Trauma to an unerupted tooth.
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In view of the remarkable number of cases of gnathogenous headache it is advisable to submit headache patients to a thorough dental and radiological inspection, even in cases of anodontous jaws, in order to identify unerupted teeth. Such an examination with consequent dental or surgical thrapy can in many cases spare lengthy neurological diagnostic or therapeutic procedures, possibly in hospital.
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The majority of previous studies that have looked at the management of delayed eruption secondary to a supernumerary tooth advocate exposure of the unerupted tooth at the time of supernumerary removal. However, accepted UK orthodontic practice is to extract the supernumerary and provide sufficient space for the unerupted tooth to erupt spontaneously. The aim of this retrospective study was to evaluate the management and outcome for 96 patients who had been referred to Newcastle Dental Hospital between 1976 and 1988 who between them had 120 teeth with delayed eruption secondary to a supernumerary tooth.
In this paper we have described the case of a 7-yr-old Moroccan osteopetrotic boy, who had received a bone marrow transplant (BMT). He was transplanted from his older brother and, despite immunosuppressive therapy, developed chronic graft-versus-host disease and was placed on corticotherapy. Seven months after the bone marrow transplant, graft versus host disease (GVHD) was stabilized, but corticotherapy had inhibited growth. There was evidence of normalizing bone, his hearing was better but he had not recovered vision. Dental findings before the bone marrow transplant revealed some missing teeth, failure of teeth to erupt and decayed teeth but no enamel hypoplasia. The patient had developed one carious lesion on one unerupted tooth: bacteria seem to have found a way through the gubernaculum dentale. The scanning electronmicrographs showed decayed tooth and tissues fitted into each other. Since the bone marrow transplant, no tooth has erupted. We think that, in this case, failure of tooth eruption would be the sign of osteopetrosis.
A case of an unusual foreign body (a tip fragment from a plastic chopstick) embedded in one of two unerupted supernumerary teeth in the premaxillary region of a 12-year-old Japanese boy is presented.
The adenomatoid odontogenic tumour most commonly presents as a 1.5-3 cm radiolucency in the anterior maxilla, and often associated with an unerupted tooth. It is very unusual for these tumours to occur behind the premolar region and the few reports of much bigger lesions have been in black African patients. This article describes an unusually large example of this tumour associated with an unerupted maxillary third molar tooth in a white female.
Maxillary crowding may cause failure of eruption of the canine. The teeth so displaced are directed buccally or palatally. In both cases, surgical intervention is indicated after space has been made in the arch. Palatally displaced canines are treated by surgical excision of palatal mucosa to promote eruption. Wide excision is indicated to prevent the healing process from covering the exposed tooth crown. Because of the anatomy of the buccal mucosa, however, surgical excision of the crowns of buccally displaced canine frequently results in periodontal problems. An alternative technique is therefore presented; this involves the surgical exposure of the crowns of buccally displaced teeth to allow the attachment of a wire traction hook. The crown is then recovered. The traction hook provides a point of attachment, so that orthodontic forces may be applied to the unerupted tooth to guide its eruption. The preservation of the mucosal flap ensures a normal epithelial attachment develops on the buccal surface of the tooth, and the normal gingival anatomy of the buccal mucosa is maintained. The procedure may also be used in cases where upper incisors have been prevented from erupting because of the presence of supernumerary teeth. Even after surgical removal of the supernumerary teeth, the permanent incisors often fail to erupt. In such cases, the placement of traction hooks will enable the orthodontist to bring the unerupted teeth into their correct positions in the arch.
Epithelia differ regionally in their patterns of phenotypic expression. The junctional epithelium (JE) that attaches the oral mucosa to the teeth is a unique tissue that shows a pattern of differentiation unlike other oral epithelia and forms basal lamina against the non-vital tooth surface. The mechanisms that establish this unusual phenotype and the developmental origin of this epithelium are both uncertain. The formation of JE by downgrowth of the oral gingival epithelium (OGE) during tooth eruption has been suggested but morphological studies indicate that it may be derived from the reduced enamel epithelium (REE) that covers the crown of the unerupted tooth. These epithelia of potential origin differ in their developmental histories: intrinsic differences between them could thus significantly influence the phenotype of an epithelium formed from them. The patterns of phenotypic expression of specimens of dissected JE, OGE and REE, and of cell cultures of these epithelia grown under standardized conditions, were examined (1) by immunocytochemistry using monoclonal antibodies with specificity for individual cytokeratins, vimentin and ICAM-1, and (2) by two-dimensional SDS-PAGE and immunoblotting. The results indicated that, in vivo, OGE expressed keratin markers typical of differentiating mucosal epithelium; JE and REE, in contrast, lacked expression of most such markers but expressed keratins typical of simple epithelia together with some undefined keratin peptides. All epithelia showed changes in vitro but OGE remained different from JE and REE. OGE lost expression of the differentiation markers K1, K10 and K13; it acquired some expression of K19, but less than JE and REE. Cultures of JE and REE retained some expression of ICAM-1 and K8 and K18, and consistently acquired high levels of vimentin expression. These findings indicate that differences persist in standardized culture conditions and that these are apparently of an intrinsic nature. They support a concept of the origins of JE from REE and suggest that the unusual in vivo phenotype of JE results partly from intrinsic differences acquired during its development.
The pathogenesis of the three common forms of odontogenic cyst is discussed. It is concluded that the dental cyst arises from proliferation of the epithelial rests of Malassez in a focus of inflammation stimulated by pulpal necrosis of the associated tooth. It enlarges by unicentric expansion from the hydrostatis pressure of its contents. The dentigerous cyst arises from pooling of inflammatory exudate, which is derived from the obstructed follicular veins of an unerupted tooth and accumulates between the reduced enamel epithelium and the crown of the tooth. It enlarges by unicentric expansion from the hydrostatic pressure of its contents. The odontogenic keratocyst arises by proliferation of the residues of the dental lamina, possibly as a hamartomatous abnormality. It enlarges by both multicentric expansion due to the proliferation of localized groups of epithelial cells in the lining and by unicentric expansion from the hydrostatic pressure of its contents.
A 36-year-old woman was examined and treated for a rare odontogenic tumor in the mandible, the calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor. The tumor extended from the left mandibular molar region to the right premolar area and had almost completely destroyed the bone in the anterior mandibular region. An orthopantomogram showed a multiloculated radiolucent lesion, with an unerupted tooth in the center surrounded by a radiopaque area. In addition, finely granular calcification was visible here and there in the tumor area. In the histologic examination the tumor tissue could be identified as calcifying epithelial odontogenic tumor. Under electron microscopy the fibrillar structure at the basal cell level suggested the presence of amyloid. The tumor was removed by enucleation with a collar of surrounding tissue. No signs of recurrence have been noted at follow-up examinations.
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