Erupted Complex Odontoma Mimicking a Mandibular Second Molar

Complex odontoma (CO) is considered one of the most common odontogenic lesions, composed by a miscellaneous of dental tissue such as enamel, dentin, pulp and sometimes cementum. They may interfere with the eruption of an associated tooth, being more prevalent in the posterior mandible. CO has been rarely reported as erupted, being considered an intraosseous lesion. This is a case report of a 17-year-old male with a benign fibro-osseous lesion consistent with CO that was located at the left second molar region, above the crown of the impacted mandibular second molar tooth. The lesion was surgically removed, and the tooth had to be extracted, since there was no indication that it could erupt naturally or with orthodontic traction. The histopathological examination confirmed the diagnosis of CO and after 6 months complete bone formation was observed radiographically. An early diagnosis will provide a better treatment option, avoiding tooth extraction or a more damaging surgery

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement. (Am J Orthod Dentofacial Orthop 2011;139:533-43

Perbandingan Tingkat Penerimaan Pasien Anak Penggunaan Chloride Ethyl dan Benzocaine Gel dalam Pencabutan Gigi Susu Berdasarkan Facial Image Scale

BACKGROUND: Tooth extraction needs to be done to prevent tooth eruption from growing in an incorrect place. If this is left unchecked it will cause malocclusion (tooth structure that is not good and right) which results in the emergence of caries, tartar, bad breath to joint disorders TMJ (Pratiwi, 2009). Before performing tooth extraction, anesthesia needs to be done first. When extraction is generally given local anesthesia, in certain circumstances general anesthesia is performed by an anesthetist. Various types of topical anesthetic ingredients according to the ingredients of the medicine are chloride ethyl, Xylestesin ointment, Xylocain Ointment, Xylocain Spray, and benzocaine (liquid, gel, spray). The level of child acceptance of the dental extraction anesthesia procedure can be measured by the "face image scale" indicator in the form of facial hedonic scale. OBJECTIVE: to determine the level of acceptance of pediatric patients for the use of ethyl cholride and benzocaine gel anesthesia in milk tooth extraction anesthesia based on facial image scale. METHODS: This research is a type of experimental research with observation and descriptive design to describe the level of acceptance of pediatric patients for the use of ethyl cholride and benzocaine gel in the procedure for anesthesia of tooth extraction based on facial image scale. The instrument in this study is a research instrument to measure the level of patient acceptance is the Facial Image Scale in the form of facial hedonic scale consisting of 5 categories of levels of admission of children to topical anesthetic in the form of chloride ethyl and benzocaine gel. A sample of 60 children was grouped into 2 groups, namely the group of patients who would be extracted from their teeth using 30 chloride ethyl anesthetics and a group of patients who would have their teeth extracted using benzocaine gel anesthetic as many as 30 patients. RESEARCH RESULTS: As many as 53.3% of children were rather dislike a little chlorethyl anesthesia when their milk teeth were removed and as much as 66.67% of children rather like (like a little) benzocain gel anesthesia when extracting their milk teeth. CONCLUSION: Benzocain gel is preferred by pediatric patients in the extraction of milk teeth. SUGGESTION: If you are going to use chloride ethyl anesthesia in tooth extraction, it should be accompanied by the implementation of good therapeutic communication so that the patient is not surprised when anesthetized, so there is no rejection of tooth extraction. Even if using benzocaine gel anesthesia, even though benzocain gel is more acceptable than chloride ethyl, it should still be accompanied by good therapeutic communication, to avoid rejection of tooth extraction. For pediatric patients with a high level of anxiety should be avoided the use of chloride ethyl anesthesia to extract milk teeth so that the child is not surprised and afraid or refuse to take his teeth, and recommended to use benzocain gel anesthesia for extraction of milk teeth. Keywords: milk tooth extraction, facial image scale, chloride ethyl, benocaine ge

A preliminary study of local administration of dexamethasone after tooth extraction: Better preservation of residual alveolar ridge?

Background/Aim. It is important that the height of the edentulous alveolar ridge after tooth extraction remains at a reasonable acceptable level for as long as possible. The aim of this study was to report preliminary results of the clinical effect of local oral submucous administration of dexamethasone after tooth extractions in order to prepare alveolar supporting tissues for acceptance of removable dentures. Methods. In a total of 15 patients (11 partially and 4 completely edentulous) the quantity of 0.25 mL to 0.5 mL of dexamethasone was injected bucally and orally in the region of the tooth socket after complicated extractions. Results. Healing of extraction wounds was uneventful in all the patients, without pain or local inflammation. Conclusion. Dexamethasone can be locally applied to oral tissues to prevent post-extraction inflammation and extensive resorption of the residual alveolar ridge. The obtained results are promising for patients undergoing classic prosthodontic rehabilitation soon after tooth extraction, demonstrating that there are no adverse effects after local oral corticosteroids administration. [Projekat Ministarstva nauke Republike Srbije, br. 175021

Outcomes of Primary Endodontic Therapy Provided by Endodontic Specialists Compared to Other Providers

Introduction: The objective of this study was to compare the outcomes of initial non-surgical root canal therapy (NSRCT) for different tooth types provided by both endodontists and other providers. Methods: Using an insurance company database, 487,476 initial NSRCT procedures were followed from the time of treatment to the presence of an untoward event indicated by Current Dental Terminology (CDT) codes for retreatment, apical surgery, or extraction. Population demographics were computed for provider type and tooth location. Kaplan-Meier survival estimates were calculated for 1, 5, and 10 years. Hazard ratios for provider type and tooth location were calculated using the Cox proportional hazards model. Analyses were performed using SAS 9.4 (Cary, NC). Results: The survival of all teeth collectively was 98% at 1 year, 92% at 5 years, and 86% at 10 years. Significant differences in survival based on provider type were noted for molars at 5 years, and for all tooth types at 10 years. The greatest difference discovered was a 5% higher survival rate at 10 years for molars treated by endodontists. This was further evidenced by a hazard ratio of 1.394 when comparing other provider’s success to endodontists within this ten-year molar group. Conclusions: These findings show that survival rates of endodontically teeth is high at ten years post treatment regardless of provider type. Molars treated by endodontists after 10 years have significantly higher survival rates than molars treated by non-endodontists

Patient-centered endodontic outcomes: a narrative review.

IntroductionRoot canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults.Materials and methodsPatient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis.ResultsApplication of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses.ConclusionDentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT

The window approach for extraction of tooth root fragments: a different soft tissue management

Different techniques have been proposed for the removal of the apical portion of fractured teeth. The window approach was proposed in the past to remove a tooth root fragment through a buccal bone opening at the level of fragment. In the classical approach, a marginal triangular flap is elevated, only the bone overlying the fractured apex is removed and then the apex is pushed out by an elevator toward the alveolar crest. In this technique, the bone removal is minimal, and it does not involve the marginal bone so that patient’s post-surgical discomfort is reduced, and bone resorption is less. A different kind of soft tissue management for bone exposure is proposed here with a simple linear incision at the level of the root apex without any vertical incision. This kind of incision is simple and versatile, leads to a lesser discomfort to the patient and avoids un-aesthetic scar

Endoscopy-assisted removal through combined lower and middle meatotomies of an ectopic upper third molar in the sinus associated with a dentigerous cyst

The aim of this case report is to present an original conservative technique for the transnasal endoscopy-assisted extraction of an ectopic upper third molar associated with a dentigerous cyst occupying the whole maxillary sinus by means of combined lower and middle meatotomies. The proposed technique is a viable, minimally-invasive alternative to the Caldwell–Luc operation (with or without the repositioning of a bone lid), and also to endoscopic middle meatal antrostomy in cases where this would be unable to ensure adequate access because of the position and size of the ectopic tooth and associated cyst