Management of Severely Aberrant Permanent First Molars in Molar Root–Incisor Malformation Patients: Case Series and a Guideline

Recently, a new type of dental anomaly, a molar–incisor malformation or molar root–incisor malformation (MRIM), was recognized. The disease phenotype is now relatively well characterized; however, its etiology and disease-mechanism need to be elucidated. The affected teeth do not respond well to conventional treatment because of severe malformation and an unusual root structure. In this study, we present the treatment of MRIM cases with the extraction of severely aberrant permanent first molars (PFMs) and suggest that the PFM extractions are performed when it is clear that third molars will develop. The purpose of this report was primarily to present amendments to the guidelines for the treatment of patients with MRIM.

Third Molar Agenesis in Post-Medieval Chichester

Third molar agenesis is a dental anomaly that occurs in approximately 25% of people worldwide and results in the complete absence of one or more of the third molars in the dentition. A rise in the prevalence of congenitally absent third molars has been noted in modern populations, and it has been proposed as the final evolutionary step in the dental reduction of the human dentition. Whilst much research has been conducted in modern cohorts, relatively little has been published on third molar agenesis in archaeological assemblages. A post-medieval assemblage from Chichester was visually and radiographically analysed to determine the prevalence of this anomaly. Third molars were measured to determine if there was an association between agenesis and size reduction. Prevalence of agenesis was found to be relatively high at 42.7% and 2 of 8 measurements were found to produce significant differences. Consequently, it can be said that high rates of third molar agenesis are not solely a modern phenomenon, as many prevalence rates in recent populations are lower. However, if we are to assess the significance of size differences in third molars of those with agenesis and those without, and to detect patterns within and between these groups, assemblages with larger sample sizes are needed. In order to better understand the trajectory and evolution of this anomaly, more archaeological assemblages must be examined.

Surgical and Orthodontic Treatment of Impaction Maxillary Central Incisor Associated With Supernumerary

Impaction of maxillary central incisors is frequent in dental practice. However its management is challenging because of its importance in aesthetics. Supernumerary teeth are the most common dental anomaly that can cause impaction of adjacent teeth, crowding, diastema, rotation and displacement of teeth. We report a case of 13 year old male with an impacted supernumerary tooth in the maxillary anterior region, which was interfering with the eruption of the permanent, left central incisor. The impacted supernumerary tooth was surgically removed. With the application of an orthodontic traction, impacted left maxillary central incisor was brought down to its proper position in the dental arch.

Chronic paronychia in cats with patellar fracture and dental anomaly syndrome

Case series summary The aim of this case series was to describe the clinical features and treatment of paronychia in cats diagnosed with patellar fracture and dental anomaly syndrome (PADS). Clinical records, photographs, microbiology, cytology and histopathology reports were collected, and follow-up was obtained. Five cats with paronychia were included. All five cats had multiple digits of multiple limbs affected and eventually underwent amputation of the third phalanx of one or multiple digits. A total of 36 digits were affected, 17% (n = 6/36) resolved with medical management and 83% (n = 30/36) were eventually treated successfully by amputation. The cats had treatment with numerous courses of antibiotics (range 7–20; mean 11 courses) over periods of time ranging from 10 to 67 months (mean 32 months). Relevance and novel information Chronic paronychia may be an additional clinical feature of PADS and the probable mechanism involves poor integrity of osteopetrotic bone, loss of normal nailbed anatomy and secondary osteomyelitis of the distal phalanx. Medical management with antibiotics, anti-inflammatory therapy and steroid treatment may improve the clinical signs in the short term; however, in severe instances, amputation of the third phalanx of the affected digit seems to be necessary to resolve repeated recurrences and discomfort. Additional information on the long-term outcome is required. In any cat with atraumatic patellar fractures and/or retained deciduous teeth, paronychia may require surgical management if medical management is unsuccessful.

Dens Invaginatus in Patients With Cleft Lip and Palate: A Case Series

Dens invaginatus is a rare developmental anomaly characterized by an infolding of the enamel organ within the crown or root of a tooth, and it is an example of a dental anomaly that has a higher incidence in patients with CL/P. If undiagnosed, dens invaginatus can lead to severe, acute pain and pulpal necrosis since it can permit direct entry of bacteria into the dental pulp. Treatment of dens invaginatus includes prophylactic sealant or composite restoration, endodontic therapy if pulpal involvement has already occurred, or extraction if aberrant tooth morphology precludes endodontic therapy. Few studies report on the incidence of dens invaginatus in patients with CL/P. The purpose of this article is to describe 4 cases of dens invaginatus in patients with CL/P which were encountered in a cleft-craniofacial orthodontic clinic. Each case describes dens invaginatus in a maxillary lateral incisor, and treatments ranged from sealant application to endodontic therapy to extraction. These cases highlight the importance of awareness of this dental anomaly among cleft team providers to facilitate early diagnosis in patients with CL/P.

Treatment of pelvic fractures in cats with patellar fracture and dental anomaly syndrome

Objectives The aim of this study was to describe the treatment and outcome of acetabular and other pelvic fractures in cats with patellar fracture and dental anomaly syndrome (PADS) and to provide advice on how to manage these cases in practice. Methods Data were collated on cats with PADS that were reported to have sustained pelvic fractures or had fractures or fissures of the pelvis identified on submitted radiographs. The details of the fractures were recorded, in addition to any treatment and outcome information. Results Of the 215 cases reported with PADS, 58 cats (27%) were found to have pelvic fractures, none of which were known to have resulted from significant trauma. There were 101 fractures in total and of these 15 were treated with surgery, including 10 acetabular fractures, two ilial, two pubic and one ischial fracture. Screw loosening and loss of fracture reduction was seen in four of the surgically treated fractures (two pubic fractures, one ilial and one acetabular fracture). Fourteen cats were euthanased as a direct result of a fracture occurring. While most pelvic fractures healed uneventfully, some cats remained intermittently lame, but it was not always possible to determine the cause of the lameness from the information available and because all cats had concurrent patellar fractures. Conclusions and relevance Many of the pelvic fractures healed with conservative management. Fractures involving articular surfaces such as acetabular fractures may benefit from surgical stabilisation as surgery may offer the benefits of articular fracture repair with improved joint congruency and a faster return to normal activity.