Mandibular lateral incisor-first premolar transposition in early mixed dentition: a rare case

Dental transposition is an anomaly of eruption which is usually seen in the maxilla and rarely in the mandible. The mandibular lateral incisor's transposition with the permanent canine has a prevalence of less than 0.03%. The following case presents an even rarer situation, of a right lateral mandibular incisor that erupted in the place of the first premolar, in transposition with the temporary canine. In the first phase, a series of extractions have been performed, to ensure the necessary free space for moving the lateral incisor closer to its appropriate place, and after that a fixed orthodontic appliance was used. The biomechanics for intra-arch tooth movement was ingenious enough to ensure a perfect alignment of all permanent teeth and a functional Class I canine and molar final occlusion. Early intervention and successful move of the permanent canine in its correct position ensured the functionality of the mandibular movements and a good long-term prognosis.

A rare find of a maxillary third molar with five roots: a case report of an unusual morphology

Third molars are frequently absent or impacted; their unpredictable prevalence and morphology, with frequent anatomical variations, is a challenge for the practitioner. The number of roots of the upper third molars vary from one to five, but five roots upper third molars' cases are extremely rare. The case reported here is of a normotrophic male patient, with no significant general medical history, having extracted an impacted maxillary upper molar, with an unusual position and dimensions and five completely separated formed roots, orientated in diverse directions. It highlights the importance of using the correct surgical technique, without excessive pressure, for avoiding the fracture of the maxillary tuberosity, the displacement of the molar into the pterygopalatine fossa or the opening of the maxillary sinus, especially in the absence of good quality imagistic information like cone-beam computed tomography. The case presented in this paper is very rare and highlights the significance of anatomical knowledge, which is mandatory for managing these cases, to avoid trauma, accidents, and complications and to maintain an optimal time of extraction, since such variations occur, and the conventional radiographs do not offer enough data to clarify the diagnosis.

Base Materials' Influence on Fracture Resistance of Molars with MOD Cavities

The aim of this study was to compare fracture resistance of teeth presenting medium-sized mesial-occlusal-distal (MOD) cavities using different base materials. Thirty-six extracted molars were immersed for 48 h in saline solution (0.1% thymol at 4 °C) and divided into six groups. In group A, the molars were untouched, and in group B, cavities were prepared, but not filled. In group C, we used zinc polycarboxylate cement, in group D—conventional glass ionomer cement, in group E—resin modified glass ionomer cement, and in group F—flow composite. Fracture resistance was tested using a universal loading machine (Lloyd Instruments) with a maximum force of 5 kN and a crosshead speed of 1.0 mm/min; we used NEXYGEN Data Analysis Software and ANOVA Method (p < 0.05). The smallest load that determined the sample failure was 2780 N for Group A, 865 N for Group B, 1210 N for Group C, 1340 N for Group D, 1630 N for Group E and 1742 N for Group F. The highest loads were 3050 N (A), 1040 N (B), 1430 N (C), 1500 N (D), 1790 N (E), and 3320 N (F), the mean values being 2902 ± 114 N (A), 972 ± 65 N (B), 1339 ± 84 N (C), 1415 ± 67 N (D), 1712 ± 62 N (E), and 2334 ± 662 N (F). A p = 0.000195 shows a statistically significant difference between groups C, D, E and F. For medium sized mesial-occlusal-distal (MOD) cavities, the best base material regarding fracture resistance was flow composite, followed by glass ionomer modified with resin, conventional glass ionomer cement and zinc polycarboxylate cement. It can be concluded that light-cured base materials are a better option for the analyzed use case, one of the possible reasons being their compatibility with the final restoration material, also light-cured.

A rare case of transmigrated mandibular canine and combined orthodontic-surgical management

Canines are paramount teeth for esthetics and function. Transmigration of the lower permanent canine is a rare process of alteration of the eruption path toward the opposite part of the mandible. The position of the migrating tooth varies at different ages, so early detection of the tendency to cross the midline is crucial; canines that have already passed through the center of the mandible can be impossible to realign. Transmigration can start any time before the normal age of eruption. Comparing two radiographic images taken at different ages offers important diagnosis information. Camilleri & Scerri (2003) described a progressive alteration of the tooth position in four steps, from the normal appearance to a low position inside the corpus of the mandible. Following this classification, this article’s aim was to present a case of an impacted lower canine that was diagnosed between the second and third stage of transmigration, around the age of 10, and to detail the combined orthodontic–surgical treatment strategy for “recapturing” and the orthodontic mechanics used to align it. After the examination of cone-beam computed tomography, we have decided to use a lingual arch as a space maintainer and anchorage tool and to surgically expose the tooth. The canine’s initial position and the direction of the force of traction used allowed a proper alignment of the tooth inside the dental arch. The periodontal tissues management was important for good healing, stability, and aesthetics. The early detection allowed a proper interdisciplinary orthodontic–surgical management, and a successful outcome.

Periodontal clinico-morphological changes in patients wearing old nickel-chromium and copper alloys bridges

Elderly population frequently presents more than one prosthetic restoration realized from different types of dental alloys which, in time, suffer various alterations in the oral environment. Metallic ions are released in saliva due to its electrolytic qualities, interacting with the contact tissues. Studies regarding cytotoxicity of dental alloys are providing contradictory results. Besides biocompatibility, the microbial factor is also greatly influencing the long-term success of the prosthetic rehabilitation. This study's aim was to assess the response of the gingival tissue to nickel-chromium (Ni-Cr) and copper (Cu)-based dental casting alloys from fixed dentures present in many patients from Romania. Gingival samples were taken from 124 patients wearing fixed dental restorations made from these two types of alloys from injured areas surrounding the abutment teeth; histological specimens were prepared, fixed in 10% neutral buffered formalin, paraffin-embedded and stained with Hematoxylin-Eosin (HE). Histological analysis showed the existence of a chronic inflammatory infiltrate in the gingival chorion, necrosis areas, and vascular congestion. Various morphological alterations appeared, depending on the intensity of the inflammation and the immune response. The surface epithelium suffered a hyperplasic reaction, either limited to acanthosis or involving the whole epithelium, the release of the Cu(2+) and Ni(2+) ions from the dental alloys used in bridges and crowns being responsible for inducing gingival hyperplasia and a chronic inflammation in the areas situated around the abutment teeth. The immunohistochemical study allowed us to observe an increased number of positive cluster of differentiation 3 (CD3) T-lymphocytes in periodontium, proving that the cellular immune response is rapid and intense.

Metal Cations Analysis Contained in Sambucus ebulus L., by Comparative Methods of Atomic Absorption Spectrometry

The purpose of this study was to perform a comparative study of cations in the vegetative organs of Sambucus ebulus by applying three different methods of digestion before atomic absorption spectrometry. Of the tested methods, the most effective was method 3 (mineralisation with nitric acid in a microwave oven), the other methods of sample digestion leading to incomplete mineralization of the samples and implicitly to the incomplete transfer of the analytes into solution, reflecting the slightly different contents in metal cations we obtained.

Biochemical Analysis of Mineral Metabolism and Central Bone Mineral Density in 157 Adult Women

This is a cross-sectional retrospective study of observational type. 157 menopausal subjects were included. A number of N1=89 were younger of 60 years old (also included) and a number of N2=68 were older than 60 years old. Median of age was of 55 years, respective 66 years.The biochemical parameters like total and ionic serum calcium, serum magnesium, and phosphorus between the two groups N1-N2 were similar (p]0.05).The median values of mentioned chemical elements were within normal limits.The bone turnover markers were not statistically significant different between N1 and N2. 25OHD was found deficient in both populations, irrespective of age. DXA- BMD and T-score N1-N2 difference was statistical significant for all the four central sites. Biochemical mineral parameters seem not to be influenced by the cut off of 60 years in menopausal women aged between 40 and 80 years. Yet, a large prevalence of hypovitaminosis D is identified regardless the age without secondary PTH raise. The statistical significant results are for BMD and T-score for all the four central sites.

Unilateral supplemental maxillary lateral incisor: report of three rare cases and literature review

Additional teeth to the normal dentition are called supernumerary teeth; they can be found in higher rates in permanent than in deciduous dentition, in both sexes, associated or not with other diseases or syndromes. The aim of this article is to report three rare cases of unilateral supplemental lateral incisors, in Romanian child and adult patients, and to evaluate the treatment options in each case, considering particularities such as age, physiognomy, associated issues and occlusion. The differential diagnosis between a supernumerary lateral incisor in formation and a rudimentary is sometimes difficult to make using only panoramic X-ray, so a cone-beam computed tomography analysis can be indicated. Usually, due to the pathological issues that they can cause, the supplemental maxillary lateral incisors are removed; although, in some cases, it may be necessary to remove the normal tooth, for example in cases of major crowding, in which the normal tooth is more displaced from the line of the arch than the supplemental one, or when there is a lack of periodontal support surrounding the normal tooth. This article highlights that even if, in younger patients, the majority of these teeth is extracted because later in life they can cause difficulties in orthodontic and prosthetic treatment, there are still rare cases which do not necessitate treatment, because they are asymptomatic, rather well aligned and go unnoticed. Also, the article includes a detailed literature review of reported cases of supplemental maxillary lateral incisor.

Non-syndromic familial hypodontia: rare case reports and literature review

Congenital absence of the teeth, affecting both physiognomy and mastication, can have a great impact on patients' quality of life. It may appear unilateral or bilateral; frequently, it associates with certain general conditions. Familial hypodontia in clinically healthy patients is rare. Genetic transmission, as a determinant factor in missing teeth, can be autosomal dominant, recessive, or related to the sex chromosomes. In case of congenitally missing permanent teeth, the corresponding deciduous teeth can be still found on the arch at adult age. The aim of this article is to present rare cases of familial non-syndromic unilateral and bilateral hypodontia in Romanian adult siblings, highlighting also a cross gene transmission between aunt and niece and evaluating the treatment options in accordance with patient's age and oral status. It shows that early diagnosis of hypodontia is crucial for the patient's future oral health. The decision to keep the temporary teeth or to extract them is influenced by the presence and status of the deciduous teeth, patient's access to treatment and parent's agreement. Asymptomatic adult patients, in which hypodontia was diagnosed during a routine control, do not usually solicit therapeutic intervention until the deciduous teeth are also lost; still, in situations where complications arise through their loss, the treatment of hypodontia is complex, involving a close collaboration between a team of specialists. The article also includes a detailed review of literature referring to the prevalence of hypodontia among different populations.

Suspicions of titanium allergic reaction influencing the prosthetic solution in a rare case of implant "flowering"

The aim of this paper is to eliminate suspicions of a titanium (Ti) allergy in a rare case of "flowered" implant in a 43-year-old female patient with metal allergies and no history of bruxism, using a histological and immunohistochemical (IHC) analysis to determine the phenotype of cells that participated in the immune response; also, to assess the prognosis of a future implant treatment and to highlight the psychological impact of osseointegrated implant failure caused by fracture, and the influence that the necessity to use extensive surgical procedures for reimplantation can have on the treatment solution chosen by the patient. The results of our IHC analysis did not indicate a clear response for a potential Ti allergy; still, due to psychological reasons, the patient rejected the replantation and considered the use of other restorative option, a three-unit bridge, as being the most appropriate for her. Considering her opinion and attitude, the fixed prosthetic denture assured the therapeutic success.

A rare case of mandibulary parapremolars in siblings: case report and literature review

Supernumerary teeth in permanent dentition are influenced by hereditary and environmental, having clinical variations such as location, number and morphology. Parapremolars can be found as a single supernumerary tooth or as multiple, usually in the lower jaw, sometimes in association with other types of supernumerary teeth. Familial inheritance often involves more than one generation. This paper presents a case of two brothers, one with only one parapremolar and a good oral status and hygiene, the other with poor hygiene, multiple parapremolars and one mesiodens, causing various complications. The aim of this paper is to show the presence of parapremolars in brothers with no other medical relevant history, located in the same site, and to point the influence of genetic factors in the etiology of supernumerary teeth. Along with a review of the literature, this article shows the importance of an early diagnosis and follow-up using successive panoramic radiographs of such cases, in order to limit or prevent the inflammatory, carious, periodontal and occlusal complications that can seriously affect both the jaws and the normal dentition.

Maxillary distomolars: case reports, differential diagnosis and literature review

Supernumerary teeth can be found anywhere in the oral cavity, during deciduous or permanent dentition, in males and females. They are rare, owned to various genetic or environmental factors and usually impacted. This article first reports three cases of young adult patients coming to the office for other reasons than their maxillary distomolars and without any pathology caused by them. The decision of keeping or removing these teeth was made based on other associated factors. The fourth case is one of a 40-year-old partially edentulous male patient, also with a good general health and no other associated condition, having a unilateral maxillary fourth molar; it was small, only partially erupted, with a normal morphology with crown and root and an impacted perpendicular position on the distal face of the third molar. It was extracted because of the periodontal and carious complications that it caused to the third molar facing it. The last reported case is a 64-year-old partially edentulous female patient with a maxillary tooth very similar to a distomolar because of its form and position; it was extracted because it interfered with the new removable partial denture treatment plan. The differential diagnosis between a distomolar and an anatomical variant of a third molar was difficult to make even using panoramic X-ray, also because of a very small inferior third molar. In young patients, distomolars are rather accidentally discovered during radiographic examination; later in life, they can cause both pathological issues and difficulties in diagnosis and prosthetic treatment.

Risk of Dental Caries for Children Aged 4 to 6 in Craiova

Dental caries represent a chronic disease of high prevalence for the human body and is produced by the interaction of a number of predisposing factors throughout the time. Specialized studies in recent years have made some progress with regard of complex interacting factors in the process of developing dental caries in children, but due to the plurifactorial nature of the disease it seems that there is still much to be studied regarding the start, progress and prevention of tooth decay.The aim of the study was to determine the risk of tooth decay in children aged 4 to 6 years in Craiova and the relationship of the main etiopathogenic cariogenic factors.

MATERIAL AND METHODS

The study included a total of 101 children of both sexes, aged 4-6 years, from two kindergartens in Craiova. They filled out questionnaires about food and oral hygiene habits and after that the study protocol included visual clinical examination in according to WHO methodology; determination of dmft index with the analysis of dt, mt and ft component The results were recorded in personal files and were analyzed statistically.

RESULTS

The results of our study were consistent with data from the literature of recent years. So, the highest value of the dmft index (2.52) was at the age group of 6.

CONCLUSIONS

The most significant contribution to the values of carious experience is the number of teeth affected by caries at the expense of obturated ones.

Immunohistochemical study of the epithelial and stromal components of Warthin's tumor

Warthin's tumor is a benign monomorphic adenoma with unclear origin with the highest incidence in the sixth and seventh decades. The analysis of tumor markers involved in the pathogenesis of Warthin's tumor can improve the patients' prognosis. This study included 29 cases of Warthin's tumor, which were histopathologically and immunohistochemically examined for different compartments of tumors. For immunohistochemical study, we used as specific markers for epithelial compartment CD117, CEA and AMA, respectively S100 and D2-40 for the stromal compartment. The evaluation of immunoreactions was performed by semiquantitative analysis. The analysis of the CEA, CD117 and AAM immunoexpression allowed observing various patterns of immunostaining for tumor double-layered epithelia, which has the tendency of being similar to that in the normal ductal epithelia. S100 protein positivity similar to Langerhans cells suggests that delayed hypersensitivity can be involved in tumor development. The presence of D2-40 expression in majority of tumor subcapsular vessels, similar to lymph nodes structure, confirms the hypothesis that Warthin's tumor has its origin in regional lymph nodes.

Prosthetic rehabilitation of complete edentulous patients with morphological changes induced by age and old ill fitted dentures

Extremely old, complete edentulous patients are very difficult to treat both because of their anatomical and psychological condition. Treatment challenges are increasing when this situation is associated with low socio-economic status, poor general health and unrealistic expectations. This article presents a prosthetic rehabilitation of a very old patient, presenting a serious bone atrophy associated with a maxillary flabby ridge, whose dentures accelerated the bone resorption because of their poor fitting, lack of retention and wrong occlusal contacts. Despite his old age and scarce social life, restoring esthetics in the trial phase had a major psychological impact for the patient, making him more optimistic about the result and helping him to accept and functionally integrate the new complete dentures.

Analyzing the morphology and intensity of occlusal contacts in implant-prosthetic restorations using T-Scan system

The dentists must have solid knowledge in occlusology in order to obtain predictable long-term results for the implant-prosthetic treatment. The aim of our study was to verify if, with methods and materials currently used in any dental office for occlusal equilibration, the dentist can successfully integrate the implant-prosthetic restoration in the habitual occlusion of the patient. Using the T-Scan II system, we analyzed occlusion of three mandibular class III Kennedy edentulous male patients, from a private practice in Bucharest (Romania), all missing the first mandibular molar and all wearing a metal-ceramic crown on implant. In all these cases, the occlusion of the crowns was adjusted using articulating paper and vinyl polysiloxane biting material. The analysis of occlusion with the T-Scan II system in those three cases showed that the crowns were successfully integrated in the habitual occlusion. This study proves that those traditional methods, which are most frequently used in practice, are good enough to adjust the morphology and intensity of the occlusal contacts, if they are correctly and conscientiously used.

Immunoexpression of vascular endothelial growth factor in gingival mucosa with papilloma and condyloma acuminata

The histological changes of the oral mucosa in contact with a metal alloy dentures is one of the current issues widely debated in the literature.

AIM

To highlight the expression of vascular endothelial growth factor (VEGF) in human paraprosthetic gingival mucosa exposed to nickel and copper compounds using the immunohistochemical technique. The selected participants were wearers of fixed dentures made of nickel-based alloys and copper-based alloys. The gingival mucosa fragments were prelevated through excision after removing fixed denture and extraction one of its affected teeth. The gingival mucosa fragments were processed through the histological technique of paraffin inclusion. The paraffin-embedded tissue sections were usually stained with Hematoxylin-Eosin and processed by immunohistochemical technique with VEGF antibody. The gingival mucosa fragments from nickel-based alloys dentures wearers were diagnosed with papilloma and, also, gingival mucosa samples prelevated from copper-based alloys dentures wearers were diagnosed with condyloma acuminata. Immunohistochemical reaction for VEGF was different in the gingival mucosa fragments with papilloma compared with condyloma acuminata samples. In papillomatosis gingival mucosa fragments, VEGF was implicated in principal in vasodilatation and inflammation process, and secondary in angiogenesis. In gingival mucosa fragments with condyloma acuminata, the principal role of VEGF was in angiogenesis and secondary in inflammation.

Changing the root morphology in a case of periodontal impairment at a maxillary molar used as a sustaining tooth

Research evolution regarding dental research determines the increase of patient's desire to preserve their dentition for a long time. The loss of a molar tooth as the last teeth present on the dental arch, raises issues regarding how the prosthesis should be placed, still patients are usually reluctant to use as last resort the prosthetic solution. This article describes the technique of root amputation to save a maxillary molar used as bridge abutments.

Pontic morphology as local risk factor in root decay and periodontal disease

INTRODUCTION

In absence of treatment, old single edentulous spaces are subjected to progressively decrease in length due to tilting and rotation of the teeth situated mesial and distal. Lately when these spaces are prosthetically restored with a bridge and these teeth are becoming abutments, sanitizing of the prosthetic restoration is achieved with difficulty, the space between the pontic and the gingival surface becoming an area rich in pathogens that can cause various complications on the abutments.

AIM

Considering these aspects, in this study we wanted to highlight the presence and the types of the microorganisms that can be found under the pontic even in an ideal situation, selecting only young adult patients with a good oral hygiene and only with metal-ceramic bridges.

MATERIALS AND METHODS

Determination of microorganisms was achieved by growing on BD Columbia Agar with 5% sheep blood. Incubation was done in anaerobe condition using GENbag system produced by BioMérieux Company.

RESULTS

The microorganisms that we determined were Streptococcus mutans, S. mitis, S. oralis, Gram-negative bacilli (Bacteroides ovatus, B. thetaiotaomicron) and Gram-positive bacilli (Bifidobacterium spp., Actinomyces israelii, Clostridium butyricum / beijerinckii) with relevance in the carious and periodontal disease.

CONCLUSIONS

In cases of single unit bridges with very narrow pontics, even in patients with a very good oral hygiene and metal-ceramic restorations, we can still find micro-organisms that can potentially generate decay or periodontal disease on the abutments, located in the gingival area underneath these pontics. These bacteria can have negative implications on the long-term prognosis of prosthetic restorations.

Anatomical variation of mandibular second molar and its implications in endodontic treatment

The variations of anatomical and morphological characteristics of the teeth are very important for any practitioner. These differences in root morphology are influencing the success of the endodontic therapy and the long-term prognosis of the tooth, especially when it is an abutment for a prosthetic restoration. Before beginning an endodontic treatment, the clinician must take into account the morphological variations of the root anatomy. This article describes the therapeutic approach in a case of mandibular second molar with four canals abnormally located instead of three. This anatomical variation is a major risk for both endodontic and prosthetic treatment failure. The lack of knowledge of root and pulp anatomy permits the errors in diagnosing and treatment planning. Unfilled canals, left like this by omission, can compromise both the endodontic and prosthetic treatment. For the success of the any dental treatment is critical to know the normal configuration of the pulp and to be aware of the possible variations.

Endodontic treatment of a mandibular canine with two roots

Lower canine is a tooth with a robust, long root and very good implantation, making it a valuable abutment tooth for any type of prosthetic treatment. In order to treat it conservatively and to prevent its loss from the dental arch it is necessary to accomplish a correct and complete endodontic treatment, which involves knowledge of all its morphological variation. The mandibular canine usually presents one root with a single large canal centrally located. The possible anatomical variations are the existence of a single root with two canals and of two different roots, each having a canal. The incidence of lower canines with two roots is usually low, as described in various studies, but their presence in everyday practice shows that the clinician must consider them if he wants to prevent dental endodontic treatment failure. This article presents a relatively rare case of a patient whose right mandibular canine has two roots and two canals. Although the frequency of mandibular canines with two roots is very low, we must not forget that we can deal with such cases, which can obviously occur even in patients in our country, as the ones described in foreign specialty literature.

Anatomical variations of mandibular first molar and their implications in endodontic treatment

The possible variations of anatomical and morphological characteristics of the teeth are very important especially for the endodontic practitioner. Before beginning any kind of endodontic treatment, the clinician must be always take into account the morphological variations in pulp anatomy. Among all human teeth, the mandibular first permanent molar is one of the most important. It is often affected by caries and usually needs root canal treatment, even at an early age. For the success of its endocanalicular treatment, dentists need to locate all root canals, debride them entirely, and after that fill the whole endocanalicular system with an inert root filling material. Unfilled canals, left like this because they were not detected, can compromise the longevity of the tooth, thus being a source of infection and a main cause of failure of the prosthetic treatment. This article presents two clinical cases of right mandibular first molars with two roots and four canals instead of three.

Treatment of a mandibular canine abutment with two canals

Human mandibular canines do not present an internal anatomy as simple as could be expected; there are such canines with a single root and two canals, two roots or fused roots. The existence of mandibular canines with more than one root canal is a fact that clinicians ought to keep in mind, in order to avoid failure during endodontic treatment. In spite of the low incidence of lower canines with one root and two canals, this possibility cannot be forgotten, inasmuch as the presence of a second canal in these teeth leads to difficulties in endodontic treatment. The precise knowledge of the dental endocanalicular system's anatomy is essential in the success of the root canal therapy, because the failure to detect the accessories canals and the incomplete radicular obturation leads to the infection of the periapical space, which will ultimately result in the loss of the tooth. The long-term success of the prosthodontic treatment depends directly on the quality of the endodontic treatment realized on the abutment teeth. The mandibular canine is very important as abutment for any type of prosthetic restoration. This article presents a clinical case of a canine tooth which displays a radicular morphology with two canals, which leads us to conclude that such anatomical variations on human teeth can also occur in our country as much as described in the international literature and cannot be overlooked when treating the teeth.

The influence of coronoradicular amputation on the shape of the subsequent prosthetic restoration

The patient's desire to preserve their natural dentition is increasing constantly; therefore, nowadays dentists have to treat teeth that once would have been extracted. Using endodontics, periodontics and restorative dentistry techniques, we can maintain these teeth on the arches in whole or in part and they can be used as independent units of mastication or as abutments in simple fixed bridges. This article describes a procedure of modifying the form and shape of the prosthetic restoration of a maxillar molar after a crown and root amputation.