To extract or not to extract? Management of infraoccluded second primary molars without successors

Characterizing infraocclusion in primary molars: prevalence, accompanying findings, and infraocclusion severity and treatment implications

BACKGROUND

This manuscript investigates the prevalence, classification, accompanying findings, and treatment modalities associated with infraoccluded primary molars. The aim of this study categorizing primary molars based on the severity of infraocclusion and assessing their respective treatment interventions across different severity groups.

METHODS

The classification, treatment types, accompanying findings, and the condition of succeeding premolars of infraoccluded molars were documented. Chi-square tests, including Fisher's Exact Chi-square test, Fisher Freeman Halton Exact Chi-square test, and One Sample Chi-square test, were conducted. The predetermined significance level was less than 0.05.

RESULTS

The study population consisted of 3132 subjects aged 3 to 15 years, with a prevalence of 4.3% for infraocclusion. Infraocclusion typically manifests between 6 and 9 years of age and predominantly affects mandibular primary molars. Treatment interventions varied based on infraocclusion severity, with more invasive procedures required for severe cases. Accompanying findings associated with infraocclusion include adjacent teeth tipping, significant deviation in midline shifts towards the affected side and increased caries. Additionally, succeeding premolar agenesis was observed in 2% of infraoccluded molars, with extraction rates higher in cases where the successor tooth was mesially or distally located.

CONCLUSIONS

The study offers novel insights to dental practitioners concerning the severity and distribution of treatment interventions for infraocclusion. It suggests that more severe cases may necessitate more invasive procedures, with the aim of enhancing patient outcomes through timely intervention and personalized therapeutic strategies.

Reduced bone dimension in patients affected by oligodontia: A retrospective study on maxillary and mandibular CBCT

AIM

Oligodontia (OD) is a rare developmental condition characterized by the absence of six or more teeth. Dental implant placement may be challenging due to anatomical factors. This study aims to evaluate the alveolar bone dimensions in OD patients compared with controls.

MATERIALS AND METHODS

On maxillary and mandibular cone-beam computed tomography (CBCT), bone height and width were measured at every tooth and edentulous site. The distance to the inferior alveolar nerve was also measured. Fifty-three OD patients (40 maxillary and 32 mandibular CBCT) and 82 controls (51 maxillary and 31 mandibular CBCT) were compared using mixed models.

RESULTS

Compared with those in OD patients, maxillary permanent teeth and edentulous sites showed significantly higher mean height in control patients (incisive-canine site height: +2.12 mm; edentulous incisive-canine site height: +4.46 mm [p > .001]). For the mandibular permanent teeth, mean height was higher in controls than in OD patients at the incisive-canine (+3.82 mm [p > .001]) and premolar areas (+2.06 mm [p > .001]). Only edentulous incisive-canine sites were significantly different between controls and OD patients (mean: +0.52 mm [p > .001]). Changes in alveolar nerve position were observed in case of molar agenesis.

CONCLUSION

Maxillary and mandibular bone dimensions are reduced in OD patients compared with controls both in sites with permanent teeth and in edentulous areas.

Tooth agenesis: An overview of diagnosis, aetiology and management

Patients with one or more developmentally absent teeth are routinely encountered in dental practice. Tooth agenesis can be associated with significant functional, aesthetic and psycho-social problems. The present article provides an overview of the prevalence and aetiology of tooth agenesis, as well as the condition's clinical characteristics and management options with reference to the evidence base. A timely diagnosis can facilitate the appropriate planning and management which might not be straightforward, and patient care will likely require multi- and inter-disciplinary input. It is critical that dental care practitioners are aware of the clinical characteristics and management options for tooth agenesis.

Restorative dentistry clinical decision-making for hypodontia: retained primary molars

Primary molar teeth that are retained beyond their exfoliation pose a clinical decision-making challenge for dental teams. The retention of these teeth may be due to absence of a permanent successor. As a result, careful planning is required to determine if retention or extraction is necessary. This article aims to discuss the prevalence of retained primary molars, assessment and treatment planning considerations, from both orthodontic and restorative perspectives.

Frequency and Local Etiological Factors of Impaction of Permanent Teeth among 1400 Patients in a Greek Population

Background: The purpose of this study is to analyze the frequency of impaction of permanent teeth, beyond the third molars, and to highlight the factors causing this condition. Methods: Panoramic radiographs of 1400 patients that sought orthodontic treatment in private practice were retrieved and examined. All teeth that had not been erupted at the time of the examination while their root formation was completed were considered impacted. Results: In total, 212 out of 1400 patients had at least one impacted tooth (15.14%). The highest incidence of tooth impaction was in the canines of the maxilla, followed by the central incisors of the maxilla, the second molars of the mandible and the second premolars of the mandible. The most common etiological factors responsible for the impaction were the ectopic eruption pathway, loss of space in the arch, the ankylosis of the deciduous teeth and the presence of supernumerary teeth. Conclusions: Tooth impaction is frequently seen in everyday orthodontic practice. The upper canines are the teeth most frequently associated with impaction and failure of eruption. It is important to diagnose cases of impaction early on and identify the etiological factors in order to achieve immediate and effective treatment per patient.

Prevalence and Manifestations of Dental Ankylosis in Primary Molars Using Panoramic X-rays: A Cross-Sectional Study

Dental ankylosis is a serious condition defined as the process that causes the fusion between the dentin or the cementum of the root and the alveolar bone, with the obliteration of the periodontal ligament becoming progressively replaced by bone tissue. The aim of the study was to determine the prevalence, location, severity, and association of dental ankylosis in primary molars with other dental anomalies such as the agenesis of permanent buds. For this study 150 panoramic x-rays were selected from patients with temporary or mixed dentition, aged six to twelve years old, from a private dentistry office and from the Pediatric Dentistry Department of UMFST in Targu-Mures, Romania. In order to identify the cases with dental ankylosis, the presence and severity of the infraocclusion, displacements of the neighboring teeth, the appearance of the root area, and the relationship with the bone tissue were examined. For evaluation of the categorical data we used Fischer’s exact test and the Chi-squared test and the chosen significance level was set at 0.05. The results showed that the highest percentage of cases with ankylosis was found in the first group (six to nine years old), respectively, with 72% of cases compared with the second group (ten to twelve years old) with 28% of cases. Findings showed that there was no positive association between dental ankylosis and gender, but a strong correlation was found regarding the location on the dental arches. Most cases were identified on the lower arch with a higher percentage in quadrant three. Of the two primary molars, the most affected by ankylosis was the first molar in quadrant three, followed by the second molar, and finally the first molar in quadrant four. Most cases diagnosed with ankylosis had a mild to moderate degree of infraocclusion; therefore, changes in the functional balance of the dental arch and on neighboring teeth were insignificant. There were some differences obtained between our results and studies from the literature, especially regarding the localization in the lower left dental arch, but these differences can be attributed to the number of the subjects selected and from the methodology of dental ankylosis diagnosis. Based on the data obtained, it was concluded that ankylosis is a dental condition which occurs in children in early mixed dentition, especially in the lower arch, with the first primary molar being the most affected tooth. The presence of infraocclusion and the absence of dental mobility, especially during the stage of primary molars’ root resorption, are the main signs which must be followed to make an early diagnosis and prevent further complications.

Eruption disturbances in the mixed dentition: orthodontic considerations for primary dental care

The primary dental care clinician is in a prime position to identify deviations from normal dental development. Disturbances can affect any new erupting tooth. The objective of this narrative review is to describe several situations in which eruption disturbances can arise during the mixed dentition. It will provide an overview of the orthodontic considerations of these disturbances in addition to key summary points on interceptive management, based on the best available evidence.

Treatment of ankylosed deciduous molars with or without permanent successors in children and adolescents: a systematic review

INTRODUCTION

The aim of this systematic review was to provide guidelines for decision-making during orthodontic treatment planning of infra-occluded deciduous molars with or without their successors in children and adolescents.

EVIDENCE ACQUISITION

Computerized search was conducted on Medline via PubMed, and Cochrane Library. Articles published until 2020 in English language were analyzed following the Preferred Reporting Items for Systematic Reviews (PRISMA) Checklist. Observational and interventional longitudinal studies reporting the treatment of ankylosed deciduous molars with or without successor tooth in 3 to 15-year-old patients were included.

EVIDENCE SYNTHESIS

In case of ankylosis with presence of successor, exfoliation took place in 77% of teeth, while extraction involved 23%. Infra-occlusion happened in 53% of teeth (worsening in 52%), alveolar bone loss in 37%, mesial tipping of first permanent molar in 5%, and over-eruption of antagonist in no cases (after exfoliation and eruption of successor). In case of ankylosis without successor, exfoliation took place in 1% of teeth, progression of infra-occlusion in 42%, progression of root resorption in 58%, development of mesial tipping of first permanent molars in 25%, while no case of antagonist over-eruption was reported.

CONCLUSIONS

When the permanent tooth is present and the ankylosed tooth is slightly or moderately infra-occluded, observation is appropriate. In case of severe infra-occlusion or absence of successor, tooth extraction may be considered together with orthodontic space closure, transplantation, or prosthetic replacement. Alternatively, nonextraction and a prosthetic build-up may be considered.