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Prophylactic removal of asymptomatic third molars: a review.

Mandibular and maxillary third molars are mostly consigned to 'waste bins' in dental practices because they are terminal in developmental timing and positioning in the dental arches, and regarded as functionally non-essential. Thus, many dental practitioners do not attach significance to the presence of third molars when making therapeutic recommendations to patients about preservation of the dentition. The need for taking more a serious account of third molars is reviewed in this paper.

Forecasting↗

Pericoronal radiolucencies and the significance of early detection.

Pericoronal radiolucencies are common radiographic findings encountered in general dental practice. They usually represent a normal or enlarged dental follicle that requires no intervention; alternatively they may represent a pathological entity that requires appropriate management and histopathological interpretation. A pericoronal space of greater than 2.5mm on an intraoral radiograph and greater than 3mm on a rotational panoramic radiograph should be regarded as suspicious. Although many pathological processes may present radiographically as pericoronal radiolucencies associated with unerupted teeth, the most common is the dentigerous cyst. These lesions may enlarge considerably if allowed to develop unchecked, and have the potential for pathological transformation. In this report we present four cases of large pericoronal radiolucencies associated with unerupted teeth, and highlight the importance of early detection and management of such lesions.

Adult↗

The palatal canine and the adjacent lateral incisor: a study of a west of Scotland population.

The hypothesis that palatally-displaced canines are associated with smaller than average lateral incisors or with congenital absence of adjacent lateral incisors was tested on a West of Scotland population. A retrospective study of the records of orthodontic patients attending Glasgow Dental Hospital was carried out. One-hundred-and-eighty-two subjects with palatally displaced canines were identified. The tooth length of lateral and central incisors was measured on radiographs and the crown widths of lateral incisors were measured on study casts. One-hundred-and-six extracted maxillary lateral incisors were examined to allow more accurate measurement of crown width and root length than was possible from radiographs. An association was sought between the size of the lateral incisor or its absence, the position of the adjacent maxillary canine, and between crown size and root length of the lateral incisor. The conclusions supported the hypothesis that there is a weak association between palatally displaced maxillary canines and lateral incisors of smaller than average crown width. There was weak support for the association between palatal canines and absence of the adjacent lateral incisor. There was no correlation between lateral incisor crown width and root length.

Adolescent↗

Unerupted incisors.

Fifty consecutive cases presenting with unerupted maxillary incisors at orthodontic clinics were recorded and progress of the unerupted tooth followed up over a 4-year period following the exposure of the unerupted tooth (including removal of supernumerary tooth, etc., if present). The occlusal level, rotation, tilting, and general appearance were assessed at the conclusion of the investigation and the results are presented in this report. The earlier the removal of the causative factor preventing eruption of the incisor the better is the prognosis, and it is suggested that all teeth that have not erupted 6 months after the normal eruption date should be subject to radiological examination to ascertain any possible cause for the delayed eruption.

Age Factors↗

Multiple supernumeraries: the importance of clinical and radiographic follow-up.

The occurrence of multiple supernumerary teeth is a rare phenomenon. Three cases of multiple supernumeraries are presented which illustrate problems which may arise during long-term follow-up: resorption of adjacent teeth, enlargement of the follicles, movement of the unerupted teeth and development of further supernumeraries. These cases highlight the importance of adequate initial surveillance, anticipation of potential problems, assessing the risk-benefits of surgery and long-term monitoring, in some cases following the surgical removal of supernumeraries.

Adolescent↗

Ectopic movement of an unerupted mandibular canine.

A case history has been given with the radiographic evidence of the migration, during development of an unerupted mandibular canine from its normal position. In a 30-month period the canine assumed a horizontal position and moved to a site that was apical to the mandibular incisors, still in the confines of the cortical plates. Because erratic movements of unerupted teeth cannot be anticipated, it would seem wise to defer the elective removal of permanent teeth during the mixed dentition stage until the clinician is assured of a normal eruption pattern of the succedaneous teeth.

Child↗

The case of the disappearing third molar.

A mandibular third molar moved into the lower border during a period of several years. When the patient experienced discomfort, an incisional biopsy and marsupialization were performed. Eight months later, adequate bone had regenerated and the molar and remaining cyst structure were removed. Full-mouth and panoramic radiographs would have allowed the dentist to locate the missing molar before surgery was necessary.

Adult↗

Cleidocranial dysostosis: a multidisciplinary approach to treatment.

To ensure eruption of the dentition in patients with cleidocranial dysostosis, close collatoration between the oral surgeon and the orthodontist is essential to determine the sequence of extraction, the teeth to be ligated, the preferred technique of ligation, and the approach for surgical exposure.

Child↗