Accurate localization of impacted
supernumerary tooth
associated with dentigerous cyst
Spiral CT evaluation

–-A case repo...
Page 3
defined as

Supernumerary teeth may be defined
as any teeth or tooth substance in
excess of the usual configuration of
twe...
• Dichotomy of the tooth bud
• Local, independent, conditioned
hyperactivity of the dental lamina
• Hereditary

Page 5
Prevalence
• Single supernumeraries - 76 to 86%
• Double supernumeraries -12 to 23%
• Multiple supernumeraries - < 1%
So L...
Effects of supernumerary teeth on the
developing dentition
Crowding
Failure of eruption
Diastema
Root resorption
Dilacerat...
Page 9
Case report

25yr old female pt
Pain in upper front
teeth region since 6
months and pain on
pressing in the nostril
since ...
PREOPERATIVE RADIOGRAPH
•Coronal
radioluscency
approaching pulp
irt 11,12
•A periapical
radioopacity
resembling tooth
•A l...
P endo
ost

Page 13
Spiral CT- Trans axial images

Page 15
Trans axial images

Page 16
Sagittal view

Inverted supernumerary tooth, not fused
Page 17
Coronal view
Pericoronal
radioluscency

Page 18
Management

Page 19
Oblique releasing incision

Intrasulcular
incision

Page 20
Elevation of the flap

Exposure of the lesion

Page 21
Exposure of the huge lesion

Page 22
Enucleation of
the lesion

Exposure of the
supernumerary tooth

Page 23
Removal of
supernumerary tooth with
bayonet forceps

Supernumarary tooth
removed

Page 24
Extracted tooth
& the lesion

Corrugation of the
epithelial remnants

Page 25
Immediate post op

Specimen for
histopathological examination

Page 26
Diagnostic

Post endo

Immediate post
op after surgery

Page 27
Page 28
Page 29
H & E stained soft tissue section
2-3 layered
Nonkeratinized
SS epithelium
Collagen fibers

Page 30
Connective tissue

Chronic
inflammatory cells

Diagnosis – Dentigerous cyst
Page 31
Page 33
• Impacted teeth are often encountered in routine
radiographic examination
• In treatment planning, it is imperative to ac...
• The major shortcoming of the conventional radiography for
the assessment of impacted teeth is the overlapping of
structu...
www.indiandentalacademy.com
Multiplanar reformation images of the tooth
revealed

Trans axial images
• showed impacted tooth located palatal to 11,21 ...
• Dentigerous cyst (24% of jaw cysts) is one of the most
common developmental odontogenic cysts which is usually
detected ...
• The radiolucency usually arises in the cemento-enamel
junction of the tooth.
• If a follicular space on the radiograph i...
Guidelines for the diagnosis of a dentigerous cyst
Daley and Winsock

1) A pericoronal radioluscency >4 mm in greatest
wid...
• Mesiodens is known to have a cone shaped crown and a
short root as seen in our patient.
• Some untreated dentigerous cys...
Page 44
conclusion
• When an unerupted supernumerary tooth is evident
the direction of the crown, the location, the influence
on a...
Page 46
References
•
•
•
•
•
•
•
•

INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(2): 39-42
Journal of Dental Research, Dental Cl...
•
•
•

Australian Dental Journal 1997;42:(3):160-5
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 130...
Acknowledgement

Dr. Dattaprasad

(HOD & PROF)

Dr. Sunil kumar. C

( PROFESSOR)

Dr. SashidharReddy ( PROFESSOR)
Dr. Hema...
www.indiandentalacademy.com
Leader in continuing dental education

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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

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  • 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.
  • Accurate localization of impacted supernumerary tooth associated with dentigerous cyst spiral ct evaluation /certified fixed orthodontic courses by Indian dental academy

    1. 1. Accurate localization of impacted supernumerary tooth associated with dentigerous cyst Spiral CT evaluation –-A case report A case report Page 1
    2. 2. Page 3
    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. 4. • Dichotomy of the tooth bud • Local, independent, conditioned hyperactivity of the dental lamina • Hereditary Page 5
    5. 5. Prevalence • Single supernumeraries - 76 to 86% • Double supernumeraries -12 to 23% • Multiple supernumeraries - < 1% So LLY. 1990 Page 6
    6. 6. Effects of supernumerary teeth on the developing dentition Crowding Failure of eruption Diastema Root resorption Dilaceration Loss of vitality. Page 8
    7. 7. Page 9
    8. 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. 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
    10. 10. P endo ost Page 13
    11. 11. Spiral CT- Trans axial images Page 15
    12. 12. Trans axial images Page 16
    13. 13. Sagittal view Inverted supernumerary tooth, not fused Page 17
    14. 14. Coronal view Pericoronal radioluscency Page 18
    15. 15. Management Page 19
    16. 16. Oblique releasing incision Intrasulcular incision Page 20
    17. 17. Elevation of the flap Exposure of the lesion Page 21
    18. 18. Exposure of the huge lesion Page 22
    19. 19. Enucleation of the lesion Exposure of the supernumerary tooth Page 23
    20. 20. Removal of supernumerary tooth with bayonet forceps Supernumarary tooth removed Page 24
    21. 21. Extracted tooth & the lesion Corrugation of the epithelial remnants Page 25
    22. 22. Immediate post op Specimen for histopathological examination Page 26
    23. 23. Diagnostic Post endo Immediate post op after surgery Page 27
    24. 24. Page 28
    25. 25. Page 29
    26. 26. H & E stained soft tissue section 2-3 layered Nonkeratinized SS epithelium Collagen fibers Page 30
    27. 27. Connective tissue Chronic inflammatory cells Diagnosis – Dentigerous cyst Page 31
    28. 28. Page 33
    29. 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. 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
    31. 31. www.indiandentalacademy.com
    32. 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. 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. 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. 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. 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. 37. Page 44
    38. 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. 39. Page 46
    40. 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. 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. 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. 43. www.indiandentalacademy.com Leader in continuing dental education Page 50

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