakve, ki niso pokazale pomembnejših odstopanj. Izvedli smo tudi tankoligelno biopsijo regionalnih bezgavk, ki je pokazala reaktivno limfadenopatijo brez znakov prisotnosti zasevkov. Po predstavitvi vseh možnosti zdravljenja se je lastnik odločil za zdravljenje s kombinacijo elektrokemoterapije in genskega elektroprenosa IL-12. Izvedli smo štiri zaporedne cikluse kombinirane terapije, s katero smo dosegli ne le popolni odgovor primarnega tumorja, pač pa tudi regresijo nezdravljenih oddaljenih podkožnih metastaz, ki so se pojavile približno mesec dni po začetku terapije. Poleg tega smo po vsaki terapiji ugotovili povečan delež cirkulirajočih CD8+ celic, kar lahko nakazuje na to, da je genska terapija z IL-12 sprožila sistemski imunski odziv. Predstavljeni primer kaže, da lahko kombinacija elektrokemoterapije in genskega elektroprenosa IL-12 predstavlja alternativno obliko tako lokalnega kot sistemskega zdravljenja določenih novotvorb, zlasti v primerih, ko skrbnik živali želi manj invazivne terapevtske postopke.Ključne besede: pes; fibrosarkom; elektroporacija; elektrokemoterapija, genski eletroprenos; interlevkin-12

Mandibular lateral incisor-canine transposition: A case series

Dental transpositions are rare anomalies, which may present to the general dental practitioner or orthodontist. Transpositions occur less frequently in the mandible compared with the maxilla, with the most common mandibular transposition involving the mandibular lateral incisor and canine. The degree of displacement can vary from a relatively minor deviation to complete transposition of the mandibular lateral incisor with the adjacent canine tooth. Due to their highly visible position at the front of the mouth, treatment, ideally involving alignment of these teeth, is important for aesthetic, social and functional purposes. This case series reports six cases with mandibular lateral incisor-canine transposition. They demonstrate the variety in presentation and subsequent management of the ectopic teeth. The importance of early diagnosis in combination with interceptive treatment is discussed, to reduce the burden of potentially lengthy orthodontic treatment at a later date.