Accurate localization of impacted supernumerary tooth associated with dentigerous cyst spiral ct evaluation /certified fixed orthodontic courses by Indian dental academy
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Accurate localization of impacted supernumerary tooth associated with dentigerous cyst spiral ct evaluation /certified fixed orthodontic courses by Indian dental academy
- 1. Accurate localization of impacted supernumerary tooth associated with dentigerous cyst Spiral CT evaluation –-A case report A case report Page 1
- 2. Page 3
- 3. defined as Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of twenty deciduous, and thirty-two permanent teeth. Schulze C.1970 Page 4
- 4. • Dichotomy of the tooth bud • Local, independent, conditioned hyperactivity of the dental lamina • Hereditary Page 5
- 5. Prevalence • Single supernumeraries - 76 to 86% • Double supernumeraries -12 to 23% • Multiple supernumeraries - < 1% So LLY. 1990 Page 6
- 6. Effects of supernumerary teeth on the developing dentition Crowding Failure of eruption Diastema Root resorption Dilaceration Loss of vitality. Page 8
- 7. Page 9
- 8. Case report 25yr old female pt Pain in upper front teeth region since 6 months and pain on pressing in the nostril since 9 months O/E- Dental caries irt 11, 12, no swelling, sinus opening Tender on percussion irt 11, 12 EPT-delayed response irt 11, 12 Page 11
- 9. PREOPERATIVE RADIOGRAPH •Coronal radioluscency approaching pulp irt 11,12 •A periapical radioopacity resembling tooth •A large periapical radioluscency irt 12,11,21 Page 12
- 11. Spiral CT- Trans axial images Page 15
- 12. Trans axial images Page 16
- 13. Sagittal view Inverted supernumerary tooth, not fused Page 17
- 17. Elevation of the flap Exposure of the lesion Page 21
- 18. Exposure of the huge lesion Page 22
- 19. Enucleation of the lesion Exposure of the supernumerary tooth Page 23
- 20. Removal of supernumerary tooth with bayonet forceps Supernumarary tooth removed Page 24
- 21. Extracted tooth & the lesion Corrugation of the epithelial remnants Page 25
- 22. Immediate post op Specimen for histopathological examination Page 26
- 23. Diagnostic Post endo Immediate post op after surgery Page 27
- 24. Page 28
- 25. Page 29
- 26. H & E stained soft tissue section 2-3 layered Nonkeratinized SS epithelium Collagen fibers Page 30
- 27. Connective tissue Chronic inflammatory cells Diagnosis – Dentigerous cyst Page 31
- 28. Page 33
- 29. • Impacted teeth are often encountered in routine radiographic examination • In treatment planning, it is imperative to accurately locate them and determine their relationships to adjacent teeth and anatomical structures in the area. • Usually, the required information can be obtained from periapical, occlusal, or panoramic radiographs. • Radiographs are important in assessing the location and nature of these anomalies. www.indiandentalacademy.com
- 30. • The major shortcoming of the conventional radiography for the assessment of impacted teeth is the overlapping of structures on the film. • This problem makes it difficult to distinguish a particular detail, especially when structures differ only slightly in density. • CT has proved to be superior to other radiographic methods in visualizing bone tissue. It overcomes the limitations of conventional radiographs • Compared with conventional plain films, 3D CT images clearly show the intraosseous location, inclination, and morphology of impacted teeth, as well as distances from adjacent structures. www.indiandentalacademy.com
- 32. Multiplanar reformation images of the tooth revealed Trans axial images • showed impacted tooth located palatal to 11,21 measuring 1.4x1.5cm Coronal image • showed inverted supernumerary tooth, which was not fused with 11, pericoronal radioluscency around the impacted tooth which was seen as periapical radioluscency involving 12,11 and 21 in the conventional radiographs Sagittal images • showed inverted supernumerary tooth measuring 1.02cm and which was not fused with the surrounding tooth. www.indiandentalacademy.com
- 33. • Dentigerous cyst (24% of jaw cysts) is one of the most common developmental odontogenic cysts which is usually detected on routine radiographic examination. • A dentigerous cyst can be defined as one that encloses the crown of an unerupted tooth by expansion of its follicle and is attached to its neck. • Mandibular third molar and maxillary canine are commonly involved followed by mandibular premolar and maxillary third molar and very rarely central incisor, deciduous teeth and supernumerary teeth • Although dentigerous cyst is a common developmental cyst, its association with supernumerary teeth is RARE and estimated to constitute 5-6% of all dentigerous cysts www.indiandentalacademy.com
- 34. • The radiolucency usually arises in the cemento-enamel junction of the tooth. • If a follicular space on the radiograph is more than 5 mm, an odontogenic cyst can be suspected. • Differential diagnoses of such radiolucency include Odontogenic keratocyst Radicular cyst Odontogenic tumors Ameloblastoma Pindborg’s tumor Odontoma Odontogenic fibroma Cementoma JODDD, Vol. www.indiandentalacademy.com5, No. 2 Spring 2011
- 35. Guidelines for the diagnosis of a dentigerous cyst Daley and Winsock 1) A pericoronal radioluscency >4 mm in greatest width, 2) Histologically, fibrous tissue lined by nonkeratinized stratified squamous epithelium 3) A surgically demonstrable cystic space between the enamel and the overlying tissue. www.indiandentalacademy.com
- 36. • Mesiodens is known to have a cone shaped crown and a short root as seen in our patient. • Some untreated dentigerous cysts rarely have potential to develop odontogenic tumors like ameloblastoma and malignancy like oral squamous cell carcinoma, mucoepidermoid carcinoma and also cholesterol clefts which are more common in radicular cysts because of constant inflammatory condition. www.indiandentalacademy.com
- 37. Page 44
- 38. conclusion • When an unerupted supernumerary tooth is evident the direction of the crown, the location, the influence on adjacent teeth, resorption of adjacent roots and the formation of dentigerous cysts should be carefully evaluated .Early detection comprising of a thorough clinical, radiographical examination and advanced diagnostic aids is necessary for accurate diagnosis to prevent associated complications. Page 45
- 39. Page 46
- 40. References • • • • • • • • INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(2): 39-42 Journal of Dental Research, Dental Clinics, Dental Prospects INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78 Journal of Clinical and Diagnostic Research , 2010 June ; 4:2601-2606. Journal of Clinical and Diagnostic Research , 2010 June , 4:2601-2606. Journal of Clinical and Diagnostic Research, 2010 June , 4:2601-2606. Journal of Clinical Rehabilitative Tissue Engineering Research January 22, 2011 Vol.15, No.4 Oral surgery, Oral medicine, Oral pathology, Oral surgery and Endodontology- vol 105,1, Jan 2008 www.indiandentalacademy.com
- 41. • • • Australian Dental Journal 1997;42:(3):160-5 American Journal of Orthodontics and Dentofacial Orthopedics Volume 130, Number 1 Journal of Clinical Rehabilitative Tissue Engineering Research January 22, 2011 Vol.15, No.4 www.indiandentalacademy.com
- 42. Acknowledgement Dr. Dattaprasad (HOD & PROF) Dr. Sunil kumar. C ( PROFESSOR) Dr. SashidharReddy ( PROFESSOR) Dr. Hemadri (SENIOR LECTURER) Dr. Pradeep Naidu (SENIOR LECTURER) Dr. Ranga Reddy (SENIOR LECTURER) www.indiandentalacademy.com
- 43. www.indiandentalacademy.com Leader in continuing dental education Page 50
Notes de l'éditeur
- of adjacent permanent teeth of adjacent teeth Malformation of adjacent teeth such as of adjacent teeth
- When the supernumerary tooth is evident, the direction of the crown, the location, the influence on adjacent teeth, the resorption of adjacent roots and the formation of dentigerous cysts should be carefully evaluated [18]. Conventional radiographical examination involving panoramic, occlusal and periapical views have been used to locate their exact position for proper treatment plan and surgical removal. Computed tomography (CT) and Cone-beam CT have emerged as diagnostic techniques to assess supernumerary teeth.
- To prevent Endanger vitality of adjacent teeth endo of 23 was done..Routine haematological and biochemical tests were normal. Maxillary left incisors [21],[22] were endodontically treated and were obturated with gutta-percha. Then, under general anaesthesia, surgical extraction of the impacted supernumerary teeth and enucleation of the cyst was done, followed by retrograde filling of 21 and 22 with mineral trioxide aggregate. The post operative course was uneventful. The histological examination of the specimen was suggestive of a dentigerous cyst.
- Multiplanar reformation image of the tooth, the sagittal image showed palatal crown labial root and the root and the root pointed to the floor of the nasal cavity
- Surgical removal of the cyst has been considered as the preferred choice of treatment. enucleation and tooth removal might result in damage to the nerve and blood vessels supplying the adjacent teeth
- Management of a supernumerary tooth depends on the type and position of the tooth and its effect on the adjacent teeth. Removal of the supernumerary has been recommended where there is evidence of the associated pathology, eruption disturbances, displacement of the incisors or where the spontaneous eruption of the supernumerary tooth has occurred
- Figure 1. Panoramic radiograph shows a large unilo-cular radiolucency in the anterior maxilla and the mesiodens in the left aspect of the lesion. The supernumerary tooth had a cone-shaped crown and a shortened root (Figure 1). The lesion was totally enucleated together with the supernumerary tooth under local anesthesia, and specimens were sent to the Department of Oral and Maxillofacial Pathology
- Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
- Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
- Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma
- CASE REPORT CT in axial and coronal planes showed fluid filled unilocular lesion along with crown of mesiodens in the maxillary alveolar process (Fig 2). The Surgical resection of the lesion along with removal of mesiodens and histopathological examination confirmed the diagnosis of dentigerous cyst associated with mesiodens. The patient is under follow up since six months and no complications are observed Histological sections of both specimens revealed cyst walls composed of loosely arranged fibrovascu-lar connective tissue, lined by 2-4 layers of flattened non-keratinizing stratified squamous epithelium (Figure 2). The epithelium and the connective tissue interface was flat. Numerous cholesterol clefts and few chronic inflammatory cells infiltration were noted. No evidence of malignant changes was noted.