Wednesday, January 17, 2018

Characteristics of Mesiodens and Its Related Complication

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident: Albert Yamoah, DDS                                                                                                     Date: 01/16/2018
Article Title: Characteristics of Mesiodens and Its Related Complication
Author(s): Nam, et al.
Journal: Pediatric Dentistry
Date: Nov /Dec 2015
Major Topic: Mesiodens, Supernumerary Tooth, Tooth Eruption, Complication
Type of Article: Retrospective Cohort Study
Main Purpose: To evaluate the effect of mesiodens on adjacent permanent anterior teeth according to mesiodens characteristics
Key Points:
·   Most supernumerary teeth appear in the anterior region of the maxilla and are most often categorized as mesiodens
·   Approximately 25% of mesiodens erupt normally
o    The remainder do not erupt spontaneously and remain impacted
·    Prolonged retention of the primary maxillary incisors
o    May indicate the presence of mesiodens
o    Warrants screening
·    Traditional techniques used for screening:
o    Periapical
o    Panoramic
o    Bitewing
o    Cephalometric radiography
·    Recently, cone beam computed tomography (CBCT) has been used as an effective screening tool for mesiodens
·    Several types of complications can result without early detection and proper treatment of mesiodens. Mesiodens can cause:
o    Ectopic eruption
o    Displacement or rotation of the central incisors
o    Root resorption
o    Eruption into the nasal cavity
o    Cystic degeneration (i.e. degeneration with formation of cysts)
o    Diastema
o    Crowding
·    The severity of complications resulting from mesiodens is affected by:
o    Number and type of mesiodens
o    Depth and angle of impaction
Background
·   107 children aged 6-11 years old were selected
·   Clinical data and demographic (age and gender) were collected from medical records
·   CBCT images were used to evaluate characteristics of mesiodens including:
o    Number
o    Morphology
o    Eruption path of mesiodens
o    Root development stage of adjacent permanent maxillary central incisors (APMCIs)
·   Study calculated correlation between these factors and complication rate
·   Morphology of mesiodens was classified into
o    Conical (small peg-shaped mesiodens)
o    Tuberculate (more than one cusp or tubercle)
o    Supplemental (resembles normal tooth)
o    Molariform (resembles molar)
o    Atypical types (does not belong to any type)
·   Eruption path of mesiodens
o    Normal
o    Inverted (position of mesiodens crown reversed)
o    Rotated (mesiodens vertical axis parallel to medial palatal suture)
o    Horizontal (mesiodens vertical axis transverse)
o    Angulated (eruption path between horizontal and rotated)


·    Degree of root development of APMCIs evaluated according to Nolla’s developmental stages



·   Positions of mesiodens were divided into 6 groups
o    Groups based on relationship crown of mesiodens and axes of adjacent central incisors on sagittal plane



·   2 categories of complications
o    Eruption disturbance (comparison of central incisor with opposite permanent maxillary CI or nearby LI
o    Displacement of APMCIs (diastema, rotation, and labiolingual movement of APMCIs)



·   Correlation and complication rates calculated

Results
·   The final sample was 107 children
o    80 males and 27 females (2.96:1)
o    Average age 7.3 years +/- 1.4 years
·   The total number of mesiodens was 153
o    58.9% had 1 mesiodens
o    39.3% had 2 mesiodens
o    1.9% had 3 mesiodens
·   58.7% of patients with 1 mesiodens, 67% with 2 mesiodens, and 100% with 3 mesiodens showed clinical complications
·   The primary morphologic type was conical (96.1%)
·   The most common direction of eruption was inverted (56.2%)
·   Most mesiodens (80.4%) were located on the palatal side of the APMCIs
·   The root formation for APMCIs was:
o    Nolla stage 7 in 40.5% of mesiodens
o    Nolla stage 8 in 32%


Conclusions:
·   During the eruption period of adjacent permanent incisors is when mesiodens complications were observed
·   Rate of complications increased when mesiodens were located either close to the eruption path or on the labial side of the adjacent permanent maxillary central incisors
·   Rate of complications decreased when mesiodens were located on the palatal side of the cervical area of adjacent permanent incisors  
·   Within the limitations of the present study, the positional relationship between mesiodens and APMCIs had the strongest influence on complications associated with mesiodens
Remarks:
1.
Assessment of Article: 
·    Level of Evidence/Comments: Level III Retrospective Study.



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