Impacted maxillary second premolars: a report of four cases

A comprehensive classification for impacted cuspids and bicuspids with a proposal for Difficulty Index Categorization: a single center evaluation of 4165 cases

BACKGROUND

The aim of the current study was to propose a classification of impacted cuspids, and bicuspids based on their spatial position in the maxillary and mandibular arches and their radiological appearance.

METHODS

This prospective study was conducted including all the patients who reported to our center for extractions, orthodontic treatment, missing permanent cuspids/bicuspids, removal of third molar teeth. All patients who reported within a time frame of 6 months were enrolled in the study. Orthopantomogram was advised for all the patients as a part of diagnostic work up. The panoramic radiographs and clinical data were reviewed and patients with evidence of impacted bicuspids and cuspids were included in the study and were advised to undergo a cone beam computed tomography to evaluate the 3-dimensional position of the impacted teeth. Treatment plan was decided based on the position of the impacted teeth and feasibility for orthodontic movement. Standard surgical protocol was followed for all the patients. The duration of the procedure from the time of incision till the suturing were tabulated and the difficulty of extraction was correlated with the current Difficulty Index to validate the same.

RESULTS

A total number of 4165 patients were enrolled in the study and based on the inclusion and exclusion criteria, 3680 patients were excluded and 487 patients with impacted cuspids/bicuspids were included in the study. A total number of 231 patients had impacted maxillary cuspids and bicuspids and 256 cases had impacted mandibular cuspids/bicuspids. Amongst the 256 mandibular cuspid and bicuspid that were impacted, 62% were in position C while the rest of 38% were in position B. More than ⅓ of the teeth which were in position C had transmigrated (35%). Seventy-three percent of the maxillary teeth were in position C and 69% of these teeth were either transmigrated (29%), or were horizontally (38%) placed in the alveolus or inverted (2%). The rest of the 31% were found to be either mesially inclined or vertical. The average Difficulty Index for maxillary teeth was 8 and mandibular teeth was 9. Mandibular cuspids and bicuspids in position B and C took longer time for surgical removal compared to the maxillary teeth and this was statistically significant.

CONCLUSIONS

The proposed clinical classification on impacted mandibular cuspids and bicuspids provides a structured approach to plan the treatment based on the 3-dimensional position of the teeth in the arch.

A retrospective study: Do all impacted teeth cause pathology?

Objective

The objective of this study is to determine the incidence of impacted teeth and the frequency of pathologies they caused by cone beam computed tomography (CBCT) retrospectively.

Materials and Methods

In this study, 608 patients' CBCT images were analyzed retrospectively. Detected impacted teeth were classified as incisor, canine, premolar, molar, third molar, and supernumerary teeth. The pathologies caused by impacted teeth are classified as cysts or tumors, tooth decay, root resorptions, and periodontal bone loss.

Results

Impacted teeth were detected in 34.37% of the 608 CBCT images included in the study. The distribution of impacted teeth was 9.4% incisor, 29.4% canine, 9.9% premolar, 2.9% molar, 9.3% supernumerary, and 39.9% third molar teeth. Approximately 63.7% of the impacted teeth caused a pathology. The pathology that was most commonly caused by impacted teeth was periodontal bone loss (44.4%), and respectively others were root resorptions (33.3%), cysts or tumors (8.6%), and tooth decay (2.3%). The most common cause of this pathology was right mandibular third molar teeth.

Conclusion

Impacted teeth were common and they often caused a pathology. CBCT is a useful device to assess the impacted teeth. When the impacted teeth are evaluated, each tooth should be assessed within itself. If the impacted teeth are not caused by pathology, they can be kept under control.

Dentigerous Cyst associated with Impacted Maxillary Premolar: A Rare Site Occurrence and a Rare Coincidence

A dentigerous cyst is a developmental odontogenic cyst occurring most commonly in the third molar region of mandible and maxilla and maxillary canine region followed by mandibular premolar areas. However, dentigerous cyst occurring in association with impacted maxillary premolars is a very rare presentation accounting for less than 0.5% of total dentigerous cyst cases. In the following case report, a dentigerous cyst was reported in maxillary premolar region in a nonsyndromic patient having one missing premolar and another malformed one associated with the dentigerous cyst. How to cite this article: Jain N, Gaur G, Chaturvedy V, Verma A. Dentigerous Cyst associated with Impacted Maxillary Premolar: A Rare Site Occurrence and a Rare Coincidence. Int J Clin Pediatr Dent 2018;11(1):50-52.