Characteristics and prevalence of non-syndrome multiple supernumerary teeth: a retrospective study

OBJECTIVE: The goal of this study was to evaluate the radiological and clinical findings of non-syndromic multiple (five or more) supernumerary teeth in patients radiographically examined between 1999 and 2004. METHODS: Among 9550 patients, 251 cases of supernumerary teeth were found, including six cases of multiple supernumerary teeth. Patients with multiple supernumerary teeth were evaluated for age, sex, unilateral or bilateral distribution of the teeth, localization, morphology and complications or associated pathologies such as dentigerous cysts, eruption anomalies, resorption of adjacent teeth, displacement of tooth germ, malformation, migration, neurological symptoms, and secondary and periapical infections. RESULTS: All patients were male and most of the multiple supernumerary teeth were seen in the premolar region. The prevalence of multiple supernumerary teeth was 0.06%. Out of 37 multiple supernumerary teeth examined, 30 were impacted. Various associated anomalies were seen in 21.6% of cases. Although the mean age was high (23.1 years), no pathologies such as root resorption on adjacent teeth or cystic formation were observed, in contradiction of previous studies. CONCLUSION: In agreement with previous studies, the majority of supernumerary teeth were seen in the lower premolar region. That all patients with multiple supernumerary teeth were male and that most of these teeth were impacted was also in agreement with previous studies. The order of location frequency in previous studies has been premolar-molar-anterior; we found the order to be premolar-anterior with no supernumerary molar teeth observed. It was also interesting that no serious pathological findings were recorded.     

多层螺旋CT在上颌埋伏多生牙的临床应用

目的探讨多层螺旋CT在颌骨埋伏多生牙诊断和定位中的应用价值。方法对43例经临床筛选的埋伏多生牙患者行多层螺旋CT扫描,采用表面遮挡法、最大密度成像及多平面重建技术,显示埋伏牙形态及位置,确定手术路径及方式,并做手术后回顾性分析。结果多层螺旋CT能清晰显示颌部埋伏多生牙的形态、唇腭侧位置及与邻牙关系。43例共52颗颌部埋伏多生牙术前诊断与术中判断完全一致,符合率100%,术后所有患者伤口均Ⅰ期愈合,无感染、邻牙损伤等并发症发生。结论多层螺旋CT能正确判断多生牙,可作为外科处理和正畸治疗的重要检查手段。     

Ruptured extratesticular epidermal inclusion cyst mimicking polyorchidism with torsion on sonography

The sonographic appearance of epidermal inclusion cysts varies in accordance with the contents of the cyst, ranging from an anechoic lesion to a hyperechoic solid appearing mass. Supernumerary testes are an uncommon congenital abnormality, in which more than two testes are present. We present a rare case of a ruptured scrotal extratesticular epidermal inclusion cyst, which had the sonographic appearance of a supernumerary testicle with torsion.     

A palatal dentigerous cyst arising from a mesiodente.

Dentigerous cysts can develop from unerupted primary, permanent, or rarely supernumerary teeth. When a supernumerary tooth is in the maxilla, near the midline, it is called a mesiodente. Such a mesiodente lies in the palate and a cyst developing about this tooth can extend directly up into the nasal fossae. More commonly a dentigerous cyst arising from unerupted maxillary teeth occurs about the molar, premolar, or canine teeth and the cyst extends up into the maxillary sinus. The CT and MR findings in a rare case of a dentigerous cyst of a mesiodente are presented.     

Unusual case of labial and lingual talon cusps

Talon cusp is an uncommon developmental anomaly affecting the anterior teeth, characterized by cusp-like projections, usually presenting on the lingual surface of the affected tooth. The occurrence ranges from 0.73% to 8% of the population. Talon cusp has been associated with other dental anomalies such as dens invaginatus, odontomas, and impacted teeth; associations with somatic anomalies such as Mohr's, Rubenstein-Taybi, and Sturge-Weber syndromes have also been reported. Only a few cases of labial talon cusp have been reported and only one previously published report exists documenting talons appearing both labially and lingually on the same tooth. This study reports the unusual case of a 10-year-old girl with bilateral talon cusps and one tooth possessing both lingual and labial talons. The lingual talon on the right maxillary lateral incisor was interfering with normal occlusion and was responsible for labioversion of the tooth. Treatment options were presented.     

Die Zuordungswahrscheinlichkeit eines numerisch-topographischen Zahnstatus bei der Identifikation unbekannter Leichen

The numerical topographical dental findings of 29,862 adult patients from several German dental practices were evaluated. Taking into account the age-dependent loos of teeth the various decades were investigated separately for increased incidences of identical findings. The total number of teeth comprising the dental findings in the form of tooth number classes was a first-line criterion aiding classification. In accordance with an underlying binominal distribution, a raised incidence of identical dental findings was found both in patients edentulous jaws or few residual teeth and in patients with largly complete dentition. The raised incidence was confined to a few standard findings in each of these high or low tooth number classes. However, more than 50% of all cases were either in the intermediate tooth number classes, in which raised incidences of ≥ 0.2% generally do not occur, or showed correspondingly rare constellations of findings in the high or low tooth number classes. In more than half of all cases, there was therefore a numerical topographical dental status which can be used in identification with a matching probability of ≥ 99.8%. Dental findings which occur less frequently can be arranged clearly according to tooth number classes.     

Cleidocranial dysplasia: radiological appearances on dental panoramic radiography.

OBJECTIVE: To report the effectiveness of dental panoramic radiography in identifying features pathognomonic for cleidocranial dysplasia. METHODS: Panoramic radiographs of nine male Caucasian patients with cleidocranial dysplasia are analysed. RESULTS: In addition to the established dental complications of failure of eruption of the permanent dentition and multiple supernumerary teeth, morphological abnormalities of the maxilla and mandible, particularly in the ascending ramus and coronoid process were present. CONCLUSION: Dental panoramic radiography is a valuable adjunct in confirming the diagnosis of cleidocranial dysplasia.     

Diagnostic tools used to predict the prevalence of supernumerary teeth: a meta-analysis

Objectives

This study sought to (i) determine the variations in prevalence figures based on the diagnostic tools employed, and (ii) provide an insight into the prevalence of supernumerary teeth.

Methods

A comprehensive literature search of the prevalence reports on supernumerary teeth was conducted using two databases. Two independent observers rated these articles according to exclusion and inclusion criteria. 28 papers were included in the analysis to determine the variations in the prevalence figures in relation to the method of diagnosis, and 14 studies were included to estimate the prevalence figures for supernumerary teeth. Statistical analysis was computed using analysis of variance (ANOVA), Student Neumann–Keuls (SNK) test and multiple regression analysis.

Results

Statistically significant differences were evident in the prevalence figures based only on a clinical examination compared with groups that also employed radiographs (p < 0.05, ANOVA, SNK). The prevalence figures for supernumerary teeth ranged from 0% to 3%. The mean prevalence value for the European white population [1.6% (±0.6)] was lower than that of the southern Chinese population [2.7% (±0.14)]. The overall prevalence of supernumerary teeth for males was significantly higher than for females [relative risk = 1.37 (1.13–1.50)].

Conclusions

Clinical examination plus some types of radiograph(s) are essential for determining the prevalence of supernumerary teeth; nevertheless, it is still underestimated. Several disparities in the prevalence reports make the available data on supernumerary teeth questionable.     

Mixed periapical lesion: differential diagnosis of a case

A radicular cyst associated with carious teeth is a very common odontogenic lesion in the oral cavity, but calcifications in residual radicular cysts are quite rare. We report one such case where a routine pre-implant radiographic assessment revealed a mixed periapical radiopaque radiolucent lesion in the right maxillary central incisor region. Histological and radiographic studies show that there is a slow increase in the mineralized deposits within the cyst lumen with time. This becomes prominent histochemically in cysts more than 8 years old and radiographically 6 years later, as seen in our case. In this paper we would like to highlight the importance of a residual radicular cyst with calcifications in the differential diagnosis of a mixed periapical radiopaque radiolucent lesion.     

数字化断层融合在颌骨疾病诊断中的应用

目的：探讨数字化断层融合技术在颌骨疾病诊断中的优势。方法：搜集牙科患者,行数字化断层融合检查,对牙周炎,颌骨囊肿,根尖脓肿,阻生齿,牙源性肿瘤,下颌骨骨折,赘生齿等疾病做出影像诊断,分析数字化断层融合技术在颌骨疾病诊断中的应用优势。结果：46例颌骨断层融合图像显示,牙周炎3例,颌骨囊肿4例,根尖脓肿3例,阻生齿19例,颌骨骨髓炎1例,赘生齿2例,断齿2例,牙源性肿瘤2例,上颌窦炎6例,下颌骨骨折3例,颞下颌关节脱位1例。随诊观察断层融合技术诊断与临床诊断相符。结论：数字化断层融合技术在颌骨疾病上均能作出正确诊断。简便,快捷,价格低,辐射少,不受体位限制,更能体现它的优点。     

Dental fractures on acute exposure to high altitude

There is little in the literature on dental restoration breakage in the aviation environment since reports of problems in combat aviators in War World II. We report two cases of dental fractures during acute exposure to a hypobaric environment. Case 1 was a young officer who suffered an amalgam restoration breakage during a 25,000-ft decompression chamber simulation. Case 2 occurred in an experienced aviator who had a tooth cusp fracture in a molar with a defective amalgam restoration during an unpressurized helicopter flight to 18,000 ft. In both cases, after removing the defective fillings, deep secondary caries were found; both teeth were successfully restored. Because hard-tissue tooth fracture during a high-altitude flight is a rare event, few flight surgeons or dentists are familiar with this phenomenon. We recommend regular dental examinations with careful assessment of previous dental restorations in aircrew subject to decompression.     

Tooth shape reconstruction from dental CT images with the region-growing method

Objectives:

The three-dimensional shape information of teeth provides useful information. However, obtaining accurate three-dimensional shapes of teeth is difficult without extracting them physically. In this study, we aimed to develop a method for automatically extracting accurate three-dimensional shapes of teeth from dental CT images.

Methods:

The proposed method includes pre-processing and region extraction. Pre-processing is a combination of image-processing techniques that enhances tooth regions. In the region-extraction process, the region-growing method is introduced for extracting a region of each tooth. Constraint conditions determined by considering the characteristics of the structure of teeth are introduced for accurate extraction. Finally, morphological image processing is applied for eliminating discontinuous points.

Results:

We carried out an experiment in which the three-dimensional shapes of teeth were reconstructed from dental CT images. Quantitative evaluation was performed by measuring the three-dimensional spatial accordance rates between the region obtained by the proposed method and the manually extracted region. The proposed method was significantly more accurate than an existing method at the 5% level.

Conclusions:

The experimental results showed that the proposed method reconstructs the shapes of teeth with high precision. However, an unextracted region remained at the surface of the enamel. Solving this problem and improving the extraction accuracy are important topics for future work.     

Multiple idiopathic cervical root resorption: systematic review and report of four cases

OBJECTIVES: The objectives of this study were to report four cases of multiple idiopathic cervical root resorption and to systematically review the literature on this condition. METHODS: The clinical and radiographic findings and the medical/dental histories of four patients who presented with multiple idiopathic cervical root resorption were recorded. Additionally, 10 references from the literature that reported on 14 patients were reviewed. RESULTS: Multiple idiopathic cervical root resorption was an incidental finding on routine clinical and radiographic examination. There appeared to be no correlation between this type of resorption and any medical/dental finding. Radiographically, multiple idiopathic cervical root resorption was found to begin at the cemento-enamel junction and then either progress to involve the entire cervical region or, at some point, spontaneously arrest. Those cases that progressed to involve the entire cervical region required extraction. The number of teeth that demonstrated this condition ranged from 5 to 24 per patient. More teeth became involved as the condition was followed in time. There was no detectable frequency of occurrence for any particular dental region or tooth among the involved teeth. Of a total of 18 patients, 13 were females whose ages ranged from 7 years to 68 years. Ten of the 18 patients were Caucasian. CONCLUSIONS: Multiple idiopathic cervical root resorption was found most frequently associated with younger females. This condition appeared to be of unknown aetiology and uncertain natural history.     

A case of tooth-filling antral rhinolithiasis presenting with blockage of the osteomeatal complex

Tooth-filling antral rhinolithiasis is the phenomenon by which dental fillings are extruded into the maxillary sinus and are a source of infection. These fillings eventually become coated by salts of calcium and therefore form a stone. We describe a rare case in which the dental amalgam was eventually seen to cause osteomeatal complex obstruction after entering the sinus.     

Odontometric sex assessment from logistic regression analysis

Odontometric sex assessment is considered a useful adjunct to more robust predictors such as pelvic and cranial bones, and discriminant function analysis (DA) has been widely applied in dental sex assessment. Logistic regression analysis (LRA) is considered a better alternative, although still untested in odontometric sex prediction. This study examines the use of LRA in dental sex assessment and compares its success to DA. Mesiodistal and buccolingual dimensions of all teeth, except third molars, were obtained on dental stone casts of 105 young adults (52 females, 53 males) using digital caliper. Application of LRA to teeth of both jaws combined and to maxillary and mandibular teeth separately yielded correct sex allocation rates ranging from 76% to 100%, which proved superior to sex assessment using DA (∼52–71%). LRA enabled optimal sex prediction (100%) when all teeth in both the jaws were included. Results were not as accurate when only maxillary (76.2%) or mandibular (84.8%) teeth were used. To assess and compare the use of these multivariate techniques in practical forensic casework, >25% of tooth variables were randomly deleted. LRA still performed better (∼91% sex allocation accuracy vs. 62.9% for DA), indicating that LRA may be superior in its ability to predict sex irrespective of the presence of complete or incomplete sets of dentitions and should be preferred in dental sex assessment. The 100% success rate of LRA in correctly assigning sex is also noteworthy considering that, in general, tooth measurements have yielded sub-optimal sex prediction levels. However, unambiguous sex assessment is possible only when the entire dentition is available and correct sex allocation levels decreases when teeth are missing.     

Abnormal modelling of the humeral head in the tricho-rhino-phalangeal syndrome: a new radiological observation

The case of a 27-year-old female patient with tricho-rhino-phalangeal (TRP) type I syndrome is reported. The patient demonstrated the classical features of slowly growing hair, a bulbous nose and brachydactyly with swelling at the interphalangeal joints, but in addition showed some of the less common manifestations such as supernumerary teeth and prognathism. To the authors' knowledge this is the first reported case in which modelling abnormalities of the proximal humerus mirror those seen in the femoral head. This adds weight to the argument that the skeletal abnormalities in TRP are part of a generalized bone dysplasia.     

Dentomaxillofacial variability of cleidocranial dysplasia: clinicoradiological presentation and systematic review

OBJECTIVES: The aim of this study was to determine the clinical and radiological presentation of cleidocranial dysplasia (CCD) in our patient group and to compare them with other reported cases by a systematic review (SR) of the literature. METHODS: The study comprises two elements, a complete series of all diagnosed patients at the Center for Craniofacial Genetics at the University of Regensburg, Germany, and a SR. Relevant literature was identified by electronic databases, review of citation lists and hand searching of key journals. The principal selection criterion was that the study should contain as many pertinent cases as possible. The presented signs and symptoms were assigned to the following categories: "supernumerary teeth", "failure of eruption", "hypoplastic maxilla" and "clavicular sign". Additionally, the family history was taken into account. RESULTS: From the 410 English, German or French articles, 40 single case presentations and 17 multiple case studies remained that met the selection criteria. This report reviews the data of 283 patients with CCD including our own patient cohort of 24 individuals. Dental signs such as supernumerary teeth and eruption failure were expressed in over 93.5%. Skeletal symptoms such as hypoplastic maxilla and the clavicular sign were exhibited in over 84.3%. The prevalence of spontaneous mutations differs slightly when comparing the single case studies (72.0%) with our patient data (58.3%). The fraction of spontaneous mutations in multiple case studies was 5.0%. CONCLUSION: The diagnosis of CCD can be difficult when typical features are not clearly expressed. Since the multiple case studies concentrated on specific clinical aspects, an overall ranking including all associated findings was not possible. Owing to their prevalence, we recommend referencing to the described list of clinical signs as major symptoms for the pathognomy in CCD, since they are infrequent in other conditions and in the general population. To categorize the expression of CCD, more interdisciplinary studies are necessary. Nevertheless, a subjective classification is possible according to the related restrictions in the patients' quality of life.     

Dental emergency rates at an expeditionary medical support facility supporting Operation Enduring Freedom

The purpose of this study was to report the dental emergency rate and the distribution of cause of dental emergencies at an Expeditionary Medical Support +25 medical facility during a 6-month deployment in support of Operation Enduring Freedom. A retrospective cohort analysis of 1,972 soldiers stationed at Seeb Air Base, Sultanate of Oman, was accomplished from a phased deployment from March to September 2002. Procedures were divided into 11 categories: endodontic, extraction of teeth other than third molars, extraction of third molar teeth, restoration of teeth (caries), restoration of broken teeth (not caries), orthodontic bracket/wire problem, sensitive teeth, temperomandibular pain, periodontal, oral pathology, and prosthodontic. One hundred thirty-five dental emergency visits were recorded, corresponding to a rate of 137 dental emergencies per 1,000 soldiers per year. Most of the emergencies (34.8%) were due to caries. Pain from third molars was the second most common reason for visiting the dental clinic (19.3%).     

Facial subcutaneous calcinosis and mandibular resorption in systemic sclerosis: a case report

Systemic sclerosis (SSc) is an autoimmune disease characterized by widespread fibrosis of subcutaneous connective tissue, causing serious complications with the involvement of other systems. Tight, firm skin is the main characteristic of SSc, causing extrinsic pressure and the obliteration of the vessels. This then leads to ischaemia and destruction of the underlying bone. This mechanism may also lead to bone resorption of the mandibular body as it affects other bones of the skeleton. To date, only two cases of reported calcinosis in the facial area have been observed. In this report, a rare case of SSc with both subcutaneous calcinosis and mandibular bone resorption is presented. The role of dental practitioners in the diagnosis of the disease with respect to the orofacial symptoms is also discussed.     

Radiographic examination of mesiodens and their associated complications

OBJECTIVES: To examine mesiodens with regard to their status, their influence on adjacent teeth and their alteration during the follow-up period. METHODS: From retrospective reviews of all patients who visited our institution from 1990-2001, we identified 200 patients (256 mesiodentes) who were shown to have mesiodentes on the basis of a periapical radiograph, a panoramic radiograph or an axial radiograph. RESULTS: The number of supernumerary teeth was one in 146 cases (73%), two in 52 cases (26%) and three in 2 cases (1%). Of 256 mesiodentes, the direction of the crown of the mesiodens was inverted in 172 (67%), in a normal direction in 69 (27%) and in a horizontal direction with regard to the tooth axis in 15 (6%). Of the 147 mesiodentes for which axial radiography was performed, 131 (89%) were located at a palatal site against the dental arch, 16 (11%) overlapped the dental arch and none were at a labial site. Of our 200 cases, a delay of eruption of the permanent central incisor was seen in 12 (6%), malposition or rotation of the central incisor in 5 (2.5%) and dentigerous cyst formation arising from mesiodens in 22 (11%). Marked movement of the mesiodens was seen in 10 cases during the follow-up period of 5-7 years. Some complication arising from mesiodens was seen in 19.5% of all cases in our research. CONCLUSION: Although mesiodentes are not caused by malocclusion, they may cause it. A long period of impaction of mesiodentes may bring about dentigerous cyst formation or movement of the mesiodentes.