The role of dentists in-diagnosing osteogenesis imperfecta in patients with dentinogenesis imperfecta

Background. Osteogenesis imperfecta (OI), also known as ""brittle bone disease,"" can be difficult to diagnose in its mild form. The authors describe a clinical case of a diagnosis of dentinogenesis imperfecta (DI), In which a literature review combined with an analysis of dental alterations led to indications of OI involvement. Case Description. Since DI can be associated with OI, the authors reviewed correlated studies and obtained a new medical history from the patient. They then conducted a radiographic and clinical examination of the dentition and submitted an affected third molar to scanning electron microscopy analysis. They compared their findings with descriptions of OI type I dental alterations in the literature and confirmed their diagnosis by means of a medical evaluation. Clinical Implications. In cases in which DI is diagnosed, patients should be examined carefully and the occurrence of OI should be considered `since, in its mild form, it might be misdiagnosed.

Paracetamol versus paracetamol-codeine in the treatment of post-operative dental pain: A randomized, double-blind, prospective trial

Background: Codeine is frequently added to paracetamol to treat post-operative dento-alveolar pain; studies have shown effectiveness in relief of post-operative pain at high doses but at the expense of central nervous and gastrointestinal side effects. There has been no trial to compare the efficacy and safety of paracetamol 1000mg with paracetamol 1000mg combined with codeine 30mg. Method. A randomized, single centre, double-blind prospective parallel group trial was performed to compare paracetamol 1000mg with paracetamol 1000mg with codeine 30mg for the relief of pain following surgical removal of impacted third molars, and analysed on an intention-to-treat (ITT) basis. Eighty-two patients were assigned randomly to receive either drug for a maximum of three doses. Patients recorded their pain intensity one hour after surgery and hourly thereafter for 12 hours. Results: The average increase in pain intensity over 12 hours was significantly less in patients receiving paracetamol plus codeine than in those receiving paracetamol alone (p=0.03) -1.81cm/h compared with 0.45cm/h - a difference of 1.13cm/h (95 per cent Cl: 0.18 to 2.08). Of the patients who received the paracetamol codeine combination, 62 per cent used escape medication compared with 75 per cent of those on paracetamol alone (p=0.20). There was no significant difference between the two groups in the proportion of patients experiencing adverse events (P=0.5). Conclusion: A combination of 1000mg paracetamol and 30mg codeine was significantly more effective in controlling pain for 12 hours following third molar removal, with no significant difference of side effects during the 12 hour period studied.

Ectodysplasin A (EDA)-EDA receptor signalling and its pharmacological modulation

L'ectodysplasine Al (EDA1 ou EDA), un ligand de la famille du TNF, et son récepteur EDAR favorisent le développement des poils, des dents et de plusieurs types de glandes. Chez l'humain, une déficience en EDA cause une dysplasie ectodermique liée à l'X, caractérisée par la genèse défectueuse des phanères. Les souris Tabby, déficientes en Eda, présentent des symptômes similaires. Nous démontrons que les souris Tabby sont en moyenne 7% plus légères que les contrôles au moment du sevrage. Ce phénotype ne dépend pas du génotype des petits, mais exclusivement de celui de la mère, suggérant que l'absence d'EDA perturbe la fonction mammaire. La glande mammaire se développe en plusieurs étapes, principalement à la puberté et pendant la grossesse. Nous avons généré des anticorps pour activer ou inhiber la signalisation d'EDAR. Les anticorps agonistes corrigent le développement de souris ou de chiens déficients en EDA, alors que les antagonistes provoquent une dysplasie ectodermique chez les souris saines. L'exposition répétée de souris Tabby aux anticorps agonistes après le sevrage accroît la taille et la fonction des glandes sébacées, démonstration pharmacologique qu'EDA contrôle l'homéostasie de la glande sébacée adulte. Ces outils seront utiles pour étudier la fonction d'EDA aux diverses étapes du développement de la glande mammaire. Fc-EDAl, un stimulateur d'EDAR, est en phase d'évaluation clinique. Nous avons montré que les structures dépendantes d'EDA qui se forment à différentes étapes du développement répondent à l'action du Fc-EDAl dans des fenêtres temporelles étroites ou larges. De plus, certaines structures peuvent être induites plusieurs jours après le début naturel de leur formation. Alors que la plupart des structures se forment suite à un seul jour d'activation d'EDAR, d'autre demandent un temps de stimulation plus long. La formation des dents est régulée par des signaux activateurs et inhibiteurs. Une forte stimulation d'EDAR spécifiquement appliquée aux deux premières molaires induit des signaux négatifs qui avortent la formation de la troisième molaire, alors qu'une forte stimulation donnée à la troisième molaire la rend hypertrophique tout en induisant parfois une quatrième molaire jamais observée chez les souris de type sauvage ou Tabby. EDA est donc un activateur important de la formation dentaire. Pris dans leur ensemble, ces résultats ont des implications pour la thérapie des dysplasies ectodermiques. - The TNF family ligand Ectodysplasin Al (EDA1 or EDA) and its receptor ED AR regulate embryonic development of hair, teeth and several types of glands. In humans, EDA mutations cause X-linked hypohidrotic ectodermal dysplasia (XLHED), a condition characterized by defective development of skin appendages. £da-deficient (Tabby) mice suffer from similar defects. We observed that Tabby pups at weaning were on average 7% smaller than WT controls, a phenotype that was curiously not linked to the genotype of pups, but to that of mothers, suggesting decreased mammary gland function in the absence of EDA. Mammary glands develop in several steps, most of which are post-natal. We generated monoclonal antibodies to block or activate EDAR signaling. Agonist antibodies rescued developmental defects when administered timely in £cfo-deficient mice and dogs, whereas blocking antibodies induced ectodermal dysplasia in WT mice. Agonist antibodies administered after weaning in £da-deficient mice for several months markedly increased both size and function of sebaceous glands, providing the first demonstration that pharmacological activation of the EDAR pathway in adults can correct important aspects of the dry skin phenotype. This also highlights a role for EDA1 in the homeostasis of adult sebaceous glands. These tools will be useful to study the function of EDA 1 at different stages of mammary gland development. Another EDAR agonist, Fc-EDAl, is currently evaluated in clinical trials. We found that EDA 1-dependent structures forming at different time points during development can respond to Fc-EDAl during time response windows that are narrow or wide. Also, some structures can be triggered up to several days after their normal time of induction. While most structures could be rescued by a single day of EDAR signaling, others required longer exposure times to form. Tooth formation is regulated by activating and inhibitory signals that impact one on the other. When strong EDAR signals were specifically given to the first two molars, overwhelming inhibitory signals completely inhibited formation of the third molar. In contrast, strong signals specifically given to the third molar induced hypertrophy of the later with occasional appearance of a fourth molar never observed in WT or £da-deficient mice. This clearly positions EDA as an important activating signal in tooth formation. Taken together, these results have implications for the therapy of ectodermal dysplasias.

Supernumerary molars. A review of 53 cases

Supernumerary molars are not uncommon and may be found nearly anywhere in the dental alveolar arches. A series of 36 patients that presented with 53 supernumerary molars are reviewed. They occurred more frequently in the maxilla (86.8%), had little or no clinical significance, tended to be impacted, and were not associated with the impactation of the third molar. Four cases of maxillary fifth molars are described

Morbilidad de la extracción de los terceros molares en pacientes entre los 12 y 18 años de edad

Objetivo: El propósito de este estudio fue analizar la incidencia de complicaciones después de la extracción quirúrgica de los terceros molares en pacientes de 12 a 18 años de edad. Pacientes y método: Se realizó un estudio retrospectivo de 390 extracciones quirúgicas de terceros molares superiores e inferiores en 173 pacientes en edades comprendidas entre los 12 y 18 años de edad, intervenidos bajo anestesia locorregional en el año 2000 en el Máster de Cirugía Bucal e Implantología Bucofacial de la Universidad de Barcelona. Los pacientes fueron divididos en tres grupos (A: 12-14 años, B:15-16 años, C: 17-18 años). Se registró la edad y el sexo del paciente, el motivo de la extracción, el grado de desarrollo dentario, la posición, la angulación y la inclusión del tercer molar. Finalmente se valoró la asociación entre dichas variables y la aparición de complicaciones postoperatorias. Resultados: La mayoría de los pacientes intervenidos fueron del sexo femenino (66,9%), y el grupo de edad en la que se realizó el mayor número de extracciones (62,8%) fue en el grupo C (17-18 años). El principal motivo de extracción fue la indicación por parte del ortodoncista (40,5%), seguido por la indicación profiláctica (39,5%). La presencia de clínica fue el motivo de extracción en un 20% de los casos. Se observó una incidencia del 15,6% de complicaciones postoperatorias tras la extracción de 390 terceros molares. En el grupo A el riesgo de complicaciones fue de 17,4%, en el grupo B de 19% y en el grupo C de 13,7%. Todas las complicaciones fueron reversibles y de corta duración como el dolor y la inflamación persistente, la infección, el trismo y la equimosis. Se presentó un caso de parestesia del nervio dentario inferior y un caso de parestesia del nervio lingual que remitieron a los 2 meses y al mes respectivamente. Conclusiones: este estudio demuestra que no hay diferencias significativas en las complicaciones observadas entre los tres grupos de edad, y por lo general, éstas son leves y reversibles. Se observó una mayor tendencia de complicaciones en las mujeres y el porcentaje de complicaciones aumenta cuanto menor es el espacio disponible para la erupción

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

Tuberous sclerosis complex with oral manifestations: A case report and literature review

Introduction: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome produced by a number of genetic mutations. The disease is characterized by the development of benign tumors affecting different body systems. The most common oral manifestations of TSC are fibromas, gingival hyperplasia and enamel hypoplasia. Clinical Case: A 35-year-old woman diagnosed with TSC presented with a reactive fibroma of considerable size and rapid growth in the region of the right lower third molar. Discussion: In the present case the association of TSC with dental malpositioning gave rise to a rapidly evolving reactive fibroma of considerable diameter. Few similar cases can be found in the literature. Patients with TSC present mutations of the TSC1 and TSC2 genes, which intervene in cell cycle regulation and are important for avoiding neoplastic processes. No studies have been found associating TSC with an increased risk of oral cancer, though it has been shown that the over-expression of TSC2 could exert an antitumor effect. Careful oral and dental hygiene, together with regular visits to the dentist, are needed for the prevention and early detection of any type of oral lesion. The renal, pulmonary and cardiac alterations often seen in TSC must be taken into account for the correct management of these patients.

Retrospective clinicopathological study of 418 odontogenic cysts

Objectives: To determine the relative incidence of odontogenic cysts and to identify the main clinicopathological features among patients treated in the Oral Surgery Department of the Dental Clinic of the University of Barcelona (Spain). Study design: A retrospective observational study was made of 418 odontogenic cysts diagnosed in 380 patients included in the database of 1235 histopathological diagnoses. The subjects were treated in the Master degree program of Oral Surgery and Implantology of the University of Barcelona in the period 1997-2006. The following variables were recorded: gender, age, clinical characteristics of the lesions (size and location), radiological features, duration, treatment, complications and relapses. A descriptive analysis was made of the study variables, using the SPSS version 15.0. Results: The incidence of odontogenic cysts was 33.8%. The mean patient age at appearance of the lesion was 42 years (range 7-83). The cysts were slightly more prevalent in males (58.4%). The lesion size ranged from 2-60 mm, with a mean size of 18.4 mm. The most frequent diagnosis was radicular cyst (50.2%). The most common location of the odontogenic cysts was in the mandible (61.5%), particularly the lower third molar region (36.8%). Conclusions: The most frequently diagnosed lesion was the radicular cyst. Odontogenic cysts were seen to be slightly more prevalent in males, and showed a high mandibular incidence. Knowledge of the biological and histological behavior of odontogenic cysts and their frequency are key aspects for ensuring early detection and adequate treatment.

Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks

Purpose: To evaluate the duration of the effect of mepivacaine when hyaluronidase is injected immediately prior to the end of pulpal anesthesia. Patients and Methods: Forty bilateral, symmetrical third molar surgeries were performed in 20 healthy patients. Inferior alveolar nerve block was induced using 2.8 mL 2% mepivacaine with epinephrine. Hyaluronidase (75 turbidity-reducing units) or a placebo was injected 40 minutes after the beginning of pulpar anesthesia (randomized and double-blind trial). The duration of effect in the pulpal and gingival tissues was evaluated by response to painful electrical stimuli applied to the Adjacent premolar, and by mechanical stimuli (pin prick) to the vestibular gingiva, respectively. Results: in both tissues, the duration of anesthetic effect with hyaluronidase was longer (P <.01) than with the placebo. Conclusion: Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks. (c) 2008 American Association of Oral and Maxillofacial Surgeons.

O tratamento ortodôntico em uma perspectiva a longo prazo: avaliação da estabilidade oclusal e do grau de satisfação dos pacientes

This study aimed to evaluate factors associated to orthodontic treatment stability and patient satisfaction in the long-term. A total of 209 patients (88 class I and 121 class II) treated with straight wire fixed appliance were selected at least 5 years post treatment. Six hundred twenty seven dental casts were examined with the PAR Index at pretreatment (T1), end of treatment (T2), and at long-term follow up (T3, mean 8.5 years post treatment). At T3, a Dental Impact on Daily Living questionnaire was used to assess patient satisfaction with the dentition in the long-term. Friedman test and multiple regression analysis were used to evaluate changes among the time points and factors associated with stability and patient satisfaction. Predictive factors used to exam the occlusion were: PAR Index at T1 and T2, age at T1, the amount of time without retainer, length of Hawley retainer wear, length of follow-up, sex, extraction and third molar status. To assess patient satisfaction were considered: changes produced by the orthodontic treatment (PAR T2-T1), post treatment stability (PAR T3), age at the start of treatment (T1), length of treatment (T2-T1), gender, and extraction. Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at T3. No significant change was observed between T2 and T3. However, when the sample was divided according to the level of finalization (PAR T2), it was observed that well-finished patients experienced some deterioration (P<.001), whereas the less well-finished ones showed some improvement (P<.05). Even with the deterioration, the well-finished patients still had a better PAR Index at T3 compared to the less well-finished ones (PAR T2- T3). Regression analysis showed that PAR Index at T1 and T2, age at T1, and length of retainer wear had a slight association with occlusal stability (R2 = 0.27). Patient satisfaction was significantly associated only with PAR Index at T3 (r2=0.125, P<.0001). We can conclude that, even thought orthodontic treatment is quite stable, not so well-finished treatments tend to show some improvement and well-finished ones deteriorate some in the long-term. Despite of that, well-finished patients still have better occlusal characteristics. Patient satisfaction is not related to the result of orthodontic treatment; nevertheless, there is a slight association with dentition in the long-term

Avaliação ortopantomográfica das angulações mesiodistais de caninos, pré-molares e molares inferiores com e sem a presença dos terceiros molares

OBJETIVOS: comparar os valores médios normais das angulações mesiodistais dentárias, propostos por Ursi, em 1989, com as angulações mesiodistais de caninos, pré-molares e molares inferiores em indivíduos com e sem a presença dos terceiros molares inferiores e idades entre 18 e 25 anos. Além disso, foram comparados os valores das angulações mesiodistais desses dentes nessas duas situações. MÉTODOS: foram utilizadas 40 radiografias ortopantomográficas de indivíduos, de ambos os gêneros, que não receberam tratamento ortodôntico, divididos em dois grupos: Grupo I, constituído por 20 radiografias que não apresentavam os terceiros molares inferiores; e Grupo II, formado por 20 radiografias com os terceiros molares inferiores presentes. RESULTADOS E CONCLUSÕES: a análise dos resultados e a análise estatística permitiram concluir que ambos os grupos exibiram pré-molares e molares inferiores mais angulados em sentido mesial, quando comparados à oclusão normal. Por outro lado, a angulação mesiodistal de caninos inferiores mostrou-se semelhante àquela apresentada em casos de oclusão normal. Os dois grupos, quando comparados entre si, exibiram semelhantes valores angulares dos caninos, pré-molares e molares inferiores, de modo que a presença dos terceiros molares não exerceu influência sobre essas angulações mesiodistais dentárias.

Avaliação radiográfica do comportamento dos terceiros molares inferiores em pacientes tratados ortodonticamente com e sem extrações de primeiros pré-molares

OBJETIVO: o presente trabalho objetivou avaliar as alterações ocorridas nas posições dos terceiros molares inferiores em pacientes tratados ortodonticamente com extrações dos primeiros pré-molares. METODOLOGIA: utilizou-se 80 ortopantomografias, obtidas no pré e pós-tratamento ortodôntico corretivo de 40 pacientes, divididos em dois grupos. O grupo 1 constou de 20 pacientes (13 femininos e 7 masculinos) que se submeteram a tratamento ortodôntico com extrações de primeiros pré-molares. O grupo 2 foi constituído por 20 pacientes (13 femininos e 7 masculinos) tratados ortodonticamente sem extrações. Foram estabelecidas medidas angulares, com o objetivo de avaliar as inclinações e medidas lineares, para analisar as modificações no sentido vertical dos terceiros molares. Todos os dados foram mensurados duas vezes, cujos valores médios foram submetidos dos testes t emparelhado e teste t independente. RESULTADOS: os resultados mostraram diferenças estatisticamente significantes (p<0,01) entre as medidas angulares finais e iniciais do grupo 1. CONCLUSÕES: concluiu-se que os deslocamentos verticais dos terceiros molares inferiores são semelhantes nos casos tratados ortodonticamente com e sem extrações e que estes elementos dentários tornam-se mais verticalizados ao final da terapia realizada com extrações de primeiros pré-molares inferiores.

Erupção dental em pacas (Agouti paca) criadas em cativeiro

Fez-se o acompanhamento radiográfico mensal da erupção dental de cinco fêmeas e sete machos da espécie Agouti paca durante 30 meses. Os animais foram radiografados mês-a-mês. As pacas nasceram com três dentes em cada hemiarcada dental, um incisivo de crescimento contínuo por toda a vida, um pré-molar decíduo (o único que é decíduo) e um molar. No quarto mês houve a erupção do segundo molar. O nivelamento da superfície de oclusão dos dentes inferiores ocorreu no sexto mês e o dos superiores ao redor do nono mês. No 14° mês, houve o início da erupção do terceiro molar e, no 16° mês, a evidenciação radiográfica do pré-molar permanente, ainda com preservação de correspondente decíduo. No 21° mês, ocorreu o nivelamento da superfície de oclusão dos quatro dentes superiores e inferiores. Entre o 22° e o 24° mês, iniciou-se a queda dos pré-molares decíduos inferiores e, entre o 23º e o 24° mês, a dos superiores. Entre o 24º e o 25º mês, a superfície de oclusão dos dentes inferiores estava nivelada, e a dos dentes superiores aconteceu no 27º mês.

Different methods of finishing and polishing enamel

Statement of problem. Highly polished enamel surfaces arc recommended for axial tooth surfaces that will serve as guiding planes and be contacted by component parts of a removable partial denture. There is little evidence to support the assumption that this tooth modification will provide accurate adaptation of the framework and prevent build-up of plaque.Purpose. The aim of this investigation was to evaluate the surface roughness of the tooth enamel, prepared to serve as guiding planes, with different polishing systems.Material and methods. Four different methods (designated A, B, C, and D) for finishing and polishing the prepared enamel surfaces of 20 freshly extracted third molar teeth were studied. Each method involved 3, 4, or 5 different steps. The roughness of each specimen was measured at the start of each method before recontouring, after recontouring, and after each step of the 4 finishing and polishing procedures. The 4 experimental finishing methods were applied after recontouring the axial surfaces (buccal, lingual, and proxinial) of each tooth. Thus the 20 teeth (60 surfaces) were finished and polished by use of 1 of the experimental methods. Surface roughness was measured with a profilometer (mum); the readings of the unpolished enamel Surfaces were recorded as control measurements. Results were statistically analyzed with one-way analysis of variance followed by Tukey's test at the 95% level of confidence.Results. The highest roughness mean values (14.41 mum to 16.44 mum) were found when the diamond bur was used at a high speed for tooth preparation. A significant decrease in roughness values was observed with the diamond bur at a low speed (P<.05). Analysis of the roughness values revealed that all polishing methods produced surface roughness similar to that of the corresponding control teeth.Conclusion. Within the limitations of this study, all finishing procedures tested effectively promoted an enamel surface similar to the original unpolished enamel.

Paradental cyst: Report of two cases

Background: the paradentat cyst is an odontogenic lesion of inflammatory origin that has few clinical signs and symptoms apart from recurring acute episodes. A well-defined radiolucency associated with the roots or distal to the crown may be seen radiographically. The purpose of this article is to report on different aspects of two cases involving paradental cysts. In the first case, the patient complained about recurring pericoronitis. A semilunar-shaped radiolucency on the distal aspect of the mandibular third molar was noted on the periapical radiograph. In the second case, the patient's main complaint was chronic trauma of the overlying mucosa. Radiographs revealed an enlarged pericoronal space.Methods: In both cases, the mandibular third molar was extracted due to a lack of space. Lesional samples were sent for histopathologic analysis.Results: In the first case, the drainage of cystic fluid and a regular concavity were found during tooth removal. In the second case, a nodular lesion was found adhering to the disto-buccal surface of the tooth arising from the distal wall of a periodontal pocket. The histopathologic analysis revealed a hyperplastic stratified squamous epithelium with arcading lining a fibrous capsule with inflammatory infiltrate, resulting in a final diagnosis of a paradental cyst.Conclusions: the presence of a paradental cyst should be considered when recurrent inflammatory periodontal processes are associated with partially erupted vital teeth, even when characteristic radiographic findings are absent. Definitive diagnosis requires a clinicopathologic correlation incorporating surgical, radiographic, and histologic findings.